Did G-d punish us or bless us when He gave us choice

I am sure that most people have heard the expression “you can’t have it both ways” many more times than they would have liked. They want it [what ever it is] to be cheaper and faster, taste better and have fewer calories, hurt less but build your muscles more, be free but always up-to-date with the latest features and so on.

We are living in a magical time [I use this term a lot, for good reason] when you really can have all the choices you want. But if you prefer one feature, physics or the gods or market forces might force you to accept a limitation. So if you are talking about smart phones, of course you want a beautiful product that is up-to-date and has the best possible graphics and excellent Internet connectivity and endless battery life, and you want all of that to presently cost $100.

There are $100 tablets, that with an Internet connection can provide voice messaging and real time video across any expanse. The quality might be poor and the battery might not last a long time. But not that long ago, the dream of $100 computer that could be given out across the developing world, was desperately looking for a solution. While there was a model that was distributed, I suspect that most users would have been happier with the hundred dollar tablets of today.

There are quite a number of day-to-day challenges that the technology world faces because people want it all. One classic example is the privacy versus accessibility trade-off. On one hand, everyone wants to be able to access their applications at any time and anywhere. They want the process of personal identification to be seamless. They don’t want to remember complicated passwords and they don’t want to struggle for five minutes trying to type them in. By the way, for people with neurological disorders, typing in a password can be a true nightmare.

But the same people want absolute privacy. They want to know about everybody else but they don’t want anyone to know about them unless they specifically allow it. They want to post photos of the great time they had last summer, but they want those photos hidden from anyone who might look at them in order to decide if the person is a good candidate for vice president.

People live in absolute fear that their personal medical information will be leaked out. I am always fascinated by this for the very simple reason that most people have pathetically boring medical histories. Here’s mine: I have high blood sugar, high blood pressure, chronic back pain, chronic facial pain and am to a great extent limited to my house. I take a whole bunch of medications every day including a lot of opioids to control my pain conditions. Everything written here, could easily have been derived from open postings on Facebook, comments on LinkedIn and of course access to my email. Admittedly, my email is supposed to be secure and safe. And I believe that as much as I believe in Santa [n.b. I still have a little stocking next to my bed].

The world didn’t end. I didn’t lose my job. My wife hasn’t left me. But my personal medical information is now out there on the web for anyone to see. I’m okay with that. Because I know that at the same time that this information is out on the web, my personal medical information is also accessible through my health fund via my mobile phone. I know that someone could hack the records from my hospital and outpatient clinic visits. But it’s much more important to me that all of the health funds and all of the hospitals and all of the independent clinics share their information. This way, overall, I can benefit from advanced analytics, automated protocols, quality assurance systems and also be protected from ridiculous errors that may simply be due to my list of allergies appearing differently in different places.

So I made my choice for more technology, more sharing and more openness. And there is no question in my mind that this was a good choice.

I was just reading an article about the four things that patients really do not want you to do  when you [assuming you are a doctor] are in the room with them. One of those things is spending too much time staring at the computer screen rather than staring at them. Well, there’s a solution. The solution is called Google Glasses (GG). I have no financial association with Google. And in fact, I hope that very soon there will be multiple versions of GG coming from multiple major companies (which will help to reduce the price via competition). And probably, until Apple comes out with their version, the market will drag.

Some people hate GG with a passion. They fear it is a horrible intrusion into their privacy. They don’t know when you are recording them and when not. They don’t know if you have just taken a snapshot of them when they are naked on the examining table. They are not always sure if you are talking to the glasses or talking to them.

But GG or the equivalent, is the best way to be both involved with the patient in front of you and to record the medical record. First of all, the entire conversation with the patient could be recorded. The doctor can have both hands free while doing a complete examination and have GG record his or her comments along the way. “Okay Google, patient is short of breath for three days, non-smoker, and has a fever. Crackles in right lower chest suggest pneumonia. Please order a chest x-ray”.

Magic. No going to the computer. No looking away from the patient. There is an unlimited list of commands that a doctor could use during a visit, which would streamline his or her work, record every piece of important information, but never cause the doctor to look away from the patient’s face. In fact, I would expect a clinical system to automatically take a number of photos and even a video of every patient during the examination. Sometimes subtle signs can be evident early on that may be missed on the first examination. A tremor of the hand, a small drooping of the lips, a change in the color of the skin – these all used to be the magical little signs that made the difference between a great diagnostician and someone who just knew how to prescribe antibiotics.

So make a choice. If you want GG to help your doctors be more attentive, then you will have to accept GG in the world. Shopowners will want to use them for similar reasons – to help clients find items for purchase, and to place orders for the purchase while standing with the client. In fact the client could even pay through an application running off of some form of digital glasses. Imagine that – you walk into a store, you see something you like, you tap the assistant on the shoulder and five minutes later you are out the door with the purchased item and the transaction done.

So now you have a legitimate reason for many people to be wearing GG. But that means you have to accept the risk that they will photograph you and they will videotape you. Make your choice.

I really do wonder if technology will really ever be able to truly give us everything we want. I think, instead, what will happen is that we will simply become accustomed to the price that technology demands. Without any intention to offend, I think anyone who fights technology due to the infringement on privacy, is fighting an unwinnable fight. In fact, I think that such people are doing more harm than good.

Every day that the entire world does not support a mechanism for sharing medical records, people die. Every day that we don’t accept universal monitoring, people die. If every one wore a bracelet that constantly monitored pulse and their position, an ambulance could be on the way to a person having a heart attack before the person him/herself was even sure that something was wrong. But the cost of this person’s life is that all of their information is out there in the cloud, and most likely in the hands of some top-level hackers.

Life is about making choices and accepting the repercussions. We live in a time when we have marvelous things to choose from. And even though these things come at a price, the price is in fact not too steep. Admittedly, for some it is already way too high. But I suspect that the number of such people is waning. For me the debate is over. I want every toy and every gadget that could possibly make my day more streamlined and more efficient and safer. And on the off chance that somebody hacks into my Google account and sees a selfie of me after exiting the shower, I can only hope that an ophthalmologist will be able to wipe that image from their eyes.

Thanks for sharing. Thanks for looking. Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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