#34 - 15 May, 2024

CONTENTS

???????????????????? - ??.?? || ??????????????????????????, ?????????????????? (????), ????????????????????

?? Collaboration: Mentorship meets AI in the operating suite: the path to smarter, safer surgery

?? Computers (AI) - Dr Google and the rise of hypochondria

?? Second helpings - Neck braces are out || Third places || Intentional failing || Decoupling growth || Evolution favours small organisms || Cave Art - Why? ||

{P}rescription - where relevance meets readers: information without the fluff

Mentorship meets AI in the operating suite: The path to smarter, safer surgery

Surgeons, as a tribe, dislike being told what to do.

"There are only two ways of doing things: my way or the wrong way."

"See one, do one, teach one" is another aphorism that every surgeon in training has heard. An apprenticeship is necessary to acquire the manual skill of surgery.

It works, but it runs the risk of perpetuating harmful habits and ideas over time.

Enter Dr Gawande (again)

In an earlier issue of {P}rescription, we talked about his use of checklists and their remarkable impact on surgical safety.

Dr. Atul Gawande is an accomplished American surgeon, writer, and public health advocate, known for his writings in The New Yorker, his influential books on medicine, and his efforts in healthcare reform.?

Gawande is a pioneer in quality control for surgery. Writing in The New Yorker, in an article called "Personal Best" he talks about the need for coaching. Coaching is not mere mentorship; it's an active process where the coach has to be there with the person being coached.?

In this article, he introduces a radical concept that can be very hard for surgeons to swallow. He writes:

"A former colleague at my hospital, the cancer surgeon Caprice Greenberg, has become a pioneer in using video in the operating room. She had the idea that routine, high-quality video recordings of operations could enable us to figure out why some patients fare better than others. If we learned what techniques made the difference, we could even try to coach for them. The work is still in its early stages. So far, a handful of surgeons have had their operations taped, and begun reviewing them with a colleague."

Now on centre stage

Theator, a cutting-edge medical technology firm, uses artificial intelligence and machine learning to improve surgical outcomes. The firm, founded in 2018 by Dr. Tamir Wolf, promises to resolve large discrepancies in surgical results with its novel platform.

• Theator uses artificial intelligence to gather and analyse surgical video footage, giving surgeons meaningful insights and feedback that were previously unattainable because of the opaque nature of surgical procedures. Often, an operating room remains a "black box."
• By connecting cameras to surgical scopes, Theator's technology records operations and compares them with patient outcomes to identify best practices and areas for improvement. This method offers the dual advantage of increasing patient safety while also lowering expenses via increased surgical efficiency.
• The business received $42.5 million in three investment rounds, exhibiting strong investor trust in its technology and goal.

It's still early days for a technology as radical as this, but many hospital systems have adopted Theator. It still faces challenges related to broader acceptance, such as regulatory barriers and concerns about potential misuse of its analytical capabilities.?

Mimicking aviation norms

Despite these difficulties, Theator continues to be at the vanguard of surgical innovation, drawing parallels with the use of check lists and flight recorders in aviation to improve safety and accountability. Similar to airline pilots who bear the responsibility for every passenger's life throughout the flight, surgeons must also embrace the monitoring and review of their operations. They cannot claim a privileged status.

Dr Google and the rise of hypochondria

Strike hypochondria; theres a new, woke term for it

The Diagnostic and Statistical Manual of Mental Disorders (DSMMD), the esteemed tome that codifies all behavioural disorders, now recommends that we drop the word "hypochondria." It carries the stigma of neurotic malingering.?

The DSMMD prefers the phrases "illness anxiety disorder" or "somatic symptom disorder." Both are neutral descriptions of people with “extensive worries about health.” What differentiates them is the presence or absence of physical symptoms accompanying those fears.

OK, whatever.

There's an oft-repeated funny story about medical students. They are required to rotate through a range of medical specialties during the course. As they encounter new diseases, the fear of having them themselves keeps arising. Till, finally, there's this male student who heaves a sigh of relief and says, "I can now have a period of rest from this torment. I am doing my obstetric rotation."

Enter Professor ChatGPT; exit Dr Google

Cyberchondria ?-- the new talk on the street

The past year has seen the rise, fear, and acceptance of AI and Large Language Models (LLM). ChatGPT is easily the frontrunner in the ever-increasing crowd of offerings. It has a far-reaching impact on hypochondriac tendencies. Here are some of the key effects:

1?? A double-edged sword: Having instant access to massive information sources may exacerbate worries because of the overwhelming amount of information, some of which may be interpreted negatively.

2?? Dangers of self-diagnosis: AI tools enable users to input symptoms and receive possible diagnoses. While these tools empower users when they consult healthcare professionals, they can also lead to misinterpretation and anxiety. They may assume the worst-case scenario—the medical student syndrome.

3?? Compulsive engagement: The ease of interaction with AI and LLMs means that individuals might engage more frequently, which can perpetuate their anxiety rather than alleviate it.

4?? Misinformation, hallucinations: The accuracy and reliability of the health information provided by AI systems can vary, and misinformation may lead to increased anxiety. Tools like Chat GPT can present information in a convincing manner: spell-checked, grammatically perfect, and logically organised.?

5?? The plus side: Easy access to vast amounts of health information can be reassuring when answering health-related questions quickly. On the positive side, AI can be programmed to offer psychological support and guidance, including techniques for managing anxiety and stress.

6?? Stigma reduction: AI interactions are impersonal and private, which may reduce the stigma associated with seeking help for health anxiety and encourage more people to seek support discreetly.

It's here to stay, but...

Overall, while AI and LLMs can provide valuable information and support, it's important for individuals with hypochondriac tendencies to use these tools wisely and supplement them with professional healthcare advice.

The medical industry's emphasis on illness detection and prevention continues to have a significant impact on the rising incidence of health-related anxiety, acknowledged as an issue that may never be completely overcome.

“Unlike some other forms of anxiety, health worries are a problem that neither better labels nor improved treatments can hope to completely banish.” O'Rourke M, The Atlantic. -- Hypochondria never dies

Second helpings

Good reading from across the internet

Did something happen to our necks? Engber D, The Atlantic

?????? - Neck braces (collars) of various designs are a common sight, especially after injuries and the "whiplash" that follows.

??????... Evidence shows the ineffectiveness, even harm, from these collars.

?????? - Current recommendations have shifted towards active recovery methods without these confining collars.

??????????????????... Except in emergency services where the neck has to be stabilised before spine injury is ruled out, these devices are of no value.

????????????????

“At some point in the past few decades, a device that once stood in for trauma and recovery was added to a list of bygone treatments, alongside leeches and the iron lung.”

If you want to belong, find a third place - Volpe A, Vox

?????? - “Third places” are communal spaces beyond home and work where people from diverse backgrounds can mingle.

??????... There is a decline in communal gatherings and third places due to individualised leisure activities, societal shifts, and economic and zoning challenges leading to the closing of third places. Many take them for granted or do not frequent them regularly.

?????? - Third places foster social ties and offer emotional support, helping combat loneliness and build community trust. Online platforms provide alternative third places that can be more inclusive, though they come with their own challenges.

??????????????????... Find a personal third place by identifying spaces that align with individual interests and participate actively in these communities.

????????????????

“Belonging isn’t some magical place that you can find in your next destination, it is where you feel most connected with the people around you, and that you have people who love you and that you love.”

What if companies rewarded employees for their failures? Brinette S, The Conversation

?????? - Companies are increasingly supporting intrapreneurship, where employees are encouraged to pursue innovative projects within the company.

??????... It's not just success that needs to be rewarded. “Every stumble can be transformed into an opportunity because it helps us uncover new problems or different perspectives.”

?????? - Innovative processes in organisations can be enhanced by not only rewarding success but also by tolerating and learning from failures. A culture that recognises and learns from failure can encourage employees to take more calculated risks and gain unique insights from their experiences.

??????????????????... Instituting an award for the “best failed ideas,” recognises projects that were innovative but unsuccessful, and promotes learning from these experiences within the company.

????????????????

"These projects did not achieve the desired results for the firm, particularly in terms of profitability, but when carried out rigorously, they provided learning opportunities for the whole company.”

Decoupling - L?hde V, Aeon

?????? - Endless material growth is unsustainable on a limited planet.

??????... Despite widespread recognition of environmental issues, economic growth is still deemed necessary for societal stability and addressing global poverty.

?????? - ‘Decoupling’ suggests that it’s possible to continue economic growth without environmental degradation. GDP as a measure of economic growth is not a good index. A focus on well-being might be more beneficial for achieving sustainable growth within ecological limits.

??????????????????... There is an urgent need for absolute decoupling, where economic growth continues but environmental impacts are reduced, in a timely manner to prevent ecological disasters.

????????????????

“If indeed there should be no possibility to sufficiently decouple growth from environmental impacts then the future will be either one of continuing global poverty or one of continuing environmental destruction, or both.”

Why evolution often favours small animals and other organisms - Wills M, The Conversation

?????? - Single-cell organisms have dominated most of Earth’s history, originating around 3.8 billion years ago, much earlier than multicellular animals. Many animal groups start small, with significant examples including the tiny ancestors of insects and mammals.

??????... Though there are several advantages to being larger, like better predator evasion and heat conservation, larger animals reproduce and evolve more slowly, making them less adaptable to environmental changes.

?????? - Despite a general increase in size over evolutionary time, mass extinctions often revert organisms to smaller sizes.

??????????????????... The smallest organisms possess unique abilities to survive extreme conditions.

????????????????

“Nothing much bigger than a domestic cat survived the asteroid impact that wiped out the dinosaurs 66 million years ago.”

Why make art in the dark? - Wisher I, Aeon

?????? - Palaeolithic cave art is an enigma. Why did our ancient ancestors chose to create elaborate drawings in deep, dark caves?

??????... They did. After a visit to Lascaux, in the Dordogne, which was discovered in 1940, Picasso reportedly said to his guide, “They’ve invented everything.”

?????? - Since the first discovery of cave art in 1868, numerous hypotheses have been proposed to explain the motivations of Ice Age artists, drawing on methods ranging from high-resolution 3D scanning to ethnographic comparisons.

??????????????????... It's possible that these ancient people were drawn to caves not just to draw but to engage deeply with the environment through a combination of visual, acoustic, and tactile experiences.

????????????????

“By seeing hidden forms in cave walls, we learnt how forms can be represented.”