Medicine and the examples of unintended effects of technology

The interaction of humans and technology will always be unpredictable.  A few months ago this thought was driven home to me in a rather malodorous manner.

I have obstructive sleep apnea (OSA) and use a CPAP machine every night to sleep comfortably.  With OSA your airway collapses when you fall asleep.  A CPAP machine is a small technological marvel, quietly delivering heated, humidified air under gentle pressure through a nasal mask to keep your airway open while you sleep.

One night while using the CPAP I was ripped out of a deep sleep by the worst odor I have ever encountered.  How bad does a smell have to be to violently awaken you?  Dazed and confused I sat up, clawed my CPAP mask off, gulped a few breaths and waited for the purple haze to clear.  I looked down towards the floor next to the bed and realized with horror what had happened.

Our dog, Jade, is a Labrador who has blessed our household for nearly 14 years.  Out of affection and respect for her sheer endurance no one begrudges old Jade her habit of passing gas almost continuously.

On the floor was Jade, sleeping comfortably with her posterior positioned next to my CPAP machine on the floor.  Jade’s colonic gift had been sucked into my CPAP machine, heated, humidified and rammed up my nose into my gray matter.  We are not sure yet if the brain damage is permanent or not.  My wife and kids insist I’m no worse off than I was to start with.

History contains many other examples of technology’s unpredictable effects.  Remember the “paperless office?”  For several years in the early 1990’s, when PCs were new and word processors were first introduced, it was widely accepted that offices would soon have no need for paper.   Just write your document on the computer, save it to your floppy disk (remember those? They were actually floppy back then) and deliver the floppy disk to the recipient, who would read your document on screen.  Who needs to print documents anymore?  Paper manufacturers were in a panic, sure that demand for their products was about to disappear.

As anyone over 40 years old remembers, the opposite happened.  Office workers were happy to create documents on a computer screen but were unwilling to read them there; all documents still got printed eventually.   Then we became obsessed with creating perfect documents.  If a 20-page report had one comma out of place, fix the comma and reprint the entire document.  Then find another mistake and reprint 20 pages again.  Paper use skyrocketed.  Today the paperless office remains an unreachable goal, an ethereal concept, a star by which you can navigate but that you will never reach.

Medicine is replete with examples of unintended effects of technology.   A 5-minute web search produces a long list of unexpected medical outcomes such as heart problems from Fen-Phen and heavy metal poisoning from prosthetic hips.  Even something as seemingly benign as an over the counter zinc-containing nasal spray has been found to cause permanent loss of smell.

It comes as no surprise, then, that when we physicians contemplate EMR we see the introduction of an unpredictable technological force into the unpredictable environment of medicine.   That raises more questions than answers.  Will EMR free us to be real doctors again or make us slaves to data capture?  Will health information exchanges give us the information we need at our fingertips, or will we be barraged with terabytes of useless data?  Will e-prescribing be a blessing or a nuisance?   Pardon us for not buying into the IT euphoria.   Our patients and we will have to bear the consequences more than anyone else.  As stewards of the health care system we recommend proceeding with some caution.

Mike Koriwchak is an otolaryngologist who blogs at the Wired EMR Practice.

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