As Doctors, We Must Make Way for Machines

I was flying to Boston to attend a medical conference in the spring of 2015 when we were delayed after boarding. The captain announced he needed clearance from the ground engineers for a minor problem that had been detected during the standard diagnostics performed before takeoff. As I sat in my seat watching the bustling airport through my window, the announcement smacked me with the undeniable recognition that my job as a doctor wasn’t much different from how the ground engineers and pilots ran the plane.

Years ago, when jet engines were adopted by commercial airline companies, they were incredibly complex systems. These planes were grounded for preventative maintenance every 125 flight hours, or approximately once every six months. Monitoring systems relied on hundreds of sensors placed in various locations within an aircraft engine to gather information about its performance — its “vital signs” — which provided real-time information to pilots and ground engineers. The moment something varied from the norm, the plane was taken down to pre-empt possible catastrophe.

For airplanes, it was the coming-together of sensors and real-time monitoring that made flying more efficient, less expensive, and increasingly accessible. And this approach was also a perfect model for tracking biological changes in the human body. Once unimaginable — just like flight monitoring systems — technological developments like these will continue to empower doctors with an unprecedented assessment of biological processes in real time.

Currently, a majority of our vital measurements are taken in a doctor’s office or in hospital labs and radiology departments. Very soon, technology and market forces will converge at the point where sensors have become more accurate and algorithms have grown sophisticated enough to record ongoing, real-time measurements of our vital parameters outside of a hospital or clinic. Wearable and implantable devices are poised to accurately and continuously measure heart rate, blood sugar, oxygen saturation, respiratory rate, blood pressure, and sleep patterns.

Wearable biosensors or peripheral devices (like a blood pressure cuff or pulse oximeter) gather key vitals from a patient and then wirelessly communicate that information to the patient, a third-party monitor, or a team of medical professionals. This information enables more successful daily care and improves preventative measures.

When patients are empowered through these devices to manage their own health, outcomes improve dramatically. Remote communication through tele-health tools aid physicians in staying informed regarding patient health issues, reaching diagnoses, and providing certain types of follow-up care.

Chronic diseases would be more easily supervised and managed, and patients who are too ill or too far away to easily travel could have greater access to care. When the Center for Disease Control took a look at non-critical emergency room visits in a 2011 study, they found that 80 percent of adult patients sought noncritical care at the ER because they lacked access to a primary-care physician. In the United States, 60 million people (nearly one in five) don’t have regular access to a primary care physician. Remote patient monitoring (RPM) and telehealth technology helps change that.

As this technology grows more ubiquitous, we’ll begin to see that doctors aren’t the only ones using it to make treatment decisions. Patients will continue to become more involved as they’re granted greater access to the data and analytics provided by RPM devices. This will enable them to arrive at appointments with their own body’s performance statistics handy. The ability to wirelessly transmit critical patient information will continue to lead to integration with our smartphones through health apps, meaning that we’ll essentially be able to carry around a miniature server equipped with our vitals, perhaps even including information as in-depth as the sequence of our entire genomes.

We’re working to detect our own bodies’ internal sophistication and enhance our abilities to preempt potential misfires — no differently than how we monitor airplanes. And this is just the beginning. In the future, technology is going to assume more of the tasks currently performed by physicians and surgeons, continually changing the style and substance of medicine as we know it today.

Surgeons are already starting to rely on 3D mapping of our internal anatomy well before they ever make the first incision, a capability that helps them anticipate potential mishaps and minimize complications. Surgeons can now perform operations while seated in consoles as they control robots that convert their hands into precision instruments, guided by multiple cameras that provide an unprecedented view inside the body.

Even more impressively, researchers from Washington DC’s Children’s National Health System started testing their Smart Tissue Autonomous Robot (STAR) surgical technology, which doesn’t depend on a doctor’s manual capability. STAR was developed to apply stitches with the same level of skill as top surgeons, all through the use of a 3D imaging system and precise touch sensors — all on its own. In trials on living pigs, the robot stitched with such submillimeter precision that it outperformed its human teachers.

For now, robotic surgery in hospitals is still controlled remotely by a human surgeon and is available for only a select cohort of operations. But with more than 45 million soft-tissue surgeries performed each year in the U.S., it won’t be long before this method becomes the norm, thus eradicating the previous leverage of dexterity that separated a good surgeon from a great one. Surgery is — and increasingly will be — no longer limited by human cognition, coordination, or sight.

Yet robots, much like their human creators, aren’t exempt from the possibility of error. There have been reports filed in the last few years documenting surgeries in which the operating robot, controlled by a surgeon at the other end of a console, has nicked blood vessels or clamped down on internal tissue and refused to let go until an entire system reboot has taken place. Still, the benefits appear to outweigh the risks. In a recent study examining a group of patients with prostate cancer, one group received gland-removal surgery by a human surgeon, while another group received the same surgery by a human-controlled robotic surgeon. After three months of recovery, both groups were doing equally well. Patients who had their surgery performed by a robot, however, experienced less blood loss during the procedure, were discharged earlier from the hospital, felt less pain a week after the surgery, and — at six weeks post-op — reported a better physical quality of life.

For Denise Parker, a 54-year-old mother and grandmother, it was a robot that ultimately saved her life. While on a vacation, Parker sought emergency care for what she thought was a bad case of food poisoning. In reality, doctors discovered a cancerous tumor growing in one of her kidneys. She was booked for immediate surgery at London’s Guy’s and St. Thomas’ Hospital. The da Vinci Xi robot, controlled by urological surgeon Ben Challacombe, excised Parker’s cancerous right kidney and carefully removed it from Parker’s body via a small keyhole incision. Though by this time Dr. Challacombe had performed over 400 partial or complete kidney extractions using the da Vinci, this particular procedure made waves because it was live-streamed for the world to see. Parker’s family watched the surgery in real time through the hospital’s Twitter feed.

Dr. Challacombe credits the robot with allowing him to work faster, more precisely, and less invasively. And it’s true: Denise Parker walked out of hospital tumor-free.

Physicians aren’t defined any more by the stethoscope, and for a sound reason. The stethoscope, like the knee hammer, is losing its relevance as a critical diagnostic instrument. Physicians are becoming less and less dependent on manual tools. In fact, continual breakthroughs in medicine are allowing us to reach previously concealed recesses of our mortal parts.

Researchers from McGill University, Université de Montréal, and Polytechnique Montréal have been hard at work on a new breakthrough in cancer research: nanorobots that invade the cells of cancerous tumors via the bloodstream, delivering medication directly to target sites. The nanorobots detect hypoxic areas — spots in the tumors that lack oxygen — and deliver powerful medication in precise locations to keep the surrounding healthy tissues and organs intact.

And as nanorobot technology improves, our treatment options could expand. Imagine if we could completely eradicate breast cancer, the second-leading cause of cancer deaths in women worldwide. Rather than using today’s standard treatments of chemotherapy, radiation, and surgical removal of breast tissue, or even shrinking tumors through targeted nanorobotic delivery, what if the cure was achieved by sending in miniature robots to repair the exact diseased gene responsible for illness?

One day, we’re going to tackle diseases by the very genes known to cause them. Eventually, this and other technological advancements will be available on a massive scale, elongating our lifespans. By the next century, centenarians will become the norm.

Our ultimate aim is to do the unthinkable — to prolong our youth, the best part of our lives. The philosopher’s stone, which our ancient and medieval alchemists labored to discover, will see its fruition by way of technology.

As technology continues to improve, more groundbreaking surgical possibilities remain on the horizon. For instance, if an organ or tissue becomes damaged, it’s possible that we’ll begin to see these parts genetically engineered or grown from healthy cells in labs and replaced surgically. The race is already underway — early in 2016 it was reported that researchers at Wake Forest Baptist Medical in North Carolina used a 3D printer to create bone fragments and successfully implanted them into the bodies of rats. Five months later, the fragments were still thriving and had matured into working tissue with a system of nerves and blood vessels.

In the future, our own skin could be grown or 3D printed if a graft for a third-degree burn is needed. Kidney dialysis machines will one day become the size of current-day insulin pumps. Eventually, biosynthetically grown organ replacement will render even those completely obsolete. The national registry for organ donation may soon become a thing of the past.

Many of these advancements are already happening at the research level, and some of them are being used in clinics and hospitals throughout the world. We’ll see their full potential when economies of scale allow such technologies to spread to every part of the globe and become the new standard of care.

This essay is an excerpt from Physician: How Science Transformed the Art of Medicine, published by Greenleaf press in 2018.