At a recent surgical conference, the speaker shared a startling statistic. “Almost 80% of surgeries are currently performed with the assistance of computer navigation or robot,” he said as the gaggle of doctors began to settle down.
The surgeon paused for a moment and asked the gathering, “How many of you would not hesitate to cancel their surgical list if either the navigation system or robot is unavailable on a particular day?” Unsurprisingly, all but the ones with wrinkled faces, crow’s feet, or a receding grey pate raised their hands.
Since time immemorial, doctors have relied heavily on their brains and their hands.
Right from the day a doctor steps inside medical school till life retires him, the brain is his storehouse of innumerable medical facts, extensive information about the many ways of disease manifestation, and continuous update of new knowledge. Diseases are diagnosed, the relevant investigations ordered, and the specific treatment initiated based on the information retrieved from this storehouse.
Along with the knowledge, the success of a doctor significantly depends on his or her clinical examination skills. These skills involve the doctor’s touch, astute observation of the patient’s walk, moving the arms and legs, palpating the affected parts, examining the eyes, mouth, and fingers, and the dexterous use of hand-held instruments like the stethoscope, tendon hammers, retinoscopes, and so on.
With these questions and examination findings, most diseases can be diagnosed with ‘reasonable’ accuracy, which can then be confirmed by a few medical tests. Such was the power of these clinical skills of yesteryear doctors that I was in awe of a neurologist who would start the prescription with the ‘diagnosis’ as he saw a patient walk into his clinic. The subsequent questioning and clinical examination would be just to confirm it!
With improvement in technology, new gadgets thronged the medical industry to diagnose diseases with surety. This included X-ray examination, ultrasound scan, a battery of blood tests, computerised tomography (CT) scan, magnetic resonance imaging (MRI), bone scans, and so on.
With enhanced affordability and accessibility, more doctors and patients, even in remote areas, started getting easy and inexpensive access to these diagnostic gadgets. As these gadgets made the task of ‘diagnosis’ simpler, more doctors found it an easier route. Instead of racking one’s brain and spending time with the patient, the reliance on diagnostic gadgets became more convenient for doctors. There were several other reasons too like matching up to the increasing expectations of patients, medico-legal issues, quicker and sure diagnosis, and sordid healthcare business models. Added to the decreasing quality of medical education, diagnostic tests have become the standard now, pushing history-taking and clinical examination to the brink of expiry.
While clinical diagnostic skills are facing a slow death, the advent of technology in surgical practice has started deskilling surgeons too. Surgeries are interventions performed to repair an organ while causing the least damage to other structures around. This is executed by surgeons through their deft hands, years mastering the nuances, and an excellent knowledge of the three-dimensional anatomy of the human body.
To reduce manual errors in executing the surgical task, medical bio-technology introduced new gadgets that improve the precision and safety of the surgeries. Computer navigation, endoscopes, robotic-assisted surgeries, and neural monitoring are some examples. While these have made the performance of really complicated and risky surgeries much simpler, their usage has been extended to even simple procedures now.
This has multiple negative repercussions such as manifold increase in the already soaring healthcare costs, decline in a surgeon’s manual skills to perform procedures without gadgets, and the muddled definitions between standards of care and unnecessary usage.
Over a period of time, the employment of these gadgets for all surgeries may become the norm, kicking smaller hospitals and peripheral centres into oblivion. Future surgeons can become totally reliant on these flashy instruments rather than their anatomical knowledge and dexterity.
To draw a parallel, just a decade ago, we had a good geographical knowledge of places that we visited even once. Once Internet-based maps started guiding our travels, it became a boon to access even unknown territories. But slowly we have lost our ability to remember places, streets, and locations, having become completely reliant on technology.
This is happening at a larger and quicker scale in the medical field too. In the years to come, diagnosis of diseases will become totally dependent on artificial intelligence, leading to proliferation of medical tests. Even simpler procedures will mandatorily be performed by complex gadgets. Inserting an intravenous line or giving an intramuscular injection in the buttock will be monitored by radiological contraptions!
(The author is a spine surgeon based in Coimbatore)
rishiortho@gmail.com
