Mechanical Medics

Rushed to a top-secret desert laboratory to study a mysterious microbe from outer space, scientists in Michael Crichton's 1969 novel The Andromeda Strain undergo a thorough physical examination before they are allowed to start work. Their hearts, lungs and brain waves are all checked, their body fluids are analyzed, and their immunities to various diseases boosted by shots. But no doctor takes part in the process; the entire examination is automated. Says one member of the team to a colleague: "That machine--you'd better not let the A.M.A. find out about it." The A.M.A. already knows. Once little more than a figment of the science-fiction writer's imagination, mechanized medicine has become a reality that reaches far beyond electrocardiographs and electroencephalographs. Physicians are turning increasingly to electronics in their efforts to lighten their labors and increase their powers of observation and analysis. In the process, the very nature of medical practice is changing.

Hot Line. One of the most versatile of the new tools is television. Closed-circuit hookups are now routinely used to give medical students a surgeon's-eye view of operations and enable overworked nurses to watch patients without having to be at the bedside. TV is also employed to extend the reach of physicians, allowing them to see and diagnose patients at a distance. Boston's Logan International Airport, one of the world's busiest, has been linked to Massachusetts General Hospital by a system called Tele-Diagnosis. Those in need of care report to the airport examining room, where a nurse takes a preliminary history and establishes contact with the hospital. Once this is done, the doctor can examine and question the patient directly through the two-way hookup, examine specific areas of the patient's body by means of a nurse-directed TV camera, listen to the patient's heart via an electronic stethoscope. He can then decide whether the symptoms require immediate attention at a hospital or merely a later visit to a family physician.

Telemetry, long-distance monitoring similar to that now conducted on astronauts during space flights, has been brought down to earth to help victims of heart attacks. San Francisco's Mount Zion Hospital and Medical Center has installed a "hot line" in its ambulances, so that hospital-based doctors can keep tabs on hospital-bound heart-attack victims and advise ambulance crews on emergency treatment.

Screening Centers. Even greater potential for progress is offered by the digital computer. Various types of computers have already proved their value in the area of information handling, allowing physicians to store complete medical records and retrieve them at the touch of a few keys on a typewriterlike office terminal. Now computers are being put to even greater use by physicians seeking to plan treatment programs for their patients. Doctors at Mary Hitchcock Memorial Hospital in Hanover, N.H., have programmed their Honeywell computer to sort through some 20,000 different radiation-treatment plans and extract the ten most suitable for a particular tumor patient.

In about five minutes, the machine does a job that would take a technician several hours. It also sketches out the area of the body involved and plots the paths the radiation will take to reach the affected organ. "It would be impossible for the human mind to perform the same task," says Dr. Edward Sternick, the radiation physicist who helped design the program.

The computer's medical applications are not confined to computation; as Crichton forecast, the intricate machines are being used increasingly to perform physical examinations. About 50 computer-operated "multiphasic-screening centers" have been established in the U.S. since 1965, and some 250,000 Americans receive electronic examinations at these facilities each year.

Early Warning. The examinations are both swift and thorough. Patients using a screening center complete their medical histories by pressing buttons to answer yes or no to questions flashed on a screen before them. Then they merely follow prerecorded instructions as they move to machines designed to measure everything from pulse rate to hearing acuity. Although a nurse is needed to take a blood sample, she need not analyze it; recently developed machines can complete up to 24 different tests on blood in less than an hour.

Many doctors regard multiphasic screening, which can be done for less than $100 a patient and may save up to $500 in fees for laboratory tests, as an ideal way of examining large numbers of people and providing the early warning necessary for the prevention or successful treatment of many diseases. Others feel that screening is economically impractical. But Dr. Marvin Klein, who runs Checkup, a private, computerized diagnostic center in Chicago, offers evidence that the process can pay. By screening members of a union that subscribed to his service, he uncovered signs of glaucoma, a serious eye disease, in six. Two of the patients would have gone blind without prompt treatment. The projected cost of supporting the two men for the rest of their lives, if they had lost their sight, equaled the cost of Checkup's entire operation for five years.

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