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Finally, the political debate also revolves around using information technology to figure out which treatments are most effective. This seems eminently sensible: might certain heart patients, for example, do just as well with clot-busting drugs as with more expensive angioplasty procedures? The drug route could save about $7000 a patient Crunching huge amounts of data from a wide cross section of patients could help us do better research than we are doing now. But what will happen when the new computerized research turns up a treatment that works a little better but costs much more? Will they tell us? What happens to the patient whose particular circumstances argue for a different treatment than the computers and the bureaucrats recommend?
There are countless ways to control costs; some of them, like liability reform, won't easily fly through a Democratic Congress. We held our breath as Mr. Obama drew a line in the sand in front of Big Agra and the teachers union last week, hoping against hope he would continue it across the trial lawyers. But the doctors I know wince whenever electronic medical records are held up as some kind of silver bullet.
Before we had them on every countertop, computers held such promise for us in medicine: doctors and patients live in a world of painful, pressing questions, the answers might be in there. Or so we thought. Twenty nine years from the night I first sat in a hospital in front of a computer screen the questions persist. And I still don't see the profit-maximizing, cost-controlling physician with his nationwide computer treating patients any better than the great physicians I've known have. With pen and paper, personal commitment to each patient and judgment born of practical experience. None of which I have found in a machine.