Two Views: Mobile Medicine and Innovation at the Point of Absurdity
Two Views is a new column from veteran EMS technologist and critic Jonathon Feit that examines current industry issues from the perspectives of both frontline personnel and leadership/management. In this column, he shares his thoughts on mobile medicine.
I began writing this essay on paper—the real stuff, made from trees, in the woods outside Yosemite, steps from a pool where, one year ago, I resuscitated a boy who almost died—to lament that we are skating on a razor blade at the point where technology becomes absurd.
We are at the point where hands must touch wizened hands, and remove needles from arms. Where food must be set before those who lack it. Where technology can help but it cannot solve, yet we desperately need to solve it. Where investment in technology actually siphons cash that could make things better, inadvertently making things worse.
Technology is shiny. Life is often dirty, gritty, and depressing. People need to be lifted from the ash and trash and reminded of the path to pride and stability because no one wants to be hurt. People may not know how to flee their demons. They may wallow in pain or even pursue it to feel alive (see also bodybuilders and BASE jumpers), just as watching horror movies makes people feel safe in real-life (“it’s just a film, darling”). But no one wants to hurt. Unless technology can solve hurt, it risks becoming a Band-Aid on a bullet hole, even more acute than lipstick on a pig.
As a technologist in the San Francisco Bay Area, I am the opposite of a Luddite. My team’s tech has won awards. I designed software for the Feds and published the first digital magazine. Yet with every headline about so-called innovation, I grow increasingly confident that our collective mindset is flawed and Mobile Medicine is in the crosshairs—but not because ambulance services will go away.
On the contrary: society will discover how to fund mobile medicine because it has to—and that’s bad. We won’t have enough rigs to tourniquet society’s wounds, but more ambulances aren’t needed where circumstances are sparkling. We’re on a weird track now.
In early November, I participated in a throwback sort of discussion titled “Innovation for Good or Profit?” We did something special and rare these days: we debated with respect, assuming that everyone else in the room was smarter than each of us. In the end, we hugged it out. (The only other occasion where I recall passionate argument yielding unvarnished camaraderie was at the Mobile Medical profession’s first “unconference” I hosted in Napa Valley a week before EMS World Expo 2022.)
I steered our roundtable toward the absurdity—the ridiculousness—of technology where it slams into the dire. We discussed Abraham Maslow’s Hierarchy of Needs, which the Harvard Business Review has described thusly: "Maslow’s idea that people are motivated by satisfying lower-level needs such as food, water, shelter, and security before they can move on to being motivated by higher-level needs such as self-actualization, is the most well-known motivation theory in the world.” HBR noted that “getting people off the streets into healthy environments is the decent thing to do.”1
Can technology help? Homeless Information Systems can ID who is on the streets, but can it get people off the streets? ePCR systems can chart the care that patients received, but can it keep them from needing help? Health information exchanges can track who received narcotics (and from whom), but can it dissuade people from seeking them? In 2012, renowned entrepreneur and venture capitalist Vinod Khosla wrote “Do We Need Doctors Or Algorithms?” arguing that “I may still need a surgeon…or other specialists for some tasks for a little while…[but] a more elaborate vision, one that is not very useful today because of lack of enough data and enough science, is defined in Experimental Man and websites like Quantified Self.”2
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Author’s note: You haven’t lived until you’ve asked a patient to participate in a telemedical proctology exam.
Ten years later, the VC firm NFX wrote about so-called “Generative Tech,” which is about getting computers to do things more quickly and efficiently than humans do—even creative things like art and music: “We’re at the point in the cycle where the mainstream adopters are not on board. Not yet. It’s important for you, the founders building leading-edge technologies, to understand why that is.”3
Is replacing people in art and science a “leading edge”? Maybe. Productivity breeds time and time breeds innovation—this has been humanity’s superpower since we domesticated animals and fire. When we didn’t have to hunt, we had time to invent. “Idle hands are the Devil’s playground” is an old industrialist adage, and the mindset that sociologist Max Weber saw as fuel for America’s economic ascendance. But how—and why—would a schizophrenic single mother living in a tent, and suffering hunger pangs alongside her child, “quantify” herself?
And what of ethics? Mustn’t we ask whether we should spend precious time and money investing in teaching computers to draw for us instead of investing those dollars in feeding/housing/clothing/healing/educating those who cannot do it for themselves? Forget the Enlightenment’s tenets of liberal society and the Social Compact. This is survivalism. Can we avoid the anvil of absurdity that threatens to land on us if we fantasize that another “app” is all it will take to rise to a safer, healthier future?
Some will cry “Black Swan Event,” claiming we couldn’t see a cataclysm coming. Rather, like Cassandra in the Greek myths or Spock in 2009’s Star Trek, we were doomed to watch a world that didn’t believe us implode. More consequential than the dot-com crash or Lehman Brothers’ demise. I’m talking about plague—or more likely, hepatitis A.4 Bigger than the HIV/AIDS tragedy of the 1980s. Fentanyl will kill children and we’ll wonder what we could have done. What were we investing in, again?
In and around San Francisco, where my ambulance partner clients administer more Narcan than should be conceivable, I struggle to square Khosla’s words—that “data, the key ingredient to useful analysis, and diagnosis, is starting to explode exponentially…about my steps, my exercises, my stress levels or my normal heart and respiration rates”—with the inability of a human in 2022 to find a toilet in the city that houses major corporations.
1. Innovation for Good or Profit?, Wed, Nov 9, 2022, 6:00 PM | Meetup
2. Do We Need Doctors Or Algorithms? | TechCrunch
