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Steven Shea, M.D.
Technology and Humanism
In the early 20th century the German literary critic and aesthetic theorist Walter Benjamin wrote a well known esssay on the nature of the work of art in the age of mechanical reproduction.1 Benjamin was interested in the emergence of photography as an accepted form of art. The reproducibility of photographic images raised fundamental questions for him about how to reconcile the perception of certain photographic images as works of art with their lack of uniqueness. Is the uniqueness of the object a requirement for a work of art? Benjamin’s anxiety about the potential of mechanical reproduction, mass culture, the assembly line, and other aspects of modern life to make individuals less unique and to dehumanize them and their most individual expressions has been echoed by many others. Benjamin’s comment might be interpreted as an expression of concern about our ability to maintain humanistic values in a technologically based culture. This concern at its least constructive may lead to machine breaking and nostalgia for the past. In a more constructive mode, it may help us to maintain our values and our focus on the healing mission of medicine2,3 and at the same time enable us to make good use of new technical capabilities.
Privacy in the Era of Computerized Data and Electronic Communication
The privacy of patient-physician communication has been a cornerstone of the patient-physician relationship since before Hippocrates and the Hippocratic oath.4 The confidentiality of the most personal information is a precondition for the trust that is essential for most patients to place themselves in the hands of their physicians, nurses, and other health professionals. Trust in confidentiality and beneficence is at the heart of the patient-physician relationship, and this relationship is at the center of the humanistic and professional values of the medical and health care professions. The threats to confidentiality embodied in the effective new technologies of computerization for health care data and electronic communication using the World Wide Web and other media are well recognized and led to the Health Insurance Portability and Accountability Act (HIPAA).5 HIPAA represents a series of compromises between the capabilities of these technologies to improve information management for individual patients, review data from many patients at the same time, and communicate effectively among health professionals, on the one hand, and the clear threat these technologies pose to the privacy of health care data and the patient-physician relationship. The effective protection of health care information and of the confidentiality of the patient’s relationships with health care providers is a necessary precondition for the widespread use and dissemination of telemedicine.
Face-to-Face vs. Distant Interaction in the Patient-Physician Relationship
One physician, shown the possibilities of telemedicine technology, responded in horror by asking how would it be to raise children by computer. This question reflects the deeply held belief that the core values of the health care professions are embodied in the personal relationships that exist between patients and physicians. The question also implies that the mode of communication between patient and physician determines the nature of these relationships. There can be no doubt that new modes of communication will lead to change and restructuring of these relationships. The medium may not be the whole message, but it will change the messages. We may note that many parents and children find that e-mail and cell phones have helped them to remain in closer touch and to communicate better. Electronic communication between patients and physicians has the potential to enrich patient-physician relationships as well as to diminish the face-to-face interactions that have characterized these relationships up until now.
Values and Professionalism in the Era of Electronic Communication
Walter Benjamin found traditional aesthetic theories bound by the sacredness or authenticity of individual objects of art to be inadequate to the aesthetics of the new art of photography. He responded by suggesting that the authenticity of a work of art lies in the relationships between the artist and the work, on the one hand, and the audience and the work of art, on the other. Similarly, the core values of the medical and healing professions remain clear and without dependence on the mode of communication. These include the empathetic ability to see the patient’s situation from his or her own perspective, beneficence and altruism toward the patient, putting the patient’s interests above our own, knowing our limits and practicing within our own sphere of competence, and maintaining confidentiality and trust.6-8 Our responsibility to maintain the values of the healing professions as we adopt new communications technologies remains undiminished.
References
1. Benjamin W. The work of art in the age of mechanical reproduction. In: Benjamin W. Illuminations. New York: Schocken Books, 1969.
2. Lipkin M. The medical interview. In: Feldman MD, Christensen JF. Behavioral medicine in primary care. Stamford, CT: Appleton & Lange: 1997:1-7.
3. Egener B. Empathy. In: Feldman MD, Christensen JF. Behavioral medicine in primary care. Stamford, CT: Appleton & Lange: 1997:8-14.
4. Garrison FH. An introduction to the history of medicine. 4th edition (reprinted). Philadelphia: W.B. Saunders Company, 1929:92-101.
5. The Health Insurance Portability and Accountability Act of 1996. HIPAA Web page. Available at: http://www.hcfa.gov/hipaa/hipaahm.htm. Accessed April 24, 2001.
6. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002;287:116-235.
7. ABIM Foundation. Medical professionalism in the new millennium: a physician charter. Ann Intern Med 2002;136:243-246.
8. American Board of Internal Medicine. Project Professionalism. Philadelphia, PA: American Board of Internal Medicine, 1995.
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