Fifteen Eighty Four

The New York Times Health section in tomorrow’s edition ran an excellent piece on Stanley Reiser’s Technological Medicine. The piece focuses on the uncomfortable tradeoff between technology and expectations at the clinic.

A stethoscope amplifies inaudible heart and lung sounds in a very satisfying way. If, however, the owner of the organs under evaluation decides to make a comment during the exam, what results is a painfully loud, unintelligible blast of noise directly into the doctor’s head.

It was during such an interruption almost 30 years ago that Dr. Richard Baron, a Philadelphia internist, grumbled at his patient: “Shhhh. I can’t hear you while I’m listening.” The phrase has undoubtedly been said by many, but Dr. Baron was the one with the wit to stop and laugh (and reflect at length in a classic medical article), realizing that he had enunciated in pure koan form probably the single greatest tension in modern medical practice.

Against the siren song of all those beautiful instruments and machines, whatever the patient has to say is sometimes just an annoying interruption. Medical technology is addictive; it is exclusionary and expensive, and it begets versions of itself like the sorcerer’s brooms. It complicates everything, and yet from X-ray and M.R.I. to the stratosphere of gene analysis, only a simpleton would opt to fly without it.

Dr. Stanley Joel Reiser, a physician, historian and medical ethicist now at George Washington University, has been ruminating on these matters in scholarly circles for years. His latest collection of essays escapes the ivory tower and resonates precisely with today’s headlines. Anyone with more than a passing interest in our present health care logjam will be intrigued and enlightened by Dr. Reiser’s painstaking retracing of its origins.

He begins with the stethoscope, the greatest medical hit of 1816. “Before stethoscopes, the coin of evaluation was words — the doctor learned about an illness from the patient’s story.”

Then, suddenly, the doctor was paying attention to something else.

Keep reading at the New York Times >>