Our Malady: Lessons in Liberty from a Hospital Diary

by Timothy Snyder

As computer programs determine how many patients can be profitably squeezed into a day, doctors become tools. Then the actual machines march triumphantly into the wards. Nurses are now separated from patients by computers on wheels that roll everywhere with them: their bossy robot taskmasters. When you first see a nurse, she or he will likely have eyes on the screen rather than on you. This has dreadful consequences for your treatment, since you become a checklist rather than a person. If you are having a problem unrelated to what is on the screen, some nurses will have a hard time gathering themselves and paying attention. For example, after my first liver procedure my liver drain was improperly attached. This was a serious problem that was easily reparable. Yet although I tried for four days to draw attention to it, I could not get through. It was not on the lists. And so I had a second liver procedure. When I read my own medical record, I was struck by how often doctors wrote what was convenient rather than what was true. It’s hard to blame them: they are locked in a terrible record-keeping system that sucks away their time and our money. When doctors enter their records, their hands are guided by the possible entries in the digital system, which are arranged to maximize revenue. The electronic medical record offers none of the research benefits that we might expect from its name; it is electronic in the same sense that a credit card reader or an ATM is electronic. It i...