by Matt Watson
2nd Year Medical Student, St. Andrews
Medicine, and surgery in particular, is in the midst of a technological revolution. Day by day new technologies are developed, opening doors to more and more complex treatments. You’d be hard pushed to find anyone with an interest in the medical field who opposed this, and for good reason. New techniques are helping to make surgery safer in a whole host of ways: reducing time under anaesthesia; limiting the avenues for human error; reducing blood loss; and many other ways besides. But is the advance of technology at odds with our ability to ensure that patients are able to fully understand their treatment, and vitally, to give fully informed consent?
Some new techniques are relatively easy for the layman to understand. One example is the latest breed of prostate models, developed by the National Institute of Biomedical Imaging and Bioengineering (NIBIB)[1]. Their team has been able to create a synthetic model that not only looks like a prostate, but it feels like the real thing too. Unlike some other models, this means that they can be used not only for mapping future surgeries, but practising them ahead of time too. The benefits of this are plain for all to see, independent of your level of expertise. It is the perfect example of technological advancement that can be easily understood by the patient.
A stark contrast is seen in technology coming out of Ghent University[2]. Researchers there have been able to map brain tumours in such a way that they have been able to predict the impact that the tumour and proposed surgeries will have on brain connectivity. Clearly, this is a valuable tool at the disposal of neurosurgeons, but it is a vastly complicated one. It is nigh on impossible to expect a patient without a medical background to be able to understand the inner workings of such a technique, despite the fact that it will have a direct impact on the outcome of their treatment. This poses several questions for the clinical team to consider. Is the patient able to understand enough to give informed consent? Are they likely to have faith in a treatment that they cannot completely understand? What effects might anxiety created by a lack of understanding have on compliance and recovery?
In this case the advance of technology has brought benefit, but also a challenge. A way of explaining the procedure must be found that allows the patient to reach a level of understanding they are comfortable with. For some this will be near full knowledge of how the thing works, but others may be content with knowing the benefits and risks it brings. Either will test the communication skills of the most seasoned clinician.
A different challenge is raised by the application of commonly used technologies. An excellent example of this is the use of video game technology in surgery, in particular and most infamously, virtual reality (VR)[3]. The potential benefits of using such technologies in surgical training has been well explored and documented. For many patients, this technology is familiar, and familiarity may bring confidence with it. However, it may also have the opposite effect; VR, and similar technologies, are seen by some as a gimmick, or a toy to be enjoyed at your leisure. These individuals would not see VR as a precision tool, which they are willing to trust in use in their treatment. This creates a rare situation where understanding, or at least awareness, does not equate to a good patient experience. It is another testing situation posed by the advent of new technologies.
Change will always leave some in its wake. Techniques that were once seen as revolutionary, such as vaccination, are now familiar to even the most medically unaware. It may be the case that some of the techniques discussed above eventually follow suit, and others may be left by the wayside. What is for certain is that many more are still to come. It is vital that doctors keep up with change, and prepare for instances where they may have to expend a lot of time and energy merely explaining a procedure. If they don’t, the gulf between the level that technology has reached and the understanding of the average patient may become so wide that it cannot be bridged.