Syndicom

Beyond the checklist, more technologies entering the clinical mainstream…

As a list maker myself, I applauded the release of the New England Journal’s article this week, and as a patient who has had to endure the redirection of surgeons to my case, I was thankful for it. As we discussed earlier this week though, what is the true effect of this checklist? Some will focus on the first order effects, the ones we see most immediately in terms of task performance, that is, there will be less mistakes, it will take more time, there will be better quality control…… but there are also the second order effects as we proposed = there will be time taken to review details, there will be connections made, there will be a move to co-orientation of efforts, there will be a safety, collaboration etc, but perhaps there will be mundane routine, there will be a lustre stripped of the surgeon’s work, there will be a technologization of their work.

Technology. From techne, meaning ‘art, artifice, or craft’. Related to the term ‘technique’ or the “non natural actualization of possibilities inherent in the physical world”. Technology is defined as the application of a specific logic of technique to the domain of human activity and behavior. Technologies are not just machines or artifacts, they are acts of making or crafting, collections of processes and knowledge that we use to extend our human abilities and satisfy wants and needs. They generate information, construct social knowledge, determine how we understand our existence, can generate a sense of purpose for ourselves and become their own form of consciousness.

In working with medical students, I hear many references made to “old school” medicine. When pushed to describe what that is, students (and physicians) for that matter, talk about the doctor who talked with people, who had more than 10 minutes for a consult, who healed the heart and mind as well as the body, who was embedded in their community….The physician who could read the body beyond any test. The surgeon who could survey an OR and know what was missing or needed to happen. The artist of healing. These conversations as they co-occur make me wonder about our technologies sometimes, like the checklist. The checklist is a reminder, an application, a determiner of what we should be doing and how, an extension of our abilities. Not a denigration of our abilities. An extension. Which makes me wonder, what abilities the following technologies are reminding us of, applying in physical form and extending. What do you think?

1. (Mobile) video streaming services such as Qik, Seesmic and Kyte. Potential uses include recording videos to answer questions or address medical news from your cellphone; stream videos of clinical surgery or injury for second opinion, recording lectures and conferences, and video blogging.

2. Smartphone and PDAs. According to Manhattan Research, medicine has adopted this mobile technology faster than any other segment of the public. It is predicted that by 2011, 70% of you will own one, using it for drug references, medical calculators, decision support and electronic health records. American Medical News states, “efficiency gained from mobile device use can help physicians realize other technology can streamline the day as well.” OK.

3. Simulation Technology. Being used in medical schools in the form of virtual reality and simulation devices, the Institute for Simulation and Interprofessional Studies at the University of Washington argues that an increasing number of studies show a reduction in error rates and operating times if students can practice surgical procedures in VR. Berci Masko from ScienceRoll has done some extensive work in Medicine 2.0 and exploring virtual reality for nursing, medicine and dentistry. Check our his blog here for some wild news about medical simulations!

Which all brings me back to my original questions – what human abilities are these technologies extending? What do they say about the world in which we live, the ways we work and who we are becoming? Your comments welcome!

With thanks to Jayel Aheram Orcoo and rosefirerising for their images!

We are the ones we have been waiting for!

Kirsten Broadfoot