https://meditropics.com/2022-1-1-ed/Relevance of Clinical Medicine in an Era of Technology

Twenty first century medicine is heavily technology oriented. However, Hippocrates, father of Modern Medicine was born when there was no technology. Other stalwarts of yesteryears born during this era of pure clinical medicine, to name a few, were Robert Grave, Rene Laennec, Cushing, William Osler etc.

Just tne clinical acumen of those physicians made the discovery of new diseases and their treatment. In Indian context one name prominently figures out is legendary Dr. Bidhan Chandra Roy , a Bharat Ratna recipient, former chief minister of  West Bengal. A clinician par excellence, his diagnosis of a patient used to come while patient enters the consulting room, be it hyperthyroidism, hypothyroidism, Parkinsonism etc.

Few examples below are to illustrate importance of clinical medicine:

1. A six year old child was admitted in a Public Health Centre (PHC) with irregular fever for last three months. Thorough clinical examination did not reveal cause of illness. Breath sounds were normal. X-ray machine in the PHC was out of order. However, on careful percussion, stony dullness was noticed in left infra axillary region. Diagnostic tap was done and straw colored fluid was drawn. Patient was treated with anti-tuberculous drugs.

2. A 30 year old female attended outpatient department with hoarseness of voice and easy fatigability. Apart from other things delayed ankle jerk was detected. Clinical diagnosis of myxedema was made. Thyroid function test (TFT) confirmed the diagnosis.

Simple clinical examination gave the diagnosis in both the cases. However, patients could have been subjected to sophisticated investigations otherwise. Lesson learnt from these two case reports is thorough clinical examination  should be done first. If no clue detected, one should proceed for sophisticated investigations like ultrasonogram, CT scan, MRI etc.  

However on the flip side, Stephen Hawking , famous astrophysicist developed a serious motor neuron disease and was wheel chair bound and had to use a voice synthesizer to produce normal voice. This was an example of total dependence on technology for survival.

There are innumerable COVID patients who are dependent on ventilators to survive.

Few diseases, where technology has no role in diagnosing the disease:

1. Tetanus
2. Rabies
3. Heat stroke
4. A bunch of psychiatric disorders like Schizophrenia, Paranoid state and manic depressive psychosis etc.

Above mentioned diseases are purely clinical entities, diagnosis and treatment is done clinically.

To conclude, patient management in modern practice can be firstly at clinical level, followed by technological support later.

Here is a look back at the top medical technologies helping manage the complicated diseases.

1. PERSONALIZED MEDICINE

If there is one overarching trend to all the advances in medical technology, it is the personalization of medicine and treating individuals as such. While this is occurring at several levels, it is most readily apparent in biotechnology and pharmacology.

One area of application is pharmacogenomics, which is seeing rapid development. Scientists and doctors can study an individual’s likely responses to drugs and doses and select personalized regimens accordingly so that they avoid some of the dangerous side effects of overprescribing a scheduled drug.

The second application is in RNA-based therapeutics, which seeks to “interfere” with genetic data at the RNA level and intercept a genetic abnormality before it gets translated into functioning (or non-functioning) proteins. The more successful methods of personalized RNA therapy (e.g., antisense nucleotides and RNA interference) are looking to combat rare genetic conditions such as Huntington’s Disease, neurologic disorders, and forms of cancer.

2. PERSONALIZED MEDICINE

Advances in video conferencing technology, combined with the expansion of mobile internet and the proliferation of wearable devices, have made telehealth one of the most important trends in medical technology in 2019. Utilizing a mobile device and a two-way camera, care providers can have one-on-one encounters with patients from a distance. These patients are usually either in rural areas or unable to secure transportation to a physical facility.

Health monitors such as wearable devices can check for heart rate, blood pressure, and blood oxygenation. Web-enabled and app-enabled supplements can filter patient requests accordingly and save both providers and patients critical time and energy. Even the most routine telehealth visits can save lives. They reduce barriers to care such as transportation, language, and geography.

For older people living alone, regular checkups can help avoid strokes, heart attacks, and other adverse events, and, logistically, there is less risk of exposure to other diseases. As the technology improves and incorporates augmented and virtual reality, usage could graduate from simple virtual check-ups to a whole fleet of medical procedures performed remotely, even including, with the aid of robotics, full-fledged surgical operations.

3. ARTIFICIAL INTELLIGENCE & MACHINE LEARNING

Humans and computers are good at different things and need to work in tandem to deliver top quality medical care. Artificial intelligence (AI) and machine learning (ML) are at their best when supplied with vast amounts of raw data, much as one would find flowing in and out of a medical facility. From there, they help physicians and care providers by taking the uncertainty out of image scan analysis, reducing burnout, and giving decision support in non-absolute diagnoses and treatment options.

Algorithms and virtual assistants enable physicians to see more patients a day and use the time with each patient more effectively. AI is increasingly being used in remote monitoring and telehealth applications. Future revolutions in computing power, such as quantum computing, could make it possible to analyze millions of CAT scans. From that could come major revelations for medical science, as detected patterns could be used to treat, prevent, or predict diseases. AI and ML are, like many disruptive technologies, ones that get better with use.

4. CANCER IMMUNOTHERAPY

Immunotherapy is changing definitions in the medical world, primarily by curing previously un-curable diseases. The premise of immunotherapy is to genetically alter a patient’s cells to work in tandem with the body’s immune system to fight cancer. Unlike chemotherapy, immunotherapy does not destroy healthy cells as collateral damage. By altering the immune system, one can “teach” it to detect and destroy more cancerous cells and reduce tumor growth.

A promising area of medicine for almost a decade, immunotherapy continues to highlight new immunotherapeutic targets and biomarkers. New treatments in combination with joint therapy and engineered T-cells can create what will ideally be effective therapies for a wide range of tumor profiles.

5. 3D PRINTING

The first-ever 3D-printed object was a piece of low-grade medical technology,  an eyewash cup, and has come a long way since. Medical devices can now be perfectly matched to the exact specifications of a patient, and be compatible with their natural anatomy. A patient’s body is more likely to accept implants, prosthetics, and devices when they’re perfectly aligned and customized, and the patient often expresses greater comfort and improved performance outcomes as a result.

The most significant developments in 3D printing have come in external prosthetics, cranial or orthopedic implants, and custom airway stents. But it has also proven helpful in surgical planning and has been used in complex open-heart surgeries, and even Cleveland Clinic’s total face transplant. Talks of printing human tissue have suggested that organ transplants may one day be obsolete.

6. AUGMENTED REALITY & VIRTUAL REALITY

Augmented and virtual reality (AR and VR) have several applications in the medical world. Simulated and hybrid environments have found a natural fit in medical education, providing simulation training that enhances and works alongside traditional school. Immersive learning with AR and VR headsets can cater to several different learning styles at once by engaging the full range of senses: audio, visual, and kinesthetic.

VR can be used in physical therapy to help patients recover from complex limb injuries and even has applications in areas like mental trauma where it can alleviate phobias. In the surgical theater, Cambridge Consultants developed AR glasses that let surgeons see the inside of a patient’s body by superimposing data from 3D scans and CAT scans. This provides a revolutionary level of visibility into minimally invasive “keyhole surgeries,” and requires practically no additional training to use.

Based on the low learning curve and relatively low cost of use, further developments should see the medical landscape further merge with augmented and virtual reality.

7. ROBOTIC SURGERY

Robotics has been making an impact on medical care since the 1980s, but as the technology behind it has improved, the applications have increased exponentially. Nanobots in the bloodstream can diagnose and prevent disease. Exoskeletons can assist with physical therapy and counteract movement disabilities. But perhaps the most visible (and multi-armed) application for 2019 is robotic surgery.

Robotic surgery is minimally invasive, more precise, less prone to infection, and quicker to heal. Image-guided robots can now investigate lesions on the brain without damaging any of the surrounding tissue. They can shape a bone to precisely fit a prosthetic with the accuracy a human never could. The da Vinci robotic surgical system is already used in 200,000 operations a year but the onset of superfast 5G connections will soon allow remote surgery, and what once was considered a novelty could quickly become standard practice.

8. QUANTITATIVE COMPUTING

We are still in the early stages of quantum computing, but this technology has already been used in combination with machine learning to quickly recognize medical tools and annotations during cataract surgery—the most commonly performed surgery in the world. While much of quantum computing’s potential is still to be actualized, past performance has already caused significant optimism for applications in medical imaging, genomics, and drug discovery.

A revolutionary amount of computational power may soon make it viable to consider all possible outcomes of incredibly complex scenarios, such as drug interactions and comparisons, or more rapidly and cheaply sequencing human genomes. The deluge of data that comes with such discoveries can be quantumly computed to further other discoveries. Already, some technical giants like IBM offer quantum cloud computing as a means for people to familiarize themselves with the format and capabilities of such technology.

9. THE INTERNET OF THINGS (IOT)

Medical facilities are brimming with gizmos and teeming with data, but the internet of things (IoT) is getting all those separate elements to talk to each other, and the results have had an immediate impact.

New York City-based Mt. Sinai Medical Center cut its emergency room wait time by 50 percent through a partnership with GE Healthcare to use an IoT software called AutoBed. The program tracks the occupancy of 1,200 beds and processes up to 80 bed requests at a time, solving the puzzle-like logistics of who to place where and when. It does so with greater efficiency and transparency than staff members would by taking into account nurse proximity, granular demographics, and over a dozen other metrics to better assess and serve the patients’ individual needs.

IoT can also be used to monitor a facility’s medical technologies and issue performance alerts when they fail or are about to fail, as is the case of e-Alert, a Philips product designed to monitor MRI system performance. By issuing mobile updates and performance reports to staff, a relatively low-intensity fail safe is put in place, saving money and time in the process. Further applications of IoT can be used to track staff, patients, devices, and other assets in a critical setting. With big players like Microsoft serving up enterprise-level healthcare IoT packages, it is poised to become an integral part of a medical facility’s infrastructure.

Conclusion: Clinical Medicine is basic minimum, any doctor at primary level should practice.  Technology is next, which is need based and varies from situation to situation. On the whole both are complementary to each other.