Just as Da Vinci and Rembrandt practiced their artistic genius with the paintbrush, Hippocrates and Nightingale practiced their art of medicine and nursing through exceptional interpersonal skills. As a primary hematology and oncology nurse working at a National Cancer Institute-designated center, I have discovered that human-to-human interaction is still the most critical component of medical and nursing practice. I currently practice in an academic tertiary setting and consider myself privileged to provide care to patients diagnosed with T-cell lymphomas, leukemias, and other rare hematological diseases.
At initial presentation, my patients often exhibit a sense of fear, hopelessness, and disappointment in their previous care. Patients tell me stories that reflect a diminished quality of life after the onset of their illness. After the patient's first visit, once a human connection has been established, most patients become physically calmer. A trusting relationship begins to grow, which evolves throughout their care.
Interpersonal skills, including direct eye contact, face-to-face verbal communication, active listening, and physical touch, are crucial to this relationship. These human skills are the best tools to communicate genuine care with invested interest in the patient's best outcome.
Modern day health care is synonymous with technology. A report titled, Crossing the Quality Chasm: A New Health System for the 21st Century, published by the Institute of Medicine, in 2001, made an urgent call for fundamental changes to health care in the U.S. to improve quality, promote evidence-based practice, and strengthen clinical information systems.1
In 2004, President George W. Bush set a goal that electronic health records be implemented for all Americans by 2014. President Barack Obama supported and offered financial incentives for health care institutions to adopt the implementation of electronic health records through both the American Recovery and Reinvestment Act and the Health Information Technology for Economic and Clinical Act.
The National Healthcare Information Network (NHIN)—a set of standards, services, and policies that enable the secure exchange of health information over the Internet—was established in 2009 as part of the Health Information Technology for Economic and Clinical Health Act.2 Its intention is for broad implementation of the network to enable the secure exchange of health information using national standards, will help improve the quality and efficiency of health care.3
Standardization, Organization, & Efficiency
Medical informatics has helped create standardization of care for patients seen by all health care team members. Based on my experience, electronic clinical information systems do enable more organized and detailed patient charting, which facilitates communication among providers and promotes continuity of care.
Electronic health records allow health care providers to create and systematically store detailed patient histories, as well as physical, medication reconciliation, and demographic records. Institutions use a standardized language for entering patient information into the records and incorporating clinical pathways specific to that institution. Electronic health records are efficient and have received much support from both the government and health insurance agencies.
But, I find these systematic technological advances paradoxical. As I interact with patients for most of my waking hours, I realize that every patient is different. Technology allowed Watson and Crick to identify the structure of the DNA. Their findings taught us that every individual is unique right down to the strands of their double helix. When contemplating the future for my patients, my fellow health care professionals, and myself, it seems quite hazy.
A system that was created to provide equal care for every individual does not afford the same opportunity for the very sick or high-risk patient populations. This system forces patients to expect the best services for their money but doesn't provide the necessary tools to render the best quality of care. Physicians and nurses are forced to spend more time interacting with computers than directly interacting by educating patients and supporting their needs. Shortcuts have been made to bypass the annoyances of the electronic health records. Ready-made templates that meet all needed documentation requirements are made but never meet the patient's unique needs and sadly are not patient-specific.
I have learned from my experience as a nurse that my patients are not products or goods—and excellence in providing their care is not easy to judge or individualize. For me, the questions grow exponentially every day: Do pay for performance, standardized health care systems, and health care cost reimbursements allow for health care providers to practice the true art of medicine or nursing? Will these standardized systems allow me to practice my calling and mission to humanity?
I find myself wondering: with all the advances in technology, why are patients still being misdiagnosed or under diagnosed? At what point does technology interfere with the connection between human interaction and the forming of a trusting provider-patient relationship which is the foundation of health care?
The Nurse's Paint Strokes
As a painter takes the brush and uses strokes unique to his talent, physicians, nurses, and other health care professionals interact with their irreplaceable acquired interpersonal skills. At what point does the click of a mouse, video chat, or an electronic questionnaire replace look, listen, and feel? At what point does human interaction become lost in cyberspace? How will the art of medicine and nursing be affected by technological uniformity and standardization?
Over the centuries, artists were not forced to follow the expert opinions of the economist to mass produce their works in a systematic and uniform way. In fact, the quality and rarity of artists is what makes their talent so monumental. I ponder the future advances of technology, and where this leaves the provider of health care. What makes our talents so specialized and needed? And what does this mean for the patient who presents with a rare or almost unheard of disease?