Friday, May 17, 2013
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).