Dr. Kenneth W. Goodman Explores Issues of Ethics, Medicine and IT in New Book
Big data and electronic health records are transforming the practice of medicine and advancing public health in ways that could not have been imagined just a few years ago. Along with these advances come a number of complex issues, obstacles and ethics questions that Kenneth W. Goodman, Ph.D., director of the University of Miami Miller School of Medicine’s Institute for Bioethics and Health Policy and co-director of UM Ethics Programs, considers in his new book Ethics, Medicine, and Information Technology: Intelligent Machines and the Transformation of Health Care.
It is impossible to overstate the impact of health information technology on all of us, Goodman says early in the book: “More than genetics and stem cells, more than left-ventricular-assist devices and extra-corporeal membrane oxygenation, more than organ transplants and gamma knives and nanomedicine and ovarian hyperstimulation — more than any technology of the sort that tends to raise or contribute to interesting and difficult ethical issues — it is the use of computers and communication technologies that will affect the lives of people in the 21st century.
“In the other direction, more human lives will be touched by health information technology than any other technology, ever.”
That technology is far from perfect, and there is not universal agreement on how we should use the information we are gathering on our patients. But Goodman points out that the benefits to quality of care and to public health advances — creating what are called “learning health care systems” — are enormous.
“Every patient we interact with generates data. Every time we don’t add that to a database and analyze it we are missing crucial information that will reduce medical uncertainty,” Goodman said. But “at what point has the standard of care shifted so that you’re providing substandard care if you don’t use the technology? We’re in a middle phase — we’re still getting used to it.”
The new expert systems are an advanced form of decision support for physicians, providing diagnoses and prognoses, and raising questions about proposed treatments. This elicits an overarching question that Goodman addresses in the book: What do the expanding tools mean for the future of medicine?
“If a computer can gather all this data about a patient and make a diagnosis and recommend a treatment plan and give a prognosis, for all of which there’s evidence that it’s going to be more accurate than any human expert, what does the practice of medicine consist of?” Goodman asked. “The conclusion I reach in the book is for a long while at least the professions of medicine and nursing will remain inherently human. The practice of medicine was never simply about making inferences, it’s about interacting with a patient, about getting to know your patient.
“That doctor/patient relationship still matters. We need to take care of people as humans and not like entities to be computationally analyzed,” Goodman added. The question becomes “how much of the tool to use and how much to rely on, and those are moving targets.”
Patient privacy issues are a concern with the spread of electronic health records, but Goodman emphasizes that the public health benefits make widespread use of de-identified patient data critically important.
“I argue that we have all individually benefited from the use of our neighbors’ information,” he said. “Every year we know the incidence and prevalence of influenza, we know the cancer rate in our community, we know how to reduce accidents — because people are analyzing data. I have benefited because other people have used my data. They’ve done it without my permission, but that’s OK because it didn’t have my name or my Social Security number next to it. I argue that we all have a duty to share our data as long as they’re used appropriately.
“We should use as much data as we can to improve the health of populations, and to help realize the goal of a learning health care system.”
To achieve that end, we need to make sure patients trust our systems, Goodman said. “It’s irresponsible not to use health information for population-based health. You need to make sure that patients’ data are de-identified so that the people you’re taking care of trust you. At the end of the day the most important concept is probably trust.
“Has the system earned your trust? We need to ensure that our patients trust our systems; otherwise, they’ll be reluctant to provide the kind of tacit consent that I think most people are willing to give.”
And we need to continue to teach our medical students empathy. “The human brain is still critical to patient treatment,” Goodman said. “We teach our students that this practice is inherently human, therefore any tool is just a tool — it’s not a replacement.”
Goodman is speaking about his book at Books & Books, 265 Aragon Ave. in Coral Gables, at 8 p.m. Wednesday, Dec. 7. The event is presented in collaboration with the University of Miami Center for the Humanities: http://humanities.miami.edu/humanities/publicprograms/booktalks/.