The Unpredictable Effects of Technology

The interaction of humans and technology will always be unpredictable.  A few months ago this thought was driven home to me in a rather malodorous manner…

I have obstructive sleep apnea (OSA) and use a CPAP machine every night to sleep comfortably.  With OSA your airway collapses when you fall asleep.  A CPAP machine is a small technological marvel, quietly delivering heated, humidified air under gentle pressure through a nasal mask to keep your airway open while you sleep.

One night while using the CPAP I was ripped out of a deep sleep by the worst odor I have ever encountered.  How bad does a smell have to be to violently awaken you?  Dazed and confused I sat up, clawed my CPAP mask off, gulped a few breaths and waited for the purple haze to clear.  I looked down towards the floor next to the bed and realized with horror what had happened.

Our dog, Jade, is a Labrador who has blessed our household for nearly 14 years.  Out of affection and respect for her sheer endurance no one begrudges old Jade her habit of passing gas almost continuously.

On the floor was Jade, sleeping comfortably with her posterior positioned next to my CPAP machine on the floor.  Jade’s colonic gift had been sucked into my CPAP machine, heated, humidified and rammed up my nose into my gray matter.  We are not sure yet if the brain damage is permanent or not.  My wife and kids insist I’m no worse off than I was to start with.

History contains many other examples of technology’s unpredictable effects.  Remember the “paperless office?”  For several years in the early 1990’s, when PCs were new and word processors were first introduced, it was widely accepted that offices would soon have no need for paper.   Just write your document on the computer, save it to your floppy disk (remember those? They were actually floppy back then) and deliver the floppy disk to the recipient, who would read your document on screen.  Who needs to print documents anymore?  Paper manufacturers were in a panic, sure that demand for their products was about to disappear.

As anyone over 40 years old remembers, the opposite happened.  Office workers were happy to create documents on a computer screen but were unwilling to read them there; all documents still got printed eventually.   Then we became obsessed with creating perfect documents.  If a 20-page report had one comma out of place, fix the comma and reprint the entire document.  Then find another mistake and reprint 20 pages again.  Paper use skyrocketed.  Today the paperless office remains an unreachable goal, an ethereal concept, a star by which you can navigate but that you will never reach.

Medicine is replete with examples of unintended effects of technology.   A 5-minute web search produces a long list of unexpected medical outcomes such as heart problems from Fen-Phen and heavy metal poisoning from prosthetic hips.  Even something as seemingly benign as an over the counter zinc-containing nasal spray has been found to cause permanent loss of smell.

It comes as no surprise, then, that when we physicians contemplate EMR we see the introduction of an unpredictable technological force into the unpredictable environment of medicine.   That raises more questions than answers.  Will EMR free us to be real doctors again or make us slaves to data capture?  Will health information exchanges give us the information we need at our fingertips, or will we be barraged with terabytes of useless data?  Will e-prescribing be a blessing or a nuisance?   Pardon us for not buying into the IT euphoria.   Our patients and we will have to bear the consequences more than anyone else.  As stewards of the health care system we recommend proceeding with some caution.

About the author

Dr. Michael Koriwchak

Dr. Michael Koriwchak

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery.
After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations.
Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia.
With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.


  • As a computer enthusiast and ER doc, I heartily agree that the EMR wave will cause as many interesting problems as it will solve. I do think it will continue to erode the elusive patient doctor relationship. Thanks for your hilarious and well written post.

  • I think ongoing studies will eventually conclude that the fermentation process in a canine’s digestive tract produces emisisons on par with the toxicity of over the counter mace and pepper sprays, with added side effect of causing nausea and loss of appetite. I’ve recently discovered that it also can double as an airborne delivered paint remover.

  • Great article! Funny and unfortunately right on the mark for concerns about technology and healthcare. The two are not mutually exclusive, and with time and patience I believe that physicians will not only benefit, but learn to enjoy the advantages of clear and concise documentation that are part of an electronic documentation system. There is more to gain as they learn to employ shortcuts in template documentation, integrated charge capture and medical necessity documentation – all needed for reimbursement.

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