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Will robots ever be able to perform surgery independently?

Will robots ever be able to perform surgery independently?

Will robots ever be able to perform surgery independently? And if they can, should they? In my last post, I wrote about some unresolved issues with driverless cars and ended by saying “So are you ready to have an autonomous robot perform your gallbladder surgery? I’m not.” But the robots are coming. A recent paper in Science Robotics proposed six different levels of autonomy for surgical robots. The authors say some devices are already at level 3. A surgeon can tell a robot to put in a row of sutures, and the robot will do so without hands-on control by the surgeon. Major issues — cyber security, privacy, risk of malfunction resulting in harm to the patient — arise as the robots approach complete autonomy. The cost of satisfying FDA regulations escalates as the robots take on more high risk activities. For such a device, the cost of premarket approval approaches $100 million and takes 4½ years to accomplish. A completely autonomous level 5 surgical robot will actually be practicing medicine raising the question of robots not only requiring FDA clearance but also licensing by medical organizations and board certification. Will they need to take examinations and participate in maintenance of certification? A huge problem already affecting pilots involves the deterioration of skills when ceding all control to the robot. Crashes, notably Air France Flight 447 from Rio de Janeiro to Paris, have occurred when computers malfunctioned and human pilots had to take control. The Air France incident occurred when ice covered a sensor resulting in autopilot disengagement. The human pilots failed to recognize the plane had stalled, and...
The Burnout Paradox: Why Are We Still Surprised?

The Burnout Paradox: Why Are We Still Surprised?

If you go to medical school, you will be stressed—bigly. It should not come as a surprise. Two posts on the Kevin MD website highlight the problems facing many medical students today. The first was by an anonymous rising fourth year student who has come to the conclusion that going to medical school was “a terrible, terrible decision.” It ended with a comment that medical school “is not fun. It’s jarring, scary, disappointing and absolutely depressing.” The second was by another anonymous student who described how miserable he (or she) has been since he started medical school. He said “’burnout’ is the word I would use to best describe my medical school experience.” On the day he wrote his post, he was about to text the surgery residents to tell them he would not be there for the last day of his rotation because he was too anxious. He mentioned a strong family history of anxiety disorders and being diagnosed with depression and anxiety as he was applying to medical school. He did not disclose this during the application process. Burnout is not limited to a few students. A literature review in 2013 found “at least half of all medical students may be affected by burnout during their medical education.” Nor is the problem confined to medical students. A national survey published in Academic Medicine in 2014 found that 58.2% of medical students, 50.8% of residents/fellows, and 40% of early career physicians screened positive for depression. Last week, Medscape’s 2017 Lifestyle Report, a survey of practicing physicians, found that 51% were burned out—an increase from 40% in 2013. The...
Who Has Grit? Cutting Resident Attrition Rates

Who Has Grit? Cutting Resident Attrition Rates

What is grit? In an article in The Guardian, Angela Duckworth, a psychologist often called the guru of grit, defined it as the commitment to finish what you start, to rise from setbacks, to want to improve and succeed, and to undertake sustained and sometimes unpleasant practice in order to do so. She said in a paper that grit is perseverance and passion for long-term goals. I think we’d all agree we would want our doctors, particularly our surgeons, to have grit. That sounds great, but how do we find people who possess grit? This is especially important in surgery because attrition rates in general surgery residency programs have been about 20% for many years. In 2014, I blogged about a paper that used grit levels, measured by a brief survey—the Short Form Grit Scale (SFGS), to predict who might drop out of surgical training programs. However the authors did not find that low grit made a significant difference because attrition rates in the programs studied were lower than expected. A recent study published ahead of print in the American Journal of Surgery used the SFGS to identify potential residency dropouts and found that residents with less grit thought about leaving their program more frequently, but the numbers were again too small to show a significant difference in resident attrition. Those with higher grit levels had a better sense of well-being which is nice. One of the problems in trying to measure grit is that the grit scale is fairly easy to “game.” For example, in response to the statement “I am a hard worker,” how many surgical residents...
A tube misconnection and a death: a medical whodunit

A tube misconnection and a death: a medical whodunit

Here’s what we know. In September 2016, a 72-year-old former member of the Australian national soccer team suffered what must have been an extremely painful death when his oxygen supply was somehow connected to his urinary catheter. The oxygen filled his bladder until it burst, and then the gas expanded his abdomen so much that his diaphragm was pushed up causing his lungs to collapse. The flow of blood returning to his heart was also obstructed. What we don’t know is how this could have happened. Some have speculated that it was caused by a system problem. For example, the design of the connections on the urinary catheter and oxygen tubing might be similar and easily confused. Although this would be a simple explanation and might lessen the degree of human error involved, I’m not buying it. The types of connections used for urinary catheters and oxygen tubing are quite different. The end of a urinary catheter is a female connection with a relatively wide diameter to accommodate the male end of the tubing leading to the drainage bag. See figure below. The oxygen administration tubing is usually a combination of tube and nasal prongs as a single unit. See figure below. Considering the incompatible tubing, it is difficult to imagine how the oxygen could have been connected to the urinary catheter by the elderly patient. Yet it is also inconceivable that any hospital staffer could think that oxygen should be given via the bladder. At the coroner’s inquest, which is still in progress, one account says a nurse recalled seeing a white connector between the green oxygen tube...
Parking lot needlestick yields $4.6 million payout

Parking lot needlestick yields $4.6 million payout

A jury awarded a woman $4,618,500 for a needlestick injury she sustained in the parking lot of Target. Skeptical Scalpel shares his opinions. A South Carolina jury awarded a woman $4,618,500 for a needlestick injury she sustained in the parking lot of a Target store. She had parked her car and while walking to the store, her daughter picked up a hypodermic needle. As she swatted the needle out of the child’s hand, it punctured the woman’s palm. She went into the store and notified an employee. HIV post-exposure prophylaxis medications were prescribed which she said rendered her sick and bedridden. Her husband had to take time off from work to care for her. Hepatitis and HIV testing proved negative. Her lawyer asked Target for $12,000 to compensate her, but the store offered $750. The plaintiff’s attorney said, “When we started this, we were just trying to get Target to make my client whole, to pay for her medical bills and the time that her husband had to take off work. We tried to be reasonable and not take this to trial. But Target took a really hard stance on it … and I think the jury sent a message.” Not surprisingly, Target is considering appealing the verdict. I have some problems with this. If the verdict stands, does it mean a store is responsible for anything left in its parking lot at any time? Should stores hire people to comb the premises 24/7? That seems overly burdensome. There is an issue of possible negligence on the part of the plaintiff. Is swatting a needle out of the hand...
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