Steve Ruffenach on accepting technology in medicine

steve_ruffenachLike every other profession, medicine has been radically changed by our friend Tech. You of course know Tech; he is that associate that is always around, always snooping where he doesn’t belong. He’s the one who won’t leave you alone no matter where you are or what you are doing.

His virtues and failings have been discussed countless times for centuries. And our love-hate relationship with him has been present ever since he first showed up. Every time Tech comes out with a new ability, we seem to immediately embrace it and then condemn it. The classical Greek philosopher Socrates condemned one of Tech’s earliest tricks, the act of writing, (“It will produce forgetfulness in the minds of those who learn to use it”), although his student Plato wrote the Socratic dialogues to preserve his work. The Luddites hated and smashed the new-fangled factory machines that threatened their work (“We wish to live peaceably and honestly by our labour” 1), but used various appliances to make their point and meet their goals. And while many people love their horses more than their automobiles, (“One can get in a car and see what man has made. One must get on a horse to see what God has made” 2), those very cars and trailers are irreplaceable in the lives of nearly every horse lover.

And so it is with the medical profession. We love Tech and yet often wish he would simply step back, leave us alone, and let us be the doctors and nurses we once imagined we would be; true and fierce caretakers treating the sick with our wits and hands and not with the constant beeping and monitoring that makes Tech so darn annoying. Still, without Tech we wouldn’t have the shared knowledge that empowers us, the connectivity that enhances us, or the harnessed power that enables us to care for our patients.

Yes, medical professionals grumble every day about Tech, living and working with that love/hate relationship in every clinic, operating room and hospital.

Well, I am tired of the griping. Tech is here to stay and I guess we either live with him or do a Thoreau and move out to the woods. Since I’m not going to do that, I have a new way to keep my complaints to myself and embrace this Tech guy no matter how perturbing or powerful he is.

I’ve decided to “accept and except.” Let me explain.

I accept the fact that Tech can, with his special power, show me things in my patient’s bodies that I cannot see, except I will put my hands on that part of the patient and truly touch and feel the affected area.

I accept that Tech can give me important electrical tracings of my patient’s intrinsic rhythms, except I will actually listen to those beating hearts and physically connect with my patients.

I accept that Tech can provide strong medications to relieve sickness and symptoms that I alone cannot, except I will talk to the patient after the medication has been started to ensure progress is being made.

I accept that Tech will ensure my surgical fields are sterile, except I will defend and maintain them.

I accept Tech knows all about my patients’ histories, except I will protect their privacy.

I accept Tech’s power, except I control him, he does not control me.

I wonder what other examples of accept and except readers of The BMJ might suggest. Please leave your suggestions in the comments section below.


1. Writings of the Luddites, Edited by Kevin Binfield. Baltimore and London: Johns Hopkins University Press, 2004.


Steve Ruffenach is an internist and medical informaticist living and practicing in Tucson, Arizona, USA. He holds a teaching position as a clinical assistant professor of medicine at the University of Arizona and has a keen interest in medicine and machines.

Competing interests: None declared.