Healthcare in the Media Age

When the people of prehistoric cultures got sick, they called on the traditional skills of the tribe's shaman, who applied a combination of magic, closely guarded herbal secrets and psychology to cure the sufferer.

If the patient died, the witch doctor was likely to blame the gods, who were obviously punishing the patient for sins committed or taboos violated.

Modern patients, on the other hand, are apt to be hooked up to the latest computerized medical device, which uses its own magic to picture and photograph their inner workings, monitor their vital signs and serve as a guide to treatment or surgery. The modern doctor's "magic" lies in the ability to interpret and utilize the information, and in the confidence the use of the most up-to-date equipment gives the patient.

When today's patient fails to recover, the doctor is often able to say that it's still his or her own fault — because the sufferer didn't keep in shape — the modern taboo.

This parallel is intended to point out that not as much has changed as we sometimes would like to think. All the same, a massive shift has occurred in medical treatment and health practices since the turn of the century, and the changes of the last few years have been even more radical.

The practice of medicine was first mechanized and then computerized. At the same time a media-supported non-medical health industry focusing on diet, exercise and attitude has sprung up. Citizens in developed countries are assuming more responsibility for their day-to-day fitness and at the same time demanding unlimited access to increasingly expensive and sophisticated medical technology.

Greater public interest in medicine and health is advantageous in one sense. Nevertheless, the rising expectations of an aging population may create a philosophical as well as a financial crisis for the medical profession as the century advances. Health-related services cost $247 billion in 1980, already an increase of over 500% from 1965. Insurance companies and government programs such as Medicaid picked up much of the slack, but they may be near their limits.

As medical care's share of the economic pie grows, ethical issues become increasingly complex and demanding. For example: is it fair to treat the uninsured poor in crowded public hospitals with fewer services and less individualized treatment? How far should extraordinary — and extraordinarily expensive — efforts to prolong the lives of the terminally ill be carried? And who should pay — the patient, the patient's family or society?

These are not new questions; only the degree of difficulty in answering them has increased with our options.

Visual Emphasis

But some of the issues are new. With the new emphasis on advanced technical equipment, the relationship of the doctor to the patient has already altered. Medicine was once a listening skill, with the physician gathering, sifting and evaluating information in the context of a one-to-one relationship — hearing symptoms and skillfully using a trusty stethoscope.

Now the doctor turns instead to a CAT scan, computer printout or monitor to review the visual data. Increased accuracy of diagnosis and ability to fine tune treatments are often unquestioned. But there are increasing complaints that the humanity of the two-way relationship sometimes gets lost in the process.

What will happen to the doctor-patient relationship when diagnosis is done mainly by computer, as is frequently predicted? A physician, after all, is a human being, the sum total of his or her culture, personal history and life experience, just like a patient. The computer's ability to process and review data is unmatched, but it doesn't have human memories and fears to bring to the diagnostic encounter.

Leaving Star Wars-type fantasies Of humanistic robots aside, as a thing itself, a computer is only capable of treating the patient as another thing, unless some human is assigned an interventionary role.

The focus on medicine as technology also obscures the fact that sickness and health are not isolated, but are strands in a complex web of societal issues. The effects of pollution, drug abuse, stress, poverty and affluence are receiving increasing media attention. But this examination is often issue-isolated and seldom directed toward an overall system of wellness planning and preventive medicine.

Self-Help Explosion

To some extent this conceptual gap is filled by numerous practitioners of holistic medicine, self-treatment and popular education in everything from calisthenics to natural childbirth. Health advisors have become media stars and books about health and physical development have become runaway successes.

The communications revolution may be expected to increase this trend as cable television and video resources provide more programming options. With the increasing use of interactive systems, as well, may come individualized health education, the long-distance questioning of experts, and self-administration of comprehensive medical records, just to mention a few prospective uses for the technology.

These scenarios are outgrowths of affluence, however. Much of the world's population does not have access to modern medical care and still suffers from unnecessary infant mortality, poor preventive medicine, malnutrition and inadequate health education. Poor countries often can't even support doctors in rural or isolated areas, let alone provide modern hospitals for all their Citizens.

Governments of developing countries have attacked this problem and leapfrogged into the twentieth century by creatively using modern media technology.

Satellites, for example, provide links for need-targeted medical care and emergency services. Paramedics on far-flung islands get step by step instructions from specialists at university hospitals half a world away.

Radio and television are used to broadcast programs on the safe use of water, nutrition, disease warning signs and prenatal care.

The most successful ones are targeted to the cultural background and educational levels of the populations they are designed to reach, and beamed to them with local news and music.

A Health Revolution

Ultimate success, of course, depends on focus and repetition, and must fight Contradictory images and messages that prevail even in the most simple of societies. A mother learning about breast feeding techniques on the government channel, for example, may not realize that the infant formula advertised on the commercial stations is not intended to be used with the polluted water in her area.

In spite of these problems, however, such programs provide essential primary care and education in areas too isolated or impoverished for traditional capital-intensive health care systems.

In American society, at least, development tends to be piecemeal, with down the road implementation tied to today's inconsistent funding, and competing medical institutions fighting for the money to purchase the equipment that will help them attract the medical staff and patients they want. The competition can provide incentives for further development, but it doesn't always put scarce resources where they're needed.

In this sense, at least, health education needs to lead the health-care system instead of following it. A public educated enough to demand a comprehensive system of wellness-planning may also demand an investigation of the ways in which society's structure shortens life and creates the illnesses that the medical system "fixes."

If the media can help people make these connections, they will have a real effect on future health. Otherwise, all of us who are affected will have to make those connections ourselves.

The witch doctor and medicine woman's magic worked because they understood how to make full use of the resources available to them. But even more important, they had an instinctive understanding of the ways in which the social connections and psychology of their societies could be expected to help them out.

As we work our modern magic we need to stay close to our own instinctive sense of connectedness. The society that can design the interwoven web of the freeway artery and the microchip should be able to remember the impact of these connections. Maybe the computer's sense of graphics can help us reach for healing and wholeness as the true meaning of the visual patterns.