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Are you prone to gizmo worship?
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By Michael Woodhead, 6minutes editor
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The medical profession has fallen into the trap of “gizmo idolatry” to the detriment of patient care, according to two US doctors writing in JAMA this week.
Doctors are like other human beings in having a weak spot for gadgets that have all the latest bells and whistles say Dr Bruce Leff and Dr Thomas Finucane of Johns Hopkins University.
They say that while some new technologies have a useful place in patient care, many doctors are becoming enthusiastic “early adopters” of new gadgets and technologies simply for the “gizmo quotient”.
Gizmos are popular, they say, because their cachet boosts the status of the user, confers more significance on the disease and increases the appeal of an intervention.
They cite examples such as coronary CT scans and PET scans for dementia where everyone is dazzled by the technology, but the evidence remains far from convincing. And yet, even without good evidence, the use of gizmos is seen as a sign of competence - especially when they are able to provide “objective” information which may be of little help to the patient.
The threat in litigation also encourages the use of gizmos, the doctors argue, because of the pervasive belief that the latest technology represents the highest form of care. And of course profit is a great driver of gizmo use in medicine, they claim, with whole business models built around particular technologies such as the recent “nerve testing device” mentioned in the New York Times.
Gizmo use is also driven by tech savvy patients who expect the same approach in medicine as they do in their everyday life surrounded by mobile phones, iPods and DVD players.
But often the best medicine is painstaking diligence, “watchful waiting” and lifestyle changes, say Drs Leff and Finucane. These are seen as the menial and low status tasks in medicine, where surgery and interventional approaches are highly prized.
There may even be harms from gizmo idolatry when early uncritical adoption of new technologies occurs in the absence of proper evaluation. They cite example such as Swan Ganz catheters, which they say did not improve outcomes and resulted in more complications.
“Clinicians should resist the clamour for the new and fancy,” they advise.
“Recognition of gizmo idolatry is the first step in educating … both clinicians and patients to be circumspect rather than enthusiastic and to seek evidence of the effectiveness of any medical technology,” they conclude.
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