High Tech, Low Touch

Look at Me, Not My Monitor

Do you remember a special teacher who made a big impression on you? Do you remember ever having the “Aha!” feeling, a light-bulb moment when you first grasped a fresh concept?

If you do, I’ll bet at your “Aha!” moment the teacher looked at the class intently. People who genuinely connect with us don’t look away; they make eye contact. It’s the same in the classroom and the doctor’s examination room. When teachers or doctors look into our eyes, they open them.

In Cloudy With a Chance of Northern Lights I described the fabulous surgery that removed my cataracts, and brightened my world. Yet I felt part of an impersonal assembly line. The nurses had little time to process each of us in the day’s lineup of patients. The subspecialist cataract surgeon zipped between patients and from one operation to another. My anesthetist was so rushed in reviewing his checklist, that he hardly glanced up from his clipboard to catch a glimpse me.

Odd that in an eye clinic he wasn’t looking me in the eye. I don’t mean clinically. The doctors knew everything about my retina, pupil and lens and that they needed to know. I mean the kind of looking in the eye that makes you know you’ve been acknowledged as a real person.

It wasn’t always this way. This Victorian painting is a poignant image of the ideal, sympathetic doctor who connects with his patients.

“The Doctor”, Luke Fildes, 1891

High touch, low tech

Some decades ago my patient—I’ll call her Linda, not her real name—was pregnant for the first time, and excited when labour began. But after she was admitted to the hospital, the labour didn’t go well. A nurse called me in my office.

“She’s been having strong contractions for three hours, but she’s making no progress. There’s a problem, but nobody’s free to sit with her and monitor the labour. Our beds are full and every nurse is really busy. We need you to come. Now.”

I finished up with the patient I was seeing, and left for the hospital.

It was before the invention of electronic monitors for the fetal heart and the contractions of labour; the monitors were human. If a woman was having a difficult labour that created a risk to her baby, and the nurses were busy with other patients, my job was to sit with my patient through the hours of labour. For as long as it took. I needed to time the contractions of her uterus: how many minutes passed between them? Then, how many seconds did each one last? Finally, how strong were they? If I pressed down really hard on the uterus, were the contractions strong enough that I couldn’t indent them with my thumb?

It was pre-computers and I recorded (with pen and paper—remember them?) in my patient’s chart the intervals, duration, and strength of the contractions, in three separate columns. Every few minutes I listened to the unborn baby’s heart and clocked it with my watch; I carefully recorded it in a fourth column.

As I walked down the hospital corridor towards Linda’s room, I heard singing. I slowed down to listen. It was Linda’s voice. Women were being taught in childbirth education classes to sing a favourite song to help them cope when the labour pains became most intense. If a woman wanted to avoid pain medication or an epidural anesthetic, focusing on a song could help her control her breathing, and provide some distraction from the pain.

Unseen, I stopped at the open door to listen. Linda was half sitting up in the hospital bed, holding her husband’s hand. He sat on a chair beside her. After almost four hours of hard labour, perspiration matted her blonde hair to her forehead and cheeks. But she was singing “Tie a Yellow Ribbon Round the Old Oak Tree”. Her voice was pure, delicate. Stoic, persistent, plaintive. It was light, like a leaf floating on a stream.

It was an entity of itself, whole and beautiful, wistful.

I felt a rush of tenderness for her, tightening my throat.

I greeted them both, sat down on the side of her bed, and grasped her other hand. Her face was flushed, her skin warm and slightly damp.

We met each other’s eyes for a long moment. “How are you managing?” I asked quietly.

She managed a tired smile. “It’s hard. I’ll be happier when the baby’s out.”

I examined her: the unborn baby was large and its head wasn’t descending properly into Linda’s pelvis. I got to work recording her contractions and the fetal heart, four columns. At first everything was normal. But after two hours of monitoring, the baby’s heart began slowing in an alarming pattern called “variable decelerations.” Linda’s contractions were pinching the umbilical cord, cutting off the blood supply to the unborn baby. The fetus was in distress. It would be dangerous to allow the labour to continue. I phoned an obstetrician colleague, Guy Winch; he quickly came in to the hospital, and together we did an emergency Caesarian section. The mother and baby boy ended up in perfect shape.

After examining the baby and talking to the exhausted, happy parents, I went back to my office. Linda’s tired eyes and clear voice, the yellow ribbon, stayed with me.

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In the glow of the birth, I forgot the tedious hours of bedside monitoring. That work is now obsolete. The data I recorded through hours of painstaking, manual measuring of the fetal heart and labour contractions is now automated. After our emergency Caesarian section, Dr. Guy told me I’d saved the baby’s life. I was young, in practice only a few years, and my heart skipped to hear it. But today a machine could take the credit.

In high-risk labours, the human monitor has been replaced by electronic fetal monitoring. It shows the fetal heart rate and labour contractions simultaneously on a screen. It makes fewer mistakes than humans. And unlike us, it never tires.

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Look at me, not my monitor

When nurses and doctors come into the patient’s room, the bedside monitor with its wonderful information demands attention. It’s exciting to look at. No wonder we gravitate towards it right away.

But when the monitors were introduced, they were used routinely, not just for higher-risk labours. And there was a backlash against the technology. Advocates of natural childbirth called the routine use of electronic monitoring an unwanted “medicalization” of a normal life event.

“Look at me, not my monitor!” became a rallying cry.

Of course we’re not going to turn our backs on technology that brings increased safety for mothers and newborns. How, then, to embrace medical advances, but stay human—and connected?

We can start by looking the patient in the eye.

High tech, low touch

Eye contact isn’t the only part of the bedside manner that’s being lost. Another crucial one is communication through physical touch. The touch of physical examination can foster feelings of warmth, connection. Without it, medicine becomes increasingly impersonal.

“My doctor just orders tests now. He hardly touches me anymore.”

I’ve heard this complaint: technological advances are distancing doctors from patients. High tech, low touch: technology versus the bedside manner. The physical examination is gradually disappearing, and being replaced by gadgets like those automated fetal monitors.

Echocardiograms that work on iPhones. Ultrasound, CT, and MRI scans—machines that peer inside the body. They give accurate images, images that can be printed, e-mailed, analyzed digitally.

It’s a breathtaking revolution. And with it we are losing the communicating power—sometimes even a healing power—of the physician’s hand.

Three doctors, three eras

In my previous post, I am a doctor but currently a patient on a cataract-removal assembly line. It is the ultimate of high-tech, low-touch: modern, safe, businesslike, and impersonal.

Decades earlier, before electronic monitors, I am at the bedside of a labouring patient who, touchingly, sings through her pain. For long hours we are close and connected. I am useful, but inefficient compared to machines.

And still earlier, in the nineteenth-century painting above, the doctor is with a little boy who is dying. There is little the doctor at the bedside can do to save him. How, we wonder, might the doctor feel if he had our knowledge and technology? We sense the helplessness in his expression. Yet we also sense his compassion, the human touch.

This powerless physician has a gift we are losing.

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