Happy New Year! This post is about Academic Emergency Medicine & Google Glass, and its potential application in supervising trainees... and then winds up at Atul Gawande's observation about the need & lack of coaching for surgeons and medical proceduralists.
Last week I had the opportunity to sit down with an academic emergency medicine physician from NYC, who commented on the sheer lack of tools to help supervise certain medical procedures being performed by Emergency Medicine residents (physicians in training).
One of the most critical scenarios is intubation -- where docs jam a breathing tube down the throat and you hope that they've hit the right place. Best case, they've landed in the trachea, right before divides into two parts -- the bronchi -- in the lungs. Worst case, they've landed in the esophagus, and instead of delivering oxygen to the lungs and helping the patient live, they're basically providing oxygen to the stomach.
I've seen attendings supervise this, particularly in anesthesia (who are masters of airway management -- this is often under-appreciated by patients). The resident will use their intubation scope to lift the tongue up and out of the way, and then the attending will stand behind them like an umpire behind a catcher at a baseball game. And, like the umpire, if they have a line of sight (the resident ducks their head out of the way briefly), they'll be able to see right as the tip of the endotracheal tube is about to enter the trachea. But it's a pain because in that fleeting moment as the attending takes a look, the resident has to move their head out of the way.
Enter Google Glass. If the camera is close enough to the line of sight of the resident physician doing the intubation, they can get a shot of the ET tube as they try to land it in the trachea. And either via Google Hangouts video-conferencing, or via the MyGlass app that can mirror what's going on in the Glass unit,
The same goes for multiple procedural specialties, from an emergency needle decompression of tension pneumothorax, to a lumbar puncture, to the more mundane insertion of an IV line. As an attending physician, I could be at another clinical site, in a call room, or I could even be at home in my jammies at home, woken up in the middle of the night, to quickly log in and lend an extra pair of eyes to the resident -- or intern -- performing the procedure in the middle of the night.
Or, imagine if there were a supervisor centralized across geographies -- what if Google Helpouts (https://helpouts.google.com) weren't just for consumers, but for professional continuing education as well? What if the nations' best doctors for XYZ procedure were available to watch you perform a procedure? You could be 30 years into your career, and want someone to peek over your shoulder (or through your Google Glass), and give you coaching on your technique.
In a 2011 issue of the New Yorker, Atul Gawande has remarked on the utility -- and rarity -- of personal coaches for surgeons and medical proceduralists like interventional cardiologists performing cardiac caths, or gastroenterologists. Link: http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande?currentPage=all
The only problem with this is that it's hard to find docs that want to supervise other docs, and handle the logistics of getting them into the OR or at the exact moment you happen to be doing the procedure (e.g. in an emergency room, for example). And also, as Dr. Gawande points out, there's the bigger issue of medical culture -- that "we may not be ready to accept -- or pay for -- a cadre of people who identify the flaws in the professionals upon whom we rely, and yet hold in confidence what they see."
So let me ask you out there. As a patient: would you rather have a medical or surgical procedure performed on you as-is today, or with one of the country's experts in that procedure able to "peek over the shoulder" of your doctor using Google Glass + Google Helpouts? And: how much would you be willing to pay for that? What if it was a procedure for your child?
Up next (hopefully): a neurologist's views on his time with Google Glass. Stay tuned!
-Dr. Wei
Very interesting Henry. This seems like a very smart use case for Glass. The biggest hurdle with existing doctors would seem to be culture. Gawande has talked about that at times. Openness to the contributions of others can be difficult for anyone accustomed to going it alone. But starting with people learning their craft makes sense. Within software development there is the idea of paired programming. Those I know who work this way swear by it and often don't go back. Over time the same could be true of surgeons.
ReplyDeleteAnd then there are, of course, lawyers. Having footage of every procedure post-op seems like it could be equal parts blessing and curse. Great for learning and litigating.
Another idea from Gawande that could be useful with Glass are the ready availability of resources such as checklists.
Of course, I'm an outsider, and half thinking of your post in the surgical context and half in contexts that are closer to me.