Workshop Talks: Life-and-death questions

From the new July-August 2011 issue of News & Letters:

Workshop Talks

Life-and-death questions

by Htun Lin

When the popular game show Jeopardy featured IBM’s “Watson,” a computer, Watson won against the best human players. For capitalists this was not just entertainment, but serious business–a way to replace masses of workers.

As Christopher Caldwell of the Financial Times put it: “If you get paid to answer questions in a structured context, it is reasonable to fear Watson’s progeny” (“Jeopardy is just the start,” Feb. 19, 2011).

Watson is already being used in the medical field, where some speculate that it will spread easy access to much medical knowledge, which they tout would “mean better medicine for most people.” But the introduction of computers into medicine did not start with Watson.

What we fear from our own experience in the medical workplace is not only more unemployment, but exacerbating the mind-numbing effect computers have on work in a capitalist context. With electronic medical records, the computer’s needs dominate the healthcare workplace. What this means concretely is checking boxes and filling in blanks on a computer screen. The allowable answers don’t always correspond to patient’s real needs and responses.

Very little of it has anything to do with real quality healthcare. A lot of it has to do with keeping up with the bottom line, which includes documenting every expenditure. It also means documenting every procedure with an eye toward thwarting potential litigation. The corporate regulatory lingo for this is “compliance.”

How many times have I heard a poor patient pleading with a nurse, “Can I get help getting on the toilet please? I’m about to burst.” Some newly hired nurses have replied, “You’ll have to wait. I have to do your charting first!” It is not that the nurse is a cold, callous person. She is transformed into an appendage to the computer by the HMO training she received.

NURSES ELBOWED ASIDE

More important is the kind of training she didn’t receive. As a veteran nurse told me, “There’s no substitute for critical thinking forged by years of experience with actual patient needs.”

The computer programmer, the software designer, is today’s high priest of HMO healthcare. Nurses complain to me that Information Technology administrators think healthcare is all about cutting and pasting at the click of the mouse, instead of talking to the patient and writing one’s own commentary. The practice of the narrative in healthcare, which captures the uniqueness of each patient’s ailment, is slowly disappearing with this cookie-cutter approach.

This approach compresses time to engage the patient into a narrow window. The role of empathy is stifled in today’s healthcare. Spend too much time with a patient, and you’re considered a rogue worker.

NO TIME FOR CARE

We don’t ask all the necessary questions, because we don’t have the time. The machine has taken over. Under the domination of the computer, our daily routine, naturally driven by a propensity to cooperate in providing care, has been transformed into a drudgery.

We have endless meetings about “customer service,” but real customer service is not practiced. For example, competing departments often pass the buck on performing essential services for patients because of the narrow computer metrics that determine their bonus. Further, managers’ main concern is avoiding legal risk, even at the cost of not providing real care.

For management today, healthcare is like a spectator sport. They watch and monitor our progress through their computer-generated “quality” measures from corporate suites. It’s been years since any of us have seen, or met in person, the current administrators at our hospital. The same is true for our union reps. To us, these leaders are like the Wizard of Oz, issuing directives from behind the curtain.

Watson may have entertained many on Jeopardy with the wonders of computerization, but when viewed from the capitalist workplace, it only underscores what Marx said a long time ago (on the anniversary of the People’s Paper, April 19, 1856): “All our invention and progress seem to result in endowing material forces with intellectual life, and in stultifying human life into a material force.”

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