Fiona Birkbeck: Hands-on Healing and The Rise of The Machine

To listen to doctors and nurses describe their everyday experience, is to realize how visceral, how raw, the interaction between them and their patients really is. We dress our doctors in white coats, our nurses in colour-coded uniforms, and dress our health policy in jargon but essentially the business of ‘healing’ is a series of ancient rituals, full of hope (Webb 2013) and at times, soaked in disappointment, fear and resentment.

But in the 21st century, the daily work of the ‘healer’ has been changing in a profound way. The increasing role of technology in medicine can be seen in this dramatic image of begowned figures circling around a prone patient in the robot run operating theatre at Hamad, Qatar. This is the very leading edge of medicine in the 21st century and the attention of the practitioners is intensely focused on the data led information coming from the machine above them.

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Figure 1 Robotic surgery in Hamad, Qatar

The patient is only visible as a tiny scrap of vulnerable flesh, he is almost completely hidden by the robotic arms which will cut into him with an accuracy much greater than that offered by the human hand of a surgeon.

If all goes well, the patient will wake up and the journey he is on, which began with a conversation with a doctor or a nurse, will continue with conversations with doctors and nurses. This interrelational core of his treatment and recovery, while not as measurable as the success rate of robotic surgery, will be essential to its outcome. As a Medical Director from a Midlands trust explained to me, ‘the NHS measures what is easily measurable, like surgical outcomes but there are many other measurements of success’ (Medicine participant 21).  As this patient lies in recovery, data will stream from him into monitors around his bed. The practitioners who come to talk to him will first check these monitors, with the same intense gaze of the theatre staff in the image above. They cannot afford to make a mistake, and so our new practitioners have become adept at reading data, at searching for electronically produced statistical anomalies. Another of my participants, a gastro-enterologist, told me that ‘the patient comes to me now with the data in front of him’. She commented that she feels ‘sad’ for new doctors because ‘although they have much more accurate instrumentation, they don’t have the same pleasure in talking to patients. In touching a hand to a belly to make a diagnosis, a decision. The machines do a lot of it for them’ (Medicine, participant 12). However, the machines have to be monitored. Even machines make mistakes. And this means that the attention of these practitioners is not focused on the person in the bed in front of them. The patient is no longer the first resource for information about himself. And, crucially, neither the patient or the doctor is seen as the most accurate source of information about the patient’s condition. The tremendous advancement of medical technology is in danger of deskilling the expert practitioner and devaluing the relationship between the expert practitioner and the client.

A third participant in my research, a consultant cardiologist,  summed up this problem. ‘It (the relationship between the practitioner and the client) is a human interaction, in the end. As a doctor, I am altered by an interaction with a patient and, if it is a good interaction, I am rewarded. Data should facilitate that interaction, not replace it.  A machine doesn’t give me positive feedback’ (Medicine, participant 18).

Shoshana Zuboff (Zuboff 1988), refers to the ‘reflexivity’ that comes from working with ICT, an ‘informating’ process she believes generates ‘intellective skill’. The effective analysis by doctors and nurses of complex data requires practical training in the handling of data and the ‘reflexivity’ described by Zuboff (1988) to allow a useful interpretation of the material. And so ‘health’ workers have also become ‘informative’ workers, as this report for the Australian Health Review by Stephen Duckett, (2005:201-210) shows

In addition to the epidemiological and demographic transition, the environment for the health workforce is also changing because of wider social trends, in particular the impact of changes in information and communication technologies. (Duckett 2005: 201-210)

He describes the use of ‘multidisciplinary care plans which systematize the treatment and care processes’ and goes on to explain how these systemized care pathways are facilitated by tailor made software packages which are changing the work practice of health care professionals.

However, one practitioner educator told me that using software packages to aid diagnosis is barely better than ‘a stab in the dark’. ‘What they (junior doctors) want,’ she went on to say, ‘is didactic teaching and hands on experience. They should be with patients, talking to patients, examining patients, not in a classroom, taking part in yet another role play.’ She concluded by saying, ‘Where’s the fun in that?’ (Medical participant 24).

I thought the use of the word ‘fun’ was intriguing, and I asked other practitioners what they thought of her comment. Yes, absolutely, they said, she’s right, it should be ‘fun’ – working face to face with patients is exciting, challenging, ever changing. I realized that no one enters a people based profession unless they get real satisfaction from interacting with people. It should be ‘fun’, it should be rewarding; instead, practising medicine has become a kind of terrifying drudgery, with endless data-led tests to interpret, where failure brings litigation.

Solomon (2004) describes how one GP interviewee explained to her that the once dyadic relationship between GP and patient has now become a threesome; the Department of Health sits in the consulting room in the shape of a demanding, data crunching computer.

And maybe this lies at the core of the dissatisfaction junior doctors feel with their training and their roles, a dissatisfaction that led to the bitter dispute between these practitioners and their employers in 2016. They want to work with people, to have the time and the resources to interact with patients, that is why they decided to be doctors, but they are working with data.

Where’s the fun in that?

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Fiona Birkbeck  is a PhD researcher at the University of Nottingham. Fiona’s interest in the systemic issues faced by expert practitioners in Health and Education in the UK today grew from her experience of delivering workshops on resilience to education and NHS staff at venues such as North Staffordshire Trust, the BPS Annual Conference and The Science Learning Centre, University of York. She currently delivers an Education and Education Assessment module on the Medical Leadership, Education and Research MSc at De Montfort University, Leicester.

ttxfb3@nottingham.ac.uk

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References

Duckett , S. J., 2005. ‘Health workforce design for the 21st century’. Australian Health Review, 29 (2), 201-210

Gerada, C.,  ‘Something is profoundly wrong with the NHS today’. British Medical Journal  16th June  2014  Available from: http://php.nhs.uk/something-profoundly-wrong-nhs-today/ [accessed 14 June 2017]

Solomon J., 2009 ‘An Exploration the relationship between prescribing Guidelines and Partnership in Medicine Taking’, University of Leeds, PhD Thesis

Solomon, J., Raynor, D.K., Knapp, P. and Atkin, K., 2012. ‘The compatibility of prescribing guidelines and the doctor-patient partnership: a primary care mixed methods study.’ British Journal of General Practice. 62 (597), pp.275-81., 10.3399/bjgp12X636119

Webb, D., 2013 Pedagogies of hope. Studies in Philosophy and Education. 32;4:397-414

Zuboff, S., 1988. In the Age of the Smart Machine: The Future of Work and Power. Oxford: Heinemann.

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