Just half a century ago, if you wanted to look at a medical textbook, you would have to go to the library and ask for special permission. The librarian would lower her glasses, look you up and down to determine whether or not you were some kind of pervert. Only then might you be granted permission to peer into the pictures of organs and naked bodies.
Such has been the spirit of medicine for centuries: Medicine and its practices are meant to be kept secret, the insider knowledge of a privileged few.
Fast forward to 2008: The Information Age has overturned the rules of privileged information. Now you have access to the same information available to practicing physicians. Breaking news in health? We all get the same reports. New developments in medical research? Same again. The playing field has been leveled.
Curiously, while information access has advanced at an instantaneous digital pace, attitudes in medicine continue to evolve at the traditional analog crawl. Many of my colleagues continue to be dismayed at the new public access to health information, belittle patients for excessive curiosity about their health, lament the erosion of their healthcare-directing authority.
History all over again
In 1910, taking a person's blood pressure was considered revolutionary, a high-tech practice that presented uncertain benefit.
Dr. Harvey Cushing of Johns Hopkins Hospital in Baltimore had observed a blood pressure device while traveling in Europe, developed by Dr. Sciopione Riva-Rocci. Dr. Cushing brought this new technology back with him to the U.S. and promptly promoted its use, convinced that the insight of gauging the forcefulness of blood pressure would yield useful clinical information.
But, in 1910, many practicing physicians rejected the new technology, preferring to use their well-established and widely practiced technique of pulse palpation (feeling the pulse), skeptical that the new tool added value. Medical practice of the day was rich with descriptions of the strength and character of the pulse: pulsus parvus et tardus (the slow rising pulse of aortic valve stenosis), the dicrotic notch of aortic valve closure transmitted to the pulse, the "water-hammer" pulse of aortic valve insufficiency.
Over the next 20 years, however, the medical community finally gave way to the new technique, although only physicians were allowed to use blood pressure devices, as nurses were regarded as incapable of mastering the skills required to perform the procedure properly.
Stethoscopes were also gaining in popularity in the early 20th century, but so were the exclusive province of physicians trained in their use. Nurses were not allowed to use stethoscopes until the 1960s. Even then, nurses were not allowed to call them "stethoscopes," but "nurse-o-scopes" or "assistoscopes," and the nurses' version of the device was made smaller and flimsy to avoid confusion with the "real" doctor's tool.
In 2008, while new concepts race ahead as we work towards a wiki-like collective expansion of healthcare knowledge, many physicians are still mired by their reluctance to abdicate their once-lofty positions as Chief Holders of Secrets.
Imagine the horror felt by physicians in 1935 when a young upstart nurse boldly tried to use a stethoscope and blood pressure cuff to take a patient's blood pressure. It’s the same annoyance all over again felt by today’s physician at being presented a reprint of a web-based report.
I see the same erosion of physician-as-dictator in the growing availability of heart scans to uncover hidden heart disease. For the first time in history, anybody is able to determine─even without a doctor’s order─whether early coronary atherosclerotic plaque is present.
Heart scans make detection of coronary heart disease a 30 second, hold-your-breath-once proposition. No longer do you and your doctor have to rely on shaky predictions provided by looking just at risk factors.
But, heart scans are the blood pressure cuff of 1910: still fairly new and thereby a source of discomfort for your doctor generally content with cholesterol, stress tests, and waiting for you to “tell” him/her when it’s time for a hospital heart procedure (meaning the appearance of symptoms).
Technology has a way of marching on. It will encounter resistance, bumps, and blind-alleys, but it will go on. For now, recognize that you, courtesy of the internet, have access to the same information that your doctor has. A shift in “power” is occurring that is putting more knowledge, insight, and healthcare decision-making ability into your own hands.
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Published On: July 15, 2008