Hospital strives to balance technology, patient stress

The half-dozen operating rooms that opened at Boston Medical Center this month are reminders of the technological prowess of medicine. Each room resembles an electronics store showroom, a multimedia center, the flight deck from "Star Trek," and, of course, with the equipment arranged around a solitary operating table, a surgical suite.

But where is the patient in all of this silicon, plastic, and metal?

Lying on a gurney, often, a stressed-out mess.

"A high-tech environment is stressful to human beings. It's not what we evolved to deal with," said Dr. Gregory Fricchione, director of the new Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

And all that anxiety isn't good for the patient's health.

"Psychological stress can lead to metabolic stress," he said. "You're putting your body at a disadvantage to recovery."

Technology obviously has its upside -- robots don't have hand tremors, personal lives, or bad days. And it is only increasing, introducing more complexity into hospitals every year, said Dr. David Blumenthal, director of the Institute for Health Policy, also at Mass. General.

"There is a trade-off between the personal and perfect," said Blumenthal. "The question is, can you develop a balance?"

Part of the downside of technology, said doctors, is that it can focus the clinician's attention on data rather than the patient.

This can make patients feel abandoned, said Dr. Arnold Gold, chairman of the Arnold P. Gold Foundation, which tries to foster a more humanistic relationship between doctors and patients. It may seem that patients have less time with their patients, but in fact, time with doctors has held steady over the last few years. The quality, however, has changed, several doctors said. There are more guidelines and treatments to consider, and more drugs, scans, and tests for a doctor to review during patient time.

Paradoxically, technology may also provide part of the solution.

"The goal with development of new technology is to relieve clinicians of the burden of the mechanics of medical care so we can spend more time in direct interaction with the patient," said Dr. Warren Sandberg, a leader of the Operating Room of the Future project at Mass. General and a staff anesthesiologist.

Having one-touch access to records and equipment via monitors allows surgeons to get information and change machine settings rather than asking a nurse to do it, for example; the nurses can continue to concentrate on the patient.

And having cables and wires threaded through high-tech booms in the OR rather than winding over the floor and under carts, as in most operating rooms, means fewer tripping hazards for the medical staff and better access to the patient. This helps decrease doctor and nurse stress, ultimately improving patient care, several doctors said.

The next leap forward, said Sandberg, is getting better at connecting all of these technologies to each other. "We're on the cusp of being able to realize the potential of what we can do," he said.

Healthcare, he explained, is at the point where computers were before technological advances allowed them to talk to other devices, such as MP3s and cellphones. Consumer electronics took off into new directions for the masses once software and hardware for plug-and-play devices was standardized. Medical devices, however, for the most part still couldn't talk easily with one another, he said.

This is not trivial. Patients are surrounded by more technology, which has the potential to distract the physician from the patient. Sandberg said he read an article about an incident -- not at Mass. General -- when an X-ray was needed that required the anesthesiologist to momentarily stop the patient's breathing. The X-ray plate got stuck, and concentrating on freeing the plate, the anesthesiologist forgot to switch back on the ventilator. When he realized his error, it was too late: The oxygen had been off for too long, and the patient died.

With a system more akin to plugging an iPod into a computer, the X-ray machine could have signaled when it was ready, the ventilator would have been shut off, the picture taken and the ventilator automatically switched back on. In this scenario, if no picture was taken (as the doctors struggled with the X-ray plate), the ventilator would have remained on.

While researchers are studying how to improve the use of technology, others, including architects, are putting changes in place.

At Boston Medical Center's new facilities, the ceiling the patient sees when being wheeled into the OR has been carefully configured so the lighting is indirect rather than blinding, and the vents are shifted to the sides to create a sense of order, said architect Richard Kobus. Once inside the operating room, the steady flow of sterile air coming over the patient has been reengineered to remove some of the "hiss" that patients find disturbing, said Kobus, a senior principal in the Cambridge architecture firm Tsoi/Kobus & Associates.