Too much technology?(Guest Editorial)

We depend on technology, and our patients and their families expect the best care through the use of technology. If a physician chooses a more conservative route, he or she may convey an aura of obsolescence, inadequacy, or even inferiority.

Technology, however, may not have created the best health care system. In fact, the use and misuse of technology has played a role in many adverse effects.

Technology can create a cascade effect--a chain of events initiated by an unnecessary test, an unexpected result, or patient or physician anxiety. Next comes an ill-advised test or treatment that may result in avoidable adverse effects, morbidity, or mortality.

Consider electronic fetal monitoring, for example. For the monitoring technology to be used, the mother must be in active labor. The use of fetal monitoring increases anxiety, though, which slows labor. Interventions are then taken to speed up labor, which can secondarily affect the infant and mother and lead to an unplanned cesarean section.

The use of diagnostic testing panels can pose problems as well. From a purely statistical standpoint, the probability that at least one test will be outside the accepted normal range increases as the number of tests increases. If one test is done, there's a 5% chance that it will be labeled abnormal. If 20 tests are done, there's a 64% chance that one test will yield an abnormal result.

We can avoid the cascade effect by using the history and physical as the basis of our medical evaluation to guide our laboratory testing and avoid unnecessary procedures.

Overreliance on technology may present an illusion of good medicine. Doctors may think that they are practicing good medicine simply because they are ordering all possible tests. Overreliance on technology may lead to a delay in treatment when technology is not available. Technology can't elicit a patient's psychosocial history.