A surgeon’s touch

A surgeon’s touch

Precisely 7.30am, room G4–123, Academic Medical Center, Amsterdam. “Good morning. This is the handover of Tuesday 3rd of January 2017.” These are the final words of the doctor on call. In a verbiage of 30 minutes, she elaborates on the events of the last 12 hours. The room is filled with surgeons, residents and interns. She is standing in front of two enormous screens, visualising the names, imaging and lab results of the patients. Now and then a remark is made. The setting resembles an episode of the evening news: informative but seldom relevant. Communication is a crucial aspect in health care, but is the use of words increasingly becoming a burden?

 

 master of deduction

master of deduction

Curing disease is an age-old profession. Medicine has always been a sensory occupation. Sir Arthur Conan Doyle, a doctor and creator of Sherlock Holmes, was renowned for his observing capacities. Without having spoken a word, Doyle could deduce numerous facts about his or her private life. The so called ‘clinical eye’, stretching far beyond the visual image, is a valuable and threatened instrument in medicine. Let me ask you about the last time you visited your doctor. Did he take the time to shake hands and observe you from head to toe or was his computer screen more interesting?

Verbal language is not an age-old instrument. There were times we existed without communicating through spoken words. Our mind consisted mainly of sensory memories. The shape and color of eatable fruits, tracks of dangerous animals, the smell of fermenting or poisonous things, the sound of an approaching thunderstorm. Gradually, we deduced patterns out of these observations leading to a more profound understanding of the world around us. We developed concepts such as landscape orientation, positioning according to the sun and a sense of time due to cyclic periods of seasons, tides and moonrise.

 

 a 'cow'

a 'cow'

During a normal day at the hospital, the handover is followed by ward rounds. A junior doctor and a team of nurses discuss the condition of the patients. In my hospital, a big part of this discussion is held in a room away from the patients, filled with a lot of computers. The computers give us a lot of information about the patients. The urine production, level of pain, results of blood tests and whether there is any growth of bacteria. Consequently, we make a plan and go to the patient to tell him. In some hospitals, it is even more modern. They have a so called ‘cow’, a computer on wheels’, which can be rolled into a the room of patient. The thing has the same effect as a smartphone on the table during an intimate conversation.

Language has the capacity to abstract information. It gives us the opportunity to communicate more efficiently with each other. For example, pneumonia is a word that comprises a set of symptoms (coughing, fever, shortness of breath) often caused by bacteria. At the same time, language alienates us from our real time observations. Even more so, language can limit us in our ability to observe. A doctor who as already read that a patient is familiar with urinary tract infections will be biased to take a shortcut towards that diagnosis when that patient presents with a similar set of symptoms rather than thinking in an open way.

This phenomena is infecting our society as a whole. Our lives are gradually shifting towards a more digital and abstract level. We rely on our smartphone rather than our senses. If you want to know whether it’s going to rain, you look down at your phone rather than up to the clouds. You don’t smell whether your milk is sour, you check the package for its durability limit. At the same time we long and admire sensory input more than ever. We want craftsmanship, authenticity and stories in our products and companies.

 

You might think that this is purely a romantic and nostalgic pledge for the old fashioned doctor. One that is so nicely depicted in doctor House: wandering in his own mind and without any aid diagnosing the patient on the spot. In an age of IBM Watson and big data, you must be kidding me right? Why should we let an biased and limited human mind such as that of an ordinary doctor get in the way of a computer that can deal a lot more structured with a clinical algorithm?

IBM Watson is in a way a superbrain that creates patterns based on the sensory input it is given. The input of IBM Watson however currently relies only on all data that was registered in our electronic medical records. Details such as the way somebody sits down, interacts with his wife, a change of voice or an emotional silence have not been recorded and consequently will not be a part of the algorithm of IBM Watson.

Should we therefore stop using language and continue our further communication purely in body language and emoticons? Quite the contrary. Nevertheless, we should think about our possibilities to expand our form of registering our observations. Visualisations can have a profound impact on our understanding of mechanisms and systems and could be of great importance in the understanding of disease.

 Anatomical drawing Leonardo da Vinci (1543)

Anatomical drawing Leonardo da Vinci (1543)

 Mapping molecular pathways in cancer, Weinberg et al. (2002)

Mapping molecular pathways in cancer, Weinberg et al. (2002)

It’s half past four. After a full day at the operating room, an older surgeon and I walk back to the wards. When the doors open he halts for a moment. He sniffs his nose loudly as if he were a hunting dog. He looks at a room of mister P, a patient with an open wound that has been in the hospital for weeks. “That sweat smell,”, he mutters, “must be pseudomonas.” A few minutes later I read the Wikipedia page: “Pseudomonas, a bacterium known for its sweet odour.” It’s about time we change the dressings.

The personal side of medicine

The personal side of medicine

Lezing afscheid Jaap Maljers KiKa Wilhelmina Kinderziekenhuis 21-09-2016

Lezing afscheid Jaap Maljers KiKa Wilhelmina Kinderziekenhuis 21-09-2016