The Machine at the Bedside: Strategies for Using Technology in Patient Care

This is the first work to examine comprehensively concepts and strategies for using health care technology effectively and humanely at the bedside. Applying knowledge from the decision sciences. ethics, economics, sociology, the physical sciences, law, history, and clinical medicine, this book provides a multidisciplinary framework for practitioners, educators, policy makers, and the public who must decide about and implement the technological agents of health care. Twelve chapters present basic knowledge about this technology, from the forces that create and disseminate it to the perspectives and techniques crucial for directing its use. The second part of the book consists of twenty-three case studies depicting the benefits and liminations of the chief health care technologies of our times, such as electronic fetal monitoring, imaging technology, intensive care, and genetic diagnosis. By discussing both theory and practice in the context of legal, economic, ethical, and other concerns, this work devolops concepts and tools that will help prepare health care students and professionals - and all concerned members of society - to deal with the complex issues and dilemmas associated with the rapidly increasing use of technology in health care.

Table of Contents:
Foreword; preface; Part I. Overview: 1. The machine at the bedside: technological transformations of practices and values; Part II. Scientific Dimensions of Technology: 2. Penetrating the black box: physical principles behind health care technology; 3. Biological bullets: side effects of health care technology; Part III. Creation and Dissemination of Technology: 4. The engineering-industrial innovations: clinical diffusion of health care technology; 5. Embracing or rejecting innovations: clinical diffusion of health care technology; Part IV. Organizing Technology in Clinical Settings: 6. Technology' front line: the intensive care unit; 7. Action with dispatch: technology in the emergency department; Part V. Applying Technology in Clinical Practice: 8. The unwanted suitor: law and the use of health care technology; 9. The machine and the marketplace: economic considerations in applying health care technology; 10. The technological strategist: employing techniques of clinical decision making; 11. The technological target: involving the patient in clinical choices; 12. Does technology work? Judging the validity of clinical evidence; Case studies; Index.

Review :
'Technologies have made modern medicine what it has become today. They are simultaneously the tools which permit many of the miracles of medical care to be carried out while at the same time depersonalizing the process, distancing the patient and his or her physician. This book, The Machine at the Bedside, is about health care technology - its creation, its dissemination, and its application. It is clearly written, interesting, and right on target. It will help all health professionals to think more deeply about the place of technologies in our system of medical care and how to use them in a restrained and discriminating manner. A most important book on some central issues facing medicine during the coming decades.' David E. Rogers, M.D., President, Robert Wood Johnson Foundation 'Both good public policy and good medical decisions become more likely when they are informed by the best information and analysis. The Machine at the Bedside is the most thoughtful approach extant on the range of issues involved in how we as a society appropriately develop and use the fascinating machines of medicine. Drs. Reiser and Anbar have assembled a panoply of contributors whose careers have been bent toward critically examining and improving what it is we physicians do to and for patients. In an era of cost containment, together they help inform decision-making to be more medically effective and to be sensitive to ethical, legal, and economic imperatives.' John R. Ball, M.D., J.D., Associate Executive Vice President, Health and Public Policy, American College of Physicians 'With high technology making medical care more complex, more effective, and more costly, the role of the machine at the bedside must be comprehended by both medical students and physicians. This book provides insights into both the opportunities and problems that high technology medicine has created.' August G. Swanson, M. D., Director, Department of Academic Affairs, Association of American Medical Colleges