SAN FRANCISCO – The proliferation of gadgets, apps and Web-based information has given doctors a black bag of new tools, but also created something of a generational divide.
電子小機具、應用程式與網路資訊快速增加普及，使醫師擁有裝滿一只黑色提袋的各式新工具，世代鴻溝卻也因而產生。

Older doctors admire, even envy, their young colleagues’ ease with new technology. But they worry that the human connections that lie at the core of medical practice are at risk of being lost.
老一輩醫師羨慕甚至妒忌年輕醫師對新科技的駕輕就熟，卻也擔心行醫核心所在的人際接觸可能隨之消失。

“Just adding an app won’t necessarily make people better doctors or more caring clinicians,” said Dr. Paul C. Tang, chief innovation and technology officer at Palo Alto Medical Foundation in California. “What we need to learn is how to use technology to be better, more humane professionals.”
加州帕拉奧圖醫學基金會創新及技術長鄧保羅（譯音）說：「只是增加一種應用程式不見得就可以使人成為更優秀或更有愛心的醫師。我們必須學習如何善用科技，以使自己成為更優秀、更仁慈的專業人士。」

At the University of California, San Francisco Medical Center, Dr. Alvin Rajkomar is among the new crop of device-happy physicians. He stores every clinical nugget he finds on an application called Evernote, an electronic filing cabinet. “I use Evernote as a second brain,” he said. “I now have a small textbook of personalized, auto-indexed clinical pearls that I carry with me at all times on my iPhone.”
舊金山加州大學醫學中心的拉吉科瑪爾是樂於使用各種新裝置的新世代醫師。他把他找到的每一筆臨床診治資料貯存在電子檔應用程式Evernote中。他說：「我把Evernote當成自己的另一個頭腦。如今，我隨時可以把存入iPhone手機的個人化自動索引診治資料小型教科書帶在身上。」

Along with MedCalc, the clinical calculator, Dr. Rajkomar’s phone has ePocrates, an app for looking up drug dosages and interactions; and Qx Calculate, which he uses to create risk profiles for his patients. His favorite technology is his electronic stethoscope, which amplifies heart sounds while canceling out ambient noise.
除了臨床診治計算機MedCalc，拉吉科瑪爾的手機另備有可供查詢藥物劑量及互動結果的應用程式ePocrates，以及為病人建立風險檔案的Qx Calculate。他偏好的科技產物是他的電子聽診器。它可以放大心跳的聲音，同時消除周圍的雜音。

Not that he is indiscriminate in his use of technology. When he decided the electronic health record was taking too long to load on his iPad, he went back to taking notes by hand, on paper. But he is experimenting with writing by hand on a Samsung mini-tablet.
他對科技並不是照單全收。他認為電子醫療紀錄下載到他的iPad耗時太長，於是回過頭來以手在紙上做筆記。不過他正在實驗如何用手在三星迷你平板電腦上書寫。

He is aware of the pitfalls of computerized records, particularly the “if the problem is X, then do Y” templates, which encourage a cut-and-paste approach to daily progress notes.
他很清楚電腦化檔案資料的缺點，尤其是所謂「碰到這樣的問題，就那麼做」的樣板。它鼓勵醫師以「剪貼」的方法處理每日進展筆記。

Tablet computers linked to electronic health records are making their way into the hands of medical trainees around the United States. All internal-medicine residents at the University of Chicago and Johns Hopkins University in Baltimore, Maryland, are given iPads; entering medical students at Stanford University in California are given vouchers they can use to buy one.
與電子病歷連線的平板電腦已經廣為全美各地實習醫師所使用。芝加哥大學與馬里蘭州巴爾的摩市約翰霍普金斯大學的全體內科住院醫師都配備一台iPad。加州史丹福大學的醫科新生都會拿到iPad兌換券。

A University of Chicago study this year in Archives of Internal Medicine found that residents with iPads were able to enter orders in a more timely manner, and a majority of residents perceived that the iPads improved their work efficiency. At the University of California, San Francisco Medical Center, some physicians use iPads, and many use one of the hospital’s computers on wheels.
芝加哥大學今年透過「內科醫學檔案」發表一項調查報告指出，配備iPad的住院醫師往往能夠以更適時的方式掌握狀況，大多數的住院醫師並認為，iPad提高了他們的工作效率。舊金山加州大學醫學中心的部分醫師使用iPad，許多醫師則使用醫院的附輪子的電腦。

At an outpatient clinic seven kilometers west of the hospital is Dr. Paul A. Heineken, a primary care physician.
從事一般醫療的韓尼根醫師在該醫院以西7公里處主持一家診所。

Dr. Heineken is a revered figure among trainees at the San Francisco V.A. Medical Center, where he makes a point of requiring something old-fashioned.
韓尼根備受舊金山退伍軍人醫療中心實習醫師敬重，原因之一是，他特別要求實習醫師謹守一些傳統。

“I tell them that their first reflex should be to look at the patient, not the computer,” Dr. Heineken said. And he tells trainees to return to each patient’s bedside at day’s end. “I say, ‘Don’t go to a computer; go back to the room, sit down and listen to them. And don’t look like you’re in a hurry.’”
韓尼根說：「我告訴他們，他們的第一個本能反應應該是看著病人而不是看著電腦。」他要求實習醫師在結束一天工作之際，來到每一名病人的床邊。他說：「我說，『不要坐在電腦前；回到病房，坐下來，聽病人說話。還有，不要讓病人覺得你在趕時間。』」

One reason for this, Dr. Heineken said, is to adjust treatment recommendations based on the patient’s own priorities. “Any difficult clinical decision is made easier after discussing it with the patient,” he said.
韓尼根表示，如此做的原因之一是，根據病人本身的輕重緩急調整診治建議。他說：「與病人共同討論後，任何為難的診治決定都會變得更容易。」

Dr. Heineken fills his teaching days with similar lessons, which can mean struggling upstream against a current of technology. Through his career, he has seen the advent of CT scans, ultrasounds, M.R.I.’s and countless new lab tests. He has watched peers turn their backs on patients while struggling with a new computer system, or rush patients through their appointments while forgetting the most fundamental tools – their eyes and ears.
韓尼根把類似的道理引進課堂。這可能意味，必須在科技急流中奮力逆流而上。他曾經目睹電腦斷層掃描、超音波、核磁共振造影與無數新實驗室檢測法一一推出。他曾經目睹一些醫生同事在摸索全新的電腦系統時，背對著病人，或者匆匆應付約診的病人，並在整個過程中忘了使用最基本的工具：他們的眼睛及耳朵。

Dr. Rajkomar heeds Dr. Heineken’s advice by making sure to keep his gaze fixed on his patients while he is typing.
拉吉科瑪爾牢記韓尼根的忠告，而且劍及屨及：打字時，眼睛看著病人。

But Dr. Rajkomar also knows when the computer needs to be set aside. During a visit, when a patient confided that his wife was taking his pain medication, Dr. Rajkomar excused himself and walked down the hall to consult with the pharmacist about a plan to keep that from happening.
拉吉科瑪爾也知道什麼時候該暫時把電腦擱在一旁。有一次，一名病人向他透露妻子服用他的止痛藥。這時候，拉吉科瑪爾暫時離開診間，下樓與藥劑師商量如何防止類似事件繼續發生。

Dr. Rajkomar knows he has a great deal to learn about being a physician, especially patients’ social and psychological complexities.
拉吉科瑪爾明白，行醫有待學習之處還多得很，特別是病人在社會與心理等方面的錯綜複雜性。

“One patient fired me,” he said, smiling as he added, “Dr. Heineken gets those patients.”
他笑道：「有個病人把我開除了。這些人都成了韓尼根醫師的病人。」

原文參照：
http://www.nytimes.com/2012/10/09/science/redefining-medicine-with-apps-and-ipads-the-digital-doctor.html

Video: Mobile Devices ‘On Call’ in Hospitals
http://nyti.ms/TcpRhj

2012-10-23聯合報/G5版/UNITEDDAILYNEWS 陳世欽譯 原文參見紐時週報十版上