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It was while watching an episode of Star Trek: the Next Generation with Shamina, who was dressed as a Borg (she is a diehard "trekkie"), that I wondered if future doctors would be like Dr Beverly Crusher. For those of you who are unfamiliar with the programme, Dr Crusher is the ship's doctor, who supports a head of firmly set ginger hair and wears blue, space age lycra tops. All she seems to do is flirt rather outrageously (and rather shamefully, if you ask me) with Captain Picard. The intensity of a phaser even at the "kill" setting is unmatched by the strength of her sultry stare - one can almost see her eyes boring a hole in Picard's bald head as they stand over a comatose, dribbling patient. In the rare times she actually does any work she will frantically wave her "tricorder" (really an oversized calculator) in front of the patient, frown, and say something like, "His DNA pattern is not like anything I've seen before. He seems to have a fusion of Klingon and human base pairs which, when mutated, cause his cell replication to slow down to such an extent that it gives him the ability to travel through time." Picard, obviously not having any idea what she is ranting on about, sagely nods his head, secretly wishing he could tickle her.
No, no, I cannot imagine the doctors of the future being like her at all, but I do think it would be rather nice having an all singing, all dancing tricorder - no more fumbling with a sphygmomanometer, no more reckless searching for the apex beat, or peripheral pulses. Come to think of it, I have never seen Dr Crusher perform a proper abdominal examination, or any full systems examination for that matter. I am straining even to recall the last time she actually touched a patient. So is this where the future of the doctor-patient relationship lies - a relationship devoid of any physical contact? Although many of my friends would rejoice at the thought of not having to touch "smelly patients", as they call them, this could be seen as taking professional detachment to extremes, and this lack of physical contact with patients may impoverish a unique relationship.
It is quite easy to swoon and gawp with wonderment at the possibilities and breakthroughs in medicine and technology, such as injectable probes to send back TV images of the extent of a patient's atheroma, or household computers that routinely monitor blood pressure, or even the role of genomics. But arguably the biggest impact on medicine will not come from these quarters at all but from the information revolution. Already, probably for the first time in history, patients have exactly the same access to medical information as their doctors. It is now common for patients to swamp their overwhelmed doctors in an avalanche of internet printouts concerning their condition, questioning the diagnosis and demanding treatment according to their research. It seems that we are entering a century of irony. On the one hand, we are on the cusp of knowing more about the human body than we ever thought possible, and on the other, we have no idea of the effects this information revolution will have, particularly on the relationship between doctors and patients.
Debashis Singh, fourth year medical student, University of Leicester
studentBMJ 2000;08:175-216 June ISSN 0966-6494
