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It's not magic -- it's medicine

Illusionist-turned-physician's specialty is inspiring confidence

By Neil Osterweil
MedPage Today Senior Associate Editor

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Dr. Daniel Sands says the roles of physician and magician aren't all that different.

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BOSTON, Massachusetts (MedPage Today) -- Doctors and hospitals once held onto medical records as closely as a poker player clutches a straight flush. But thanks to Dr. Daniel Z. Sands and collaborators, Boston's Beth Israel Deaconess Medical Center is laying its cards on the table.

Beth Israel Deaconess, a major teaching hospital of Harvard Medical School, was the first to allow patients to get access to their records from their home computers, with its PatientSite system. Now other hospitals throughout the nation are jumping onto the electronic bandwagon.

As one of the chief architects of the online medical record system at Beth Israel Deaconess, Sands, an M.D. and Ph.D., is serious about putting the power of clinical computing into the hands of patients. He calls it good medicine.

Sands says that unlike automated phone systems that throw up barriers between businesses and their customers, computer technology wisely used can bring doctors and patients closer together.

"First of all, when a patient walks into the doctor's office and the doctor is not shuffling through papers and trying to find something he can't find, but instead has all of the information right there on the computer and it's neatly organized, that automatically tells the patient, 'This is a good doctor'," he said.

With electronic systems, patients can log on securely from any computer to check on their test results, schedule appointments, send confidential e-mail to their physicians, request prescription refills, and get detailed health information about their diseases or conditions.

Sands, an assistant clinical professor of medicine at Harvard Medical School, said that with pressures to both see more patients and to keep costs down, physicians need help coping with a flood of information. As one with a self-confessed high CNP (computer nerd potential), he is tapping into his lifelong flair for gadgets.

"The computer is a tool to help me take better care of the patient, and also to help the patients take better care of themselves," he said. "That's a very powerful thing."

Escape artist a la Houdini

Sands, who grew up in University Heights, Ohio, in the 1960s and 1970s, and attended Cleveland Heights High, says that he didn't start out to be a doctor. In fact, he once wanted to be a professional magician, and the sense of creating illusions is still strong. Except he does it with computers, and his creations are real -- not illusions.

"I started performing magic when I was 5 1/2 and started performing for money when I was 10, and kept doing that through med school," he said. "At one point, I wanted to be a fully professional magician."

His best trick was a version of a Houdini illusion, in which audience members would tie him up at his invitation, and he would escape from the bonds while reciting Casey at the Bat.

"I was interested in computers before I was interested in medicine," he said. "I didn't actually like life sciences when I was in high school, but I did like computers, and I taught myself how to use computers at that point."

It was at Brown University in Providence, Rhode Island, that he both found his true calling, and encountered his first personal computer -- an early Apple Macintosh that one of his roommates bought.

Although the boxy machine with its small monochrome screen was about as modern by today's standards as clay tablets and cuneiform, it was highly advanced technology for its day, and Sands was hooked. And despite his early disdain for the life sciences, he graduated from Brown in 1984 with a degree in biology.

"As I eventually decided to go to medical school, I realized that a lot of what we do in medicine is manage information, and having access to that information, being able to sort through it effectively, and knowing when to do things is really crucial," he recalled.

"So I made a conscious decision that I would at some point marry my medical interest with my technology interests."

Power to the patient

In his practice, instead of hiding behind the screen and shielding the information, Sands turns the screen to make sure that patient can read it as well.

"It allows us to discuss that patient's health in the way that nothing else can, because we're looking at the record together -- we don't have the computer interposed between the doctor and the patient."

Perhaps the greatest power afforded by clinical computing, however, is the power that it gives to patients.

"Not only can patients see their test results online, but increasingly patients are going to be managing their health benefits online as we move to more consumer-directed health care, using the technology to help patients determine where they want to be referred for their specialty care or surgical procedures," he said. "That's all going to be very important for the patient."

That claim is backed by a recent Wall Street Journal poll, in which nearly 80 percent of respondents said they favor or strongly favor electronic medical records.

Gameboy generation goes into practice

Just a few years ago, the only place you'd be likely to find a computer in a medical practice was at the front desk or billing office. That may be because physicians tend to be slow adopters of communications technologies, according to Alissa R. Spielberg, J.D., M.P.H., of the division of medical ethics at Harvard Medical School in a 1998 article in the Journal of the American Medical Association.

She noted that in the early days of the telephone, "many practitioners believed that practicing medicine over the telephone compromised the moral integrity of the profession and promoted substandard care, with patients forgoing necessary physical examinations and misinterpreting muffled prescriptions."

But today's medical school graduates cut their teeth on Nintendo Gameboys and Sony PlayStations, and personal digital assistants (PDAs) have for most newly minted doctors taken the place of hefty paper manuals. For this tech-savvy group, the benefits of technology are obvious.

"There is much more pressure from the doctors themselves who are now coming up in the system to get the technology," Sands says. "They expect their hospitals to provide them with the information technology they need to make better decisions to manage their patients, they expect this in their practices. Those who aren't getting are using their own tools like PDAs to help them make better medical decisions."

Piano, guitar, and magic

Sands got his M.D. from Ohio State School of Medicine in 1988, and followed up with a master's degree in public health from the Harvard School of Public in 1993.

In addition to his role at Beth Israel Deaconess' Center, Sands serves as chief medical officer and vice-president of clinical strategies, for the Zix Corporation, a Dallas-based firm specializing in secure communications for health care, finance, insurance and government.

He spends what leisure time he has playing piano and guitar, sailing, reading and, when he can, performing magic.

"The role of the physician and the magician are not all that different," he said.

"A social psychologist once said that the physician in large measure must be very like the magician, because he must inspire confidence."

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