Technology in Medicine—How Much Do You Rely on it?

Technology in Medicine!!!!!
I think we all know how much medical technology exposure we had in medical school (three decades ago) and during house surgeon (an internship): Barely any!
My friend, Ramana, came to visit me in cardiology one evening when we were house surgeons. I was showing him a patient who had an amoebic liver abscess that burst in to his pericardium. He had pericardiocentesis and was put on a cardio-respiratory monitor. I was told to watch this guy closely as he might develop sudden cardiac arrest; however, I was not told what to do in such an event. Hence, I was well prepared!! :-(

I was showing Ramana around the unit and told him about this special patient he might have cardiac arrest. As I was finishing the sentence, the EKG tracing on the monitor went flat. I panicked! I called for help from the cardiac nurse who was supposedly watching all the patients through a cubby hole in another room. She was one uncompassionate, uncaring nurse and did not budge an inch. I rushed and started cardiac massage. I told Ramana to get the cardiologist, Dr. Sai, immediately. I silently cursed the nurse who was sitting with her chin on the table seemingly unconcerned about the life and death situation before her.

Nevertheless, the patient's life was important to me. I yelled, "Nurse get me epinephrine now." I saw some movement and she slowly got up and moved at snail’s pace to the bed as I continued the cardiac massage. . She did not bring the epinephrine! Heartless and inconsiderate I thought As I watched her tap on the patient's shoulder and ask him to sit up and lean back in the cardiac bed. The dead patient (for all practical purposes) obliged her promptly.

I was ecstatic that my first CPR was successful until I notice the nurse adjust the fallen cardiac leads, and lo and behold, the EKG tracing was back to normal. I was shocked and felt so sheepish and was about to faint from my foolish actions. When I thought about it, the oddest thing was that patient never objected to what I was doing. Dr. Sai Gopal arrived and inquired about the situation and asked me if I had checked the patient's pulse. I replied negatively. He advised me t never to rely on technology without first conducting a clinical exam. Sensing that I was half dead from shame already, he said I was better than the last house surgeon, who wanted to DC shock a patient based on flat EKG on the monitor even though the patient was vehemently protesting "no, no, no don't do that doc" as the house surgeon apparently was trying to convince the patient "Please listen, your heart has stopped and it needs electric shock".

I thought that I would share this to emphasize to the residents and students that technology is useful but cannot replace good clinical exam!