Tuesday, January 22, 2008 we posed the question: "How is healthcare like banking?" in connection with an article written by Mssrs. Kevin Leonard and David Wiljer, titled: “Patients Are Destined to Manage Their Care ” and which was originally published in Healthcare Quarterly, 10(3) 2007: 76-78. Today we publish a first response to this question, given by Dr. Merrilee Fullerton.

written by Dr. Merrilee Fullerton

Being a physician is a humbling experience. There are many grey areas amidst some black and white in health care. Some health care issues that seem straight forward can come back to haunt you when you least could have suspected it.

I suppose one might be able to say the same thing about one's bank account particularly if there has been a computer glitch but for the most part information is tracked well and the necessary calculations are made to complete successful transactions.

Certainly there may be an element of risk in banking and managing one's own investment portfolio but for the most part there are no life and death decisions and there are usually no deleterious health outcomes directly related to using the automatic bank teller.

Not so with health care.

This is why physicians are discouraged from treating themselves and their families or friends and acquaintances. Because the risk of losing objectivity exists in these circumstances.

There is a saying in medicine that I can never express word for word but it boils down to the concept that if you are your own treating physician, you have a fool for a doctor.

Which means that it is difficult to maintain one's perspective when looking after oneself or one's family or friends.

Poor outcomes in these kinds of scenarios leads to life long guilt if complications arise...and life is always full of surprises.

Unless you have been trained in medicine or worked with patients directly,it may be difficult to understand how treating oneself could lead to difficulties but it is definitely a very significant concern in the concept of "self-care".

Although technology may be helpful for putting patients in contact with a health care provider and providing an organized and available method of data reporting, treating patients requires the person to be seen and the physical cues to be viewed and assessed.

How patients look on lab tests can be significantly different from their physical examination and we must not be lulled into thinking that taking care of patients is about data storage and management of lab tests or investigations.

Providing patient care is much more than this.

So although more technology in health care will be necessary to enhance the provision of health care by providers it will not replace to any significant extent the human interaction necessary for quality health care.

And the concept of self-care will probably be limited to more patient involvement in chronic disease indicator management. However, the assessment of the patient as a living, breathing being will be far more important than looking at numbers on a screen.

Innovation in technology in health care has made many advances in the past 20 years....but in Canada healthcare IT lags behind other developed countries.

But it will not replace the need for providers as bank machines have replaced tellers simply because patients are human with complex physiological requirements and emotions...and bank statements and investment portfolios are simply numbers.

Having said all that, I doubt many health care providers would reject improved technology to assist their care of patients to engage patients more actively in monitoring their health.