Robert M. Wachter

The practice of medicine in the United States is currently in a profound state of transition; this is due to many factors, but primarily because of the implementation and integration of computer technology into the patient-doctor interface. In particular, in the last five years, we’ve seen the widespread adoption of electronic health records (EHR). “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age,” by Robert Wachter, aims to chart and inform readers about this transition. Specifically, the book pinpoints the transition’s problems, errors, and unanticipated consequences, discusses their ramifications, and suggests alternatives that could resolve the issues. The book is based on the author’s research, as well as more than one hundred interviews with key people involved in all aspects of the process.

I am not a medical professional, but I was a key player in the IT transition of academic libraries (in the state of California) from the analog, card-catalog era to the digital, web-based research libraries of today. It was not a smooth transition; no transition like this is ever entirely smooth. It took many decades and there were many unanticipated casualties. Currently in retirement, I am an avid fan of the modern digital library: the abundance and depth of their academic databases, the growth of e-books and e-textbooks, Wikipedia, Google, and countless other marvelous advances that that particular transition jump-started.

It will be the same with medicine. I’m sure of it! But then I’m an optimist, and this outstanding book held me in thrall with the detail of what is now occurring, as well as Wachter’s ideas about how the future might unfold. In addition, I found it fascinating that the book was full of so many relevant human interest stories and that it was written in a language that any educated reader could easily understand.

Wachter’s book should not only appeal to clinicians and other healthcare workers who are awash in the day-to-day upheavals of this transition, but also others (like myself) who have weathered another industry’s analog-to-digital transition. What is unique about the healthcare industry is that is that this transition effects each and every one of us in a very personal way because, as patients, we are participants in the transition.

The author is a prominent academic physician on the faculty of one of the world's leading medical universities (University of California, San Francisco); he is also the academic leader of the hospitalist movement, as well as a renowned expert in the field of medical errors and patient safety. With credentials like that, it is no wonder that he undertook to research and write a book on this particular topic.

For me, one of the most interesting sections of the book was the one that dealt with medicine and artificial intelligence. Can the computers of tomorrow ever replace doctors or some significant data-intensive aspects of what doctors do in the performance of their daily discipline? The book offers fascinating glimpses into what may be possible.

Medicine’s change from analog to digital is happening later than many other major industries because it is a system of enormous complexity. It is heartening to remind ourselves that computers have demonstrated that they can deal with these types of challenges better than humans. For example, the author bemoans the fact that medicine is advancing so fast today that there are currently “more than 2,100 medical articles published each day.” Obviously, no one individual can keep up with that degree of complexity and rate of change! But a computer can…to a certain degree. Computers won’t replace doctors, but they will greatly change the over all practice of medicine for everyone, doctors and patients alike.

Wachter’s book gives us a clear view of the wrenching transformation that is currently happening to our healthcare system. These are “changes that will transform the doctor-patient relationship, profoundly alter the roles of physicians and other health professionals, and ultimately result in some, perhaps many, people losing their jobs, income, and prestige.” In the next decade or so, Wachter anticipates that our healthcare system will have morphed into one that “is better, safer, and cheaper.” Time will tell, but in the meantime, if you are interested in this topic, I heartily recommend this book.… (altro)