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High-tech health

How digital medicine is improving patient care

By Tracie White

Illustration by Bryan Christie

Photography by Timothy Archibald

As digital technology has become more portable, easy to use and affordable, it has begun to capture the minds of medical researchers. From new imaging tools to mobile devices, Stanford researchers are exploring how to use technologically advanced tools to fill gaps in patient care. And it’s begun to make a difference.

The following four stories show ways researchers at Stanford are exploring the use of new technologies to solve old problems. An emergency room physician uses tablet computers to train community health care workers in underserved rural areas of Haiti and India. Radiologists transform holograms to assist in breast tumor removal. Heart doctors are dovetailing on society’s obsession with smartphones to try “pinging” people off the couch and onto their feet. And researchers are using Google Glass to provide at-home therapy for children with autism.

“There is a revolution in health care that is in large parts driven by technology,” said Michael Halaas , associate dean for industry relations and digital health. “There are a lot of great ideas emerging about how to transform health care that are digitally driven, but they need to be validated and thoughtfully introduced. We remain focused on developing digital health tools that can improve health while keeping the human element that is vital to care delivery.”

E-curriculum

Years ago,  Ayesha Khan ’s grandfather was hit by a semitruck as he rode a bicycle along a road in rural Pakistan. With no emergency response system in place — no 911, no ambulance service — he lay severely injured by the side of the road until someone eventually drove by and delivered him to the hospital. After 30 more minutes, he died in the waiting room without receiving care.

Now Khan, MD, a  Stanford emergency medicine  physician, uses digital devices to address these kinds of voids in care in the developing world. Working first in Haiti and now in rural India, Khan and her team have developed an app-based curriculum to train community members in basic health care delivery — from half a world away at Stanford.

“My grandfather, he died in this sort of unceremonious way,” said Khan, Stanford Medicine clinical assistant professor of emergency medicine, who immigrated to the United States from Pakistan when she was 3. “Where my family comes from has somewhat inspired me. I’m passionate about health equity.”

By studying animated, spoken lesson plans accessed on digital tablets, completing a work book and passing the tests provided on the tablet, health care workers with limited education have been successfully trained in first-line treatment for acute complaints. These providers are now controlling bleeding, and stabilizing airway obstructions and seizures.

They diagnose and treat urinary tract infections, sexually transmitted diseases, broken limbs, skin infections, fever, upper respiratory infections, diarrhea and high blood pressure. They care for severe wounds. And they triage patients toward more intense levels of care when necessary.

“My desire was that the program we created not rely heavily on people flying back and forth; that’s just not sustainable,” Khan said. “We developed an e-curriculum so that the program was not dependent on live trainers.”

Currently, five health care workers ages 19 to 21 who grew up as orphans are providing first-line care for patients within their community of 28,000 in Haiti. In rural India, 54 women from the states of Uttar Pradesh and Bihar provide care to patients in the 54 villages where they live and now work. Four local facilitators in India used the app to train the women, who are considered past childbearing age and are seen as a burden in their communities.

“This project has a twofold advantage,” Khan said. “It provides health care to communities without it, and it employs people marginalized within their own communities.” The workers are paid through the community where they work, and a Stanford grant helped fund their training. “Now that we see the program working, I’m so eager for the chance to grow,” said Khan, adding that she’s exploring opportunities to expand into Kenya. “There is so much scope for it to help around the world.”

Reading minds

Nine-year-old Alex, who has a high-functioning form of autism, has always had difficulty making eye contact and understanding social cues, traits that are typical of someone with his disorder. Making friends has been a challenge, particularly on the playground.

“In preschool, he was hit with a mallet and kicked in the face by children. They were upset with him, and he couldn’t see it coming,” said his mother, Donji Cullenbine. “Children were very scary for him.”

About a year and a half ago, Stanford researchers hooked Alex up with a Google Glass visual headset, which he thought was really cool. It helped teach him how to read other people’s emotions through their facial expressions.

The new form of behavioral therapy uses a Stanford-designed app paired with Google Glass to help children distinguish between eight classical facial expressions indicating happiness, sadness, anger, disgust, surprise, fear, contempt or neutral. The wearable computer links to the smartphone app through the local wireless network. The device has a glasses-like frame with a camera to record the view of the person wearing it, a small screen and a speaker for verbal cues.

“Within a couple of weeks, he started to flick glances at me. I had tried for years to get him to engage with my face, but he never stayed for more than a second.”

Researchers designed three different formats to help engage kids. The first is “free play,” which gives auditory clues about the emotions of others. The other two are games — “Guess My Emotion,” in which parents act out emotions for the child to guess what they are, and “Capture the Smile,” in which the child tries to elicit a certain emotion from the parent or other caregiver. Alex particularly liked the “Guess My Emotion” game and free play. The app seemed to his mother to make a difference.

“Within a couple of weeks, he started to flick glances at me,” said Cullenbine, who agreed to have Alex participate in a clinical trial in 2017 to test the new home-based therapy. “I had tried for years to get him to engage with my face, but he never stayed for more than a second.”

The clinical trial included 14 families, each with a child who had been clinically diagnosed with autism. The children used the Google Glass setup over a 10-week period, according to the study, which was published in Digital Medicine in August.

One-on-one treatment with a trained therapist has been shown to be effective in treating autism, but a shortage of therapists means many children aren’t being treated early enough, said Dennis Wall , PhD, the study’s senior author and Stanford Medicine associate professor of pediatrics and of biomedical data science.

A window of opportunity is being missed, and that’s where Wall hopes this new digital health-based therapy can step in.

“The only way to break through the problem is to create reliable, home-based treatment systems,” he said. “It’s a really important unmet need.”

Results from early clinical trials have been overwhelmingly positive, Wall said.

“We’re seeing improved eye contact, emotional awareness, an ability to understand and appreciate emotions,” he said. And comments from parents have reflected this early success. “Parents said things like, ‘A switch has been flipped; my child is looking at me.’ Or, ‘Suddenly the teacher is telling me that my child is engaging in the classroom.’”

By the trial’s end, Alex recognized emotions so well in others that one day at home he exclaimed: “Mommy, I can read minds!”

“I thought, ‘He got it!’” his mother said. “He understands there is information on people’s faces that he can interpret.”

Couch potatoes

Doctors know exercise helps prevent heart disease, but trying to motivate people to get off the couch is no easy task. MyHeart Counts, an iPhone app developed by Stanford researchers, not only collects massive amounts of research data from smartphone users to study cardiovascular health, it also pings them when it’s time to stand up.

“We are giving them customized prompts to encourage them to exercise,” said Anna Shcherbina , a graduate student in biomedical informatics on the MyHeart Counts team. “We’re trying to determine which prompts work the best to encourage exercise.”

If a user sits for more than an hour, for example, the Stanford MyHeart Counts app sends a reminder to get up even if just for a moment. Users who set daily goals of 10,000 steps will get a friendly prompt on the days they fall short, such as, “You are at 115 steps now, and you need 9,885 more to reach your goal. Walking to your next appointment will help you reach your step goal.”

The app also presents users with graphs that show how they compare with other users in terms of daily step counts, how happy they are, how much they sleep and even how many vegetables they are eating.

“Consumer adoption of smartphones really has opened up this whole new world,” said Steve Hershman , PhD, a member of the MyHeart Counts team and director of  mHealth in cardiovascular medicine at Stanford Medicine. “It’s amazing the volume of information researchers can get from these apps. And they’re also just sort of fun to use. They help make research more human.”

The app, which now collects such data as daily activity levels, blood pressure, cholesterol and cardiovascular health from 50,000 users in the United States, Hong Kong and the United Kingdom, was designed in 2015. It was one of the inaugural mobile health apps launched on Apple’s ResearchKit platform.

“It’s amazing the volume of information researchers can get from these apps. And they’re also just sort of fun to use. They help make research more human.”

Researchers published their first study based on data collected from 49,000 MyHeart Counts app users in  JAMA Cardiology  in December 2016. The study found that use of apps for collecting large amounts of health care data could transform cardiovascular research. Results also showed that among groups of subjects with similar activity levels, those who were active throughout the day, rather than in a single, relatively short interval, reported better levels of cardiovascular health with lower rates of chest pain, heart attacks and atrial fibrillation. The next research study is expected to be ready for publication soon, Hershman said.

Today’s 2.0 version of the app also includes an added consent module that allows users who have a 23andMe account to securely share their genetic information with Stanford researchers. “At first it was just a way to collect data for medical research,” Hershman said. “Now we’re really hoping to change people’s health.”

Holograms in surgery

Looking to increase precision during the surgical removal of breast tumors, a Stanford research team developed a technique that brings holographic images into the operating room.

Surgeons refer to MRI images on computer displays to help guide their incisions, but there is still quite a bit of guesswork because tumors come in various three-dimensional shapes and sizes.

As a result, either too much tissue gets removed or too little, said Bruce Daniel , MD, professor of radiology and director of IMMERS , the incubator for medical mixed and extended reality at Stanford.

“The surgeon can’t always tell what’s what,” Daniel said. The team developed a mixed-reality system using Microsoft’s HoloLens headsets to reflect a three-dimensional image of a patient’s tumor, based on MRI scans, directly on the diseased breast. The surgeon looks through the headset, which includes a holographic computer, and aligns a floating holographic image of the tumor onto the surgical site. The goal is to use the tools to increase the precision of the removal of the entire tumor, leaving as much of the healthy breast tissue as intact as possible, said Brian Hargreaves , PhD, Stanford Medicine professor of radiology and of electrical engineering and co-director of IMMERS.

“It gives me X-ray vision,” said Amanda Wheeler , MD, clinical associate professor of surgery who is participating in a pilot clinical research study of 10 patients that uses the new system. Prior to surgery, Wheeler puts on the headset, then uses markers to sketch the reflection of the hologram onto the patient’s breast. “It helps me plan the surgical site, making sure I’m getting as much accuracy as possible. I love it.”

Among the 300,000 women who are diagnosed yearly with breast cancer, about half are eligible for radiation and a lumpectomy that removes the tumor and leaves the remainder of the breast intact, the American Cancer Society reported. But deciding whether to have a lumpectomy rather than a mastectomy — total breast removal — is often difficult. It’s further hampered by the fact that 20 percent of women who have lumpectomies require a second surgery because the surgeon didn’t remove all the cancerous tissue the first time.

“Because this new method helps surgeons determine exactly where to cut out the cancerous breast tumor, it should reduce the number of second surgeries,” Daniel said.

Tracie White

Tracie White is a science writer in the Office of Communications. Email her at [email protected] .

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Medical Technologies Past and Present: How History Helps to Understand the Digital Era

• Published: 07 July 2021
• Volume 43 , pages 343–364, ( 2022 )

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• Vanessa Rampton   ORCID: orcid.org/0000-0003-4445-8024 1 ,
• Maria Böhmer 2 &
• Anita Winkler 2  

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This article explores the relationship between medicine’s history and its digital present through the lens of the physician-patient relationship. Today the rhetoric surrounding the introduction of new technologies into medicine tends to emphasize that technologies are disturbing relationships, and that the doctor-patient bond reflects a more ‘human’ era of medicine that should be preserved. Using historical studies of pre-modern and modern Western European medicine, this article shows that patient-physician relationships have always been shaped by material cultures. We discuss three activities – recording, examining, and treating – in the light of their historical antecedents, and suggest that the notion of ‘human medicine’ is ever-changing: it consists of social attributions of skills to physicians that played out very differently over the course of history.

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Human beings have their own goals and intentions, and products should help them to realize them in an optimal way. In many cases, though, these goals and intentions do not exist independently from the technologies that are used. [Technologies] do much more than merely function – they help to shape human existence. Peter-Paul Verbeek (2015, 28)

Introduction

A wide range of novel digital technologies related to medicine and health seem poised to change medical practice and to challenge traditional notions of the patient-physician relationship (Boeldt et al. 2015; Loder 2017; Fagherazzi 2020). A number of recent pieces have explored the ethical implications of this, asking, for example, whether new means of delivering ‘greater efficiency, consistency and reliability might do so at the expense of meaningful human interaction in the care context’ (Topol Review 2019, 22). Various contributions from patients, physicians, bioethicists, and social scientists have warned that computer technologies somehow stand between the physician and the patient and that there is a fundamentally human aspect of medicine that coexists uneasily with machines (e.g. Gawande 2018; Verghese 2017). As a remedy, recent contributions call for ‘clinical empathy’ not only as a desirable characteristic trait of future physicians, but even as a selection criterion for medical students (Bartens 2019). The role history plays in these discussions is striking. Commentators often assume that current concerns about how technologies may lead to the ‘de-humanisation of care’ (Topol Review 2019, 22) are the unprecedented products of technological, social, and cultural transformations in the late twentieth-/early twenty-first centuries. When the history of medicine is referenced, it is largely in one of the following ways: first, to emphasize that today ‘[w]e are at a unique juncture […] with the convergence of genomics, biosensors, the electronic patient record[,] smartphone apps, [and AI]’ (Ibid., 6), whereby the singularity of the digital era makes historical comparisons with antique predecessors seemingly irrelevant. Second, the history of medicine is used in a nostalgic manner to refer to past medical practices, seemingly grounded in the ability of a doctor to ‘liste[n] well and sho[w] empathy,’ as having a fundamentally human element that is threatened by the digital era (Liu, Keane and Denniston 2018, 113; see also Johnston 2018). With some notable exceptions (e.g. Greene 2016, Kassell 2016, Timmermann and Anderson 2006), historians of medicine have largely refrained from attempting to interpret recent digital developments within their broader historical contexts. The historicity of digital medicine in its various forms and the insights of the history of medicine for contextualising the patient-physician relationship in the digital era have yet to be fully fleshed out.

In this contribution, we draw on historical examples and the work of historians of medicine to highlight how all technological devices are ‘expressions of medical change’ (Timmermann and Anderson 2006, 1), and to show how past analogue objects shaped physician-patient relationships in ways that remain relevant today. Our focus is on Western European medicine since the early modern period. While acknowledging the profound differences between medicines in particular historical times and places, we argue, first, that patients and doctors have always interacted in complex relationships mediated by objects. Medical objects and technologies are not only aids for performing certain human tasks, but themselves have a mediating function and impact how physicians and patients alike perceive illness and treatment. We then contend, second, that history helps inform current discussions because it highlights the plurality of ways in which the physician-patient relationship has been conceived in different eras. In particular, the ability of the physician to listen well and show empathy seems to be not so much a historical constant but rather a social attribution of certain skills to physicians that played out very differently over the course of history. Both points help us to show that some of the hopes and fears related to digital technologies are not so entirely new after all.

We work through these hypotheses in relation to three activities in the clinical encounter that have been significantly affected by digital medical technologies, namely i) recording (Electronic Health Records), ii) examining (Telemedicine), and iii) treating (Do-It-Yourself medical devices). In each case, we begin with a specific contemporary technology and the debates around it before showing how a historical perspective can contribute to our understanding of them. First, we discuss electronic health records in the light of current criticisms which maintain that this technology cuts valuable time the doctor should be spending with the patient, thereby threatening an assumed core responsibility of the physician, namely listening empathetically to the patient. History shows that physicians have not always seen administrative record-keeping as foreign to their main work with patients; rather, it has been a formative part of their professional identity at different times. Moreover, the value that both physicians and patients ascribed to empathic listening has varied substantially over time. Second, in the case of examining, we start from the observation that current debates about telemedicine focus on the greater distance between patients and physicians this technology brings about. The historical perspective demonstrates that these debates are but one example of how changing examination technologies affect both physical distance and reciprocal understanding in the patient-physician relationship. Our examples illuminate that physical proximity in the medical encounter is a modern phenomenon, and that it did not always imply a meeting of the minds between physician and patient and vice versa. Finally, our third section on self-treatment demonstrates that Do-It-Yourself devices have the potential to challenge medical authority and, by giving patients more power, alter those power balances between physician and patient that are constitutive of an idealised view of the patient-physician relationship. Yet here too there are significant historical precedents for thinking of doctors and patients as but two players within complex networks of people and technologies, in which patients ascribe value to a multiplicity of relationships.

Record-keeping: computers and the administered patient

Electronic health records (EHRs), that is computer-based patient records, have transformed the way contemporary medicine is practiced (see, for example, Topol, Steinhubl and Torkamani 2015, 353). While the electronic recording of patient files by individual health care providers has become common practice since the 1990s, a central virtual collection and storage of all health data relating to an individual patient is a rather new development which is currently being debated and technically introduced in various states. This virtual patient file is of secondary order because it is fed with original electronic files derived from various primary recording systems (GP, clinic etc.), and it follows a population health surveillance logic rather than the logic of the treatment of individual cases. The main idea is that both patients and health care providers have access to a corpus of health documents, which is as complete as possible, to make diagnosis and treatment more efficient, more precise and safer for patients, and less costly for the health system. While patients may make use of this possibility on a voluntary basis and are asked to distribute access rights to providers, healthcare providers are obliged to cooperate and feed the system with relevant data (for a local example see current implementation efforts in Switzerland and its pitfalls as described in Wüstholz and Stolle 2020). One of the main premises of supporters is that EHRs will facilitate not only networking and interprofessional cooperation but also enhance communication between doctors and patients: they ‘provide health care teams with a more complete picture of their patients’ health [and] improve communication among members of the care team, as well as between them and their patients’ (Canada Health Infoway; see also Porsdam, Savulescu and Sahakian 2016).

Yet critical discussions surrounding the introduction of EHRs doubt exactly that. They suggest that the increasing documentation, virtual storage and sharing of sensitive patient data threatens an assumed historical core value of the doctor-patient relationship, namely the possibility of physicians establishing an intimate and ‘deeper connection’ with their patients (Ratanawongsa et al. 2016, 127). From the perspective of healthcare providers, professionals criticise the time-consuming nature of EHRs, arguing that this technology supplants the time the doctor has for direct communication and time spent ‘in meaningful interactions with patients’ (Sinsky et al. 2016, 753). That screens are coming ‘in between doctors and patients’ is a widespread notion (Gawande 2018). In addition, medicine’s increasing dependence on screens is perceived as undermining important social rituals, such as exchanges between physicians and other healthcare colleagues who used to discuss their cases in more informal ways (Verghese 2017). Last but not least, EHRs are seen as a major factor contributing to declining physician health and professional satisfaction because of their time-consuming data entry that reduces face-to-face patient care (Friedberg et al. 2013). This last point seems to be crucial as the digital interfaces of EHRs indeed require a maximum of standardisation, homogenisation and formalisation of recording styles that necessarily conflicts with more informal, individual recording techniques. On the one hand, doctors are forced to fill in fields and checkboxes that do not correspond to their own knowledge priorities, that is the things they would want to highlight in a certain case from the perspective of their specialty. On the other hand, they have difficulties in identifying relevant information when too much data on an individual patient has been entered by too many people. The desired interprofessional collaboration thus runs the risk of complicating instead of facilitating the making of a diagnosis. Surgeon Atul Gawande maintains that in the past, analogue documentation forced physicians to bring essential points into focus: ‘[d]octors’ handwritten notes were brief and to the point. With computers, however, the shortcut is to paste in whole blocks of information […] rather than selecting the relevant details. The next doctor must hunt through several pages to find what really matters’ (2018). Together, these points of critique suggest not only a certain fear that the increasing digitisation of patient records might disturb relationships that in the pre-digital era were based on professional intuition and meaningful, trust-building face-to-face communication. The critique also suggests that what is threatened is the meaning and satisfaction a physician takes from his/her recording work.

From the perspective of patients, other concerns related to EHRs are more relevant, among them the safety of personal health data. But while notions of privacy – who has control over the data, who owns the patient history – are important for patients, a number of studies also show that patients perceive the careful digital documentation of their case as something positive (Assis-Hassid et al. 2015; Sobral, Rosenbaum and Figueiredo-Braga 2015). ‘Forced to choose between having the right technical answer and a more human interaction, [patients] picked having the right technical answer,’ reports Gawande (2018; see also Hammack-Aviran et al., 2020). It thus seems that as long as patients think EHRs are providing them with a higher quality of care, they readily accept EHRs and their doctors’ dependence on screens – hence adapting their expectations to technological change.

In order to scrutinize these purported threats and attitudes towards EHRs, the rich history of patient records provides a relevant historical backdrop. In studying patient records, historians have addressed exactly these issues: they have examined how the patient-physician relationship has changed over time and have used medical records to gain insights into how past physicians documented medical knowledge, how this influenced their perceptions of their professional identity, and their obligations vis-à-vis patients (Risse and Warner 1992). As a first step, it is important to see that even though EHRs pose new challenges because of their digital form, recording individual patients’ histories as part of medical practice and ‘thinking in cases’ as a form of epistemic reasoning are a historical continuum (Forrester 1996; Hess and Mendelsohn 2010). The patient history dates to ancient Hippocratic medicine when detailed medical records were written on clay tablets and handed down for centuries to preserve the esteemed knowledge of antiquity (Pomata 2010). Yet the content and form of medical records, as well as the practices producing them have changed remarkably over time (Behrens, Bischoff, and Zelle 2012). In Western Europe, physicians in sixteenth-century Italy re-appropriated the ancient practice and typically recorded their cases in paper notebooks, as part of a larger trend to systematize and record information (Kassell 2016; see also Pomata 2010). As Lauren Kassell notes, the records of early modern practitioners ‘took the form of diaries, registers or testimonials, often they were later ordered, through indexing or commonplacing, by patient, disease or cure, providing the basis for medical observations, sometimes printed as a testimony to a doctor’s expertise as well as his contribution to the advancement of science’ (2016, 122). The historical perspective reveals that the rationale for a particular type of medical record-keeping always developed in tandem with the technical capabilities for its enactment, changing ideas of how diseases should be recorded, as well as with the preferences of individual physicians (ibid. 120). Crucially, as the organization of these collections of patient histories changed, so too did medical knowing and normative ideas about the physician-patient relationship (Hess and Mendelsohn 2010; Dinges et al. 2016).

As shown above, current critical discussions about EHRs tend to evoke a medical past in which patients were given time to talk about their illness, doctors listened and engaged in meaningful interactions, and record-keeping did not interfere with these processes. Allegedly, there were few concerns over misuse of data as there was less data produced and fewer players in the game. How does this popular nostalgic view correspond to research findings in the history of medicine? To some extent, the context of ‘bedside medicine’ comes close to these ideas. This model of care remained dominant in Western Europe until the nineteenth-century. One of the main ways in which physicians generated medical knowledge at the bedside of patients was to conduct ‘verbal analysis of subjectively defined sensations and feelings’ by patients (Jewson 1976, 229-230), and these patient testimonials provided the details recounted in physicians’ notes (Fissell 1991, 92). This is partly because the early modern doctor-patient relationship was based on a ‘horizontal’ model of healing (Pomata 1998, 126-27, 135) and a legally binding ‘agreement for a cure’ (ibid., 25 passim), which gave considerable power to patients, placing them on ‘near-equal hermeneutic footing’ with doctors (Fissell 1991, 92). Physician and patron (patient) made a contract in which the mostly upper class-patient would only pay fees after ‘successful’ treatment; vice versa, doctors were not obliged to treat a patient but would rather take on patients whose potential cure, and ability to pay fees, could be foreseen. Patients’ verbal satisfaction and willingness to conduct word-of-mouth publicity for a practicing physician were key to his reputation at that time and influenced physicians’ relationships with their clients.

However, it is problematic to project today’s vision of a desirable empathic relation between doctors and patients back into the past. Although upper-class patients clearly had some power in their relationship with physicians, the dominance of patients’ speech in medical records as such should not be interpreted as proof that doctors cared about their patients in the modern sense of showing understanding. With respect to nineteenth-century bourgeois medicine, Roy Porter noted that flattery and attention in the medical encounter were calculated practices of physicians concerned to secure clients and that ‘solemn bedside palaver[,] a grave demeanour, an air of benign and unflappable authority’ were all part of the prized ‘art of never leaving without a favourable prognosis’ (1999, 672). In a similar vein, Iris Ritzmann has emphasized that eighteenth-century doctors were eager to adhere to a certain ‘savoir faire,’ that is rules of conduct that would allow them to obscure the fact that in many cases, their abilities to heal were very limited (1999). And in Paul Weindling’s assessment of German medical routines, physicians’ desires to satisfy the patient subjectively were even purely instrumental: ‘[s]ympathy with the feelings of the sick was an economic necessity owing to the competition between practitioners’ (1987, 409). In all these cases, the value ascribed to direct physician-patient dialogue was very different from today’s ideas about an empathic encounter between physicians and patients; an engaged bedside manner often had more to do with calculated support for an upper class and sometimes hypochondriac clientele.

Similarly, as concerns the careful documentation of a patient’s medical condition and history, historical evidence shows that doctors did not do it primarily for their patients’ needs but for purposes of professional standing. This was important at a time when physicians’ scientific authority still needed to be established. The fact that in many cases there were several physicians involved in the treatment of the same case made documentation and communication between physicians (and sometimes for the public) especially relevant – and especially conflictual. Eighteenth-century case histories reflecting the context of bedside medicine indeed suggest that doctors were sometimes eager to publish case histories of patients that would bespeak their ability to heal by highlighting the misfortune of their competitors in order to enhance their own reputation. This shows how misleading the popular nostalgic view of a past intimate and unbroken bond between physicians and patients is, and that analogue paper technology did not necessarily strengthen this bond but could also be used in ways that were not beneficial for patients. Unlike today, this was an era in which practices of record-keeping mirror multiple, local and highly individual ways of documentation; the formalisation and standardisation of patient files which 19 th -century hospital medicine would trigger was yet to come.

As hospitals and laboratories became important institutions for medicine in the century roughly between 1770 and 1870, they also changed the practices of record-keeping, as the customary interrogation of patients’ accounts of the course of their disease did not coincide with changing understandings of disease, scientific interests and cultural expectations (see Granshaw 1992). For instance, French anatomist and pathologist Xavier Bichat (1771-1802) dismissed note-keeping based on patients’ narratives as an obsolete method for knowledge-making. He observed in his Anatomie générale (1801), ‘you will have taken notes for twenty years from morning to night at the bedside of the sick [and] it will all seem to you but confusion stemming from symptoms that fail to coalesce, and therefore provide a sequence of incoherent phenomena’ (1801, xcix, our translation). The kind of medicine favoured by Bichat and like-minded physicians focused on gaining anatomical and physiological insights directly from the body, using both physical examination and remote techniques in the laboratory. One way in which record-keeping changed to accommodate these interests was in the use of a more technical language to describe the experiences and expressions of patients. Mary Fissell argues that with the rise of hospital medicine, ‘doctors begin to sound like doctors, and patients’ voices disappear’ because doctors interpret patients’ words and replace them with medical equivalents (1991, 99). More generally, historians have shown that during the nineteenth century, medical culture changed in a way that gradually diminished the importance of patient narratives in medical writing (Nolte 2009).

How did these changes in recording practices play out for patients in the medical encounter ? From the historical perspective, the fact that physicians adopted a more technical language in their interactions and records should not be taken as evidence for a loss of human interaction or as something that patients necessarily disliked. On the contrary, the more systematised and formalised type of record-keeping was considered state of the art and was in accordance with a rapidly growing belief in the natural sciences among both patients and the general public (Huerkamp 1989, 64). This is related to the emergence of a specific concept of scientific reasoning that, in turn, fostered a sense of ‘scientific objectivity’ that called for dispassionate observation and accurate recording (Daston and Gallison 2010; Kennedy 2017). By the end of the nineteenth century, academic physicians had managed to create such professional authority that the ‘horizontal model of healing,’ in which the physician courted his upper-class clients, was replaced by a vertical model, in which the patient subjected himself to the authority of the physician. A Berlin doctor advised his fellow colleagues in 1896 that they should communicate their medical prescriptions to patients in a way that ‘prevents any misunderstandings and so that no further question can be addressed to him’ (cited in Huerkamp 1989, 66, our translation). For patients, this growing scientific authority and paternalism meant very different things, depending on class and social status. While medical services became accessible to more people, in particular thanks to the introduction of obligatory health insurance for workers, lower classes often experienced medicine as an instrument of power rather than benevolence (Huerkamp 1989). But even for the well-to-do, who undoubtedly benefitted from newly developed medical techniques, in particular in the realm of surgery, the acceptance of medical paternalism, male rhetoric and heroic cures came with high costs. This is suggested, for instance, in a famous letter by the court lady and writer Frances (Fanny) Burney who underwent a mastectomy in 1811, a rare document offering a patient’s perspective on these matters (Epstein, 1986).

From the perspective of doctors at the turn of the nineteenth century, record-keeping was associated not only with professional obligations but also with personal fulfilment. In many European countries, physicians were asked to provide expert opinion for juridical and administrative regulations as the state was increasingly interested in tracking its population’s health (Ruckstuhl and Ryter 2017; Schmiedebach 2018). In her study of Swiss physician Caesar Adolf Bloesch’s private practice (1804-1863), Lina Gafner shows the extent to which he perceived medical practice documentation as constitutive of his professional role and self-understanding as a medical expert. Bloesch’s patient journal ‘constitutes one single gigantic research report’ (2016, 265) because it was key for allowing him to generalize from the experiences gained in his practice in order to produce knowledge to contribute to contemporary scientific discussions. Gafner notes that the ‘format he gave his journals [leads] us to assume that scientific or public health-related ambitions were part of Bloesch’s professional self-image’ (263). In contrast to this historical example, where patient care and journal keeping were combined in the light of professional ambition, it stands out that healthcare providers of today tend to see their administrative work as opposed to patient care, even as separate and conflicting tasks; it is assumed that for physicians ‘seeing patients doesn't feel like work in the way that data entry feels like work’ (Amenta 2017). This is probably related to the fact that many physicians experience the requirement of working with a given software as a limiting restraint, which they are not really able to control, while they experience working with patients as something they have learned to master. As Gawande admits: ‘a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me’ (2018). It thus seems that it is primarily the question of ownership that distinguishes past recording styles from today’s recording systems: it is difficult to individually appropriate something which is designed to harmonize if not eliminate individual recording styles.

Yet even as Bloesch and contemporaries embraced the administrative tasks associated with medical note-taking as an opportunity to become a medical expert, other nineteenth-century physicians had different views of its value. But their criticisms of record-keeping were not motivated by the inherent value they saw in interactions with patients. Rather, their critiques were linked to a notable shift during the nineteenth century as scientific interest, triggered by administrative requirements as well as different disease conceptions and methods (e.g. in epidemiology research), changed its focus from the individual case study to population studies (see Hess and Mendelsohn 2010). In Nikolas Rose’s words, ‘the regularity and predictability of illness, accidents and other misfortunes within a population’ became ‘central vectors in the administration of the biopolitical agendas of the emerging nation states’ (2001, 7). Bound up with a new emphasis on tabulation, as well as ‘precision and reliability,’ various German-speaking hospitals instigated a new tabular format designed to enable physicians to compile their observations of patients into ward journals organized into columns and, eventually, generate an annual account of the course of disease (Hess and Mendelsohn 2010, 294). Yet in response some physicians rejected what they saw as excessively confining recording requirements. Volker Hess and J. Andrew Mendelsohn describe how the chief physician at a Berlin clinic ranted about the ‘inadequacy of our [tabular] journals’ and their inability to produce medical knowledge (295). While Mendelsohn and Hess themselves remark that such tabular ward journals were very ‘far from the patient history as observation, as prose narrative’ (293), the physicians’ rejection of the use of columns to record cases was not motivated by a concern to recover patients’ own narrations of their ailments or the feeling that record-keeping prevented them from properly attending to their patients’ needs. On the contrary, these physicians were concerned with producing an annual disease history and were frustrated that ‘the ultimately administrative format’s own rigid divisions blocked the writing of a synoptic history’ (296). Rather than recovering a face-to-face encounter with patients, they were interested in finding a recording format that would allow them to present a more compelling and sophisticated general description of disease, relying on mass information.

The current consensus among historians of medicine is that we should neither conceive medical records as ‘unmediated records of experiences of illness and healing’ (Kassell 2016, 126) nor as disentangled from the medical encounter itself. Rather, ‘processes of record-keeping were integral to medical consultations’ because ‘as ritualised displays and embodied knowledge, case books shaped the medical encounters that they recorded’ (122; see also Warner 1999). In relation to how ‘computerization’ is shaping contemporary medical encounters, three main points are of note. First, physicians have not always seen time spent writing and recording patient histories as in competition with interacting with patients themselves. At various times in history, the careful documentation of individual cases was perceived as a fundamental resource for generating medical knowledge and time spent doing so as part of the self-identity of physicians. Against the repudiation of digital record-keeping by today’s physicians, historical evidence shows that to the extent that physicians saw record-keeping as coinciding with their overall knowledge objectives, they accepted and even embraced it. This is linked to a second point, namely that prolonged time spent listening to the patient talk was not historically seen as evidence of good medical practice. For example, in an era when listening at length to patients was associated with the obsequious physician catering to the ego of the upper-class patient, the sober inscription in a nineteenth-century casebook noted that ‘too much talking showed that little was wrong’ with the patient (Weindling 1987, 395). Finally, patients too accepted administrative work by doctors as a sign of expertise and not necessarily as something that reduced the doctor’s attention to them. While the power balance changed in favour of doctors and ascribed less epistemic value to patients’ words, this was not necessarily negatively received by patients. History therefore shows that we should not view technological changes as isolated from the broader medical culture surrounding them but rather as shaping and co-constructing this culture. Today’s fear that the introduction of EHRs might change the communication and relation between physicians and patients for the worse tends to blame technology for a broader cultural and medical change of which it is just one tiny aspect, that is the growing belief in data and the logic of gaining stratified knowledge to provide relevant information about any one patients’ condition. Given that patients’ expectations exist in a dynamic relationship with how physicians learn, make decisions and interact with them, EHRs are themselves bound up with creating new conditions for the physician-patient relationship.

Examining: telemedicine and the distant patient

A further way in which digitalization has influenced the medical encounter is that it has emerged as the new virtual consulting room, thereby radically transforming the settings and procedures of physical examination. Although most people still go to ‘see the doctor,’ medical encounters today no longer have to take place in physical spaces but can occur via telephone or internet – what is broadly referred to as telemedicine, literally healing at a distance (from the Greek ‘tele’ and Latin ‘medicus’) (Strehle and Shabde 2006, 956). According to the World Health Organization, as a global phenomenon, telemedicine is more widespread than EHRs with more than half of responding member states having a telehealth component in their national health policy (WHO 2016). In the context of the COVID-19 pandemic, telemedicine has been overwhelmingly seen as ‘[a]n opportunity in a crisis’ and has further gained in popularity (Greenhalgh et al., 2020; see also Chauhan et al., 2020). A senior NHS official cited by The Economist called the widespread adoption of remote care (viz. telemedicine) a ‘move away from the dominant mode of medicine for the last 5,000 years’ (2020, 55). In the virtual examination room, patients can ask a physician for a diagnosis, a prescription and a treatment plan and send information about diseased body parts via digital media. When inquiring about the health conditions of their patients from a virtual consultation room, physicians sometimes need to ask their patients for certain practices of self-examination and self-treatment (Mathar 2010, section III). Advocates of telemedicine emphasize that there is no risk of mutual infection, advantages of cost savings, convenience, and better accessibility to medical care generally and for people living in rural and remote areas in particular. In Switzerland, for instance, the Medgate Tele Clinic promises to ‘bring the doctor to you, wherever needed’ (2019) while the U.S. Doctor on Demand characterizes itself as ‘[a] doctor who is always with you’ (2019). Patients, meanwhile, appreciate the greater availability of physicians, less travel time and better overall experience (Abrams and Korba 2018). However, telemedicine also raises various critical questions about the effects of physical distance on the physician-patient relationship. In particular, can the quality of the examination and diagnosis be high enough if a physician only sees his/her patient via screen but cannot smell, palpate and auscultate him/her? Furthermore, how can a trusting doctor-patient relationship be established virtually and at a distance? (see Mathar 2010, 13). While some of these critiques are based on the assumption that a fitting medical encounter between physician and patient should be a ‘good, old-fashioned, technology-free, dialogue between physician and patient’ (Sanders 2003, 2), we show below that all encounters inevitably ‘pass through a cultural sieve’ (Mitchell and Georges 2000, 387). Not only has the perceived need for the physical proximity of physician and patient varied substantially over history, but historical physicians and patients have not seen physical distance as preventing them from achieving emotional understanding. Whether physical examinations took place in-person or remotely, at each point in history doctors relied on their knowledge and its applications, that is a cultural lens through which s/he gazes on, over or into the human body. Regardless if examined remotely or closely, changes in examination procedures always challenge the established sense of the emotional bond between patient and physician, which therefore needs to be defined anew.

The standard physical examination as we know it today was considered less important in Europe up to roughly 1800 because of the conventions governing the relationship between physician and patient/patron, and also because of the conventions governing the relationship between male doctor and female patients. Many physicians considered physical examination morally inappropriate and saw it as dispensable for making a diagnosis. Physicians of upper-class patients generally considered their task more to advise than to examine and treat (Ritzmann 1999, 203). From his close analysis of a casebook by a seventeenth-century English physician, Stanley Joel Reiser concludes that the ‘maintenance of human dignity and physical privacy placed limits on human interaction through touch’ (1978, 4). Given the desirability of maintaining physical distance, physicians relied on and developed other sources of knowledge than their own sense of touch. The physical examination was ‘the method least used’ by the seventeenth-century physician who rather favoured ‘the patient’s narrative and [his] own visual [outward] observations’ of the patient’s body. In her study of a manuscript authored by a surgeon-apothecary of the same historical period, Fissell singles out blood-letting as one ‘of the few occasions on which a professional […] might routinely touch a patient’ and notes that it was necessarily ‘transformed into a careful ritual, one which attempted to compensate for the transgressive nature of the encounter. The blood-letter's courteous attention to returning the patient to his or her un-touched status underlines the mixture of courtesy and technique which made good medical practice’ (1993, 23). In ways now unfamiliar to us, manners and morals interacted to make physical examination and touching patients an ancillary part of the desirable patient-doctor encounter at that time.

Regular in-person physical examination as a routine practice and diagnostic technology is a rather recent development that came along with a new anatomical understanding of disease during the course of the nineteenth century, namely that diseases can be traced to individual body parts such as organs, tissues and cells, rather than unbalanced bodily humours (Reiser 1978, 29). It was at this time that the doctor’s examination skills no longer depended on the patient’s word and the surface of the (possibly distant) body, but started relying on what the doctor could glean from the patient’s organic interior (Kennedy 2017). In order to ‘get’ to the physical conditions of the body’s interior, a number of instruments were developed to facilitate the new credo of examination. The most famous example of such a nineteenth-century examination technology is the stethoscope, invented by French physician René Laennec (1781-1826). ‘By giving access to body noises – the sounds of breathing, the blood gurgling around the heart – the stethoscope changed approaches to internal disease,’ wrote Roy Porter, ‘the living body was no longer a closed book: pathology could now be done on the living’ (1999, 208). Crucially, technologies like the stethoscope brought the physician and patient into the examination room together but by providing physicians with privileged access to the seat of disease did not necessarily bring them closer in terms of understanding. Doctors now heard things that remained unheard to the patient, and this provoked a distancing in terms of illness perceptions. In Reiser’s account, the stethoscope ‘liberated doctors from patients and, by doing so, paradoxically enabled doctors to think they helped them better. […] Listening to the body seemed to get one further diagnostically than did listening to the patient’ (2009, 26).

The result is visible in the resistance surrounding some examination technologies that allowed physicians to delve into the body’s interior in order to gain new anatomical and pathological insights but that proved too transgressive for some existing physician-patient contacts. The vaginal speculum, introduced into examination procedures in Paris in the early-nineteenth century, may have fitted well with physicians’ new commitments to empiricism and observation. But at the time of the speculum’s introduction, female genital organs, in contrast to other organs, were regarded ‘as so mysterious and so sacred that no matter how serious the disease that afflicted them might be, it was no justification for an examination either by sight or touch’ (Murphy 1891, cited in Moscucci 1990, 110). Although the speculum was in line with pathological disease concepts and close, interior observation, moral considerations continued to undermine its suitability in the clinical context. At a meeting of the Royal Medical and Chirurgical Society, chronicled in the Lancet , commentators associated the speculum with both female and physician corruption, and the loss of moral virginity and innocence caused by its insertion into the body (Anon. 1850). In Margarete Sandelowski’s estimation, the vaginal speculum ‘required physicians not only to touch women’s genitals, but also to look at them, and thus imperiled the relationship male physicians wanted to establish with female patients’ (2000, 75). Here was a case in which technology challenged the socially accepted relationship between (male) physicians and (female) patients of a particular class because its application demanded increased physical closeness, and therefore was seen as undesirable and transgressive. As Claudia Huerkamp notes, it took a long time to establish a specific ‘medical culture’ in which the physical examination of female parts by a male physician was not perceived as breaking a taboo (1989, 67).

In other instances, the use of the speculum and the unprecedented access it provided to women’s anatomy mirrored existing power structures. The first uses of the speculum were justified in reference to and tested on the most vulnerable members of society. Deirdre Cooper Owens (2017) has demonstrated that in the U.S., racist arguments helped to defend the speculum’s application and experimentation on black, enslaved women as they were deemed to have a particularly ‘robust’ constitution, high tolerance of pain, and so on. Medical men such as James Marion Sims, who by his own account was the inventor of the speculum, combined his privileged access to enslaved women’s bodies with intrusive forms of examination in order to gain new knowledge crucial for the emerging field of gynaecology. This was also true for Irish immigrants in the U.S. (Owens 2017) and in the case of prostitutes in France and Germany, where the speculum was used as an instrument of the medical police (Moscucci 1990, 112). Prostitutes were screened using this new instrumentation as supposed carriers of venereal disease, whereas male clients did not need to undergo any screening. This highlights how intrusion into the body in the name of more accurate examination was frequently bound up with power and control, especially of marginalized groups.

Even as the seat of disease became increasingly associated with specific locations inside the body, this coexisted with the notion that medicine could still be conducted ‘at a distance.’ The example of the telephone demonstrates how tele-instruments worked alongside close examination devices that adhered to the principle of disease as located in particular interior body parts. In fact, the potentiality of the telephone for the medical profession was apparent from its invention in 1876; 4  as Michael Kay notes, the first inter-connected users were doctors, pharmacists, hospitals and infirmaries (2012). Practitioners used the technology, which enabled the clear transmission and reproduction of complex sounds for the first time, to improve existing instruments, or to devise entirely new examination methods. For instance, in November 1879, the Lancet published the case of an American doctor who, when phoned in the middle of the night by a woman anxious about her granddaughter’s cough, asked for the child to be held up to the telephone so that he could hear it (Anon. 1879). A group of physicians predicted in 1880 that home telephones would allow a new specialty of long-distance practitioners to ‘each settle themselves down at the centre of a web of wires and auscult at indefinite distances from the patients,’ potentially replacing the traditional stethoscope (cited in Greene 2016, 306). The telephone was also lauded for its potential to uncover foreign objects lodged in patients’ bodies, for example by acting as a metal detector (see Kay 2012). In line with the belief that a ‘good examination’ required a physician having access to the body’s interior in order to discover the seat of disease according to the localisation principle, the telephone was seen as an extension of the doctor’s ear that could improve examination and diagnosis.

In this context, reactions to the increased physical distance between physician and patient varied. The benefits of using a telephone instead of the more traditional speaking tube, which allowed breath to pass from one speaker to another, when communicating with patients with contagious diseases were recognised very early (Aronson 1977, 73). A testimonial letter, written by the Lady Superintendent at the Manchester Hospital for Sick Children in 1879, stated: ‘[The recently installed telephone] is of the greatest value in connection with the Fever Ward, enabling me to always be in communication without risk of infection’ (cited in Kay 2012). Yet some physicians worried that telephone technology had effectively ‘shrunk’ perceived social distance between them and the working classes, making them liable to be overly contacted by the general public. As one doctor complained in the Lancet in 1883: ‘[a]s if the Telegraph and the Post Office did not sufficiently invade and molest our leisure, it is now proposed to medical men that they should become subscribers to the Telephone Company, and so lay themselves open to communications from all quarters and at all times. […] The only fear we have is that when people can open up a conversation with us for a penny, they will be apt to abuse the privilege […] ’ (cited in Kay 2012) . Not only were doctors concerned about the telephone invading their ‘leisure,’ they worried that they might be overrun by the public, and their medical expertise would be needlessly exploited. Because of the inherent fear of doctors that an excessively frequent use of the telephone could flatten the social order and their standing within society, it is not surprising that the public use of the telephone came under critical medical scrutiny. This is visible in the way that telephones themselves came to be seen as seats of infection. At the end of the nineteenth century when most telephones were for public use (Fischer 1992), the British Medical Journal cautioned there was a need to curtail ‘the promiscuous use of the mouth-pieces of public telephones’ (Anon. 1887, 166). In general, the use of the telephone was informed by insights from bacteriology, which transformed individual disease ‘into a public health event affecting communities and nations’ (Koch 2011, 2), and placed new emphasis on the need to keep potentially infectious bodies as well as social classes at clear distance from one another (see Peckham 2015).

In relation to the pitfalls of today’s telemedicine and the fundamental questions of physical distance and emotional rapprochement in the medical encounter, these historical findings demonstrate that what was perceived as the ‘normal’ setting and procedure of medical examination could change remarkably within a rather short time. Before the nineteenth century, close physical examination generally played a less prominent role while patients’ illness accounts had a greater weight in the medical encounter. Indeed, in some contexts physical distance was seen as the prerogative of good medical practice. Post-1800, by contrast, is characterized by the standardisation of physical close examination, but also by the introduction of new technologies into the patient-physician relationship that themselves challenged socially-accepted degrees of physical closeness. However, this does not necessarily mean that such technologies disturbed a former unbroken bond, rather, various technologies became players in the game and could (or not) be appropriated by patients and doctors alike. Technology did not simply affect the physician-patient relationship, rather, existing societal and moral understandings influenced how technologies came into being and how they were used (Peckham 2015, 153). Our historical examples suggest that rather than seeing telemedicine as something fundamentally new and potentially threatening because it seemingly undermines a personal relationship, it may be more useful to acknowledge that technologies and cultural understandings always govern the degree of physical closeness and distance in medical encounters, and that this has had manifold implications for the emotional doctor-patient bond. The success of telepsychotherapy during the Covid-19 pandemic is perhaps a case in point. Even as it is unique among medical specialities because of the extent to which it considers the human relationship as fundamental for healing, psychotherapy via phone or video link has increased dramatically during the public health crisis, and also had good results (Békés and Aafjes-van Doorn 2020). This points not only to how physician-patient closeness and emotional understanding can exist in times of physical distance, but also to the constantly variable ways in which both the cultural imagination and experience of distance manifest themselves (Kolkenbrock 2020).

Self-treatment: do-it-yourself medical devices and the expert patient

The third field of digital medicine that we would like to put into historical perspective is one of the fastest growing fields of eHealth, namely do-it-yourself (DIY) health technologies. Such technologies broadly refer to the mobile devices that ‘now allow consumers to diagnose and treat their own medical conditions without the presence of a health professional’ (Greene 2016, 306). Silicon Valley firms sell ‘disintermediation,’ that is the possibility of cutting out middlemen – physicians – and allowing consumers to better control their health via their devices (Eysenbach 2007). Significant private investments have been driving these changes which, in the forms of smart devices and wearable technologies, often imply purchasing a product (e.g. a smartphone) and related applications and tools (see Greene 2016; Matshazi 2019). The website Digital Trends 2019 ranking of ‘the 10 best health apps’ range from Fitocracy, a running app that allows you to track your progress and that promises a fitness experience with a ‘robust community of like-minded individuals’, to Carbs that transfers the meals you have eaten into charts of calories, to Fitbit Coach that promises you the experience of having a personal trainer on your smartphone (de Looper 2019). 5 Health systems have bought on and increasingly ask patients to observe and monitor themselves with the help of these technologies, and in some cases, the use of apps to measure blood pressure, pulse and body weight such as Amicomed and Beurer HealthManager are closely connected to the possibilities of sharing one’s data remotely with a physician. In terms of reception, the delegation of tasks to digital devices is associated with patients having new options and new knowledge of their own health. In the estimation of one hospital CEO, this dramatic ‘democratization’ of technology and of knowledge signals ‘a true coming of age of the patient at the centre of the healthcare universe’ (Rosenberg 2019). In the words of chronic patient and patients’ rights advocate Michael Mittleman, while there may be benefits for patients when technologies take over certain tasks that were previously the prerogative of physicians, such technologies nevertheless pose a fundamental challenge to the ‘golden bond’ that previously characterized the patient physician-relationship, for example in the age of the house call (conversation with the author, 2019). It is clear from these statements that DIY devices – because they suggest that the more beneficial relationship is that between the patient/consumer and his/her devices – challenge previous assumptions about the inherent value of the physician-patient relationship as well as the balance of power between those two actors (see Obermeyer and Emmanuel 2016).

Both the notion that patients inherently benefit from circumventing physicians and taking their health into their own hands, as well as the idea of a close, almost familial bond that characterized the physician-patient relationship prior to contemporary DIY practices can be nuanced if we acknowledge that do-it-yourself medical practices have a long and varied history. As Roy Porter has noted, in the eighteenth-century, ‘ordinary people mainly treated themselves, at least in the first instance[,] “medicine without doctors” [was] a necessity for many and a preference for some’ (1999, 281). Only in the nineteenth-century did the medical profession establish a monopoly in health care and have the official power to determine what was ‘health’ and ‘sickness’. In the previous centuries, local and pluralistic ‘medical markets’ embraced far more providers of health services and their varied tools, including barbers, surgeons, quacks and charlatans, so that patients chose among the options that most convinced them or that were affordable to them (Ritzmann 2013, 418). But patients also had the option to help and treat themselves using the means at their disposal – Fissell argues that a person who fell ill in 1500 and still in 1800 almost always first sought medical treatment in a domestic context: ‘[h]e or she relied upon his or her own medical knowledge of healing plants and procedures, consulted manuscript or printed health guides, and asked family, neighbors, and friends for advice’ (2012, 533). As Fissell points out, the enormous diffusion and importance of self-therapy at the time meant that the ‘boundary between patients and practitioners was hard to pin down’ (534). While current depictions of an idealised interaction between physician and patient assume a physician who through his/her knowledge examines, advises and treats the non-knowing patient, history shows that the presumed boundaries between the expert and lay person are far more blurred than is usually assumed.

The presumed novelty of a de-centralised market for DIY devices that potentially threatens the dual relationship between physicians and patients can be put into perspective when considering historical examples. Due to a fairly unregulated medical market in the early modern period, competition was high and the business of medicinal recipes lucrative. In this context, profit-motivated apothecaries benefited from offering new recipes made from exotic products: as of the fifteenth century European pharmacies stocked many wares with medicinal properties – including spices, elements such as sulphur, and plants, for examplemastic and sundew – and these were bought by people who gathered and dealt in medicinal plants (or ‘simples’) and other apothecaries, who made them into medicines. In the wake of the European voyages of discovery, the range of products became ever wider and more expensive, and apothecaries were a very profitable business branch for a long time (Ehrlich 2007, 51-55). King and Weaver have used evidence from remedy books in eighteenth-century England to show how families purchased recipes for remedies, and resold both the recipes and the medicines they brewed to other local people (2000, 195). Until the nineteenth century the medical market flourished and was accessible and lucrative for many participants, while the demand for ‘medical’ services was high, particularly in towns and cities. Access to the technologies of healing – whether domestic medical guides or healing herbs – allowed patients to control their health and treatments according to a wide range of scientific explanations. In contrast to other European countries that meanwhile had developed some restrictions for apothecaries and their suppliers, in Britain the market-place was remarkably varied in the light of the free-market principle caveat emptor (let the buyer beware). ‘In English conditions,’ wrote Porter, ‘irregulars, quacks and nostrum-mongers seized the opportunities a hungry market offered’ (1995, 460). In these conditions of market-oriented healing, both patients and healers alike believed, sometimes fervently, in the effectiveness of the remedies on offer. Moreover, the network of relationships in which such transactions took place was remarkably fluid, with patients using the services of several health professionals in succession or simultaneously.

In the following centuries, medical practice and science would change dramatically due to the rise of academic training as a prerequisite to enter the medical profession, a development seen across Europe, as well as the integration of physicians into national health agendas. A growing belief in science and a paternalistic ideal of the academic physician attributed to him the sole power over medical practice and technologies. It became more difficult for other healers to participate in the health market, and the knowledge of the self-treating patient was diminished as well. As part of the attempt to counteract competition from non-educated or apprenticed healers, in the United Kingdom only registered doctors could hold various public posts, such as public vaccinator, medical officer and the like (Bynum 2006, 214). Yet ‘alternative’ medicine, a term that contained all those healers not licenced and accepted by the respective medical registers, continued to satisfy patients’ needs, although to a lesser extent. In Weindling’s assessment of the prospects of university-educated physicians to attract clients in nineteenth-century Berlin, ‘[f]ierce competition from a range of unorthodox practitioners must be assumed’ (1987, 398). The popularity of hydropathic doctors and water cures, mud-bathing and vegetarianism are but some examples of how alternative medicines co-existed alongside official ones and were increasingly popular treatments even though they did not meet the contemporary academic criteria of standards regarding safety and efficacy (Ko 2016). Thus patients often looked beyond qualified physicians to other practitioners, and their own sensibilities played a considerable role in which relationships they chose to develop.

A look into twentieth-century history shows that DIY practices were integrated into official medicine as well (Timmermann 2010; Falk 2018). The significant rise of chronic diseases and life-long treatment, for instance, required the co-operation of patients in the form of self-tracking and observation of their bodies since it could not be done by medical experts alone. In the first decades of the twentieth century, DIY methods and technologies for measuring blood pressure or sugar became particularly vital, transforming the roles of ‘patient’ and ‘doctor’ and relationship between them. Examining the history of self-measuring blood pressure, Eberhard Wolff notes that patients doing so in the 1930s required both patience and training, and also were pushed into a more active and participatory role during medical treatment: it was not the doctor anymore but the patient who produced and controlled relevant data that were decisive for further medical decisions and treatment (2014, 2018). With the rise of the risk factor model in mid-twentieth century – the identification of factors in patient’s behaviour and habits that were suspected of contributing to the development of a chronic disease – DIY practices grew ever more important and so did its technologies. From this moment, the idea of preventing disease shifted towards individual, possibly damaging behaviours such as smoking and diet that could trigger a number of different diseases. As a consequence, the patient received more responsibility in order to live up to the new credo of maintaining his or her personal health (Lengwiler and Madarász 2010). Optimizing a personal healthy life style hence did not necessarily occur in direct consultation with a doctor but rather in conjunction with health products available on the market. In the words of sociologist Nikolas Rose, in the course of the twentieth century:

[t]he very idea of health was re-figured – the will to health would not merely seek the avoidance of sickness or premature death, but would encode an optimization of one’s corporeality to embrace a kind of overall “well-being” … It was this enlarged will to health that was amplified and instrumentalized by new strategies of advertising and marketing in the rapidly growing consumer market for health (2001, 17-18).

According to Rose, by such developments, ‘selfhood has become intrinsically somatic – ethical practices increasingly take the body as a key site for work on the self’ (18). But he also argues that by linking our well-being to the quality of our individual biology we have not become passive in the face of our biological fate. On the contrary, biological identity has become ‘bound up with more general norms of enterprising, self actualizing, responsible personhood’ (18-19). By considering ourselves responsible for our own biology as key to our health, we have come to depend on ‘professionals of vitality’ (22) whether they be purveyors of DIY devices, genetic counsellors, drug companies or doctors.

With respect to contemporary debates over DIY practices, some have argued that they allow both doctors and patients to be ‘experts’ and call for ‘a relationship of interactive partnership,’ not only because patients today are often informed but also because ideally they know best their own bodies and ailments (Kennedy 2003). Against this idealising assessment, the historical perspective makes us aware that while self-help and self-treatment have been an important dimension of past medical cultures, it appears that historically, patients have not relied as much on a face-to-face empathetic encounter with any one physician as today’s debates suggest. Moreover, today as in the past, the mere existence of markets for medical devices influences how consumers/patients decide whether to resist or embrace the various possibilities of self-treatment as well as their relationships with those who provide it. As Porter has argued, purveyors of ‘alternative’ medicines rationalised their therapeutic effects in ways that differed from official scientific methods and using arguments that likewise changed over time. Depending on the perspective of whose model of evidence users deemed most credible, the co-existence of diverse models for practicing medicine must be assumed throughout history and despite nineteenth-centuries attempts to eliminate unorthodox medicines (Timmermann 2010). The result was a diverse network of fast-changing relationships in which no single one was ascribed the ultimate power to heal. Reflecting on this history, historian of medicine and physician Jeremy Greene has stated that contemporary DIY devices therefore appear ‘neither wholly new nor wholly liberating’ (2016, 308). Our analysis corroborates Greene’s, in that it shows how those who use new DIY technologies may free themselves from their traditional relationship of dependence on physicians, while also creating new relationships with those actors who produce apps or conduct marketing. Yet our study also suggests that there is no one ethical conclusion about whether DIY or physician-dominated care is a better way of living up to a more humane medicine. Ethical arguments and the grounds on which we are supposed to resolve them are complex and variable. As seen in these historical examples, they have changed profoundly over time with each technology and medical concept challenging and refashioning the doctor-patient bond anew. Furthermore, there is no such thing as a ‘timeless’ doctor’s healing presence, or even medical expertise, or an ill person/patient. As shown above, as health and illness are defined, redefined and challenged throughout history, this process creates both expert and patient, as well as shapes the relationship between them.

An oft-heard concern about ‘computerization’ in medicine is that digital objects are changing human interactions. While various representatives from the tech side are optimistic about the effects of increasingly dynamic and intelligent objects in the medical encounter, some patients and physicians are more skeptical and see their social relationships as disturbed by new technologies. ‘Doctors don’t talk to patients’ is the most common complaint the CEO at a Montreal hospital recounted hearing from current patients (conversation between the author and Lawrence Rosenberg, 2019). Fears that increasing digitization of medicine will disturb the relationship that can potentially make the patient ‘whole’ again are not without foundation (King 2020). However, without a clear baseline for assessing changes we have limited scope for drawing conclusions about present day realities or long-term trends. Given the appeal of using the past to suggest a more ‘human’ but lost era of medical practice, a less nostalgic but more sophisticated understanding of the past as provided by historical research would serve us well. In this sense, history can counteract a characteristically modern myopia, namely, as intellectual historian Teresa Bejan has put it, our ‘endearing but frustrating tendency to view every development in public life as if it were happening for the first time’ (2017, 19).

As we saw in the examples dealing with record keeping, examining and self-treatment, trends that consider the patient as an object – a diseased lung, or a malfunctioning heart valve – and the concomitant use of technologies to record, examine and treat physical symptoms were necessarily in tension with patients’ own accounts of how they became ill and of the symptoms they experienced. In fact, concerns about the loss of meaningful personal contact in the medical encounter are incomprehensible without reference to a historical trend dating back to the beginning of the nineteenth century which seems to undermine the patient’s perspective by focusing on increasingly specialised processes within the body. Yet neither before nor after that time is there an unmediated patient’s voice that we are able to recover: the medical record as historical source has its own distinct material history, and patients’ expectations were always bound up with broader societal views about acceptable standards of healing. The historical perspective also shows that we should not take for granted the linear narrative of the technological as adverse to human relations and reducing empathetic understanding in the medical encounter – to paraphrase Lauren Kassell, the digital is not just the enemy of the human (2016, 128). Rather, it makes us aware that our understanding of the doctor-patient relationship and of its role in healing are themselves historically contingent. The idea of ‘a friendly, family doctor “being there”’ and the association of medicine with a ‘desirable clinical relationship’ (as opposed to e.g. perfect health) is an idea that has played out very differently in the course of history (Porter 1999, 670). There were times in which listening to patients was bound up with completely different expectations from both sides, and there were times in which physical examination was not seen as an indispensable part of medical practice. Moreover, while the monopoly of the physician in matters of health care and the focus on the (exclusive) healing potential of the clinical relationship is of relatively recent origin, we have seen that the popularity and economy of DIY devices has a much longer history, one that resists a linear account of DIY devices as something purely liberating. Hence, in contrast to idealised and simplified historical narratives that lament the loss of human relationships, more sophisticated accounts should acknowledge that medical objects and technologies are not the strange and disturbing ‘other’ in the medical encounter but rather integral players therein. As Frank Trentmann has put it, ‘things and humans are inseparably interwoven in mutually constitutive relationships’ (2009, 307). While the authors of a recent study suggest that ‘the traditional dyadic dynamics of the medical encounter has been altered into a triadic relationship by introducing the computer into the examination room’ (Assis-Hassid et al. 2015, 1), it seems more likely that the dyadic relationship has never existed.

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Vanessa Rampton received funding from the Branco Weiss Fellowship – Society in Science.

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1 We rely on a definition used by science and technology scholars whereby the term ‘technology’ operates on three levels (see Bijker, Hughes and Pinch 2012, xlii). First, there is the physical level, referring to tangible objects such as a smartphone, wellness band, or stethoscope. The second level of meaning concerns activities or processes, such as 3D printing or creating X-rays. The third level refers to knowledge people have in addition to what they do, for example the knowledge that underpins the conduct of a surgical procedure. This approach shows the extent to which specific tools and techniques, knowledge, and rationales for intervention are intricately bound together. Our use of the term ‘digital,’ that is involving computer technology, in relation to medicine ‘includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine’ (U.S. Food and Drug Administration).

2 As a rule, while systematic reviews of telemedicine generally portray it as effective as in-person consultation or promising, evidence is limited and fast-evolving (Ekeland, Bowes and Flottorp 2010; Kruse et al. 2017; Lee et al. 2017).

3 In Germany, legislators have reacted to these concerns by limiting video consultation to cases in which physician and patient have physically met before, and primarily using it for monitoring the course of disease, including chronic ones, or the healing of an injury (Heinrich 2017).

4 Scottish-born US inventor Alexander Graham Bell was the first to be awarded the U.S. patent for the invention of the telephone in 1876 (Fischer 1992).

5 Interestingly, and probably most important for their users, nine out of ten among the ranked apps are available as free downloads ( https://www.digitaltrends.com/mobile/best-health-apps/ , June 16, 2019).

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Rampton, V., Böhmer, M. & Winkler, A. Medical Technologies Past and Present: How History Helps to Understand the Digital Era. J Med Humanit 43 , 343–364 (2022). https://doi.org/10.1007/s10912-021-09699-x

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Issue Date : June 2022

DOI : https://doi.org/10.1007/s10912-021-09699-x

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Technology in the Medical Field Essay Example

Technology plays a key function in many people’s day-to-day lives, within recent years medical technology has greatly advanced allowing for more efficient transactions between patients and caregivers. The evolution from medical files being strictly paper documentation to a person being able to pull up their file digitally at really any given place. These new innovative technologies allow medical professionals to be able to get a more accurate diagnosis with unusual symptoms. Smart technology, such as smartphones, has allowed patients to be able to communicate with medical professionals instantly. While a few decades ago patients would have to ask for their care provider to mail a copy of their medical history to wherever it needed to be. There are several benefits of smart technology within the medical field, such as appoints can be held virtually and medical information is more accessible in poor or rural areas. Smartphones have allowed patients to track their health easily and this information can be quickly sent to medical professionals for further evaluation.

While many people view smart technology to be very beneficial for our society and individual health. Others fear there is a lack of privacy for their medical information, along with the fear of anyone possibly accessing medical information without their permission. A survey was conducted that asked medical physicians' and consumers'/patients view on innovative medical technology, one of the questions asked was about their confidence in the privacy and security of their medical records. The results of the survey about the question about security and privacy of digital health technology showed that 35% of the medical physicians surveyed were slightly less concerned about this issue, while 42% of patients had concerns relating to using digital health technology (Boeldt et. al). This idea of accessing or having digital medical history will put your privacy and security at risk can be relieved by the fact firstly it is illegal for a physician to share your medical information without your written consent. Also, due to the advancement of technology has resulted in software being created that helps protect and block those trying to breach private medical information. New medical technologies allow us to have a greater understanding of our health at a faster rate compared to paper medical files. Private medical is greatly protected and with a person’s consent, a physician is capable of sharing and receiving information from other physicians for a more accurate diagnosis. 

Managing a patient’s health can be very difficult without having specific details and vitals, but evolving technology has allowed for multiple apps that can be downloaded on a patient's smartphone that records, notifies, and informs them and their physician about their health. The apps on smartphones can be catered to various amounts of people with different medical issues and provide a more precise measurement of a patient’s health and can notify a physician immediately if there were issues. An example that was found while researching the topic of smart technology’s role in patient health management was an app for people with Pompe disease. According to the national institute of neurological disorders and stroke defines Pompe disease is a rare inherited gene mutation that disables the heart and skeletal muscles. An app called AIGkit was created for people that were diagnosed with Pompe disease to have easy access to knowledge about their disease, clinical file, and a training plan (Ricci et. al). This is just one of the many health tracking apps that represent the significance that smart technology has accomplished for improving how we record and manage patient health today. Another example of new smart technology that is both beneficial for patients and medical personal is robot-assisted surgery. The article goes into fine detail about the increased usage and spread of robot technology being used during surgery during the early 2000s. According to Barbash et. al laparoscopic surgery results in less recovery time, less scarring, and a decreasing percentage of infection due to the robot technology being a less invasive form of surgery compared to the typical surgeries performed. While these are positive results of new technology, a negative is the expensiveness of the robot and many new smart technologies that range around $1 million. While these inventions are beneficial for helping advance the medical world, it is more expensive to use smart technology. This overall results in making these resources less accessible for poor and rural areas.

This topic relates to health systems management because in this field your job involves recording the medical information of patients and this career will be using these new technologies to help patients. It is important to be able to compare how medical information use to be recorded and how it got t it where it is today and will continue to improve for the betterment of the patients and people in medical professions. Especially within the last 2 years during covid has shown the significance of digital medical technology plays in many people’s lives. Telehealth was steadily increasing for a few years before COVID-19, but when quarantine occurred it became very common for patients to meet or communicate with physicians virtually due to limitations. El-Miedany analyzed how standard health care was changing to become more digital. In the beginning when the shift to health care went more digital many people were skeptical and were worried that when discussing with physicians instead of focusing on the patient they would be more fixated on their computer or smartphone. As years passed having medical information becoming digital allowed for more accessibility for medical information and communication with medical personal. According to El-Miedany when a group was surveyed about a telehealth consultation 84% of the patients believed the virtual appointment was just as good as a in-person appointment. The telehealth and telemedicine article was very useful in my research because it also broke down that digital medical fits can be divided into different divisions from only having one physician having access to the file and if needed to be shared it would need to be printed and mailed. While the other 2 were more digital and allowed multiple physicians access along with having a more advanced family medical history. Our society is still transitioning to understanding and using smart technology to record our medical information and health.

Researching the significance that smart technology has had on the medical field and managing a patient’s health taught me that working in this field will require a great understanding of technology and being able to adapt to it to help patients. Also, this taught me that my career will help facilitate conversations and provide support to both physicians and patients and I will need to learn to be able to do so in an efficient way. I feel this topic of digital healthcare and smart technology's role in patient health because of the pandemic and we quickly relied on telehealth for receiving health consultations. If I were to do more research on this topic I would probably look more into the smartphones possibly being able to track symptoms of mental illnesses and send the recorded information to a psychiatrist or psychological care. Mou’s article about using smartphones to help improve psychiatric care stated, “Multiple National Health Service sites in England have implemented a smartphone app that notifies clinicians in real-time when patients report alarming changes in their symptoms of psychosis.” This statement interests me more about this topic because being able to detect mental illness symptoms can be difficult, even for the patient, and will possibly help define what that person may need. 

Barbash, Gabriel I,M.D., M.P.H., & Glied, S. A., PhD. (2010). New technology and health care costs -- the case of robot-assisted surgery. The New England Journal of Medicine, 363(8), 701-4. doi:http://dx.doi.org/10.1056/NEJMp1006602

Boeldt, D. L., Wineinger, N. E., Waalen, J., Gollamudi, S., Grossberg, A., Steinhubl, S. R., McCollister-Slipp, A., Rogers, M. A., Silvers, C., & Topol, E. J. (2015, September 14). How consumers and Physicians View New Medical Technology: Comparative Survey. Journal of medical Internet research. Retrieved November 6, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642377/. 

El-Miedany, Y. (2017). Telehealth and telemedicine: How the digital era is changing standard health care. Smart Homecare Technology and TeleHealth, 4, 43-51. doi:http://dx.doi.org/10.2147/SHTT.S116009

Mou D. (2016). Battling severe mental illnesses with smartphones: how patients' smartphone data can help improve clinical care. mHealth, 2, 32. https://doi.org/10.21037/mhealth.2016.08.03

Ricci, G., Baldanzi, S., Seidita, F., Proietti, C., Carlini, F., Peviani, S., Antonini, G., Vianello, A.,& Siciliano, G. (2018, March 12). A mobile app for patients with Pompe disease and its possible clinical applications. Neuromuscular Disorders. Retrieved November 4, 2021, from https://www.sciencedirect.com/science/article/pii/S0960896617314979. 

U.S. Department of Health and Human Services. (n.d.). Pompe Disease Information Page. National Institute of Neurological Disorders and Stroke. Retrieved November 4, 2021, from https://www.ninds.nih.gov/Disorders/All-Disorders/Pompe-Disease-Information-Page#:~:text=onset%20Pompe%20disease.-,Pompe%20disease%20is%20a%20rare%20(estimated%20at%201%20in%20every,alpha%2Dglucosidase%20(GAA).

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Essay About Medical Technology

Medical digitized records, powerful imaging devices, small sophisticated tools – medical technology plays an important role in modern healthcare system and significantly alter the provision of care.

The world of medical technology is vast. It includes all the medicines, instruments, procedures, and support systems necessary to provide care. Recognized medical experts indicate that medicine become increasingly dependent on the technology. They already became a part of hospitals and even invade our homes.

According to the experts, the technologies are used in all medical fields.

Doctors and specialists use them both for the prevention, diagnosis, and treatment as well as for the rehabilitation or home care. For example, doctors use vaccines to prevent disease outbreaks, medical imaging for early detection, or laboratory tests and screening for diagnoses. In addition, there are supporting technologies, such as sterilization, and those relating to infrastructure of hospitals, particularly for ensuring the power supply in case of failure. Without this technology, about 80% of care could not be provided.

Technology Term Paper

Medical technology is often associated with big expensive devices such as scanners, the magnetic resonance imaging, and nuclear medicine imaging systems. However, these devices represent only a small part of the medical arsenal of a health facility. The park equipment also includes thousands of small instruments and medical devices. It is in this area where there is the largest number of innovations.

In many other sectors there are important technological advances, including laboratory analysis. For example, development in genetic testing allows to predict the risk of certain cancer types.

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Drug technologies also demonstrate considerable progress. Today, drugs are used not only to treat patients, but also to prevent diseases, reduce symptoms, and improve quality of life for people with chronic disease. This change affects spending on drugs. According to the Canadian Institute for Health Information, the cost of drugs has increased from 288 million in 1975 to six billion thirty years later, which represents 22% of health spending in Quebec.

In short, if medical technologies improve the quality of health care and health care delivery, they also pose many challenges to be faced.

As it was mentioned above, medical technology plays today a very important role in healthcare system. Students, who want to write their research project on medical technology, have to thoroughly study the origins and evolution of the phenomenon. They will have to find and process a great deal of information from reliable and verified sources and present clearly their own ideas on the matter.

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Medical Technologies Past and Present: How History Helps to Understand the Digital Era

Vanessa rampton.

1 Institute for Health and Social Policy and Department of Philosophy, McGill University, Montréal, Canada

Maria Böhmer

2 Center for Medical Humanities, History of Medicine Section, University of Zurich, Zürich, Switzerland

Anita Winkler

This article explores the relationship between medicine’s history and its digital present through the lens of the physician-patient relationship. Today the rhetoric surrounding the introduction of new technologies into medicine tends to emphasize that technologies are disturbing relationships, and that the doctor-patient bond reflects a more ‘human’ era of medicine that should be preserved. Using historical studies of pre-modern and modern Western European medicine, this article shows that patient-physician relationships have always been shaped by material cultures. We discuss three activities – recording, examining, and treating – in the light of their historical antecedents, and suggest that the notion of ‘human medicine’ is ever-changing: it consists of social attributions of skills to physicians that played out very differently over the course of history.

Human beings have their own goals and intentions, and products should help them to realize them in an optimal way. In many cases, though, these goals and intentions do not exist independently from the technologies that are used. [Technologies] do much more than merely function – they help to shape human existence. Peter-Paul Verbeek (2015, 28)

Introduction

A wide range of novel digital technologies related to medicine and health seem poised to change medical practice and to challenge traditional notions of the patient-physician relationship (Boeldt et al. 2015; Loder 2017; Fagherazzi 2020). A number of recent pieces have explored the ethical implications of this, asking, for example, whether new means of delivering ‘greater efficiency, consistency and reliability might do so at the expense of meaningful human interaction in the care context’ (Topol Review 2019, 22). Various contributions from patients, physicians, bioethicists, and social scientists have warned that computer technologies somehow stand between the physician and the patient and that there is a fundamentally human aspect of medicine that coexists uneasily with machines (e.g. Gawande 2018; Verghese 2017). As a remedy, recent contributions call for ‘clinical empathy’ not only as a desirable characteristic trait of future physicians, but even as a selection criterion for medical students (Bartens 2019). The role history plays in these discussions is striking. Commentators often assume that current concerns about how technologies may lead to the ‘de-humanisation of care’ (Topol Review 2019, 22) are the unprecedented products of technological, social, and cultural transformations in the late twentieth-/early twenty-first centuries. When the history of medicine is referenced, it is largely in one of the following ways: first, to emphasize that today ‘[w]e are at a unique juncture […] with the convergence of genomics, biosensors, the electronic patient record[,] smartphone apps, [and AI]’ (Ibid., 6), whereby the singularity of the digital era makes historical comparisons with antique predecessors seemingly irrelevant. Second, the history of medicine is used in a nostalgic manner to refer to past medical practices, seemingly grounded in the ability of a doctor to ‘liste[n] well and sho[w] empathy,’ as having a fundamentally human element that is threatened by the digital era (Liu, Keane and Denniston 2018, 113; see also Johnston 2018). With some notable exceptions (e.g. Greene 2016, Kassell 2016, Timmermann and Anderson 2006), historians of medicine have largely refrained from attempting to interpret recent digital developments within their broader historical contexts. The historicity of digital medicine in its various forms and the insights of the history of medicine for contextualising the patient-physician relationship in the digital era have yet to be fully fleshed out.

In this contribution, we draw on historical examples and the work of historians of medicine to highlight how all technological devices are ‘expressions of medical change’ (Timmermann and Anderson 2006, 1), and to show how past analogue objects shaped physician-patient relationships in ways that remain relevant today. Our focus is on Western European medicine since the early modern period. While acknowledging the profound differences between medicines in particular historical times and places, we argue, first, that patients and doctors have always interacted in complex relationships mediated by objects. Medical objects and technologies are not only aids for performing certain human tasks, but themselves have a mediating function and impact how physicians and patients alike perceive illness and treatment. We then contend, second, that history helps inform current discussions because it highlights the plurality of ways in which the physician-patient relationship has been conceived in different eras. In particular, the ability of the physician to listen well and show empathy seems to be not so much a historical constant but rather a social attribution of certain skills to physicians that played out very differently over the course of history. Both points help us to show that some of the hopes and fears related to digital technologies are not so entirely new after all.

We work through these hypotheses in relation to three activities in the clinical encounter that have been significantly affected by digital medical technologies, namely i) recording (Electronic Health Records), ii) examining (Telemedicine), and iii) treating (Do-It-Yourself medical devices). In each case, we begin with a specific contemporary technology and the debates around it before showing how a historical perspective can contribute to our understanding of them. First, we discuss electronic health records in the light of current criticisms which maintain that this technology cuts valuable time the doctor should be spending with the patient, thereby threatening an assumed core responsibility of the physician, namely listening empathetically to the patient. History shows that physicians have not always seen administrative record-keeping as foreign to their main work with patients; rather, it has been a formative part of their professional identity at different times. Moreover, the value that both physicians and patients ascribed to empathic listening has varied substantially over time. Second, in the case of examining, we start from the observation that current debates about telemedicine focus on the greater distance between patients and physicians this technology brings about. The historical perspective demonstrates that these debates are but one example of how changing examination technologies affect both physical distance and reciprocal understanding in the patient-physician relationship. Our examples illuminate that physical proximity in the medical encounter is a modern phenomenon, and that it did not always imply a meeting of the minds between physician and patient and vice versa. Finally, our third section on self-treatment demonstrates that Do-It-Yourself devices have the potential to challenge medical authority and, by giving patients more power, alter those power balances between physician and patient that are constitutive of an idealised view of the patient-physician relationship. Yet here too there are significant historical precedents for thinking of doctors and patients as but two players within complex networks of people and technologies, in which patients ascribe value to a multiplicity of relationships.

Record-keeping: computers and the administered patient

Electronic health records (EHRs), that is computer-based patient records, have transformed the way contemporary medicine is practiced (see, for example, Topol, Steinhubl and Torkamani 2015, 353). While the electronic recording of patient files by individual health care providers has become common practice since the 1990s, a central virtual collection and storage of all health data relating to an individual patient is a rather new development which is currently being debated and technically introduced in various states. This virtual patient file is of secondary order because it is fed with original electronic files derived from various primary recording systems (GP, clinic etc.), and it follows a population health surveillance logic rather than the logic of the treatment of individual cases. The main idea is that both patients and health care providers have access to a corpus of health documents, which is as complete as possible, to make diagnosis and treatment more efficient, more precise and safer for patients, and less costly for the health system. While patients may make use of this possibility on a voluntary basis and are asked to distribute access rights to providers, healthcare providers are obliged to cooperate and feed the system with relevant data (for a local example see current implementation efforts in Switzerland and its pitfalls as described in Wüstholz and Stolle 2020). One of the main premises of supporters is that EHRs will facilitate not only networking and interprofessional cooperation but also enhance communication between doctors and patients: they ‘provide health care teams with a more complete picture of their patients’ health [and] improve communication among members of the care team, as well as between them and their patients’ (Canada Health Infoway; see also Porsdam, Savulescu and Sahakian 2016).

Yet critical discussions surrounding the introduction of EHRs doubt exactly that. They suggest that the increasing documentation, virtual storage and sharing of sensitive patient data threatens an assumed historical core value of the doctor-patient relationship, namely the possibility of physicians establishing an intimate and ‘deeper connection’ with their patients (Ratanawongsa et al. 2016, 127). From the perspective of healthcare providers, professionals criticise the time-consuming nature of EHRs, arguing that this technology supplants the time the doctor has for direct communication and time spent ‘in meaningful interactions with patients’ (Sinsky et al. 2016, 753). That screens are coming ‘in between doctors and patients’ is a widespread notion (Gawande 2018). In addition, medicine’s increasing dependence on screens is perceived as undermining important social rituals, such as exchanges between physicians and other healthcare colleagues who used to discuss their cases in more informal ways (Verghese 2017). Last but not least, EHRs are seen as a major factor contributing to declining physician health and professional satisfaction because of their time-consuming data entry that reduces face-to-face patient care (Friedberg et al. 2013). This last point seems to be crucial as the digital interfaces of EHRs indeed require a maximum of standardisation, homogenisation and formalisation of recording styles that necessarily conflicts with more informal, individual recording techniques. On the one hand, doctors are forced to fill in fields and checkboxes that do not correspond to their own knowledge priorities, that is the things they would want to highlight in a certain case from the perspective of their specialty. On the other hand, they have difficulties in identifying relevant information when too much data on an individual patient has been entered by too many people. The desired interprofessional collaboration thus runs the risk of complicating instead of facilitating the making of a diagnosis. Surgeon Atul Gawande maintains that in the past, analogue documentation forced physicians to bring essential points into focus: ‘[d]octors’ handwritten notes were brief and to the point. With computers, however, the shortcut is to paste in whole blocks of information […] rather than selecting the relevant details. The next doctor must hunt through several pages to find what really matters’ (2018). Together, these points of critique suggest not only a certain fear that the increasing digitisation of patient records might disturb relationships that in the pre-digital era were based on professional intuition and meaningful, trust-building face-to-face communication. The critique also suggests that what is threatened is the meaning and satisfaction a physician takes from his/her recording work.

From the perspective of patients, other concerns related to EHRs are more relevant, among them the safety of personal health data. But while notions of privacy – who has control over the data, who owns the patient history – are important for patients, a number of studies also show that patients perceive the careful digital documentation of their case as something positive (Assis-Hassid et al. 2015; Sobral, Rosenbaum and Figueiredo-Braga 2015). ‘Forced to choose between having the right technical answer and a more human interaction, [patients] picked having the right technical answer,’ reports Gawande (2018; see also Hammack-Aviran et al., 2020). It thus seems that as long as patients think EHRs are providing them with a higher quality of care, they readily accept EHRs and their doctors’ dependence on screens – hence adapting their expectations to technological change.

In order to scrutinize these purported threats and attitudes towards EHRs, the rich history of patient records provides a relevant historical backdrop. In studying patient records, historians have addressed exactly these issues: they have examined how the patient-physician relationship has changed over time and have used medical records to gain insights into how past physicians documented medical knowledge, how this influenced their perceptions of their professional identity, and their obligations vis-à-vis patients (Risse and Warner 1992). As a first step, it is important to see that even though EHRs pose new challenges because of their digital form, recording individual patients’ histories as part of medical practice and ‘thinking in cases’ as a form of epistemic reasoning are a historical continuum (Forrester 1996; Hess and Mendelsohn 2010). The patient history dates to ancient Hippocratic medicine when detailed medical records were written on clay tablets and handed down for centuries to preserve the esteemed knowledge of antiquity (Pomata 2010). Yet the content and form of medical records, as well as the practices producing them have changed remarkably over time (Behrens, Bischoff, and Zelle 2012). In Western Europe, physicians in sixteenth-century Italy re-appropriated the ancient practice and typically recorded their cases in paper notebooks, as part of a larger trend to systematize and record information (Kassell 2016; see also Pomata 2010). As Lauren Kassell notes, the records of early modern practitioners ‘took the form of diaries, registers or testimonials, often they were later ordered, through indexing or commonplacing, by patient, disease or cure, providing the basis for medical observations, sometimes printed as a testimony to a doctor’s expertise as well as his contribution to the advancement of science’ (2016, 122). The historical perspective reveals that the rationale for a particular type of medical record-keeping always developed in tandem with the technical capabilities for its enactment, changing ideas of how diseases should be recorded, as well as with the preferences of individual physicians (ibid. 120). Crucially, as the organization of these collections of patient histories changed, so too did medical knowing and normative ideas about the physician-patient relationship (Hess and Mendelsohn 2010; Dinges et al. 2016).

As shown above, current critical discussions about EHRs tend to evoke a medical past in which patients were given time to talk about their illness, doctors listened and engaged in meaningful interactions, and record-keeping did not interfere with these processes. Allegedly, there were few concerns over misuse of data as there was less data produced and fewer players in the game. How does this popular nostalgic view correspond to research findings in the history of medicine? To some extent, the context of ‘bedside medicine’ comes close to these ideas. This model of care remained dominant in Western Europe until the nineteenth-century. One of the main ways in which physicians generated medical knowledge at the bedside of patients was to conduct ‘verbal analysis of subjectively defined sensations and feelings’ by patients (Jewson 1976, 229-230), and these patient testimonials provided the details recounted in physicians’ notes (Fissell 1991, 92). This is partly because the early modern doctor-patient relationship was based on a ‘horizontal’ model of healing (Pomata 1998, 126-27, 135) and a legally binding ‘agreement for a cure’ (ibid., 25 passim), which gave considerable power to patients, placing them on ‘near-equal hermeneutic footing’ with doctors (Fissell 1991, 92). Physician and patron (patient) made a contract in which the mostly upper class-patient would only pay fees after ‘successful’ treatment; vice versa, doctors were not obliged to treat a patient but would rather take on patients whose potential cure, and ability to pay fees, could be foreseen. Patients’ verbal satisfaction and willingness to conduct word-of-mouth publicity for a practicing physician were key to his reputation at that time and influenced physicians’ relationships with their clients.

However, it is problematic to project today’s vision of a desirable empathic relation between doctors and patients back into the past. Although upper-class patients clearly had some power in their relationship with physicians, the dominance of patients’ speech in medical records as such should not be interpreted as proof that doctors cared about their patients in the modern sense of showing understanding. With respect to nineteenth-century bourgeois medicine, Roy Porter noted that flattery and attention in the medical encounter were calculated practices of physicians concerned to secure clients and that ‘solemn bedside palaver[,] a grave demeanour, an air of benign and unflappable authority’ were all part of the prized ‘art of never leaving without a favourable prognosis’ (1999, 672). In a similar vein, Iris Ritzmann has emphasized that eighteenth-century doctors were eager to adhere to a certain ‘savoir faire,’ that is rules of conduct that would allow them to obscure the fact that in many cases, their abilities to heal were very limited (1999). And in Paul Weindling’s assessment of German medical routines, physicians’ desires to satisfy the patient subjectively were even purely instrumental: ‘[s]ympathy with the feelings of the sick was an economic necessity owing to the competition between practitioners’ (1987, 409). In all these cases, the value ascribed to direct physician-patient dialogue was very different from today’s ideas about an empathic encounter between physicians and patients; an engaged bedside manner often had more to do with calculated support for an upper class and sometimes hypochondriac clientele.

Similarly, as concerns the careful documentation of a patient’s medical condition and history, historical evidence shows that doctors did not do it primarily for their patients’ needs but for purposes of professional standing. This was important at a time when physicians’ scientific authority still needed to be established. The fact that in many cases there were several physicians involved in the treatment of the same case made documentation and communication between physicians (and sometimes for the public) especially relevant – and especially conflictual. Eighteenth-century case histories reflecting the context of bedside medicine indeed suggest that doctors were sometimes eager to publish case histories of patients that would bespeak their ability to heal by highlighting the misfortune of their competitors in order to enhance their own reputation. This shows how misleading the popular nostalgic view of a past intimate and unbroken bond between physicians and patients is, and that analogue paper technology did not necessarily strengthen this bond but could also be used in ways that were not beneficial for patients. Unlike today, this was an era in which practices of record-keeping mirror multiple, local and highly individual ways of documentation; the formalisation and standardisation of patient files which 19 th -century hospital medicine would trigger was yet to come.

As hospitals and laboratories became important institutions for medicine in the century roughly between 1770 and 1870, they also changed the practices of record-keeping, as the customary interrogation of patients’ accounts of the course of their disease did not coincide with changing understandings of disease, scientific interests and cultural expectations (see Granshaw 1992). For instance, French anatomist and pathologist Xavier Bichat (1771-1802) dismissed note-keeping based on patients’ narratives as an obsolete method for knowledge-making. He observed in his Anatomie générale (1801), ‘you will have taken notes for twenty years from morning to night at the bedside of the sick [and] it will all seem to you but confusion stemming from symptoms that fail to coalesce, and therefore provide a sequence of incoherent phenomena’ (1801, xcix, our translation). The kind of medicine favoured by Bichat and like-minded physicians focused on gaining anatomical and physiological insights directly from the body, using both physical examination and remote techniques in the laboratory. One way in which record-keeping changed to accommodate these interests was in the use of a more technical language to describe the experiences and expressions of patients. Mary Fissell argues that with the rise of hospital medicine, ‘doctors begin to sound like doctors, and patients’ voices disappear’ because doctors interpret patients’ words and replace them with medical equivalents (1991, 99). More generally, historians have shown that during the nineteenth century, medical culture changed in a way that gradually diminished the importance of patient narratives in medical writing (Nolte 2009).

How did these changes in recording practices play out for patients in the medical encounter ? From the historical perspective, the fact that physicians adopted a more technical language in their interactions and records should not be taken as evidence for a loss of human interaction or as something that patients necessarily disliked. On the contrary, the more systematised and formalised type of record-keeping was considered state of the art and was in accordance with a rapidly growing belief in the natural sciences among both patients and the general public (Huerkamp 1989, 64). This is related to the emergence of a specific concept of scientific reasoning that, in turn, fostered a sense of ‘scientific objectivity’ that called for dispassionate observation and accurate recording (Daston and Gallison 2010; Kennedy 2017). By the end of the nineteenth century, academic physicians had managed to create such professional authority that the ‘horizontal model of healing,’ in which the physician courted his upper-class clients, was replaced by a vertical model, in which the patient subjected himself to the authority of the physician. A Berlin doctor advised his fellow colleagues in 1896 that they should communicate their medical prescriptions to patients in a way that ‘prevents any misunderstandings and so that no further question can be addressed to him’ (cited in Huerkamp 1989, 66, our translation). For patients, this growing scientific authority and paternalism meant very different things, depending on class and social status. While medical services became accessible to more people, in particular thanks to the introduction of obligatory health insurance for workers, lower classes often experienced medicine as an instrument of power rather than benevolence (Huerkamp 1989). But even for the well-to-do, who undoubtedly benefitted from newly developed medical techniques, in particular in the realm of surgery, the acceptance of medical paternalism, male rhetoric and heroic cures came with high costs. This is suggested, for instance, in a famous letter by the court lady and writer Frances (Fanny) Burney who underwent a mastectomy in 1811, a rare document offering a patient’s perspective on these matters (Epstein, 1986).

From the perspective of doctors at the turn of the nineteenth century, record-keeping was associated not only with professional obligations but also with personal fulfilment. In many European countries, physicians were asked to provide expert opinion for juridical and administrative regulations as the state was increasingly interested in tracking its population’s health (Ruckstuhl and Ryter 2017; Schmiedebach 2018). In her study of Swiss physician Caesar Adolf Bloesch’s private practice (1804-1863), Lina Gafner shows the extent to which he perceived medical practice documentation as constitutive of his professional role and self-understanding as a medical expert. Bloesch’s patient journal ‘constitutes one single gigantic research report’ (2016, 265) because it was key for allowing him to generalize from the experiences gained in his practice in order to produce knowledge to contribute to contemporary scientific discussions. Gafner notes that the ‘format he gave his journals [leads] us to assume that scientific or public health-related ambitions were part of Bloesch’s professional self-image’ (263). In contrast to this historical example, where patient care and journal keeping were combined in the light of professional ambition, it stands out that healthcare providers of today tend to see their administrative work as opposed to patient care, even as separate and conflicting tasks; it is assumed that for physicians ‘seeing patients doesn't feel like work in the way that data entry feels like work’ (Amenta 2017). This is probably related to the fact that many physicians experience the requirement of working with a given software as a limiting restraint, which they are not really able to control, while they experience working with patients as something they have learned to master. As Gawande admits: ‘a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me’ (2018). It thus seems that it is primarily the question of ownership that distinguishes past recording styles from today’s recording systems: it is difficult to individually appropriate something which is designed to harmonize if not eliminate individual recording styles.

Yet even as Bloesch and contemporaries embraced the administrative tasks associated with medical note-taking as an opportunity to become a medical expert, other nineteenth-century physicians had different views of its value. But their criticisms of record-keeping were not motivated by the inherent value they saw in interactions with patients. Rather, their critiques were linked to a notable shift during the nineteenth century as scientific interest, triggered by administrative requirements as well as different disease conceptions and methods (e.g. in epidemiology research), changed its focus from the individual case study to population studies (see Hess and Mendelsohn 2010). In Nikolas Rose’s words, ‘the regularity and predictability of illness, accidents and other misfortunes within a population’ became ‘central vectors in the administration of the biopolitical agendas of the emerging nation states’ (2001, 7). Bound up with a new emphasis on tabulation, as well as ‘precision and reliability,’ various German-speaking hospitals instigated a new tabular format designed to enable physicians to compile their observations of patients into ward journals organized into columns and, eventually, generate an annual account of the course of disease (Hess and Mendelsohn 2010, 294). Yet in response some physicians rejected what they saw as excessively confining recording requirements. Volker Hess and J. Andrew Mendelsohn describe how the chief physician at a Berlin clinic ranted about the ‘inadequacy of our [tabular] journals’ and their inability to produce medical knowledge (295). While Mendelsohn and Hess themselves remark that such tabular ward journals were very ‘far from the patient history as observation, as prose narrative’ (293), the physicians’ rejection of the use of columns to record cases was not motivated by a concern to recover patients’ own narrations of their ailments or the feeling that record-keeping prevented them from properly attending to their patients’ needs. On the contrary, these physicians were concerned with producing an annual disease history and were frustrated that ‘the ultimately administrative format’s own rigid divisions blocked the writing of a synoptic history’ (296). Rather than recovering a face-to-face encounter with patients, they were interested in finding a recording format that would allow them to present a more compelling and sophisticated general description of disease, relying on mass information.

The current consensus among historians of medicine is that we should neither conceive medical records as ‘unmediated records of experiences of illness and healing’ (Kassell 2016, 126) nor as disentangled from the medical encounter itself. Rather, ‘processes of record-keeping were integral to medical consultations’ because ‘as ritualised displays and embodied knowledge, case books shaped the medical encounters that they recorded’ (122; see also Warner 1999). In relation to how ‘computerization’ is shaping contemporary medical encounters, three main points are of note. First, physicians have not always seen time spent writing and recording patient histories as in competition with interacting with patients themselves. At various times in history, the careful documentation of individual cases was perceived as a fundamental resource for generating medical knowledge and time spent doing so as part of the self-identity of physicians. Against the repudiation of digital record-keeping by today’s physicians, historical evidence shows that to the extent that physicians saw record-keeping as coinciding with their overall knowledge objectives, they accepted and even embraced it. This is linked to a second point, namely that prolonged time spent listening to the patient talk was not historically seen as evidence of good medical practice. For example, in an era when listening at length to patients was associated with the obsequious physician catering to the ego of the upper-class patient, the sober inscription in a nineteenth-century casebook noted that ‘too much talking showed that little was wrong’ with the patient (Weindling 1987, 395). Finally, patients too accepted administrative work by doctors as a sign of expertise and not necessarily as something that reduced the doctor’s attention to them. While the power balance changed in favour of doctors and ascribed less epistemic value to patients’ words, this was not necessarily negatively received by patients. History therefore shows that we should not view technological changes as isolated from the broader medical culture surrounding them but rather as shaping and co-constructing this culture. Today’s fear that the introduction of EHRs might change the communication and relation between physicians and patients for the worse tends to blame technology for a broader cultural and medical change of which it is just one tiny aspect, that is the growing belief in data and the logic of gaining stratified knowledge to provide relevant information about any one patients’ condition. Given that patients’ expectations exist in a dynamic relationship with how physicians learn, make decisions and interact with them, EHRs are themselves bound up with creating new conditions for the physician-patient relationship.

Examining: telemedicine and the distant patient

A further way in which digitalization has influenced the medical encounter is that it has emerged as the new virtual consulting room, thereby radically transforming the settings and procedures of physical examination. Although most people still go to ‘see the doctor,’ medical encounters today no longer have to take place in physical spaces but can occur via telephone or internet – what is broadly referred to as telemedicine, literally healing at a distance (from the Greek ‘tele’ and Latin ‘medicus’) (Strehle and Shabde 2006, 956). According to the World Health Organization, as a global phenomenon, telemedicine is more widespread than EHRs with more than half of responding member states having a telehealth component in their national health policy (WHO 2016). In the context of the COVID-19 pandemic, telemedicine has been overwhelmingly seen as ‘[a]n opportunity in a crisis’ and has further gained in popularity (Greenhalgh et al., 2020; see also Chauhan et al., 2020). A senior NHS official cited by The Economist called the widespread adoption of remote care (viz. telemedicine) a ‘move away from the dominant mode of medicine for the last 5,000 years’ (2020, 55). In the virtual examination room, patients can ask a physician for a diagnosis, a prescription and a treatment plan and send information about diseased body parts via digital media. When inquiring about the health conditions of their patients from a virtual consultation room, physicians sometimes need to ask their patients for certain practices of self-examination and self-treatment (Mathar 2010, section III). Advocates of telemedicine emphasize that there is no risk of mutual infection, advantages of cost savings, convenience, and better accessibility to medical care generally and for people living in rural and remote areas in particular. In Switzerland, for instance, the Medgate Tele Clinic promises to ‘bring the doctor to you, wherever needed’ (2019) while the U.S. Doctor on Demand characterizes itself as ‘[a] doctor who is always with you’ (2019). Patients, meanwhile, appreciate the greater availability of physicians, less travel time and better overall experience (Abrams and Korba 2018). However, telemedicine also raises various critical questions about the effects of physical distance on the physician-patient relationship. In particular, can the quality of the examination and diagnosis be high enough if a physician only sees his/her patient via screen but cannot smell, palpate and auscultate him/her? Furthermore, how can a trusting doctor-patient relationship be established virtually and at a distance? (see Mathar 2010, 13). While some of these critiques are based on the assumption that a fitting medical encounter between physician and patient should be a ‘good, old-fashioned, technology-free, dialogue between physician and patient’ (Sanders 2003, 2), we show below that all encounters inevitably ‘pass through a cultural sieve’ (Mitchell and Georges 2000, 387). Not only has the perceived need for the physical proximity of physician and patient varied substantially over history, but historical physicians and patients have not seen physical distance as preventing them from achieving emotional understanding. Whether physical examinations took place in-person or remotely, at each point in history doctors relied on their knowledge and its applications, that is a cultural lens through which s/he gazes on, over or into the human body. Regardless if examined remotely or closely, changes in examination procedures always challenge the established sense of the emotional bond between patient and physician, which therefore needs to be defined anew.

The standard physical examination as we know it today was considered less important in Europe up to roughly 1800 because of the conventions governing the relationship between physician and patient/patron, and also because of the conventions governing the relationship between male doctor and female patients. Many physicians considered physical examination morally inappropriate and saw it as dispensable for making a diagnosis. Physicians of upper-class patients generally considered their task more to advise than to examine and treat (Ritzmann 1999, 203). From his close analysis of a casebook by a seventeenth-century English physician, Stanley Joel Reiser concludes that the ‘maintenance of human dignity and physical privacy placed limits on human interaction through touch’ (1978, 4). Given the desirability of maintaining physical distance, physicians relied on and developed other sources of knowledge than their own sense of touch. The physical examination was ‘the method least used’ by the seventeenth-century physician who rather favoured ‘the patient’s narrative and [his] own visual [outward] observations’ of the patient’s body. In her study of a manuscript authored by a surgeon-apothecary of the same historical period, Fissell singles out blood-letting as one ‘of the few occasions on which a professional […] might routinely touch a patient’ and notes that it was necessarily ‘transformed into a careful ritual, one which attempted to compensate for the transgressive nature of the encounter. The blood-letter's courteous attention to returning the patient to his or her un-touched status underlines the mixture of courtesy and technique which made good medical practice’ (1993, 23). In ways now unfamiliar to us, manners and morals interacted to make physical examination and touching patients an ancillary part of the desirable patient-doctor encounter at that time.

Regular in-person physical examination as a routine practice and diagnostic technology is a rather recent development that came along with a new anatomical understanding of disease during the course of the nineteenth century, namely that diseases can be traced to individual body parts such as organs, tissues and cells, rather than unbalanced bodily humours (Reiser 1978, 29). It was at this time that the doctor’s examination skills no longer depended on the patient’s word and the surface of the (possibly distant) body, but started relying on what the doctor could glean from the patient’s organic interior (Kennedy 2017). In order to ‘get’ to the physical conditions of the body’s interior, a number of instruments were developed to facilitate the new credo of examination. The most famous example of such a nineteenth-century examination technology is the stethoscope, invented by French physician René Laennec (1781-1826). ‘By giving access to body noises – the sounds of breathing, the blood gurgling around the heart – the stethoscope changed approaches to internal disease,’ wrote Roy Porter, ‘the living body was no longer a closed book: pathology could now be done on the living’ (1999, 208). Crucially, technologies like the stethoscope brought the physician and patient into the examination room together but by providing physicians with privileged access to the seat of disease did not necessarily bring them closer in terms of understanding. Doctors now heard things that remained unheard to the patient, and this provoked a distancing in terms of illness perceptions. In Reiser’s account, the stethoscope ‘liberated doctors from patients and, by doing so, paradoxically enabled doctors to think they helped them better. […] Listening to the body seemed to get one further diagnostically than did listening to the patient’ (2009, 26).

The result is visible in the resistance surrounding some examination technologies that allowed physicians to delve into the body’s interior in order to gain new anatomical and pathological insights but that proved too transgressive for some existing physician-patient contacts. The vaginal speculum, introduced into examination procedures in Paris in the early-nineteenth century, may have fitted well with physicians’ new commitments to empiricism and observation. But at the time of the speculum’s introduction, female genital organs, in contrast to other organs, were regarded ‘as so mysterious and so sacred that no matter how serious the disease that afflicted them might be, it was no justification for an examination either by sight or touch’ (Murphy 1891, cited in Moscucci 1990, 110). Although the speculum was in line with pathological disease concepts and close, interior observation, moral considerations continued to undermine its suitability in the clinical context. At a meeting of the Royal Medical and Chirurgical Society, chronicled in the Lancet , commentators associated the speculum with both female and physician corruption, and the loss of moral virginity and innocence caused by its insertion into the body (Anon. 1850). In Margarete Sandelowski’s estimation, the vaginal speculum ‘required physicians not only to touch women’s genitals, but also to look at them, and thus imperiled the relationship male physicians wanted to establish with female patients’ (2000, 75). Here was a case in which technology challenged the socially accepted relationship between (male) physicians and (female) patients of a particular class because its application demanded increased physical closeness, and therefore was seen as undesirable and transgressive. As Claudia Huerkamp notes, it took a long time to establish a specific ‘medical culture’ in which the physical examination of female parts by a male physician was not perceived as breaking a taboo (1989, 67).

In other instances, the use of the speculum and the unprecedented access it provided to women’s anatomy mirrored existing power structures. The first uses of the speculum were justified in reference to and tested on the most vulnerable members of society. Deirdre Cooper Owens (2017) has demonstrated that in the U.S., racist arguments helped to defend the speculum’s application and experimentation on black, enslaved women as they were deemed to have a particularly ‘robust’ constitution, high tolerance of pain, and so on. Medical men such as James Marion Sims, who by his own account was the inventor of the speculum, combined his privileged access to enslaved women’s bodies with intrusive forms of examination in order to gain new knowledge crucial for the emerging field of gynaecology. This was also true for Irish immigrants in the U.S. (Owens 2017) and in the case of prostitutes in France and Germany, where the speculum was used as an instrument of the medical police (Moscucci 1990, 112). Prostitutes were screened using this new instrumentation as supposed carriers of venereal disease, whereas male clients did not need to undergo any screening. This highlights how intrusion into the body in the name of more accurate examination was frequently bound up with power and control, especially of marginalized groups.

Even as the seat of disease became increasingly associated with specific locations inside the body, this coexisted with the notion that medicine could still be conducted ‘at a distance.’ The example of the telephone demonstrates how tele-instruments worked alongside close examination devices that adhered to the principle of disease as located in particular interior body parts. In fact, the potentiality of the telephone for the medical profession was apparent from its invention in 1876; 4  as Michael Kay notes, the first inter-connected users were doctors, pharmacists, hospitals and infirmaries (2012). Practitioners used the technology, which enabled the clear transmission and reproduction of complex sounds for the first time, to improve existing instruments, or to devise entirely new examination methods. For instance, in November 1879, the Lancet published the case of an American doctor who, when phoned in the middle of the night by a woman anxious about her granddaughter’s cough, asked for the child to be held up to the telephone so that he could hear it (Anon. 1879). A group of physicians predicted in 1880 that home telephones would allow a new specialty of long-distance practitioners to ‘each settle themselves down at the centre of a web of wires and auscult at indefinite distances from the patients,’ potentially replacing the traditional stethoscope (cited in Greene 2016, 306). The telephone was also lauded for its potential to uncover foreign objects lodged in patients’ bodies, for example by acting as a metal detector (see Kay 2012). In line with the belief that a ‘good examination’ required a physician having access to the body’s interior in order to discover the seat of disease according to the localisation principle, the telephone was seen as an extension of the doctor’s ear that could improve examination and diagnosis.

In this context, reactions to the increased physical distance between physician and patient varied. The benefits of using a telephone instead of the more traditional speaking tube, which allowed breath to pass from one speaker to another, when communicating with patients with contagious diseases were recognised very early (Aronson 1977, 73). A testimonial letter, written by the Lady Superintendent at the Manchester Hospital for Sick Children in 1879, stated: ‘[The recently installed telephone] is of the greatest value in connection with the Fever Ward, enabling me to always be in communication without risk of infection’ (cited in Kay 2012). Yet some physicians worried that telephone technology had effectively ‘shrunk’ perceived social distance between them and the working classes, making them liable to be overly contacted by the general public. As one doctor complained in the Lancet in 1883: ‘[a]s if the Telegraph and the Post Office did not sufficiently invade and molest our leisure, it is now proposed to medical men that they should become subscribers to the Telephone Company, and so lay themselves open to communications from all quarters and at all times. […] The only fear we have is that when people can open up a conversation with us for a penny, they will be apt to abuse the privilege […] ’ (cited in Kay 2012) . Not only were doctors concerned about the telephone invading their ‘leisure,’ they worried that they might be overrun by the public, and their medical expertise would be needlessly exploited. Because of the inherent fear of doctors that an excessively frequent use of the telephone could flatten the social order and their standing within society, it is not surprising that the public use of the telephone came under critical medical scrutiny. This is visible in the way that telephones themselves came to be seen as seats of infection. At the end of the nineteenth century when most telephones were for public use (Fischer 1992), the British Medical Journal cautioned there was a need to curtail ‘the promiscuous use of the mouth-pieces of public telephones’ (Anon. 1887, 166). In general, the use of the telephone was informed by insights from bacteriology, which transformed individual disease ‘into a public health event affecting communities and nations’ (Koch 2011, 2), and placed new emphasis on the need to keep potentially infectious bodies as well as social classes at clear distance from one another (see Peckham 2015).

In relation to the pitfalls of today’s telemedicine and the fundamental questions of physical distance and emotional rapprochement in the medical encounter, these historical findings demonstrate that what was perceived as the ‘normal’ setting and procedure of medical examination could change remarkably within a rather short time. Before the nineteenth century, close physical examination generally played a less prominent role while patients’ illness accounts had a greater weight in the medical encounter. Indeed, in some contexts physical distance was seen as the prerogative of good medical practice. Post-1800, by contrast, is characterized by the standardisation of physical close examination, but also by the introduction of new technologies into the patient-physician relationship that themselves challenged socially-accepted degrees of physical closeness. However, this does not necessarily mean that such technologies disturbed a former unbroken bond, rather, various technologies became players in the game and could (or not) be appropriated by patients and doctors alike. Technology did not simply affect the physician-patient relationship, rather, existing societal and moral understandings influenced how technologies came into being and how they were used (Peckham 2015, 153). Our historical examples suggest that rather than seeing telemedicine as something fundamentally new and potentially threatening because it seemingly undermines a personal relationship, it may be more useful to acknowledge that technologies and cultural understandings always govern the degree of physical closeness and distance in medical encounters, and that this has had manifold implications for the emotional doctor-patient bond. The success of telepsychotherapy during the Covid-19 pandemic is perhaps a case in point. Even as it is unique among medical specialities because of the extent to which it considers the human relationship as fundamental for healing, psychotherapy via phone or video link has increased dramatically during the public health crisis, and also had good results (Békés and Aafjes-van Doorn 2020). This points not only to how physician-patient closeness and emotional understanding can exist in times of physical distance, but also to the constantly variable ways in which both the cultural imagination and experience of distance manifest themselves (Kolkenbrock 2020).

Self-treatment: do-it-yourself medical devices and the expert patient

The third field of digital medicine that we would like to put into historical perspective is one of the fastest growing fields of eHealth, namely do-it-yourself (DIY) health technologies. Such technologies broadly refer to the mobile devices that ‘now allow consumers to diagnose and treat their own medical conditions without the presence of a health professional’ (Greene 2016, 306). Silicon Valley firms sell ‘disintermediation,’ that is the possibility of cutting out middlemen – physicians – and allowing consumers to better control their health via their devices (Eysenbach 2007). Significant private investments have been driving these changes which, in the forms of smart devices and wearable technologies, often imply purchasing a product (e.g. a smartphone) and related applications and tools (see Greene 2016; Matshazi 2019). The website Digital Trends 2019 ranking of ‘the 10 best health apps’ range from Fitocracy, a running app that allows you to track your progress and that promises a fitness experience with a ‘robust community of like-minded individuals’, to Carbs that transfers the meals you have eaten into charts of calories, to Fitbit Coach that promises you the experience of having a personal trainer on your smartphone (de Looper 2019). 5 Health systems have bought on and increasingly ask patients to observe and monitor themselves with the help of these technologies, and in some cases, the use of apps to measure blood pressure, pulse and body weight such as Amicomed and Beurer HealthManager are closely connected to the possibilities of sharing one’s data remotely with a physician. In terms of reception, the delegation of tasks to digital devices is associated with patients having new options and new knowledge of their own health. In the estimation of one hospital CEO, this dramatic ‘democratization’ of technology and of knowledge signals ‘a true coming of age of the patient at the centre of the healthcare universe’ (Rosenberg 2019). In the words of chronic patient and patients’ rights advocate Michael Mittleman, while there may be benefits for patients when technologies take over certain tasks that were previously the prerogative of physicians, such technologies nevertheless pose a fundamental challenge to the ‘golden bond’ that previously characterized the patient physician-relationship, for example in the age of the house call (conversation with the author, 2019). It is clear from these statements that DIY devices – because they suggest that the more beneficial relationship is that between the patient/consumer and his/her devices – challenge previous assumptions about the inherent value of the physician-patient relationship as well as the balance of power between those two actors (see Obermeyer and Emmanuel 2016).

Both the notion that patients inherently benefit from circumventing physicians and taking their health into their own hands, as well as the idea of a close, almost familial bond that characterized the physician-patient relationship prior to contemporary DIY practices can be nuanced if we acknowledge that do-it-yourself medical practices have a long and varied history. As Roy Porter has noted, in the eighteenth-century, ‘ordinary people mainly treated themselves, at least in the first instance[,] “medicine without doctors” [was] a necessity for many and a preference for some’ (1999, 281). Only in the nineteenth-century did the medical profession establish a monopoly in health care and have the official power to determine what was ‘health’ and ‘sickness’. In the previous centuries, local and pluralistic ‘medical markets’ embraced far more providers of health services and their varied tools, including barbers, surgeons, quacks and charlatans, so that patients chose among the options that most convinced them or that were affordable to them (Ritzmann 2013, 418). But patients also had the option to help and treat themselves using the means at their disposal – Fissell argues that a person who fell ill in 1500 and still in 1800 almost always first sought medical treatment in a domestic context: ‘[h]e or she relied upon his or her own medical knowledge of healing plants and procedures, consulted manuscript or printed health guides, and asked family, neighbors, and friends for advice’ (2012, 533). As Fissell points out, the enormous diffusion and importance of self-therapy at the time meant that the ‘boundary between patients and practitioners was hard to pin down’ (534). While current depictions of an idealised interaction between physician and patient assume a physician who through his/her knowledge examines, advises and treats the non-knowing patient, history shows that the presumed boundaries between the expert and lay person are far more blurred than is usually assumed.

The presumed novelty of a de-centralised market for DIY devices that potentially threatens the dual relationship between physicians and patients can be put into perspective when considering historical examples. Due to a fairly unregulated medical market in the early modern period, competition was high and the business of medicinal recipes lucrative. In this context, profit-motivated apothecaries benefited from offering new recipes made from exotic products: as of the fifteenth century European pharmacies stocked many wares with medicinal properties – including spices, elements such as sulphur, and plants, for examplemastic and sundew – and these were bought by people who gathered and dealt in medicinal plants (or ‘simples’) and other apothecaries, who made them into medicines. In the wake of the European voyages of discovery, the range of products became ever wider and more expensive, and apothecaries were a very profitable business branch for a long time (Ehrlich 2007, 51-55). King and Weaver have used evidence from remedy books in eighteenth-century England to show how families purchased recipes for remedies, and resold both the recipes and the medicines they brewed to other local people (2000, 195). Until the nineteenth century the medical market flourished and was accessible and lucrative for many participants, while the demand for ‘medical’ services was high, particularly in towns and cities. Access to the technologies of healing – whether domestic medical guides or healing herbs – allowed patients to control their health and treatments according to a wide range of scientific explanations. In contrast to other European countries that meanwhile had developed some restrictions for apothecaries and their suppliers, in Britain the market-place was remarkably varied in the light of the free-market principle caveat emptor (let the buyer beware). ‘In English conditions,’ wrote Porter, ‘irregulars, quacks and nostrum-mongers seized the opportunities a hungry market offered’ (1995, 460). In these conditions of market-oriented healing, both patients and healers alike believed, sometimes fervently, in the effectiveness of the remedies on offer. Moreover, the network of relationships in which such transactions took place was remarkably fluid, with patients using the services of several health professionals in succession or simultaneously.

In the following centuries, medical practice and science would change dramatically due to the rise of academic training as a prerequisite to enter the medical profession, a development seen across Europe, as well as the integration of physicians into national health agendas. A growing belief in science and a paternalistic ideal of the academic physician attributed to him the sole power over medical practice and technologies. It became more difficult for other healers to participate in the health market, and the knowledge of the self-treating patient was diminished as well. As part of the attempt to counteract competition from non-educated or apprenticed healers, in the United Kingdom only registered doctors could hold various public posts, such as public vaccinator, medical officer and the like (Bynum 2006, 214). Yet ‘alternative’ medicine, a term that contained all those healers not licenced and accepted by the respective medical registers, continued to satisfy patients’ needs, although to a lesser extent. In Weindling’s assessment of the prospects of university-educated physicians to attract clients in nineteenth-century Berlin, ‘[f]ierce competition from a range of unorthodox practitioners must be assumed’ (1987, 398). The popularity of hydropathic doctors and water cures, mud-bathing and vegetarianism are but some examples of how alternative medicines co-existed alongside official ones and were increasingly popular treatments even though they did not meet the contemporary academic criteria of standards regarding safety and efficacy (Ko 2016). Thus patients often looked beyond qualified physicians to other practitioners, and their own sensibilities played a considerable role in which relationships they chose to develop.

A look into twentieth-century history shows that DIY practices were integrated into official medicine as well (Timmermann 2010; Falk 2018). The significant rise of chronic diseases and life-long treatment, for instance, required the co-operation of patients in the form of self-tracking and observation of their bodies since it could not be done by medical experts alone. In the first decades of the twentieth century, DIY methods and technologies for measuring blood pressure or sugar became particularly vital, transforming the roles of ‘patient’ and ‘doctor’ and relationship between them. Examining the history of self-measuring blood pressure, Eberhard Wolff notes that patients doing so in the 1930s required both patience and training, and also were pushed into a more active and participatory role during medical treatment: it was not the doctor anymore but the patient who produced and controlled relevant data that were decisive for further medical decisions and treatment (2014, 2018). With the rise of the risk factor model in mid-twentieth century – the identification of factors in patient’s behaviour and habits that were suspected of contributing to the development of a chronic disease – DIY practices grew ever more important and so did its technologies. From this moment, the idea of preventing disease shifted towards individual, possibly damaging behaviours such as smoking and diet that could trigger a number of different diseases. As a consequence, the patient received more responsibility in order to live up to the new credo of maintaining his or her personal health (Lengwiler and Madarász 2010). Optimizing a personal healthy life style hence did not necessarily occur in direct consultation with a doctor but rather in conjunction with health products available on the market. In the words of sociologist Nikolas Rose, in the course of the twentieth century:

[t]he very idea of health was re-figured – the will to health would not merely seek the avoidance of sickness or premature death, but would encode an optimization of one’s corporeality to embrace a kind of overall “well-being” … It was this enlarged will to health that was amplified and instrumentalized by new strategies of advertising and marketing in the rapidly growing consumer market for health (2001, 17-18).

According to Rose, by such developments, ‘selfhood has become intrinsically somatic – ethical practices increasingly take the body as a key site for work on the self’ (18). But he also argues that by linking our well-being to the quality of our individual biology we have not become passive in the face of our biological fate. On the contrary, biological identity has become ‘bound up with more general norms of enterprising, self actualizing, responsible personhood’ (18-19). By considering ourselves responsible for our own biology as key to our health, we have come to depend on ‘professionals of vitality’ (22) whether they be purveyors of DIY devices, genetic counsellors, drug companies or doctors.

With respect to contemporary debates over DIY practices, some have argued that they allow both doctors and patients to be ‘experts’ and call for ‘a relationship of interactive partnership,’ not only because patients today are often informed but also because ideally they know best their own bodies and ailments (Kennedy 2003). Against this idealising assessment, the historical perspective makes us aware that while self-help and self-treatment have been an important dimension of past medical cultures, it appears that historically, patients have not relied as much on a face-to-face empathetic encounter with any one physician as today’s debates suggest. Moreover, today as in the past, the mere existence of markets for medical devices influences how consumers/patients decide whether to resist or embrace the various possibilities of self-treatment as well as their relationships with those who provide it. As Porter has argued, purveyors of ‘alternative’ medicines rationalised their therapeutic effects in ways that differed from official scientific methods and using arguments that likewise changed over time. Depending on the perspective of whose model of evidence users deemed most credible, the co-existence of diverse models for practicing medicine must be assumed throughout history and despite nineteenth-centuries attempts to eliminate unorthodox medicines (Timmermann 2010). The result was a diverse network of fast-changing relationships in which no single one was ascribed the ultimate power to heal. Reflecting on this history, historian of medicine and physician Jeremy Greene has stated that contemporary DIY devices therefore appear ‘neither wholly new nor wholly liberating’ (2016, 308). Our analysis corroborates Greene’s, in that it shows how those who use new DIY technologies may free themselves from their traditional relationship of dependence on physicians, while also creating new relationships with those actors who produce apps or conduct marketing. Yet our study also suggests that there is no one ethical conclusion about whether DIY or physician-dominated care is a better way of living up to a more humane medicine. Ethical arguments and the grounds on which we are supposed to resolve them are complex and variable. As seen in these historical examples, they have changed profoundly over time with each technology and medical concept challenging and refashioning the doctor-patient bond anew. Furthermore, there is no such thing as a ‘timeless’ doctor’s healing presence, or even medical expertise, or an ill person/patient. As shown above, as health and illness are defined, redefined and challenged throughout history, this process creates both expert and patient, as well as shapes the relationship between them.

An oft-heard concern about ‘computerization’ in medicine is that digital objects are changing human interactions. While various representatives from the tech side are optimistic about the effects of increasingly dynamic and intelligent objects in the medical encounter, some patients and physicians are more skeptical and see their social relationships as disturbed by new technologies. ‘Doctors don’t talk to patients’ is the most common complaint the CEO at a Montreal hospital recounted hearing from current patients (conversation between the author and Lawrence Rosenberg, 2019). Fears that increasing digitization of medicine will disturb the relationship that can potentially make the patient ‘whole’ again are not without foundation (King 2020). However, without a clear baseline for assessing changes we have limited scope for drawing conclusions about present day realities or long-term trends. Given the appeal of using the past to suggest a more ‘human’ but lost era of medical practice, a less nostalgic but more sophisticated understanding of the past as provided by historical research would serve us well. In this sense, history can counteract a characteristically modern myopia, namely, as intellectual historian Teresa Bejan has put it, our ‘endearing but frustrating tendency to view every development in public life as if it were happening for the first time’ (2017, 19).

As we saw in the examples dealing with record keeping, examining and self-treatment, trends that consider the patient as an object – a diseased lung, or a malfunctioning heart valve – and the concomitant use of technologies to record, examine and treat physical symptoms were necessarily in tension with patients’ own accounts of how they became ill and of the symptoms they experienced. In fact, concerns about the loss of meaningful personal contact in the medical encounter are incomprehensible without reference to a historical trend dating back to the beginning of the nineteenth century which seems to undermine the patient’s perspective by focusing on increasingly specialised processes within the body. Yet neither before nor after that time is there an unmediated patient’s voice that we are able to recover: the medical record as historical source has its own distinct material history, and patients’ expectations were always bound up with broader societal views about acceptable standards of healing. The historical perspective also shows that we should not take for granted the linear narrative of the technological as adverse to human relations and reducing empathetic understanding in the medical encounter – to paraphrase Lauren Kassell, the digital is not just the enemy of the human (2016, 128). Rather, it makes us aware that our understanding of the doctor-patient relationship and of its role in healing are themselves historically contingent. The idea of ‘a friendly, family doctor “being there”’ and the association of medicine with a ‘desirable clinical relationship’ (as opposed to e.g. perfect health) is an idea that has played out very differently in the course of history (Porter 1999, 670). There were times in which listening to patients was bound up with completely different expectations from both sides, and there were times in which physical examination was not seen as an indispensable part of medical practice. Moreover, while the monopoly of the physician in matters of health care and the focus on the (exclusive) healing potential of the clinical relationship is of relatively recent origin, we have seen that the popularity and economy of DIY devices has a much longer history, one that resists a linear account of DIY devices as something purely liberating. Hence, in contrast to idealised and simplified historical narratives that lament the loss of human relationships, more sophisticated accounts should acknowledge that medical objects and technologies are not the strange and disturbing ‘other’ in the medical encounter but rather integral players therein. As Frank Trentmann has put it, ‘things and humans are inseparably interwoven in mutually constitutive relationships’ (2009, 307). While the authors of a recent study suggest that ‘the traditional dyadic dynamics of the medical encounter has been altered into a triadic relationship by introducing the computer into the examination room’ (Assis-Hassid et al. 2015, 1), it seems more likely that the dyadic relationship has never existed.

Vanessa Rampton received funding from the Branco Weiss Fellowship – Society in Science.

1 We rely on a definition used by science and technology scholars whereby the term ‘technology’ operates on three levels (see Bijker, Hughes and Pinch 2012, xlii). First, there is the physical level, referring to tangible objects such as a smartphone, wellness band, or stethoscope. The second level of meaning concerns activities or processes, such as 3D printing or creating X-rays. The third level refers to knowledge people have in addition to what they do, for example the knowledge that underpins the conduct of a surgical procedure. This approach shows the extent to which specific tools and techniques, knowledge, and rationales for intervention are intricately bound together. Our use of the term ‘digital,’ that is involving computer technology, in relation to medicine ‘includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine’ (U.S. Food and Drug Administration).

2 As a rule, while systematic reviews of telemedicine generally portray it as effective as in-person consultation or promising, evidence is limited and fast-evolving (Ekeland, Bowes and Flottorp 2010; Kruse et al. 2017; Lee et al. 2017).

3 In Germany, legislators have reacted to these concerns by limiting video consultation to cases in which physician and patient have physically met before, and primarily using it for monitoring the course of disease, including chronic ones, or the healing of an injury (Heinrich 2017).

4 Scottish-born US inventor Alexander Graham Bell was the first to be awarded the U.S. patent for the invention of the telephone in 1876 (Fischer 1992).

5 Interestingly, and probably most important for their users, nine out of ten among the ranked apps are available as free downloads ( https://www.digitaltrends.com/mobile/best-health-apps/ , June 16, 2019).

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The Information Technology in Medicine Essay

Modern healthcare, being primarily focused on providing quality patient care, cannot exist apart from information technology. For this reason, medical employees are now obliged to learn how to beneficially use technology as well as practice proper communication with patients on the subject of its use in the process of treatment. The discipline, which will be analyzed in the course of the paper, is aimed at defining major tools necessary for providing quality healthcare to the community. Thus, the most significant insight acquired during the course is the high necessity of learning how to convey the importance of information technology to the patients in the simplest way possible.

To begin with, it is necessary to dwell upon the notions that should be processed by the students throughout the course. The subject’s primary goal was to introduce the most common technologies now used in healthcare and their significance to the sphere. Another part of the course was dedicated to the nuance of proper communication with patients using both technology and interpersonal communication.

Before the course enrollment, I considered information technology to be more of an arbitrary helping tool rather than part and parcel of medical practice. However, by the end of the course, I have discovered that the proper use of technology tools can potentially help save hundreds of human lives. Researchers claim that such tools as the Clinical Decision Support System (CDSS) prevent doctors from making false diagnoses due to cognitive overload (Ancker et al., 2017). Besides helping medicals focus more on the treatment process, it is also a key tool for the precise statistical data, crucial for the further development of healthcare across the state.

Another crucial aspect obtained during the course is the ability to assess personal strengths and weaknesses when it comes to cooperation with information systems. As a result, I have discovered that my major strength is the ability to adapt to technology use quite quickly. This benefit also concerns almost all young specialists who are used to information technology from an early age. Such knowledge puts more adolescent specialists at a serious advantage in terms of healthcare system development. However, the skills of fast learning do not concern some patients who are to be educated on the use of technology tools during their treatment process.

According to the researchers, effective patient education is the key to successful treatment due to the patient’s willingness to collaborate (Jimenez & Lewis, 2018). Hence, I believe my major weakness to be the ability to communicate with patients in a way beneficial for their desire to be educated. Despite various already existing methods on patient education, there is still a strong need to develop further research on the topic in order to make it more productive.

In my opinion, the development of healthcare informatics is now rapidly moving towards its zenith due to the beneficial environment. The strategies of further researches are now being planned for the next decades. However, automatized systems of clinical history have introduced the issue of privacy for both patients and medical employees (Iyengar et al., 2018). For this reason, I believe sustaining privacy while maintaining technological advancements in the medical sphere to be one of the most significant topics for further investigation. Moreover, the field of healthcare informatics develops too fast for educators to adapt to the process.

As a result, many specialized educational establishments fail to provide proper students’ preparation on the subject (Ashrafi et al., 2019). Hence, another subject of further investigation should be the methods in which students could be informed of the information technologies used in the field.

Speaking of my personal evaluation of the competencies aligned to the course, the progress is definitely visible by the end of the course, but there are still a lot of details requiring reconsideration. My understanding of the outlines introduced in the course syllabus, including the ability to analyze major programs and methods of computer-human interaction critically is clear and exhaustive. However, in order to maintain the obtained knowledge and skills, there should be more practical tasks, which may help build on the progress. The most valuable output I realized throughout the course is the fact that subjects concerning medicine and technology require constant and comprehensive learning in order to remain relevant in the field.

Taking everything into consideration, it may be concluded that the course of healthcare informatics is an integral part of medical education in the context of the 21st century. In the following reflection of the course, some of its major constituents and outputs were introduced and analyzed. When it comes to personal knowledge and skills gained, the most significant discoveries are the necessity to continually improve on the subject in order to realize how to convey the information to the patients. Even the most advanced technology may be of no help if the patients are not willing to collaborate. Further research on the subject includes more methods for patient education and examination of privacy maintenance.

Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., & Kaushal, R. (2017). Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC medical informatics and decision making , 17 (1), 36.

Ashrafi, N., Kuilboer, J. P., Joshi, C., Ran, I., & Pande, P. (2019). Health informatics in the classroom: An empirical study to investigate higher education’s response to healthcare transformation. Journal of Information Systems Education , 25 (4), 5.

Iyengar, A., Kundu, A., & Pallis, G. (2018). Healthcare informatics and privacy. IEEE Internet Computing , 22 (2), 29-31.

Jimenez, Y. A., & Lewis, S. J. (2018). Radiation therapy patient education using VERT: a combination of technology with human care. Journal of medical radiation sciences , 65 (2), 158-162.

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Medical Technology Essays Examples

Type of paper: Essay

Topic: Health , Aging , Treatment , Life , Community , Nursing , Medicine , Technology

Published: 04/27/2021

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The major problem that normally affects the community we leave in and to solve this kind of a problem, one has to get a way of solving the problem. Many old aged people are believed to be diminishing within the community due to lack of proper medical care as per the initial means of administering the treatment to the patients.

They also lack adequate care from the close relatives and this makes their lives to be in jeopardy. But with the emergence of the technology in the field medicine, there are improved methods of administering treatment to the patients. There are machines used in ensuring that there is adequate and efficient way of administering treatment which subsequently enable their lives to be saved.

Technology has been a major boast in every sector without the consideration of the age bracket of the individual involved. With the considerably developing number of aging persons around the world and most importantly the developed world, the demand for enough health and social attention shall have gained momentum. Health and social service providers must formulate policies and programs granting the elderly to head rich and autonomous lives for as long as potential.

As in the case of the advancement in age-related illnesses are made, the elderly will definitely live longer and lead more dynamic and accomplishing the demands of their lives. The Society, governments and those demanded in the care of the older must conform to the new disputes of this aging population in a humane and respectful way.

Those with the responsibility of caring for the aged group must be sensitive to them and aware of the particular indications and dangers of medications. Health care providers must carefully and routinely monitor the use of all medications, including ethical drug prescriptions and proprietary means of administering treatment.

For the aged group, they are more susceptible to sickness as compared to the younger generation. They get attacked by the common diseases like mild malaria and other common diseases like the high blood pressure since they have inadequate defense mechanism. They make them prone to attack and in turn make them life more susceptible to illnesses. This may make them get admitted to the medical center for more advanced treatment.

In such places, they may be put under some medical conditions with an aim of improving their live conditions and hence prolonged life. Like in the case of a patient with the breathing problem, he or she can be put under medication with the aid of a breathing gadget which will enable the patient to gain more energy will promote quick recovery.

The medical technology has many advantages in relation to the aging group in that they will be able to get more attention since they normally have inadequate care from the closest family members. With the aide of the new advanced technology in the hospitals, the patient can be able to receive treatment without the help of the care taker since some of the machines are automatic in operation. They can operate in the absence of the human intervention and give accurate results as required by the medical practitioner.

The machines normally come with numerous benefits to the aging group like the case of the inpatient patients. In the case of saving the lives of the aging group, the machines are to substitute the human labor which is also convenient but very slow in operation. With respect to the topic I chose, the use of machines for the purpose of saving lives is very vital and will enhance the possibility of saving lives.

Medical technology is a broad field with vast advantages in the current medical field and this has helped in achieving the vision for the developing nation and those of the developed nations in increasing the living conditions and the age bracket for the old age. This helps in increasing their chances of living. The machines can be used to help elevate lives of the aging group by ensuring that they have adequate time still to live.

In conclusion, medical technology helps in enhancing the living standards of the aging group. In case the patient is in a coma, it is always the application of technology that helps to rescue the lives of the patient. The patient will at some points be put under the aide of breathing equipment that will enable them to recover from the complications they could be undergoing through.

Morgan, Leslie A, and Suzanne Kunkel. Aging, Society and the Life Course. New York: Springer, 2007. Internet resource. Hackler, Chris. Health Care for an Aging Population. Albany, NY: State Univ. of New York Press, 1994. Print. Maguire, Maria. Ageing Populations: The Social Policy Implications. Paris: Organisation for Economic Co-operation and Development, 1988. Print. Vos, Rob, José A. Ocampo, and Ana L. Cortez. Ageing and Development. London: Zed, 2008. Print.

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Essay on the Impact of Technology on Health Care

Technology has grown to become an integral part of health. Healthcare organizations in different parts of the world are using technology to monitor their patients’ progress while others are using technology to store patients’ data (Bonato 37). Patient outcomes have improved due to technology, and health organizations that sought profits have significantly increased their income because of technology. It is no doubt that technology has influenced medical services in varied ways. Therefore, it would be fair to conclude that technology has positively affected healthcare.

First, technology has improved access to medical information and data (Mettler 33). One of the most significant advantages triggered by technology is the ability to store and access patient data. Medical professionals can now track patients’ progress by retrieving data from anywhere. At the same time, the internet has allowed doctors to share medical information rapidly amongst themselves, an instance that leads to more efficient patient care.

Second, technology has allowed clinicians to gather big data in a limited time (Chen et al. 72). Digital technology allows instant data collection for professionals engaged in epidemiological studies, clinical trials, and those in research. The collection of data, in this case, allows for meta-analysis and permits healthcare organizations to stay on top of cutting edge technological trends.

In addition to allowing quick access to medical data and big data technology has improved medical communication (Free et al. 54). Communication is a critical part of healthcare; nurses and doctors must communicate in real-time, and technology allows this instance to happen. Also, healthcare professionals can today make their videos, webinars and use online platforms to communicate with other professionals in different parts of the globe.

Technology has revolutionized how health care services are rendered. But apart from improving healthcare, critics argue that technology has increased or added extra jobs for medical professionals (de Belvis et al. 11). Physicians need to have excellent clinical skills and knowledge of the human body. Today, they are forced to have knowledge of both the human body and technology, which makes it challenging for others. Technology has also improved access to data, and this has allowed physicians to study and understand patients’ medical history. Nevertheless, these instances have opened doors to unethical activities such as computer hacking (de Belvis et al. 13). Today patients risk losing their medical information, including their social security numbers, address and other critical information.

Despite the improvements that have come with adopting technology, there is always the possibility that digital technological gadgets might fail. If makers of a given technology do not have a sustainable business process or a good track record, their technologies might fail. Many people, including patients and doctors who solely rely on technology, might be affected when it does. Apart from equipment failure, technology has created the space for laziness within hospitals.

Doctors and patients heavily rely on medical technology for problem-solving. In like manner, medical technologies that use machine learning have removed decision-making in different hospitals; today, medical tools are solving people’s problems. Technology has been great for our hospitals, but the speed at which different hospitals are adapting to technological processes is alarming. Technology often fails, and when it does, health care may be significantly affected. Doctors and patients who use technology may be forced to go back to traditional methods of health care services.

Bonato, P. “Advances in Wearable Technology and Its Medical Applications.”  2010 Annual International Conference of The IEEE Engineering in Medicine and Biology , 2010, pp. 33-45.

Chen, Min et al. “Disease Prediction by Machine Learning Over Big Data from Healthcare Communities.”  IEEE Access , vol. 5, 2017, pp. 69-79.

De Belvis, Antonio Giulio et al. “The Financial Crisis in Italy: Implications for The Healthcare Sector.”  Health Policy , vol. 106, no. 1, 2012, pp. 10-16.

Free, Caroline et al. “The Effectiveness of M-Health Technologies for Improving Health and Health Services: A Systematic Review Protocol.”  BMC Research Notes , vol. 3, no. 1, 2010, pp. 42-78.

Mettler, Matthias. “Blockchain Technology in Healthcare: The Revolution Starts Here.”  2016 IEEE 18Th International Conference On E-Health Networking, Applications and Services (Healthcom) , 2016, pp. 23-78.

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10 Successful Medical School Essays

Sponsored by.

-- Accepted to: Harvard Medical School GPA: 4.0 MCAT: 522

Sponsored by A ccepted.com : Great stats don’t assure acceptance to elite medical schools. The personal statement, most meaningful activities, activity descriptions, secondaries and interviews can determine acceptance or rejection. Since 1994, Accepted.com has guided medical applicants just like you to present compelling medical school applications. Get Accepted !

I started writing in 8th grade when a friend showed me her poetry about self-discovery and finding a voice. I was captivated by the way she used language to bring her experiences to life. We began writing together in our free time, trying to better understand ourselves by putting a pen to paper and attempting to paint a picture with words. I felt my style shift over time as I grappled with challenges that seemed to defy language. My poems became unstructured narratives, where I would use stories of events happening around me to convey my thoughts and emotions. In one of my earliest pieces, I wrote about a local boy’s suicide to try to better understand my visceral response. I discussed my frustration with the teenage social hierarchy, reflecting upon my social interactions while exploring the harms of peer pressure.

In college, as I continued to experiment with this narrative form, I discovered medical narratives. I have read everything from Manheimer’s Bellevue to Gawande’s Checklist and from Nuland’s observations about the way we die, to Kalanithi’s struggle with his own decline. I even experimented with this approach recently, writing a piece about my grandfather’s emphysema. Writing allowed me to move beyond the content of our relationship and attempt to investigate the ways time and youth distort our memories of the ones we love. I have augmented these narrative excursions with a clinical bioethics internship. In working with an interdisciplinary team of ethics consultants, I have learned by doing by participating in care team meetings, synthesizing discussions and paths forward in patient charts, and contributing to an ongoing legislative debate addressing the challenges of end of life care. I have also seen the ways ineffective intra-team communication and inter-personal conflicts of beliefs can compromise patient care.

Writing allowed me to move beyond the content of our relationship and attempt to investigate the ways time and youth distort our memories of the ones we love.

By assessing these difficult situations from all relevant perspectives and working to integrate the knowledge I’ve gained from exploring narratives, I have begun to reflect upon the impact the humanities can have on medical care. In a world that has become increasingly data driven, where patients can so easily devolve into lists of numbers and be forced into algorithmic boxes in search of an exact diagnosis, my synergistic narrative and bioethical backgrounds have taught me the importance of considering the many dimensions of the human condition. I am driven to become a physician who deeply considers a patient’s goal of care and goals of life. I want to learn to build and lead patient care teams that are oriented toward fulfilling these goals, creating an environment where family and clinician conflict can be addressed efficiently and respectfully. Above all, I look forward to using these approaches to keep the person beneath my patients in focus at each stage of my medical training, as I begin the task of translating complex basic science into excellent clinical care.

In her essay for medical school, Morgan pitches herself as a future physician with an interdisciplinary approach, given her appreciation of how the humanities can enable her to better understand her patients. Her narrative takes the form of an origin story, showing how a childhood interest in poetry grew into a larger mindset to keep a patient’s humanity at the center of her approach to clinical care.

This narrative distinguishes Morgan as a candidate for medical school effectively, as she provides specific examples of how her passions intersect with medicine. She first discusses how she used poetry to process her emotional response to a local boy’s suicide and ties in concern about teenage mental health. Then, she discusses more philosophical questions she encountered through reading medical narratives, which demonstrates her direct interest in applying writing and the humanities to medicine. By making the connection from this larger theme to her own reflections on her grandfather, Morgan provides a personal insight that will give an admissions officer a window into her character. This demonstrates her empathy for her future patients and commitment to their care.

Her narrative takes the form of an origin story, showing how a childhood interest in poetry grew into a larger mindset to keep a patient's humanity at the center of her approach to clinical care.

Furthermore, it is important to note that Morgan’s essay does not repeat anything in-depth that would otherwise be on her resume. She makes a reference to her work in care team meetings through a clinical bioethics internship, but does not focus on this because there are other places on her application where this internship can be discussed. Instead, she offers a more reflection-based perspective on the internship that goes more in-depth than a resume or CV could. This enables her to explain the reasons for interdisciplinary approach to medicine with tangible examples that range from personal to professional experiences — an approach that presents her as a well-rounded candidate for medical school.

Disclaimer: With exception of the removal of identifying details, essays are reproduced as originally submitted in applications; any errors in submissions are maintained to preserve the integrity of the piece. The Crimson's news and opinion teams—including writers, editors, photographers, and designers—were not involved in the production of this article.

-- Accepted To: A medical school in New Jersey with a 3% acceptance rate. GPA: 3.80 MCAT: 502 and 504

Sponsored by E fiie Consulting Group : “ EFIIE ” boasts 100% match rate for all premedical and predental registered students. Not all students are accepted unto their pre-health student roster. Considered the most elite in the industry and assists from start to end – premed to residency. EFIIE is a one-stop-full-service education firm.

"To know even one life has breathed easier because you have lived. This is to have succeeded." – Ralph Waldo Emerson.

The tribulations I've overcome in my life have manifested in the compassion, curiosity, and courage that is embedded in my personality. Even a horrific mishap in my life has not changed my core beliefs and has only added fuel to my intense desire to become a doctor. My extensive service at an animal hospital, a harrowing personal experience, and volunteering as an EMT have increased my appreciation and admiration for the medical field.

At thirteen, I accompanied my father to the Park Home Animal Hospital with our eleven-year-old dog, Brendan. He was experiencing severe pain due to an osteosarcoma, which ultimately led to the difficult decision to put him to sleep. That experience brought to light many questions regarding the idea of what constitutes a "quality of life" for an animal and what importance "dignity" plays to an animal and how that differs from owner to owner and pet to pet. Noting my curiosity and my relative maturity in the matter, the owner of the animal hospital invited me to shadow the professional staff. Ten years later, I am still part of the team, having made the transition from volunteer to veterinarian technician. Saving a life, relieving pain, sharing in the euphoria of animal and owner reuniting after a procedure, to understanding the emotions of losing a loved one – my life was forever altered from the moment I stepped into that animal hospital.

As my appreciation for medical professionals continued to grow, a horrible accident created an indelible moment in my life. It was a warm summer day as I jumped onto a small boat captained by my grandfather. He was on his way to refill the boat's gas tank at the local marina, and as he pulled into the dock, I proceeded to make a dire mistake. As the line was thrown from the dock, I attempted to cleat the bowline prematurely, and some of the most intense pain I've ever felt in my life ensued.

Saving a life, relieving pain, sharing in the euphoria of animal and owner reuniting after a procedure, to understanding the emotions of losing a loved one – my life was forever altered from the moment I stepped into that animal hospital.

"Call 911!" I screamed, half-dazed as I witnessed blood gushing out of my open wounds, splashing onto the white fiberglass deck of the boat, forming a small puddle beneath my feet. I was instructed to raise my hand to reduce the bleeding, while someone wrapped an icy towel around the wound. The EMTs arrived shortly after and quickly drove me to an open field a short distance away, where a helicopter seemed to instantaneously appear.

The medevac landed on the roof of Stony Brook Hospital before I was expeditiously wheeled into the operating room for a seven-hour surgery to reattach my severed fingers. The distal phalanges of my 3rd and 4th fingers on my left hand had been torn off by the rope tightening on the cleat. I distinctly remember the chill from the cold metal table, the bright lights of the OR, and multiple doctors and nurses scurrying around. The skill and knowledge required to execute multiple skin graft surgeries were impressive and eye-opening. My shortened fingers often raise questions by others; however, they do not impair my self-confidence or physical abilities. The positive outcome of this trial was the realization of my intense desire to become a medical professional.

Despite being the patient, I was extremely impressed with the dedication, competence, and cohesiveness of the medical team. I felt proud to be a critical member of such a skilled group. To this day, I still cannot explain the dichotomy of experiencing being the patient, and concurrently one on the professional team, committed to saving the patient. Certainly, this experience was a defining part of my life and one of the key contributors to why I became an EMT and a volunteer member of the Sample Volunteer Ambulance Corps. The startling ring of the pager, whether it is to respond to an inebriated alcoholic who is emotionally distraught or to help bring breath to a pulseless person who has been pulled from the family swimming pool, I am committed to EMS. All of these events engender the same call to action and must be reacted to with the same seriousness, intensity, and magnanimity. It may be some routine matter or a dire emergency; this is a role filled with uncertainty and ambiguity, but that is how I choose to spend my days. My motives to become a physician are deeply seeded. They permeate my personality and emanate from my desire to respond to the needs of others. Through a traumatic personal event and my experiences as both a professional and volunteer, I have witnessed firsthand the power to heal the wounded and offer hope. Each person defines success in different ways. To know even one life has been improved by my actions affords me immense gratification and meaning. That is success to me and why I want to be a doctor.

This review is provided by EFIIE Consulting Group’s Pre-Health Senior Consultant Jude Chan

This student was a joy to work with — she was also the lowest MCAT profile I ever accepted onto my roster. At 504 on the second attempt (502 on her first) it would seem impossible and unlikely to most that she would be accepted into an allopathic medical school. Even for an osteopathic medical school this score could be too low. Additionally, the student’s GPA was considered competitive at 3.80, but it was from a lower ranked, less known college, so naturally most advisors would tell this student to go on and complete a master’s or postbaccalaureate program to show that she could manage upper level science classes. Further, she needed to retake the MCAT a third time.

However, I saw many other facets to this student’s history and life that spoke volumes about the type of student she was, and this was the positioning strategy I used for her file. Students who read her personal statement should know that acceptance is contingent on so much more than just an essay and MCAT score or GPA. Although many students have greater MCAT scores than 504 and higher GPAs than 3.80, I have helped students with lower scores and still maintained our 100% match rate. You are competing with thousands of candidates. Not every student out there requires our services and we are actually grateful that we can focus on a limited amount out of the tens of thousands that do. We are also here for the students who wish to focus on learning well the organic chemistry courses and physics courses and who want to focus on their research and shadowing opportunities rather than waste time deciphering the next step in this complex process. We tailor a pathway for each student dependent on their health care career goals, and our partnerships with non-profit organizations, hospitals, physicians and research labs allow our students to focus on what matters most — the building up of their basic science knowledge and their exposure to patients and patient care.

Students who read her personal statement should know that acceptance is contingent on so much more than just an essay and MCAT score or GPA.

Even students who believe that their struggle somehow disqualifies them from their dream career in health care can be redeemed if they are willing to work for it, just like this student with 502 and 504 MCAT scores. After our first consult, I saw a way to position her to still be accepted into an MD school in the US — I would not have recommended she register to our roster if I did not believe we could make a difference. Our rosters have a waitlist each semester, and it is in our best interest to be transparent with our students and protect our 100% record — something I consider a win-win. It is unethical to ever guarantee acceptance in admissions as we simply do not control these decisions. However, we respect it, play by the rules, and help our students stay one step ahead by creating an applicant profile that would be hard for the schools to ignore.

This may be the doctor I go to one day. Or the nurse or dentist my children or my grandchildren goes to one day. That is why it is much more than gaining acceptance — it is about properly matching the student to the best options for their education. Gaining an acceptance and being incapable of getting through the next 4 or 8 years (for my MD/PhD-MSTP students) is nonsensical.

-- Accepted To: Imperial College London UCAT Score: 2740 BMAT Score: 3.9, 5.4, 3.5A

My motivation to study Medicine stems from wishing to be a cog in the remarkable machine that is universal healthcare: a system which I saw first-hand when observing surgery in both the UK and Sri Lanka. Despite the differences in sanitation and technology, the universality of compassion became evident. When volunteering at OSCE training days, I spoke to many medical students, who emphasised the importance of a genuine interest in the sciences when studying Medicine. As such, I have kept myself informed of promising developments, such as the use of monoclonal antibodies in cancer therapy. After learning about the role of HeLa cells in the development of the polio vaccine in Biology, I read 'The Immortal Life of Henrietta Lacks' to find out more. Furthermore, I read that surface protein CD4 can be added to HeLa cells, allowing them to be infected with HIV, opening the possibility of these cells being used in HIV research to produce more life-changing drugs, such as pre-exposure prophylaxis (PreP). Following my BioGrad laboratory experience in HIV testing, and time collating data for research into inflammatory markers in lung cancer, I am also interested in pursuing a career in medical research. However, during a consultation between an ENT surgeon and a thyroid cancer patient, I learnt that practising medicine needs more than a scientific aptitude. As the surgeon explained that the cancer had metastasised to her liver, I watched him empathetically tailor his language for the patient - he avoided medical jargon and instead gave her time to come to terms with this. I have been developing my communication skills by volunteering weekly at care homes for 3 years, which has improved my ability to read body language and structure conversations to engage with the residents, most of whom have dementia.

However, during a consultation between an ENT surgeon and a thyroid cancer patient, I learnt that practising medicine needs more than a scientific aptitude.

Jude’s essay provides a very matter-of-fact account of their experience as a pre-medical student. However, they deepen this narrative by merging two distinct cultures through some common ground: a universality of compassion. Using clear, concise language and a logical succession of events — much like a doctor must follow when speaking to patients — Jude shows their motivation to go into the medical field.

From their OSCE training days to their school’s Science society, Jude connects their analytical perspective — learning about HeLa cells — to something that is relatable and human, such as a poor farmer’s notable contribution to science. This approach provides a gateway into their moral compass without having to explicitly state it, highlighting their fervent desire to learn how to interact and communicate with others when in a position of authority.

Using clear, concise language and a logical succession of events — much like a doctor must follow when speaking to patients — Jude shows their motivation to go into the medical field.

Jude’s closing paragraph reminds the reader of the similarities between two countries like the UK and Sri Lanka, and the importance of having a universal healthcare system that centers around the just and “world-class” treatment of patients. Overall, this essay showcases Jude’s personal initiative to continue to learn more and do better for the people they serve.

While the essay could have benefited from better transitions to weave Jude’s experiences into a personal story, its strong grounding in Jude’s motivation makes for a compelling application essay.

-- Accepted to: Weill Cornell Medical College GPA: 3.98 MCAT: 521

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Following the physician’s unexpected request, we waited outside, anxiously waiting to hear the latest update on my father’s condition. It was early on in my father’s cancer progression – a change that had shaken our entire way of life overnight. During those 18 months, while my mother spent countless nights at the hospital, I took on the responsibility of caring for my brother. My social life became of minimal concern, and the majority of my studying for upcoming 12th- grade exams was done at the hospital. We were allowed back into the room as the physician walked out, and my parents updated us on the situation. Though we were a tight-knit family and my father wanted us to be present throughout his treatment, what this physician did was give my father a choice. Without making assumptions about who my father wanted in the room, he empowered him to make that choice independently in private. It was this respect directed towards my father, the subsequent efforts at caring for him, and the personal relationship of understanding they formed, that made the largest impact on him. Though my decision to pursue medicine came more than a year later, I deeply valued what these physicians were doing for my father, and I aspired to make a similar impact on people in the future.

It was during this period that I became curious about the human body, as we began to learn physiology in more depth at school. In previous years, the problem-based approach I could take while learning math and chemistry were primarily what sparked my interest. However, I became intrigued by how molecular interactions translated into large-scale organ function, and how these organ systems integrated together to generate the extraordinary physiological functions we tend to under-appreciate. I began my undergraduate studies with the goal of pursuing these interests, whilst leaning towards a career in medicine. While I was surprised to find that there were upwards of 40 programs within the life sciences that I could pursue, it broadened my perspective and challenged me to explore my options within science and healthcare. I chose to study pathobiology and explore my interests through hospital volunteering and research at the end of my first year.

Though my decision to pursue medicine came more than a year later, I deeply valued what these physicians were doing for my father, and I aspired to make a similar impact on people in the future.

While conducting research at St. Michael’s Hospital, I began to understand methods of data collection and analysis, and the thought process of scientific inquiry. I became acquainted with the scientific literature, and the experience transformed how I thought about the concepts I was learning in lecture. However, what stood out to me that summer was the time spent shadowing my supervisor in the neurosurgery clinic. It was where I began to fully understand what life would be like as a physician, and where the career began to truly appeal to me. What appealed to me most was the patient-oriented collaboration and discussions between my supervisor and his fellow; the physician-patient relationship that went far beyond diagnoses and treatments; and the problem solving that I experienced first-hand while being questioned on disease cases.

The day spent shadowing in the clinic was also the first time I developed a relationship with a patient. We were instructed to administer the Montreal cognitive assessment (MoCA) test to patients as they awaited the neurosurgeon. My task was to convey the instructions as clearly as possible and score each section. I did this as best I could, adapting my explanation to each patient, and paying close attention to their responses to ensure I was understood. The last patient was a challenging case, given a language barrier combined with his severe hydrocephalus. It was an emotional time for his family, seeing their father/husband struggle to complete simple tasks and subsequently give up. I encouraged him to continue trying. But I also knew my words would not remedy the condition underlying his struggles. All I could do was make attempts at lightening the atmosphere as I got to know him and his family better. Hours later, as I saw his remarkable improvement following a lumbar puncture, and the joy on his and his family’s faces at his renewed ability to walk independently, I got a glimpse of how rewarding it would be to have the ability and privilege to care for such patients. By this point, I knew I wanted to commit to a life in medicine. Two years of weekly hospital volunteering have allowed me to make a small difference in patients’ lives by keeping them company through difficult times, and listening to their concerns while striving to help in the limited way that I could. I want to have the ability to provide care and treatment on a daily basis as a physician. Moreover, my hope is that the breadth of medicine will provide me with the opportunity to make an impact on a larger scale. Whilst attending conferences on neuroscience and surgical technology, I became aware of the potential to make a difference through healthcare, and I look forward to developing the skills necessary to do so through a Master’s in Global Health. Whether through research, health innovation, or public health, I hope not only to care for patients with the same compassion with which physicians cared for my father, but to add to the daily impact I can have by tackling large-scale issues in health.

Taylor’s essay offers both a straightforward, in-depth narrative and a deep analysis of his experiences, which effectively reveals his passion and willingness to learn in the medical field. The anecdote of Taylor’s father gives the reader insight into an original instance of learning through experience and clearly articulates Taylor’s motivations for becoming a compassionate and respectful physician.

Taylor strikes an impeccable balance between discussing his accomplishments and his character. All of his life experiences — and the difficult challenges he overcame — introduce the reader to an important aspect of Taylor’s personality: his compassion, care for his family, and power of observation in reflecting on the decisions his father’s doctor makes. His description of his time volunteering at St. Michael’s Hospital is indicative of Taylor’s curiosity about medical research, but also of his recognition of the importance of the patient-physician relationship. Moreover, he shows how his volunteer work enabled him to see how medicine goes “beyond diagnoses and treatments” — an observation that also speaks to his compassion.

His description of his time volunteering at St. Michael's Hospital is indicative of Taylor's curiosity about medical research, but also of his recognition of the importance of the patient-physician relationship.

Finally, Taylor also tells the reader about his ambition and purpose, which is important when thinking about applying to medical school. He discusses his hope of tackling larger scale problems through any means possible in medicine. This notion of using self interest to better the world is imperative to a successful college essay, and it is nicely done here.

-- Accepted to: Washington University

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Running has always been one of my greatest passions whether it be with friends or alone with my thoughts. My dad has always been my biggest role model and was the first to introduce me to the world of running. We entered races around the country, and one day he invited me on a run that changed my life forever. The St. Jude Run is an annual event that raises millions of dollars for St. Jude Children’s Research Hospital. My dad has led or our local team for as long as I can remember, and I had the privilege to join when I was 16. From the first step I knew this was the environment for me – people from all walks of life united with one goal of ending childhood cancer. I had an interest in medicine before the run, and with these experiences I began to consider oncology as a career. When this came up in conversations, I would invariably be faced with the question “Do you really think you could get used to working with dying kids?” My 16-year-old self responded with something noble but naïve like “It’s important work, so I’ll have to handle it”. I was 16 years young with my plan to become an oncologist at St. Jude.

As I transitioned into college my plans for oncology were alive and well. I began working in a biochemistry lab researching new anti-cancer drugs. It was a small start, but I was overjoyed to be a part of the process. I applied to work at a number of places for the summer, but the Pediatric Oncology Education program (POE) at St. Jude was my goal. One afternoon, I had just returned from class and there it was: an email listed as ‘POE Offer’. I was ecstatic and accepted the offer immediately. Finally, I could get a glimpse at what my future holds. My future PI, Dr. Q, specialized in solid tumor translational research and I couldn’t wait to get started.

I was 16 years young with my plan to become an oncologist at St. Jude.

Summer finally came, I moved to Memphis, and I was welcomed by the X lab. I loved translational research because the results are just around the corner from helping patients. We began a pre-clinical trial of a new chemotherapy regimen and the results were looking terrific. I was also able to accompany Dr. Q whenever she saw patients in the solid tumor division. Things started simple with rounds each morning before focusing on the higher risk cases. I was fortunate enough to get to know some of the patients quite well, and I could sometimes help them pass the time with a game or two on a slow afternoon between treatments. These experiences shined a very human light on a field I had previously seen only through a microscope in a lab.

I arrived one morning as usual, but Dr. Q pulled me aside before rounds. She said one of the patients we had been seeing passed away in the night. I held my composure in the moment, but I felt as though an anvil was crushing down on me. It was tragic but I knew loss was part of the job, so I told myself to push forward. A few days later, I had mostly come to terms with what happened, but then the anvil came crashing back down with the passing of another patient. I could scarcely hold back the tears this time. That moment, it didn’t matter how many miraculous successes were happening a few doors down. Nothing overshadowed the loss, and there was no way I could ‘get used to it’ as my younger self had hoped.

I was still carrying the weight of what had happened and it was showing, so I asked Dr. Q for help. How do you keep smiling each day? How do you get used to it? The questions in my head went on. What I heard next changed my perspective forever. She said you keep smiling because no matter what happened, you’re still hope for the next patient. It’s not about getting used to it. You never get used to it and you shouldn’t. Beating cancer takes lifetimes, and you can’t look passed a life’s worth of hardships. I realized that moving passed the loss of patients would never suffice, but I need to move forward with them. Through the successes and shortcomings, we constantly make progress. I like to imagine that in all our future endeavors, it is the hands of those who have gone before us that guide the way. That is why I want to attend medical school and become a physician. We may never end the sting of loss, but physicians are the bridge between the past and the future. No where else is there the chance to learn from tragedy and use that to shape a better future. If I can learn something from one loss, keep moving forward, and use that knowledge to help even a single person – save one life, bring a moment of joy, avoid a moment of pain—then that is how I want to spend my life.

The change wasn’t overnight. The next loss still brought pain, but I took solace in moving forward so that we might learn something to give hope to a future patient. I returned to campus in a new lab doing cancer research, and my passion for medicine continues to flourish. I still think about all the people I encountered at St. Jude, especially those we lost. It might be a stretch, but during the long hours at the lab bench I still picture their hands moving through mine each step of the way. I could never have foreseen where the first steps of the St. Jude Run would bring me. I’m not sure where the road to becoming a physician may lead, but with helping hands guiding the way, I won’t be running it alone.

This essay, a description of the applicant’s intellectual challenges, displays the hardships of tending to cancer patients as a milestone of experience and realization of what it takes to be a physician. The writer explores deeper ideas beyond medicine, such as dealing with patient deaths in a way to progress and improve as a professional. In this way, the applicant gives the reader some insight into the applicant’s mindset, and their ability to think beyond the surface for ways to become better at what they do.

However, the essay fails to zero in on the applicant’s character, instead elaborating on life events that weakly illustrate the applicant’s growth as a physician. The writer’s mantra (“keep moving forward”) is feebly projected, and seems unoriginal due to the lack of a personalized connection between the experience at St. Jude and how that led to the applicant’s growth and mindset changes.

The writer explores deeper ideas beyond medicine, such as dealing with patient deaths in a way to progress and improve as a professional.

The writer, by only focusing on grief brought from patient deaths at St. Jude, misses out on the opportunity to further describe his or her experience at the hospital and portray an original, well-rounded image of his or her strengths, weaknesses, and work ethic.

The applicant ends the essay by attempting to highlight the things they learned at St. Jude, but fails to organize the ideas into a cohesive, comprehensible section. These ideas are also too abstract, and are vague indicators of the applicant’s character that are difficult to grasp.

-- Accepted to: New York University School of Medicine

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“Is this the movie you were talking about Alice?” I said as I showed her the movie poster on my iPhone. “Oh my God, I haven’t seen that poster in over 70 years,” she said with her arms trembling in front of her. Immediately, I sat up straight and started to question further. We were talking for about 40 minutes, and the most exciting thing she brought up in that time was the new flavor of pudding she had for lunch. All of sudden, she’s back in 1940 talking about what it was like to see this movie after school for only 5¢ a ticket! After an engaging discussion about life in the 40’s, I knew I had to indulge her. Armed with a plethora of movie streaming sights, I went to work scouring the web. No luck. The movie, “My Son My Son,” was apparently not in high demand amongst torrenting teens. I had to entreat my older brother for his Amazon Prime account to get a working stream. However, breaking up the monotony and isolation felt at the nursing home with a simple movie was worth the pandering.

While I was glad to help a resident have some fun, I was partly motivated by how much Alice reminded me of my own grandfather. In accordance with custom, my grandfather was to stay in our house once my grandmother passed away. More specifically, he stayed in my room and my bed. Just like grandma’s passing, my sudden roommate was a rough transition. In 8th grade at the time, I considered myself to be a generally good guy. Maybe even good enough to be a doctor one day. I volunteered at the hospital, shadowed regularly, and had a genuine interest for science. However, my interest in medicine was mostly restricted to academia. To be honest, I never had a sustained exposure to the palliative side of medicine until the arrival of my new roommate.

The two years I slept on that creaky wooden bed with him was the first time my metal was tested. Sharing that room, I was the one to take care of him. I was the one to rub ointment on his back, to feed him when I came back from school, and to empty out his spittoon when it got full. It was far from glamorous, and frustrating most of the time. With 75 years separating us, and senile dementia setting in, he would often forget who I was or where he was. Having to remind him that I was his grandson threatened to erode at my resolve. Assured by my Syrian Orthodox faith, I even prayed about it; asking God for comfort and firmness on my end. Over time, I grew slow to speak and eager to listen as he started to ramble more and more about bits and pieces of the past. If I was lucky, I would be able to stich together a narrative that may or may have not been true. In any case, my patience started to bud beyond my age group.

Having to remind him that I was his grandson threatened to erode at my resolve.

Although I grew more patient with his disease, my curiosity never really quelled. Conversely, it developed further alongside my rapidly growing interest in the clinical side of medicine. Naturally, I became drawn to a neurology lab in college where I got to study pathologies ranging from atrophy associated with schizophrenia, and necrotic lesions post stroke. However, unlike my intro biology courses, my work at the neurology lab was rooted beyond the academics. Instead, I found myself driven by real people who could potentially benefit from our research. In particular, my shadowing experience with Dr. Dominger in the Veteran’s home made the patient more relevant in our research as I got to encounter geriatric patients with age related diseases, such as Alzhimer’s and Parkinson’s. Furthermore, I had the privilege of of talking to the families of a few of these patients to get an idea of the impact that these diseases had on the family structure. For me, the scut work in the lab meant a lot more with these families in mind than the tritium tracer we were using in the lab.

Despite my achievements in the lab and the classroom, my time with my grandfather still holds a special place in my life story. The more I think about him, the more confident I am in my decision to pursue a career where caring for people is just as important, if not more important, than excelling at academics. Although it was a lot of work, the years spent with him was critical in expanding my horizons both in my personal life and in the context of medicine. While I grew to be more patient around others, I also grew to appreciate medicine beyond the science. This more holistic understanding of medicine had a synergistic effect in my work as I gained a purpose behind the extra hours in the lab, sleepless nights in the library, and longer hours volunteering. I had a reason for what I was doing that may one day help me have long conversations with my own grandchildren about the price of popcorn in the 2000’s.

The most important thing to highlight in Avery’s essay is how he is able to create a duality between his interest in not only the clinical, more academic-based side of medicine, but also the field’s personal side.

He draws personal connections between working with Alice — a patient in a hospital or nursing home — and caring intensely for his grandfather. These two experiences build up the “synergistic” relationship between caring for people and studying the science behind medicine. In this way, he is able to clearly state his passions for medicine and explain his exact motives for entering the field. Furthermore, in his discussion of her grandfather, he effectively employs imagery (“rub ointment on his back,” “feed him when I came back from school,” etc.) to describe the actual work that he does, calling it initially as “far from glamorous, and frustrating most of the time.” By first mentioning his initial impression, then transitioning into how he grew to appreciate the experience, Avery is able to demonstrate a strength of character, sense of enormous responsibility and capability, and open-minded attitude.

He draws personal connections between working with Alice — a patient in a hospital or nursing home — and caring intensely for his grandfather.

Later in the essay, Avery is also able to relate his time caring for his grandfather to his work with Alzheimer’s and Parkinson’s patients, showcasing the social impact of his work, as the reader is likely already familiar with the biological impact of the work. This takes Avery’s essay full circle, bringing it back to how a discussion with an elderly patient about the movies reminds him of why he chose to pursue medicine.

That said, the essay does feel rushed near the end, as the writer was likely trying to remain within the word count. There could be a more developed transition before Avery introduces the last sentence about “conversations with my own grandchildren,” especially as a strong essay ending is always recommended.

-- Accepted To: Saint Louis University Medical School Direct Admission Medical Program

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The tension in the office was tangible. The entire team sat silently sifting through papers as Dr. L introduced Adam, a 60-year-old morbidly obese man recently admitted for a large open wound along his chest. As Dr. L reviewed the details of the case, his prognosis became even bleaker: hypertension, diabetes, chronic kidney disease, cardiomyopathy, hyperlipidemia; the list went on and on. As the humdrum of the side-conversations came to a halt, and the shuffle of papers softened, the reality of Adam’s situation became apparent. Adam had a few months to live at best, a few days at worst. To make matters worse, Adam’s insurance would not cover his treatment costs. With no job, family, or friends, he was dying poor and alone.

I followed Dr. L out of the conference room, unsure what would happen next. “Well,” she muttered hesitantly, “We need to make sure that Adam is on the same page as us.” It’s one thing to hear bad news, and another to hear it utterly alone. Dr. L frantically reviewed all of Adam’s paperwork desperately looking for someone to console him, someone to be at his side. As she began to make calls, I saw that being a physician calls for more than good grades and an aptitude for science: it requires maturity, sacrifice, and most of all, empathy. That empathy is exactly what I saw in Dr. L as she went out of her way to comfort a patient she met hardly 20 minutes prior.

Since high school, I’ve been fascinated by technology’s potential to improve healthcare. As a volunteer in [the] Student Ambassador program, I was fortunate enough to watch an open-heart surgery. Intrigued by the confluence of technology and medicine, I chose to study biomedical engineering. At [school], I wanted to help expand this interface, so I became involved with research through Dr. P’s lab by studying the applications of electrospun scaffolds for dermal wound healing. While still in the preliminary stages of research, I learned about the Disability Service Club (DSC) and decided to try something new by volunteering at a bowling outing.

As she began to make calls, I saw that being a physician calls for more than good grades and an aptitude for science: it requires maturity, sacrifice, and most of all, empathy.

The DSC promotes awareness of cognitive disabilities in the community and seeks to alleviate difficulties for the disabled. During one outing, I collaborated with Arc, a local organization with a similar mission. Walking in, I was told that my role was to support the participants by providing encouragement. I decided to help a relatively quiet group of individuals assisted by only one volunteer, Mary. Mary informed me that many individuals with whom I was working were diagnosed with ASD. Suddenly, she started cheering, as one of the members of the group bowled a strike. The group went wild. Everyone was dancing, singing, and rejoicing. Then I noticed one gentleman sitting at our table, solemn-faced. I tried to start a conversation with him, but he remained unresponsive. I sat with him for the rest of the game, trying my hardest to think of questions that would elicit more than a monosyllabic response, but to no avail. As the game ended, I stood up to say bye when he mumbled, “Thanks for talking.” Then he quickly turned his head away. I walked away beaming. Although I was unable to draw out a smile or even sustain a conversation, at the end of the day, the fact that this gentleman appreciated my mere effort completely overshadowed the awkwardness of our time together. Later that day, I realized that as much as I enjoyed the thrill of research and its applications, helping other people was what I was most passionate about.

When it finally came time to tell Adam about his deteriorating condition, I was not sure how he would react. Dr. L gently greeted him and slowly let reality take its toll. He stoically turned towards Dr. L and groaned, “I don’t really care. Just leave me alone.” Dr. L gave him a concerned nod and gradually left the room. We walked to the next room where we met with a pastor from Adam’s church.

“Adam’s always been like that,” remarked the pastor, “he’s never been one to express emotion.” We sat with his pastor for over an hour discussing how we could console Adam. It turned out that Adam was part of a motorcycle club, but recently quit because of his health. So, Dr. L arranged for motorcycle pictures and other small bike trinkets to be brought to his room as a reminder of better times.

Dr. L’s simple gesture reminded me of why I want to pursue medicine. There is something sacred, empowering, about providing support when people need it the most; whether it be simple as starting a conversation, or providing support during the most trying of times. My time spent conducting research kindled my interest in the science of medicine, and my service as a volunteer allowed me to realize how much I valued human interaction. Science and technology form the foundation of medicine, but to me, empathy is the essence. It is my combined interest in science and service that inspires me to pursue medicine. It is that combined interest that makes me aspire to be a physician.

Parker’s essay focuses on one central narrative with a governing theme of compassionate and attentive care for patients, which is the key motivator for her application to medical school. Parker’s story focuses on her volunteer experience shadowing of Dr. L who went the extra mile for Adam, which sets Dr. L up as a role model for Parker as she enters the medical field. This effectively demonstrates to the reader what kind of doctor Parker wants to be in the future.

Parker’s narrative has a clear beginning, middle, and end, making it easy for the reader to follow. She intersperses the main narrative about Adam with experiences she has with other patients and reflects upon her values as she contemplates pursuing medicine as a career. Her anecdote about bowling with the patients diagnosed with ASD is another instance where she uses a story to tell the reader why she values helping people through medicine and attentive patient care, especially as she focuses on the impact her work made on one man at the event.

Parker's story focuses on her volunteer experience shadowing of Dr. L who went the extra mile for Adam, which sets Dr. L up as a role model for Parker as she enters the medical field.

All throughout the essay, the writing is engaging and Parker incorporates excellent imagery, which goes well with her varied sentence structure. The essay is also strong because it comes back full circle at its conclusion, tying the overall narrative back to the story of Dr. L and Adam, which speaks to Parker’s motives for going to medical school.

-- Accepted To: Emory School of Medicine

Growing up, I enjoyed visiting my grandparents. My grandfather was an established doctor, helping the sick and elderly in rural Taiwan until two weeks before he died at 91 years old. His clinic was located on the first floor of the residency with an exam room, treatment room, X-ray room, and small pharmacy. Curious about his work, I would follow him to see his patients. Grandpa often asked me if I want to be a doctor just like him. I always smiled, but was more interested in how to beat the latest Pokémon game. I was in 8th grade when my grandfather passed away. I flew back to Taiwan to attend his funeral. It was a gloomy day and the only street in the small village became a mourning place for the villagers. Flowers filled the streets and people came to pay their respects. An old man told me a story: 60 years ago, a village woman was in a difficult labor. My grandfather rushed into the house and delivered a baby boy. That boy was the old man and he was forever grateful. Stories of grandpa saving lives and bringing happiness to families were told during the ceremony. At that moment, I realized why my grandfather worked so tirelessly up until his death as a physician. He did it for the reward of knowing that he kept a family together and saved a life. The ability for a doctor to heal and bring happiness is the reason why I want to study medicine. Medical school is the first step on a lifelong journey of learning, but I feel that my journey leading up to now has taught me some things of what it means to be an effective physician.

With a newfound purpose, I began volunteering and shadowing at my local hospital. One situation stood out when I was a volunteer in the cardiac stress lab. As I attached EKG leads onto a patient, suddenly the patient collapsed and started gasping for air. His face turned pale, then slightly blue. The charge nurse triggered “Code Blue” and started CPR. A team of doctors and nurses came, rushing in with a defibrillator to treat and stabilize the patient. What I noticed was that medicine was not only about one individual acting as a superhero to save a life, but that it takes a team of individuals with an effective leader, working together to deliver the best care. I want to be a leader as well as part of a team that can make a difference in a person’s life. I have refined these lessons about teamwork and leadership to my activities. In high school I was an 8 time varsity letter winner for swimming and tennis and captain of both of those teams. In college I have participated in many activities, but notably serving as assistant principle cellist in my school symphony as well as being a co-founding member of a quartet. From both my athletic experiences and my music experiences I learned what it was like to not only assert my position as a leader and to effectively communicate my views, but equally as important I learned how to compromise and listen to the opinions of others. Many physicians that I have observed show a unique blend of confidence and humility.

What I noticed was that medicine was not only about one individual acting as a superhero to save a life, but that it takes a team of individuals with an effective leader, working together to deliver the best care.

College opened me up to new perspectives on what makes a complete physician. A concept that was preached in the Guaranteed Professional Program Admissions in Medicine (GPPA) was that medicine is both an art and a science. The art of medicine deals with a variety of aspects including patient relationships as well as ethics. Besides my strong affinity for the sciences and mathematics, I always have had interest in history. I took courses in both German literature and history, which influenced me to take a class focusing on Nazi neuroscientists. It was the ideology of seeing the disabled and different races as test subjects rather than people that led to devastating lapses in medical ethics. The most surprising fact for me was that doctors who were respected and leaders in their field disregarded the humanity of patient and rather focused on getting results from their research. Speaking with Dr. Zeidman, the professor for this course, influenced me to start my research which deals with the ethical qualms of using data derived from unethical Nazi experimentation such as the brains derived from the adult and child euthanasia programs. Today, science is so result driven, it is important to keep in mind the ethics behind research and clinical practice. Also the development of personalized genomic medicine brings into question about potential privacy violations and on the extreme end discrimination. The study of ethics no matter the time period is paramount in the medical field. The end goal should always be to put the patient first.

Teaching experiences in college inspired me to become a physician educator if I become a doctor. Post-MCAT, I was offered a job by Next Step Test Prep as a tutor to help students one on one for the MCAT. I had a student who stated he was doing well during practice, but couldn’t get the correct answer during practice tests. Working with the student, I pointed out his lack of understanding concepts and this realization helped him and improves his MCAT score. Having the ability to educate the next generation of doctors is not only necessary, but also a rewarding experience.

My experiences volunteering and shadowing doctors in the hospital as well as my understanding of what it means to be a complete physician will make me a good candidate as a medical school student. It is my goal to provide the best care to patients and to put a smile on a family’s face just as my grandfather once had. Achieving this goal does not take a special miracle, but rather hard work, dedication, and an understanding of what it means to be an effective physician.

Through reflecting on various stages of life, Quinn expresses how they found purpose in pursuing medicine. Starting as a child more interested in Pokemon than their grandfather’s patients, Quinn exhibits personal growth through recognizing the importance of their grandfather’s work saving lives and eventually gaining the maturity to work towards this goal as part of a team.

This essay opens with abundant imagery — of the grandfather’s clinic, flowers filling the streets, and the village woman’s difficult labor — which grounds Quinn’s story in their family roots. Yet, the transition from shadowing in hospitals to pursuing leadership positions in high schools is jarring, and the list of athletic and musical accomplishments reads like a laundry list of accomplishments until Quinn neatly wraps them up as evidence of leadership and teamwork skills. Similarly, the section about tutoring, while intended to demonstrate Quinn’s desire to educate future physicians, lacks the emotional resonance necessary to elevate it from another line lifted from their resume.

This essay opens with abundant imagery — of the grandfather's clinic, flowers filling the streets, and the village woman's difficult labor — which grounds Quinn's story in their family roots.

The strongest point of Quinn’s essay is the focus on their unique arts and humanities background. This equips them with a unique perspective necessary to consider issues in medicine in a new light. Through detailing how history and literature coursework informed their unique research, Quinn sets their application apart from the multitude of STEM-focused narratives. Closing the essay with the desire to help others just as their grandfather had, Quinn ties the narrative back to their personal roots.

-- Accepted To: Edinburgh University UCAT Score: 2810 BMAT Score: 4.6, 4.2, 3.5A

Exposure to the medical career from an early age by my father, who would explain diseases of the human body, sparked my interest for Medicine and drove me to seek out work experience. I witnessed the contrast between use of bone saws and drills to gain access to the brain, with subsequent use of delicate instruments and microscopes in neurosurgery. The surgeon's care to remove the tumour, ensuring minimal damage to surrounding healthy brain and his commitment to achieve the best outcome for the patient was inspiring. The chance to have such a positive impact on a patient has motivated me to seek out a career in Medicine.

Whilst shadowing a surgical team in Texas, carrying out laparoscopic bariatric procedures, I appreciated the surgeon's dedication to continual professional development and research. I was inspired to carry out an Extended Project Qualification on whether bariatric surgery should be funded by the NHS. By researching current literature beyond my school curriculum, I learnt to assess papers for bias and use reliable sources to make a conclusion on a difficult ethical situation. I know that doctors are required to carry out research and make ethical decisions and so, I want to continue developing these skills during my time at medical school.

The chance to have such a positive impact on a patient has motivated me to seek out a career in Medicine.

Attending an Oncology multi-disciplinary team meeting showed me the importance of teamwork in medicine. I saw each team member, with specific areas of expertise, contributing to the discussion and actively listening, and together they formed a holistic plan of action for patients. During my Young Enterprise Award, I facilitated a brainstorm where everyone pitched a product idea. Each member offered a different perspective on the idea and then voted on a product to carry forward in the competition. As a result, we came runners up in the Regional Finals. Furthermore, I started developing my leadership skills, which I improved by doing Duke of Edinburgh Silver and attending a St. John Ambulance Leadership course. In one workshop, similar to the bariatric surgeon I shadowed, I communicated instructions and delegated roles to my team to successfully solve a puzzle. These experiences highlighted the crucial need for teamwork and leadership as a doctor.

Observing a GP, I identified the importance of compassion and empathy. During a consultation with a severely depressed patient, the GP came to the patient's eye level and used a calm, non-judgmental tone of voice, easing her anxieties and allowing her to disclose more information. While volunteering at a care home weekly for two years, I adapted my communication for a resident suffering with dementia who was disconnected from others. I would take her to a quiet environment, speak slowly and in a non-threatening manner, as such, she became talkative, engaged and happier. I recognised that communication and compassion allows doctors to build rapport, gain patients' trust and improve compliance. For two weeks, I shadowed a surgeon performing multiple craniotomies a day. I appreciated the challenges facing doctors including time and stress management needed to deliver high quality care. Organisation, by prioritising patients based on urgency and creating a timetable on the ward round, was key to running the theatre effectively. Similarly, I create to-do-lists and prioritise my academics and extra-curricular activities to maintain a good work-life balance: I am currently preparing for my Grade 8 in Singing, alongside my A-level exams. I also play tennis for the 1st team to relax and enable me to refocus. I wish to continue my hobbies at university, as ways to manage stress.

Through my work experiences and voluntary work, I have gained a realistic understanding of Medicine and its challenges. I have begun to display the necessary skills that I witnessed, such as empathy, leadership and teamwork. The combination of these skills with my fascination for the human body drives me to pursue a place at medical school and a career as a doctor.

This essay traces Alex's personal exploration of medicine through different stages of life, taking a fairly traditional path to the medical school application essay. From witnessing medical procedures to eventually pursuing leadership positions, this tale of personal progress argues that Alex's life has prepared him to become a doctor.

Alex details how experiences conducting research and working with medical teams have confirmed his interest in medicine. Although the breadth of experiences speaks to the applicant’s interest in medicine, the essay verges on being a regurgitation of the Alex's resume, which does not provide the admissions officer with any new insights or information and ultimately takes away from the essay as a whole. As such, the writing’s lack of voice or unique perspective puts the applicant at risk of sounding middle-of-the-road.

From witnessing medical procedures to eventually pursuing leadership positions, this tale of personal progress argues that Alex's life has prepared him to become a doctor.

The essay’s organization, however, is one of its strengths — each paragraph provides an example of personal growth through a new experience in medicine. Further, Alex demonstrates his compassion and diligence through detailed stories, which give a reader a glimpse into his values. Through recognizing important skills necessary to be a doctor, Alex demonstrates that he has the mature perspective necessary to embark upon this journey.

What this essay lacks in a unique voice, it makes up for in professionalism and organization. Alex's earnest desire to attend medical school is what makes this essay shine.

-- Accepted To: University of Toronto MCAT Scores: Chemical and Physical Foundations of Biological Systems - 128, Critical Analysis and Reading Skills - 127, Biological and Biochemical Foundations of Living Systems - 127, Psychological, Social, and Biological Foundations of Behavior - 130, Total - 512

Moment of brilliance.

Revelation.

These are all words one would use to describe their motivation by a higher calling to achieve something great. Such an experience is often cited as the reason for students to become physicians; I was not one of these students. Instead of waiting for an event like this, I chose to get involved in the activities that I found most invigorating. Slowly but surely, my interests, hobbies, and experiences inspired me to pursue medicine.

As a medical student, one must possess a solid academic foundation to facilitate an understanding of physical health and illness. Since high school, I found science courses the most appealing and tended to devote most of my time to their exploration. I also enjoyed learning about the music, food, literature, and language of other cultures through Latin and French class. I chose the Medical Sciences program because it allowed for flexibility in course selection. I have studied several scientific disciplines in depth like physiology and pathology while taking classes in sociology, psychology, and classical studies. Such a diverse academic portfolio has strengthened my ability to consider multiple viewpoints and attack problems from several angles. I hope to relate to patients from all walks of life as a physician and offer them personalized treatment.

I was motivated to travel as much as possible by learning about other cultures in school. Exposing myself to different environments offered me perspective on universal traits that render us human. I want to pursue medicine because I believe that this principle of commonality relates to medical practice in providing objective and compassionate care for all. Combined with my love for travel, this realization took me to Nepal with Volunteer Abroad (VA) to build a school for a local orphanage (4). The project’s demands required a group of us to work closely as a team to accomplish the task. Rooted in different backgrounds, we often had conflicting perspectives; even a simple task such as bricklaying could stir up an argument because each person had their own approach. However, we discussed why we came to Nepal and reached the conclusion that all we wanted was to build a place of education for the children. Our unifying goal allowed us to reach compromises and truly appreciate the value of teamwork. These skills are vital in a clinical setting, where physicians and other health care professionals need to collaborate as a multidisciplinary team to tackle patients’ physical, emotional, social, and psychological problems.

I hope to relate to patients from all walks of life as a physician and offer them personalized treatment.

The insight I gained from my Nepal excursion encouraged me to undertake and develop the role of VA campus representative (4). Unfortunately, many students are not equipped with the resources to volunteer abroad; I raised awareness about local initiatives so everyone had a chance to do their part. I tried to avoid pushing solely for international volunteerism for this reason and also because it can undermine the work of local skilled workers and foster dependency. Nevertheless, I took on this position with VA because I felt that the potential benefits were more significant than the disadvantages. Likewise, doctors must constantly weigh out the pros and cons of a situation to help a patient make the best choice. I tried to dispel fears of traveling abroad by sharing first-hand experiences so that students could make an informed decision. When people approached me regarding unfamiliar placements, I researched their questions and provided them with both answers and a sense of security. I found great fulfillment in addressing the concerns of individuals, and I believe that similar processes could prove invaluable in the practice of medicine.

As part of the Sickkids Summer Research Program, I began to appreciate the value of experimental investigation and evidence-based medicine (23). Responsible for initiating an infant nutrition study at a downtown clinic, I was required to explain the project’s implications and daily protocol to physicians, nurses and phlebotomists. I took anthropometric measurements and blood pressure of children aged 1-10 and asked parents about their and their child’s diet, television habits, physical exercise regimen, and sunlight exposure. On a few occasions, I analyzed and presented a small set of data to my superiors through oral presentations and written documents.

With continuous medical developments, physicians must participate in lifelong learning. More importantly, they can engage in research to further improve the lives of their patients. I encountered a young mother one day at the clinic struggling to complete the study’s questionnaires. After I asked her some questions, she began to open up to me as her anxiety subsided; she then told me that her child suffered from low iron. By talking with the physician and reading a few articles, I recommended a few supplements and iron-rich foods to help her child. This experience in particular helped me realize that I enjoy clinical research and strive to address the concerns of people with whom I interact.

Research is often impeded by a lack of government and private funding. My clinical placement motivated me to become more adept in budgeting, culminating in my role as founding Co-President of the UWO Commerce Club (ICCC) (9). Together, fellow club executives and I worked diligently to get the club ratified, a process that made me aware of the bureaucratic challenges facing new organizations. Although we had a small budget, we found ways of minimizing expenditure on advertising so that we were able to host more speakers who lectured about entrepreneurship and overcoming challenges. Considering the limited space available in hospitals and the rising cost of health care, physicians, too, are often forced to prioritize and manage the needs of their patients.

No one needs a grand revelation to pursue medicine. Although passion is vital, it is irrelevant whether this comes suddenly from a life-altering event or builds up progressively through experience. I enjoyed working in Nepal, managing resources, and being a part of clinical and research teams; medicine will allow me to combine all of these aspects into one wholesome career.

I know with certainty that this is the profession for me.

Jimmy opens this essay hinting that his essay will follow a well-worn path, describing the “big moment” that made him realize why he needed to become a physician. But Jimmy quickly turns the reader’s expectation on its head by stating that he did not have one of those moments. By doing this, Jimmy commands attention and has the reader waiting for an explanation. He soon provides the explanation that doubles as the “thesis” of his essay: Jimmy thinks passion can be built progressively, and Jimmy’s life progression has led him to the medical field.

Jimmy did not make the decision to pursue a career in medicine lightly. Instead he displays through anecdotes that his separate passions — helping others, exploring different walks of life, personal responsibility, and learning constantly, among others — helped Jimmy realize that being a physician was the career for him. By talking readers through his thought process, it is made clear that Jimmy is a critical thinker who can balance multiple different perspectives simultaneously. The ability to evaluate multiple options and make an informed, well-reasoned decision is one that bodes well for Jimmy’s medical career.

While in some cases this essay does a lot of “telling,” the comprehensive and decisive walkthrough indicates what Jimmy’s idea of a doctor is. To him, a doctor is someone who is genuinely interested in his work, someone who can empathize and related to his patients, someone who can make important decisions with a clear head, and someone who is always trying to learn more. Just like his decision to work at the VA, Jimmy has broken down the “problem” (what his career should be) and reached a sound conclusion.

By talking readers through his thought process, it is made clear that Jimmy is a critical thinker who can balance multiple different perspectives simultaneously.

Additionally, this essay communicates Jimmy’s care for others. While it is not always advisable to list one’s volunteer efforts, each activity Jimmy lists has a direct application to his essay. Further, the sheer amount of philanthropic work that Jimmy does speaks for itself: Jimmy would not have worked at VA, spent a summer with Sickkids, or founded the UWO finance club if he were not passionate about helping others through medicine. Like the VA story, the details of Jimmy’s participation in Sickkids and the UWO continue to show how he has thought about and embodied the principles that a physician needs to be successful.

Jimmy’s essay both breaks common tropes and lives up to them. By framing his “list” of activities with his passion-happens-slowly mindset, Jimmy injects purpose and interest into what could have been a boring and braggadocious essay if it were written differently. Overall, this essay lets the reader know that Jimmy is seriously dedicated to becoming a physician, and both his thoughts and his actions inspire confidence that he will give medical school his all.

The Crimson's news and opinion teams—including writers, editors, photographers, and designers—were not involved in the production of this content.

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