The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age - Paperback

by Robert Wachter (Author)

The New York Times Science Bestseller from Robert Wachter, Modern Healthcare's #1 Most Influential Physician-Executive in the US

While modern medicine produces miracles, it also delivers care that is too often unsafe, unreliable, unsatisfying, and impossibly expensive. For the past few decades, technology has been touted as the cure for all of healthcare's ills.

But medicine stubbornly resisted computerization - until now. Over the past five years, thanks largely to billions of dollars in federal incentives, healthcare has finally gone digital.

Yet once clinicians started using computers to actually deliver care, it dawned on them that something was deeply wrong. Why were doctors no longer making eye contact with their patients? How could one of America's leading hospitals give a teenager a 39-fold overdose of a common antibiotic, despite a state-of-the-art computerized prescribing system? How could a recruiting ad for physicians tout the absence of an electronic medical record as a major selling point?

Logically enough, we've pinned the problems on clunky software, flawed implementations, absurd regulations, and bad karma. It was all of those things, but it was also something far more complicated. And far more interesting . . .

Written with a rare combination of compelling stories and hard-hitting analysis by one of the nation's most thoughtful physicians, The Digital Doctor examines healthcare at the dawn of its computer age. It tackles the hard questions, from how technology is changing care at the bedside to whether government intervention has been useful or destructive. And it does so with clarity, insight, humor, and compassion. Ultimately, it is a hopeful story.

"We need to recognize that computers in healthcare don't simply replace my doctor's scrawl with Helvetica 12," writes the author Dr. Robert Wachter. "Instead, they transform the work, the people who do it, and their relationships with each other and with patients. . . . Sure, we should have thought of this sooner. But it's not too late to get it right."

This riveting book offers the prescription for getting it right, making it essential reading for everyone - patient and provider alike - who cares about our healthcare system.

Back Jacket

"Janus is the god of medicine these days, and it is the great strength of Dr. Robert Wachter's eloquent new book that it has captured every one of these conflicting emotions, all powerfully felt and intelligently analyzed. . . . Most previous authors have chosen sides, either mourning the old or hailing the new. Dr. Wachter is unusual for his equipoise. He is old enough to remember the way things used to work (or fail to work), young enough to be reasonably technology friendly . . . He is also an exceptionally good, fluent writer."
The New York Times

"While he refuses to play 'Dr. Luddite, ' Wachter warns that healthcare is going through a difficult, disruptive transition in which positive outcomes are possible but not guaranteed . . . . Whatever the capabilities of the enabling technology, humans will still be challenged with working with it effectively to serve human needs. In the meantime, there is plenty of room to improve the technology itself to make sure it is helping more than hurting."
Forbes

"As I read The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age, I found myself feeling nostalgic for medicine before the digital age, even though its challenges sometimes drove me crazy. Is computerized medicine really an improvement on the past? Or are we at risk of losing the vital bond of the doctor-patient relationship? Fortunately, the author, a practicing internist, has considered these questions carefully. The Digital Doctor makes the case that, despite some serious shortcomings, computerized medicine is here to stay and, in the long run, will improve our health."
The Wall Street Journal

"Technology's multifaceted effect on medicine is illustrated by patients' new empowerment to become active participants in their own health care and the potential dangers that arise when computers micromanage clinical decision-making. Wachter weaves in interviews, portraits, and anecdotes throughout, making this an engaging book that will appeal to both general and specialist audiences. Recommended. All readers."
Choice

"The Digital Doctor is not a Pollyanna-ish hyperbole about the promise of the digitalization of medicine, 'romanticizing how wonderful things were when your doctor was Marcus Welby, ' or a dire prediction about how computerization will eliminate the need for a doctor altogether. It is quite simply an excellent book written with intelligence and balance for both the general public and health care practitioners."
The New York Journal of Books

"Robert Wachter, voted the most influential physician [in the U.S.] by Modern Healthcare magazine, sums the optimism and frustration with the electronic health record (EHR) in The Digital Doctor--which stands to be a classic. . . . The reformers may have asked too much, too soon of electronic health records, which may deliver too little, too late. Time will tell, of course, and in twenty years either the tinkerer or the central planner will have the satisfaction of 'I told you so.' But both will applaud Wachter's tome."
The Healthcare Blog

"The Digital Doctor is the eye-opening, well-told, and frustrating story of how computerization is pulling medicine apart with only a vague promise of putting it back together again. I kept muttering, 'Exactly!' while reading it, and that is a measure of Wachter's accomplishment in telling the tale. This is the real story of what it's like to practice medicine in the midst of a painful, historic, and often dangerous transition."
Atul Gawande, author of Being Mortal and The Checklist Manifesto

"As scientific breakthroughs and information technology transform the practice of medicine, there is a crying need for explication, for an eyewitness who can go from the trenches to the observation booth. Wachter is one of the few people with the insight, credibility, and investigative skills to do just this. The Digital Doctor is first of all a personal journey, as Wachter travels the country, meets with key players who are shaping our future, and wrestles with their views. His intimate narrative left me entertained, amazed, alarmed at times, but always engrossed as I came to a new understanding of my own profession as it is reshaped by technology. Simply brilliant."
Abraham Verghese MD, MACP, FRCP(Edin), author of Cutting for Stone, and Linda R. Meier and Joan F. Lane Provostial Professor and Vice Chair for the Theory and Practice of Medicine, Stanford University School of Medicine

"A much-needed study of the moment in technological change we don't want to see: the in-between moment where technology is making things worse because we just assumed that 'adding it' would make things better. Wachter maintains his enthusiasm for the long view, but helps the reader see that getting there requires understanding of medicine and technology and, most of all, people and their needs. It needs thinking and caring; the hope for a magic bullet got in our way. Wachter deserves our gratitude for his clarity of vision and our support so that his views can become influential in policy circles."
Sherry Turkle, Professor, MIT, and author of Alone Together

"One of the best books I've ever read. Wachter's warm humor and deep insights kept me turning the pages without interruption. To make our healthcare system work, we need new models of care and new ways of managing our technology. The Digital Doctor brings us much closer to making this happen, which is why I finished the book far more optimistic than I was when I began it. It is a must-read for everyone--patients, clinicians, technology designers, and policymakers."
Maureen Bisognano, President and CEO, Institute for Healthcare Improvement (IHI)

"I've long admired Bob Wachter for his skill and acumen as a physician and as a leader in the field of patient safety and healthcare quality, but this book has made me appreciate him in a new light. In The Digital Doctor, Wachter is our indispensable guide through the computerization of medicine--the rich history, forces that impede progress, and the potential for today's technology innovations to transform every aspect of healthcare. Read this book and you will see the future of medicine."
Marc Benioff, Chairman and CEO, Salesforce

"Bob Wachter takes the reader on a fascinating journey of discovery through medicine's nascent digital world. He shows us that it's not just the technology but how we manage it that will determine whether the computerization of medicine will be for good or for ill. And he reminds us that the promise of technology in healthcare will only be realized if it augments, but does not replace, the human touch."
Captain Chesley "Sully" Sullenberger, speaker, consultant, pilot of US Airways 1549 "Miracle on the Hudson," and author of Highest Duty and Making a Difference

"With vivid stories and sharp analysis, Wachter exposes the good, the bad, and the ugly of electronic health records and all things electronic in the complex settings of hospitals, physician offices, and pharmacies. Everyone will learn from Wachter's intelligent assessment, and become a believer that despite today's glitches and frustrations the future computer age will make medicine much better for us all."
Ezekiel J. Emanuel, M.D., Ph.D., Vice Provost for Global Initiatives and Chair, Departments of Medical Ethics and Health Policy, University of Pennsylvania

"In Bob Wachter, I recognize a fellow mindful optimist: someone who understands the immense power of digital technologies, yet also realizes just how hard it is to incorporate them into complicated, high-stakes environments full of people who don't like being told what to do by a computer. Read this important book to see what changes are ahead in healthcare, and why they're so necessary."
Andrew McAfee, cofounder of the MIT Initiative on the Digital Economy, and coauthor of The Second Machine Age

"An engaging, accessible, and terribly important book by one of our finest medical writers. The electronic health record is not only the most disruptive innovation in the history of healthcare, it will also prove to be transformative. In his inimitable mix of conversation, reporting, and insightful analysis, Bob Wachter explains to you why. A must-read for healthcare professionals and the public alike."
Lucian Leape, MD, Professor, Harvard School of Public Health and Chair, Lucian Leape Institute of the National Patient Safety Foundation

"This is the book that truly defines today's epoch of technological transformation in healthcare. Wachter tells a gripping tale about the personalities and politics behind healthcare's digital revolution. With a sweeping view that takes us from the grand political battles in Washington to the subtle changes in the interactions between people when a computer enters the picture, Wachter offers surprising, often shocking insights into how technology changes the daily lives of clinicians and patients--sometimes for the better, sometimes for the worse."
Leah Binder, MA, MGA, President and CEO, The Leapfrog Group

"In this brilliant and compelling book, Wachter provides us a view from the balcony of the last decade of healthcare information technology. As one of the players, I'm amazed by the way he's captured the characters, the plot subtleties, and the triumphs and tragedies of the work we've done. The book is the definitive chronicle of our modern efforts to wire our healthcare system."
John Halamka, MD, Chief Information Officer, Beth Israel Deaconess Medical Center, and Professor of Emergency Medicine, Harvard Medical School

"Wachter not only has unmatched insider knowledge of healthcare but he deeply understands technology as well. This breadth allows him to prescribe common sense solutions to the problems emerging from the inevitable marriage between the fields, which he reveals as a more troubled union than many suspect. The Digital Doctor not only enlightens and awakens, but it is a delight to read -- rare for such an important book."
Steven Levy, author of Hackers and In the Plex

"A fascinating and insightful look at the digital transformation of healthcare. Thoroughly researched and brought to life by dozens of stories and interviews with practicing clinicians, Wachter plots a realistic roadmap to navigate the obstacles ahead, without the hype that frequently accompanies digital health solutions. It's an essential read for anyone involved in our health care system: from everyday providers in exam rooms to politicians and policy makers who shape our health care system."
Kevin Pho, MD, founder and editor, KevinMD.com, /p>

"In a style that combines the best of storytelling, historical inquiry, and investigative reporting, Wachter takes us on the journey of how healthcare information technology is transforming healthcare, highlighting the risks along the way as well as the powerful future state we might achieve."
Tejal Gandhi, MD, MPH, CPPS, President and CEO, National Patient Safety Foundation

"This is a brilliant book: funny, informative, well written, and accessible. Wachter takes a very complicated subject and makes it understandable, giving new perspectives and insights whether you are yourself an EHR user or you are a patient who has watched your doctor struggle to use one. Given how rapidly EHRs have moved into health care, all of us need to understand how technology changes medicine, and, even more importantly, how it doesn't."
Richard Baron, MD President and CEO, American Board of Internal Medicine

Author Biography

Robert Wachter is Professor and Chair of the Department of Medicine at the University of California, San Francisco. Author of 250 articles, he coined the term "hospitalist" in 1996 and is generally considered the "father" of the hospitalist field, the fastest growing specialty in the history of modern medicine. He is past president of the Society of Hospital Medicine, past chair of the American Board of Internal Medicine, and a recipient of the Eisenberg Award, the nation's top honor in patient safety. For every year beginning 2008, Modern Healthcare magazine has named him one of the 50 most influential physician-executives in the U.S.; he was #1 on the list in 2015. He has been profiled in the New York Times and contributes regularly to the Wall Street Journal. The Digital Doctor is his sixth book.