In the early 1930s the practice of medicine was akin to the Model A. The Model A, first built in 1928, was certainly destined to change the world. But in retrospect, the technology was very basic. New medical discoveries, such as insulin, were being made. But there was much to learn. Surgery carried a significant mortality, and death from infections such as TB was expected by both patients and physicians. Innovations loitered on the horizon while patients died of illnesses we can easily cure or prevent today as we drive around in our cars equipped with collision avoidance systems, Bluetooth, and GPS.

Patrick Taylor has written a series of books about a GP who practices in rural Ireland. I am currently reading “A Dublin Student Doctor.” His story captures the trials and thrills of being a medical student in 1930s Ireland. He does a beautiful job of portraying the wide-eyed enthusiasm and sometimes trepidation in the medical students. The fear of senior physicians, the excitement of the diagnostic process, and the disdain for the brown-nosing student are brought to life through his characters.

Much of this is and will always be so. What I found most interesting is the way that physicians interacted with their patients then. On rounds, patients were referred to by their initials, even in their presence. Given names were never used, and physicians avoided creating personal connections with patients. Conversations were strictly clinical. Nobody asked the patients if they were satisfied.

Our interactions with patients have changed quite a bit since then. Patient autonomy is king, and we don’t keep patients at arm’s length as much. Patients are included in decision making, and we don’t shield them from bad news. And we want them to be satisfied. These are fantastic changes, and we are all better for them. Yet I believe, in this digital age, that we are being pulled away from our patients by technology.

In the fast pace of emergency care, the path of least resistance seems to be to order tests first and ask questions later. We spend an inordinate amount of time at computers pecking away or trying to log back into programs that maddeningly evict us because of 5 minutes of inactivity. We spend less time truly communicating with our patients. What is odd to me is the fact that patients equate all this testing with good doctoring.

Patients, of course, have no clue that little skill is required to click off a bunch of tests and then pronounce good health 3 hours later. A recent article in Forbes Magazine suggests that the push for patient satisfaction is actually bad for patients. A good argument is made that in the name of patient satisfaction, higher scores, and higher reimbursement physicians are ordering more tests and prescribing more medication. Thanks to our federal government and the push for satisfaction measures, this is the law of unintended consequences in action.