No Red Lights – The Unstoppable March
Of Technology In Healthcare
(Disclaimer: This post was written
for a competition organized by Indi-blogger and Apollo hospitals on the topic
of “How does modern healthcare touch lives” – please check this link for
further details: http://www.apollohospitals.com/cutting-edge.php)
The other day I was at a swanky
new private medical college on the outskirts o the city, the venue for a
surgical workshop. They had invited me over for a small live-demo surgery of the
trapdoor technique of harvesting connective tissue. For those who don’t know
what a trapdoor is (go Google it) - sometimes when you need a bit of skin to
graft someplace you can take it off from the patient by cutting up the patients
skin on three sides, lifting up the patch of skin and then by cutting off the
layers underneath (the skin has many layers) you can take them and use them
elsewhere and meanwhile stitch back the upper layer of skin in the same place
with no hint of anything missing underneath. The technique is first taught to
youngsters by asking them to cut an orange by peeling off a little bit of the
skin carefully and getting the pulp out from underneath without damage and then
putting back the skin of the orange so that no one who looks at the orange
should ever suspect that it’s hollow inside.
I trained in a government hospital
which has a big reputation for many, many years and so we used to get a lot of
patients from all over the state and even from our neighboring states. We used
to get such a surfeit of patients that after a few times practicing surgery on
oranges, we immediately shifted over to real patients and real skin. But
unfortunately the same cannot be said for the kids in some of these newly
started private colleges. The students (who have often paid extremely large
amounts of money to get a seat) have to keep on practicing on oranges for a
long time and wait and wait for a chance to do it on real patient’s skin.
Being fairly familiar with this
technique I had been invited to visit one such college and do a small
demonstration surgery to teach the kids there the differences between an orange
skin and human skin. As my surgical workshop was scheduled for the afternoon
and the lectures in the morning session were boring me, I took to wandering all
over the swanky new campus taking in the sights. And that’s when I noticed
something which really brought home to me the advances in health care from the
times I had studied and the situation now.
Impact On Hospitals –Tablet Computers
In Wards
As I wandered around the bright
and gleaming wards, i could see that there were ward rounds going on with the
chief issuing instructions and the students taking down notes diligently. But
unlike in my student days when we had small scribble pads for jotting down the
chiefs muttered instructions (one of this and two of that etc) these kids were
using tablets for note taking, real tablets of the electronic kind - i-pads and
galaxy tabs etc. The students were taking photos of the patient with their tab
cameras, attaching it to the case notes and whenever there was something they didn’t
understand or when the chief asked them a sudden question they were checking
for it on Google, like the values for sodium or potassium in normal human body.
We on the other hand used to mug up the entire values table and carry all that
useless information around on our brains for instant recall but these kids were
just storing it all on the cloud- on Google’s servers and accessing the
relevant info when needed. That was quite a revelatory moment for me when I
realized how much new technology can impact on health care.
Impact on Investigations –Digital
X-rays
Take x-rays for instance. Previously
any x-ray we got from the radiology department was iffy at the best. On some days
the radiography technician would send us clear x-rays, some days they would
send us cloudy x-rays with nothing visible depending on their moods (or what
their wives said to them at breakfast). The only way to get a guaranteed good
x-ray (for any complicated case) was to personally go to the x-ray department,
take an x-ray by yourself, head into the dark room (pinch a few girls there-
under the red lights) and develop the x-ray by yourself by alternately dipping
them into the large tanks full of developer and fixer solutions. If you were
skilled at it, you could make even an average x-ray gorgeous by timing the developing
(by under or over developing) and fixing processes.
But now all that’s become
superfluous for you have digital x-rays. Now it’s all about pixels and values
and the results can be seen in seconds on a monitor. Every digital x-ray is standardized
to the same incredible level of detail and clarity- by idiot proofing (removing
the human being off the loop). Of course when you press a button and get an
x-ray immediately, you are tempted to order more and more x-rays sitting in
your chair compared to when you had to haul your ass off to the radiology department
every time you wanted to get an x-ray. So digital x-rays do have the drawback
of tempting doctors to order more x-rays then necessary. That and missing out
on all the fun and romances which used to take place in the x-ray dark rooms,
behind the developer tanks, under the red lights.
Impact on Surgeries –Using
Simulation Software
The same kind of technological
ease of use is seen with surgical planning nowadays. With all the modern CT’s-
with their various slices of info- 64/128 etc, you get all the info as bits and
bytes which you can take and feed into a simulation program to recreate the CT
as a 3-D human dummy and virtually practice the surgery. If you have ever
played Microsoft Flight Simulator, then you would understand how awesome it is
do a simulation practice before doing the actual thing. Previously we used to
lie back with our eyes closed and imagine the entire thing in our minds from cutting
to stitching in a step by step imagination. Now we just switch on the
simulation program and start cutting. But again with all this wealth of detail
available, it’s so tempting to order more and more CT’s for every stage of
diagnosis rather than being satisfied with just one preliminarily.
On a related note, I know that a
lot of patients feel that doctors nowadays order a lot of useless
investigations and tests. But the best person to decide the necessity of that
test is the person who might ultimately be held responsible for the
consequences- your doctor is the best judge for what is needed or not. And for
every extra investigation ordered by the doctor, which you feel is useless,
think how you would feel if the doctor had not ordered that test and you ended
up getting that disease. And how thankful you should be that your test results
came back negative, rather than cribbing about paying for that test.
Using Robotic Surgery Machines –
Da Vinci Robots
When it comes to the actual
surgery, only the best surgeons were said to be confident enough to make their
incisions (cuts) in one long fluid single stroke at the correct length, depth
and angle. But now with robotic surgical machines and lasers replacing scalpel
blades even mediocre surgeons can make the cuts with the same precision as, hey
they aren’t actually making it, they just have to set the depth and length on
the touchpad screen and the laser does it for them – thereby leveling the field
between good surgeons and great surgeons. But there are also drawbacks to these
robots, for we hear that the Da Vinci Surgical Robot has been known to freeze
up halfway during surgery – once with a patient’s liver grasped tightly in its
clamps- due to a software glitch (or virus attack) and they had to shut down
the whole system (the robot) and re-boot it again to get the robot to release
the patients liver. So if you ever have a robot doing your surgery and it stops
suddenly- don’t panic, just press Ctrl+Alt+Del to have it re-start (if its
windows based).
Using Stem Cell Therapy- Via Star
Trek The Series
Finally we come to the big daddy
of medical technology- stem cell therapy for organ replacement. Let me share a
small personal anecdote here. When I was a little kid they used to show Star
Trek the original series on Television. One episode of which was quite an
unforgettable experience for me. The episode I am talking about involves the
Star Trek crew coming back in time to the 20th century to save the
whales from destruction. In one point in the serial as Captain Kirk, Spock and
the rest of the crew of Starship Enterprise rush through the corridor of a typical
20th century hospital Dr.Bones is stopped by an old woman who asks
for some relief from her severe pain. The surprised Dr.Bones hangs back (while
the others leave) to ask her what she is suffering from and she says that both
her kidneys had failed and she was going to die soon.
Dr.Bones looks around carefully to
see that no one is observing his actions and pulls out a pill and gives it to
the old woman to swallow. At the end of the episode we are shown a television
reporter standing outside the hospital and talking about a medical miracle
where an old woman with kidney failure suddenly grew two new kidneys inside
herself and everyone turns to stare at Dr.Bones. That decided me in my career –
that exact moment. I wanted to be the guy who handed over such magical pills to
cure patients in pain- I wanted to be a doctor. I wanted to be Dr.Bones. With
today’s technology I know that we are very far from such instant organ
replacements. But who knows about the future? A breakthrough might happen any
time or any day. We can always hope.
The Future Is Here- As Google
Glass.
And some of those hopes might even
be coming true in our own times- example – Google Glass. Do you recall those
medical students I was jealous of? The ones using i-pads to review notes? Now
imagine using Google Glass to get real time information about all the medicines
being taken and test results of each patient who is lying on the bed as we walk
down the wards – is there any way we can miss anything important about the
patient?. Imagine using Google Glass to layer a real time surgical simulation
as we do the actual surgery- is there any way we can miss any important step? I
am very, very excited about Google glass and its effect on how we practice
medicine. Off-hand I can think up a dozen new ways I can use Google glass in my
daily practice to help my patients.
So to come back to the premise of
this post. Technological advances stop for no person. Technology keeps developing
at a rapid pace and it is up to us to evolve to keep pace with the advances in
technology. This is as true for the healthcare profession as it is for any
other profession. We cannot close our eyes and insist on practicing medicine
the old way, for the old ways are dead. Evolve or perish is the new mantra. As wise master Yoda once said "There is only Do, there is no Try"
And finally, technological
advances can make a mediocre doctor a good doctor, a good doctor into a great
doctor and a great doctor into, ahem, ahem, me…(just kidding).
Good to know the doctor's side of tech advancements in the medical field!
ReplyDeletethanks Anne...and welcome to my blog
DeleteSo, technology is eliminating human touch and hence it is making medicine better? Actually it's correct. That's the whole basis of automation - Eliminating human interference! Why? Because humans are inaccurate, humans are greedy, humans are unpredictable.
ReplyDeleteThe basic thing I am trying to say is, technology is a double edged sword - Nuclear technology can be used to create bombs as well as power, for example. Similarly, modern day technologies also have their limitations (cost of treatments skyrocketing, unnecessary procedures, etc.), along with their advantages.
Whether technology is used for the benefit of patients or not, depends entirely on the doctor who is treating that patient. There are cases where no surgery is required, but still surgery is suggested. Greedy doctors use technologies and medicines in the wrong way. You can't blame them entirely - Medicine has become business and doctors are under pressure to show ROI and profits.
I am not saying that everyone is greedy, but with limited knowledge on medical topics, patients are unable to decide which doctor is prescribing the right thing, and which one is trying to extract money out of them. Sometimes, wrong medications can do more harm, than good.
The only way for the patients is to maybe increase their medical knowledge using the social media, Internet and other technologies. But patients' level of understanding and time available for them is very limited. That's why they trust some doctors, who take advantage of it.
Destination Infinity
Due Diligence Rajesh...before you buy a SIM card, dont you go around asking your friends which service provider gives the best coverage? before you go out for dinner dont you ask somebody how the food was there? so how much more careful should you be in slecting someone who can take care of your health? thats how word of mouth used to weed out out the bad doctors from the good... but what do people do nowadays? they check out the snazzy website..see that vasan has branches in every area..even near their house and they go to a nameless, faceless guy has to answer to the corporate department for his salary every month and hence orders unnecessary things...its not enough to trust doctors because they are doctors- just like in every field there are bad apples in medicine too.its to everyone's advantage to find out and separate the good from the bad
Deletethanks doc...
ReplyDeleteAwesome blog post :-) all the very best for the contest :-)
ReplyDelete