The surgeon who blogs as Skeptical Scalpel writes that he (she?) is unable to contain him(her)self any longer and then lunges into a review of evidence (or lack thereof) for robotic surgery.
You may disagree with Skeptical Scalpel’s decision to be anonymous, but he/she explains:
“I’ve been a surgeon for almost 40 years and a surgical department chairman for over 23 of those years. During much of that time, conforming to the norms, rules and regulations of government agencies, accrediting bodies, hospitals, societies, and social convention was necessary for survival. I was always somewhat outspoken but in a controlled way most of the time. I now have a purely clinical surgery practice with no meetings, site visits or administrative hassles. I am free to speak my mind about medicine or anything else.”
On robotics, Skeptical Scalpel writes: Read more »
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
At this writing, I am in Atlanta visiting our daughter at Emory University. This may be the only college campus in the nation where you can’t buy Pepsi. Coke is King here. If you don’t know this, do some due diligence before you or someone you love interviews here.
I remember a few decades interviewing at the medical school here. There are only 2 medical school interviews that I recall after all these years. At N.Y.U. School of Medicine, the canny interviewer asked me what the death rate of Americans is. I correctly responded, “100%”. I suppose that untangling enigmatic questions was an N.Y.U. admission requirement, since they did accept me, and I did attend. The other medical school interview I still recall was at Emory, although it’s not the questions I remember. Their unique interview format made the experience memorable. Three medical school applicants were interviewed simultaneously as we faced a bank of questioners. This was reminiscent of the ancient and popular TV show, The Dating Game, where 3 bachelors or bachelorettes heard their competitors’ responses and often had to respond to the same questions. Read more »
*This blog post was originally published at MD Whistleblower*
After the computer known as Watson easily dispatched of the best two human Jeopardy! contestants in history, IBM announced that one of the first applications of their artificial intelligence technology would be in the medical field. We should soon expect virtual physician assistants in the exam room. At least one of my friends even speculated that the days of human doctors are numbered.
Is it possible that machines will replace humans in the doctor-patient relationship? I doubt it. According to a study done by the Mayo Clinic in 2006, the most important characteristics patients feel a good doctor must possess are entirely human. According to the study, the ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Watson may have proved his cognitive superiority, but can a computer ever be taught these human attributes needed to negotiate through patient fear, anxiety, and confusion? Could such a computer ever come across as sincere?
I’m afraid some major calibrations might be needed to substitute artificial intelligence for an “ideal” physician. What do you think? Here’s an artist’s conception (read: farce) of how such an application in the examining room might play out. Click HERE to watch the medical cartoon.
*This blog post was originally published at The Examining Room of Dr. Charles*
Yesterday in our cath conference, we discussed the substudy from the prospective randomized trial called PREVENT-IV just published in the New England Journal of Medicine. That study evaluated the major adverse cardiac event rates of minimally invasive vein harvesting compared to open vein harvesting prior to coronary bypass surgery.
I was surprised to see that minimally-invasive vein harvesting had a higher combined complication rate of death, myocardial infarction (heart attack) and need for revascularization in the patients who received vein grafts harvested by the minimally-invasive technique. Following the presentation of the data, our surgeons were asked why this might be the case. While none knew for sure, they postulated that the art of harvesting vein-conduits using endovascular techniques might play a role (it’s more difficult), or the effects of the thrombolytic state induced by on-pump bypass vs. off-pump bypass might create the discrepency in post-surgery vein survival, since patients are less likely to develop clinical thromboses in the post-open chest bypass population.
So this morning, I was surprised that President Obama toured Cleveland Clinic yesterday and had such an up-front experience with minimally-invasive robotic surgical techniques for mitral valve repair that hardly represents mainstream American health care. While the marvels of the technology cannot be disputed, like the endovascular vein harvesting study above, might we find that robotics could be as deleterious to patients compared to open chest techniques? After all, these techniques have yet to be compared in multi-center trials to more conventional open techniques for mitral valve repair. But more concerning as we move forward is this question: will academic centers be granted more funds to test comparative effectiveness research for robotics at the expense of front-line American health care? Surely, this won’t be, will it?
But when I see pieces like this I wonder why the article does not question the cost and risks of this technique compared to conventional open-chest procedures, especially in this era of touting the need for health care cost containment. How much is this piece about the marketing of this technique to the community (for financial gain) or to the President (for obtaining grants or political favors)?
Perhaps we should ask ourselves how many of the physicians and surgeons at Cleveland Clinic stand to earn a seat on the proposed MEDPAC board that will determine if Congress will approve payment for robotic techniques even when few data exist to show their superiority over conventional techniques.
Now that might make for some really interesting reading.
*This blog post was originally published at Dr. Wes*