George Clooney Was Onto Something

In the Oscar-nominated movie “Up in the Air,” Ryan Bingham (aka George Clooney), travels around the country firing employees for company bosses who don’t have the stomach to do it themselves -– the ones who prefer to “outsource the downsizing function.”

He finds his own job threatened by a hotshot business school graduate who convinces the president of their company that it would be more efficient to do the long-distance layoffs via the Internet.

Sitting in a hotel bar, our hero makes a passionate speech to his young colleague about how important it is to fire people face-to-face: that a look in the eye, a few words that personalize the institutional rejection and a handshake allow them to maintain some small shred of dignity at the very moment they lose their identity as a valued employee.

This speech resonates with me as I contemplate the waves of e-mail notices in my inbox announcing new electronic tools and personalized Web-based services and sites that can help me take care of myself.  I can take a picture of my rash with my iPhone and send it to my dermatologist.  I can check online to see when I had my last tetanus shot or schedule my next mammogram.  I like interacting with my doctors by e-mail about minor matters.  And if I lived in the empty plains of Eastern Montana, I would probably often prefer a telemedicine visit with a doctor or nurse over a 10-hour round-trip drive for a 20-minute in-person appointment.

What takes place during an in-person visit — the physical examination, the conversation, the look in the eye and the handshake — that can’t be accomplished any other way?

I have a hunch that the value of the in-person firing — as opposed to online — so passionately defended by George Clooney’s character is dwarfed by the value of the face-to-face, hands-on meeting between me and my doctor or nurse practitioner…that sometimes the interaction between us is a critically important part of my doctor’s diagnosis and treatment recommendations as well as my willingness to participate in care.

The active ingredients in that interaction are not widely specified or quantified.  And while most people and most health professionals probably share my hunch that in-person interactions are sometimes critical, all of us appear to be willing to forego such contact at different times for reasons of convenience and expense.

High cost and poor efficiency are cruel taskmasters, though, and the drive — by health plans, the government and providers — to reduce the former and improve the latter is well served by out-sourcing interactions between us and our doctors to automated and Web-based programs and services.   How will they — and we — know when the balance tips — when the lack of the physical encounter, the look in the eye; the hand on the shoulder begin to erode the quality of care we receive and the outcomes we hope for?

Jessie Gruman, PhD, is the founder and director of the Washington, DC- based Center For Advancing Health. She is the author of “Aftershock. What to Do When You or Someone you Love is Diagnosed with a Devastating Diagnosis.”

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