Tuesday, October 14, 2014

Is There a 'Black Box' In Your Future?

The article Does a surgical 'black box' open the floodgates for malpractice suits? reports that a Canadian team of surgeons is creating a black box for surgery similar to aircraft. 

In ancient times surgeries were viewed in a theatre where one could watch and learn.  However, most surgeries today are isolated to the direct participants.  The black box would give a real-time analysis of surgical performance, errors, and endless feedback.

The problem is not the data itself, but potential downside use of the data for malpractice litigation.  Most surgeons of course, would avoid adding suit-risk to their practice, if indeed litigation is the use that is given the most press.  Yet it is sad to ignore the potential of such devices that have potential clinical application in many other settings, such as in the emergency department and heart catheterization lab.

The use of the term black box is a bit Orwellian.  We are not in 1984 and most physicians, even may surgeons, recognize the value in real-time feedback.  Being human, mistakes happen, and any device that enables more comprehensive observation of the care process, giving guidance when needed, will be well appreciated.  BUT, that appreciation will disappear, if the name black box is used or the look over your shoulder aspect is the one that is emphasized.  Even may p-to-date cars warn drivers of impending accidents.  Why not offer the same technology in the surgical suite?  As with most innovation, the devil is in the details and marketing of such products is key.  These provide feedback in a manner no different from any other clinical decision support (CDS) device.  Advice from a CDS system can be either accepted or rejected, and the ultimate responsibility remains that of the physician in charge.

Similarly, the advent of Google Glass, with its ability to record every viewpoint, is in the same vein, ad may make the concept of the black box already obsolete.

What will surgeons do?
  1. Resist, if able
  2. Perform only life-threatening surgery in these arenas
  3. Try to perform most surgeries in a Surgery Center
These are doubtful.  Most likely they will initially explore, then comply with whatever mandate requires use of real-time feedback technology.  Indeed, providers may be forced to behave as if always on camera (and that may be a good thing).

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