Like other health care professionals, chiropractors must utilize technology whenever it can improve patient care. However, we must remember that while technology can minimize human shortcomings, it can also minimize our humanity, a most important element in the doctor/patient relationship.
Words and their meanings seem to be changing these days. Enthusiasm, dedication and hard work in one's profession are now called "input," and their results, "output." Doctors who once cared for patients now "deliver a commodity called health service." Patients who once required care are now "consumers who utilize health service."
The concept of "delivery of services" brings to mind such things as bread, milk and ice, and a time when these important commodities were conveniently delivered directly to the home. All were important services, and those who performed them were valued members of the community. But for the most part, such services no longer exist, victims of more efficient and cheaper ways of doing things. Does the fate of those long gone delivery people await doctors too? For instance, we are being told that health care must become more efficient. (Note: "effective" is seldom used). The remedies being prescribed seem only to make health care cheaper, not more efficient, and certainly not more effective. Has "efficient" somehow become synonymous with "cheaper"? My thesaurus says not, but I have an old edition. Perhaps it's time for a new one.
The new language, to a considerable extent, can be attributed to the invasion of computers and their vocabulary into everyday living. They seem to touch almost every aspect of life. It is inevitable, though. If we humans are to continue increasing our numbers on the face of the earth as we have in the past, technology will have to play an ever-increasing role in the logistics of life. Paper and pencil calculations simply can't keep up.
So it appears that to survive we must take advantage of the computer and the technology it makes possible. However by so doing we are presented with a serious dilemma: A culture based on the efficiencies of computerized algorithms and paradigms, though avoiding many of the shortcomings of humans, is predictably more inhuman.
If chiropractors and the chiropractic profession are to compete and flourish in the new world of health care, it must strive to be a mover in the creation, development and use of appropriate health care technology. However, we must be ever on guard against losing one of the great strengths of our profession: close and warm patient/doctor human relations. Where then can computer technology play a role in chiropractic practice? Where can it help? Where can it hurt? In its present stage of development there are three areas: management, clinical care and communications.
The Computer as Office Manager
The computer is ideally suited to act as chief assistant to the office manager. It efficiently serves in the capacity of appointment keeper, accountant, insurance coordinator, and the many other functions provided by today's office management software systems. The computer has become essential in what can be called "standard and customary" business practice.
But while the computer is unsurpassed at calculation and organizing functions, it is only a machine. Care must be taken to be certain the main and lasting impression left with the patient is that of chiropractic care, not computer activity. Patients best remember caring people, not efficient technology. (The "best" computer is the "least visible" computer.)
The Computer as Communicator and Information Manager
We live in the information age. What happens to a chiropractor or a chiropractic patient in Boston today really can affect practice in San Diego tomorrow. Important new research findings are expected to be widely known by clinicians soon after their release. The whims of third-party payers are constantly changing the health care environment. These changes need to be quickly communicated and their meanings understood.
The computer is both a cause and a solution to the problems of our rapidly changing world. During recent years, high speed online information transmission has been revolutionized; costs have plummeted and the required equipment has become readily available everywhere. The use of the technology that instantly delivers "need to know" information is expected of today's professionals.
When presented with the myriad of online information choices, some tackle the challenge with vigor, becoming consumed with what is now the newest of addictions: cyber-communications. However, for the many others, who prefer to continue involvement with family, fishing and golf, a more appropriate role for computer online technology is that of an information manager.
One's practice can effectively keep current with important professional happenings with very little intrusion into other office/clinic routines.
Consider the following:
- Online effectiveness and comfort are early facilitated when technical help is obtained in the very beginning, especially if computers are not of one's primary interest and pastime.
- Valuable information on the ever-expanding highway can be found if there is a careful assessment/selection of the information source. Don't hesitate to take advantage of the free trial time offered by online companies before you subscribe to the service, and don't be discouraged the first time -- it does take a little practice.
- Active involvement of office staff members in the process of online information gathering can serve the needs of the whole office and can go a long way in keeping the doctor from becoming a computer technician.
- Use of the off-line capabilities of an online system can reduce office time and expense. By using this capability, an office routine can easily be set up whereby a staff member makes scheduled online scans for relevant information, then makes this available for doctors at their convenience.
Again, the most appropriate use of online technology is one that is as nearly invisible as possible, without undue intrusion into other more important doctor/patient routines.
The Computer as Clinical Assistant
Computer technology is increasingly making inroads into the chiropractic care of patients. Whether it be in the treatment room recording of SOAP notes, the digitization of x-ray films, or the pre/post-treatment analysis of various biomechanical functions, chiropractic care has entered the digital age; more, not less, can be expected in the future. Taking full advantage of technical advances is essential, but chiropractors must maintain their great strength of caring for patients as human beings, not as objects that require technical solutions.
We know that improved acceptance of chiropractic in recent years is attributable to many things. The list is long: improvements in chiropractic education, a growing body of research, and increased inclusion in health insurance and government health programs are but a few. It's interesting that during a time that chiropractic has become more accepted, medicine has become more high-tech (and efficient). And as medical doctors have used more technology, they have become increasingly removed from patients, and less revered by the public. Could there be a lesson here?
While chiropractors have no choice but to utilize technology wherever it can improve patient care, we must remember that when technology is used, and we minimize our human shortcomings, we also tend to minimize our humanity, a most important element in the doctor/patient relationship.
In our everyday experiences we witness the many wonders of technology. However, we frequently experience technology gone awry. A typical scenario goes something like this: We have just made a small purchase in a well-known department store. After paying for the item and getting our receipt, we decide to buy two, instead of one. Our lack of foresight now sets us "on the path to a computer ordeal." It is only after several minutes of noisy computerized cash register calculations, including a session in which our clerk is instructed by an equally unknowing supervisor that we are finally able to be on our frustrated way.
In these few minutes we have experienced a technological wonder. Simultaneously, two items are removed from inventory, their replacements ordered from suppliers, and at the same time, the office in Chicago is notified of the sale so the transaction can be included in the president's annual report to the stockholders. Yet we the customers walk away remembering only the wait and frustration, not the technological marvel.
The computer and the technology it makes possible undoubtedly will continue to grow in every aspect of our future. As part of chiropractic practice, it can help, but it can also hurt! Our profession must strive to be a mover in the use of appropriate health care technology, and ever on guard against losing one of its great strengths: close and warm patient/doctor human relations. At the end of the next hundred years, if chiropractic is still a profession, it will be because chiropractors continued to give care rather than deliver outcomes.
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