Editor`s Opinion: Toys, Technology, and TLC

The economic and technological triumphs of the past few years have not solved as many problems as we thought they would, and, in fact, have brought us new problems we did not foresee. - Henry Ford, 1863-1947

  We love technology. Every holiday season, the most recent electronic innovation is sure to appear on the wish list of adults and children alike. From the mechanical fountains designed to provide an instant sense of tranquility to the smallest, most feature-laden computer to the latest litter of mechanical pets, technology sells. Listening to experts airing their concerns about the declining purchases of toys that require children to use their imagination, I couldn't help but wonder whether children are really attracted to all the new technology or if it is the adults who are fascinated by the gadgetry. After all, parents purchase these items, convinced (with the help of savvy marketing) that a particular toy will make their children happy, smart, or both. One can argue that mechanical creatures that need care foster a sense of responsibility, but the vast majority of mechanical toys -eg, popular video games- are not designed to teach children how to listen, share, care, or be generally sensitive to the needs of others.

  Enter the world of healthcare at the turn of this century. During the past several years, we have learned that many clinicians no longer appear to have (or ever had) the basic diagnostic and communication skills that were common just a few decades ago. We hear about much-needed courses in medical school on how to listen to, interact with, and teach patients. We watched as experienced (read: more costly) nurses were let go and saw what happened when these experts were replaced by unlicensed personnel who supposedly can easily operate equipment or carry out tasks that appear to require limited education (as determined by people with zero experience in healthcare, of course). We observe the results of nursing shortages on patient care, and sometimes employing - believe it or not - the same faulty logic used to replace nurses with unlicensed personnel, we hear rumblings about expediting the nursing education process to alleviate this shortage. The thinking: Who needs physicians, nurses, physical therapists, or anyone with an expensive education or extensive experience in a world full of innovative tools and technologies? Who needs the diagnostic skills of an experienced, knowledgeable clinician when one can order a battery of high-tech tests?

  Under the heading "Sustainable technology: a medical oxymoron?" Daniel Callahan observes that people who live in a world dominated by technology expect the same in medical care and that the technology of medicine is the "most touted of all."¹

  Our love of technology in general, and our high expectations for its ability to solve all problems and cure all ills in healthcare in particular, fit perfectly with our ongoing logical-positivist, scientific approach to illness. Instruments, gadgets, and tests are perfect for looking at limbs, organs, and cells; high-tech interventions document that we are addressing the patient's needs. Hence, many people continue to think that high-tech surgery is a better method of managing incontinence than simple exercises.² We focus on wounds and interventions as if they exist in a vacuum and rarely ask about the patient's perspective on life following major, life-altering, surgical procedures.^2-4

  Technology may make us smarter, but it doesn't help us listen, care, share, or be sensitive to the needs of patients. Other unforeseen problems related to our love of technology and its presumed ability to cure all ills involve the limits of biology itself which, according to Callahan, will guarantee that technology will create an "endless financial, social, and psychological struggle."¹ This struggle is evident in current issues ranging from stem cell research and the use (or nonuse) of a respirator to questions about the cost benefit of (possibly) reducing healing time by 1 or 2 weeks.

  The 21st century will certainly bring more technology. As clinicians, we must address its unforeseen consequences. Will these innovations make us happy, smart, rich (or all three)? Will they truly help meet patients' needs and optimize care? New technologies that fail to improve care are simply expensive toys destined to be discarded when next year?s new model becomes available. Let's hope the new year carries with it the ability to know the difference.

1. Callahan D. False Hopes: Overcoming the Obstacles to a Sustainable, Affordable Medicine. New Brunswick, NJ: Rutgers University Press; 1999. 

2. Blanes L, de Cassia Toledo Pinto R, Conceicao de Gouveia Santos VL. Urinary incontinence knowledge and attitudes in Sao Paulo. Ostomy/Wound Management. 2001;47(12):43-51. 

3. Engle VF. Comprehensive care: the healthcare provider's perspective. Ostomy/Wound Management. 2000;46(5):40-44.

4. Beitz J. The lived experience of having an ileoanal reservoir: a phenomenologic study. JWOCN. 1999;26:185-200.