Written by Dr Dhananjay Kelkar ex
(medical director.. deenanath mangeshkar hospital Pune )
Robotic surgery and more….
Last 12 months, i am looking at robotic surgery and perceived future of high tech surgery. The focus of surgery is shifting from patient needs and benefits to leadership in surgery and perceived needs. Companies come up with new technology which is supposedly beneficial to mankind and create a need which portrays high tech is better than ordinary. This onslaught of tech advertising is already in our mindset and blood, starting right from toothpaste to car and from proteins to our appearance. We want spot remedies for lifestyle illnesses. We earn our diabetes, hypertension and heart disease from modern living and expect more modern medicare to give quickfix solutions.
As a society we have unrealistic expectations from medicine and hence dramatic and dreamlike technology advances are wanted more than ever. Patients like to hear keywords for every surgery like laser, endoscopy, robot, min invasive, automated, remote controlled and so on..
What patients want is a mirage which we have created. It is like the olympic logo of higher, faster, stronger and we have lost the amateur sporting spirit along the way. Doping and cheating is a new standard in sport to create a level playing field. Professional sportmen who achieve the impossible and earn the impossible and who are often corrupted from inside are our new heroes.
The medicine is on the same path. We want star hospitals and hightech medicine and glamorous doctors to deliver unrealistic results. We are no longer dictated by the right indications, right investigations and right decisions but by more and more investigations, most sophisticated technology and mostly for wrong indications. The basics in medicine are horribly missing. Even the best doctors are swayed by this onslaught of leadership roles into so called ultramodern medicine. There is no doubt that newer is better in tecnology terms but many of these evolving technologies belong to research labs and not in hospitals. Even the guidelines are dictated by commerce. That is the gift america has given to the world.
Evidence based is the new keyword in medicine and evidence comes to print, based on trials which are almost always sponsored. The evidence is created and printed to serve the cause of the master which is bottomline i.e. profit. Almost all surgical conferences are now dominated by robot and stapler and laser and newer technologies. The reason is not medical importance but of sponsorship for the conference. The younger doctors are corrupted right from the word go.
No one even talks about indication of surgery, necessity of intervention, additional benefit of technology and cost efficiency on national scale. The loss of overall perspective is glaring. We have lost vision of the greater good and individual factors both for doctors, hospital and patients perceived wishes are over-riding. Even hospital administration has willingly and occasionally unwillingly been subjugated to join the aggressive bandwagon.
Pune has recently witnessed advertisements of robotic knee replacement. The robot is used only to make the bone cuts and useful for 5% of the main surgery, but the aggressive advertising makes it sound like a tesla car which is fail proof. The mostly less known hospitals and doctors start this campaign, fuelled by hoardings on street, helpleless medical council as onlookers and patients feeling a perceived need that they have clear benefit from this robot. The truth is far different. Many times these surgeons are not using the robot, it is a marketing tool for an ignorant population, which deserves better.
Then the good doctors feel left out as the conferences are funded by robotic companies, who alas, then will dare to speak the truth.
In this modern world of advertising, the good doctor is confused more than ever. Everybody wants to become great… But what exactly is greatness? Appearing in the newspapers every week with prepaid write-ups, advertising new techniques like Starr surgery for constipation, staplers for piles and lasers for almost every ailment on earth. Good surgeons start feeling outdated and conservative. There are no easy answers in the modern world. Medicine for profit has shaken the core of noble profession.
I am myself confused, which is not a common thing to happen. What will stand the test of times? What is good both for patients and for the society? The conflict has been eternal but the issues have become murkier than ever. The need is to have नीरक्षीरविवेक, abilty to identify milk from water.
Dr Dhananjay Kelkar