At the moment I’m in Traverse City, Michigan with the Society of Philippine Surgeons in America attending their 34th annual Continuing Medical Education seminar in surgery, more specifically entitled “Surgical Highlights 2008: Controversies, Problems and Techniques”. I’ve been coming to this annual meeting for two years now, where last I year I was in Norfolk Virginia attending “Surgical Highlights 2007: From Complications to new Technology”.
Rather than droll on about the different surgical lectures (all of which at the moment I have trouble following due to my inferior medical knowledge), I have found a common thread that seems to catch the perview of all the experienced surgeons that attend. It is a simple one; new surgeons that are practicing now have been subject to advanced technology and are therefore losing “old school”, yet critical surgical technique. Case in point, the ability to convert a percutaneous laparoscopic procedure to an open procedure when complications begin to arise.
Take for example a laparoscopic cholecystectomy. The stigma is that opening a laparoscopic procedure is a sign of an unskilled surgeon. However, the opinion and statistical data show that laparoscopic complications (i.e. bile leak) occur after the learning curve; it is the experienced surgeon that becomes a bit too comfortable, thus leading to a problem. Compound that fact with no training in open surgery, and we are left with the statistic that only 0.1% of open choly procedures have a post-op complication, versus the 0.6% complication rate of a lapcholy. How does such a stigma still survive when the “advanced technique” produces 6 times the complication rate of an open procedure?
I guess the point is that yes modern technology helps in tremendous ways. Yet, we lose the art of surgery; the feel for the anatomy is lost to the secondary interaction via cold steel, the surgeon is now working in two dimensions on a tv screen, rather than three. I think the take home message is frugality with technology, and therefore one should not abandon the classic procedures, but cultivate such skills.
Marx talks about this phenomena. He describes man as “an appendage to the machine”. I’d like to think that what I will be doing in the future evades such a benign fate. I think that I am fortunate to have such a glimpse into the minds of the experienced, and I plan on taking their concerns to heart when doing my surgical training. To some, technology is God, but to others, I hope some of us find it scary when surgical procedures are no longer the outcome of a surgeon’s dexterity, but an outcome of the maturity of the technology being utilized. The newest and best thing in the technical world always has a built in expiration date, but refined skill and practice remains constant.
Thoughts?
It gets a little interesting when you consider the structure of medical revolutions. For example, a simple paradigm of asking a few questions and taking into account certain vital signs is shown to be more accurate in diagnosing major heart attacks in patients who show up to the ER complaining of chest pain than the diagnosing abilities of real life flesh-and-blood clinicians. Yet I think I can be safe in saying that both you and I would much rather if a real live doctor examined us.
It’s a difficult divide when to “give in” to technology.
Yash