The Curious Evolution of Medicine

When you think of evolution you imagine it happening in the natural world. Simpler organisms turning into more complex life forms. As evolution unfolds plants and animals becomes more diversified and specialized. In medicine it's the same.

Recently I visited a hospital where it had a small museum. It displayed old medical equipment. Crash carts used to be wooden and the size of a cabinet. Pacemakers were chunky, huge metal devices that looked like they could barely fit into a patient's chest.

Radiology (a relatively new medical science along with anesthesiology) started out using heavy and fragile glass plates for X-rays. The exposure time was long (think of holding 45 minutes completely still while in pain) and the plates had a nasty habit of breaking. 

Enter World War I and the need to find X-ray plates that were both durable and could be developed quickly. This was the beginning of X-ray plates using film. Fast forward to the 21s century and film plates are all but obsolete and Computed Radiography is giving way to Digital Radiography. 

Now everything is becoming miniaturized. We have endoscopes and catheters, lessening the the need for invasive surgery. We have microscopes and robotic arms in the operating room. If physicians from a century ago stepped into today's hospitals they'd probably be amazed and overwhelmed.

Just like in evolution, however, medicine is becoming more specialized as it grows increasingly more complex. Whereas physicians used to have to know a little bit about everything in general medicine now it's impossible to know everything about every specialty. The need for more specialized physicians communicating and coordinating the care of patients sometimes lead to confusion and miscommunication.

Are we becoming over specialized to the point medicine is too complex, unwieldy and inefficient? Is is possible that even with the advances in medicine we don't provide the best quality care? 

While I'm not one to long of the simpler (and less effective) days of healthcare sometimes I worry we've lost the human, personal touch in medicine. We need to start focusing on being less clinical and more compassionate toward our patients. We shouldn't let the "care" in healthcare go extinct.

- Kim Schure, RRT (R)

Healthcare Copywriter

RSNA 2013 comes to Chicago

When I'm not writing I work in X-ray as a radiologic technologist. It seems pretty straightforward. You need an X-ray machine, the right technique (kilovoltage and milliamperage) and a way to move your patient so you get a good picture without causing too much patient discomfort. When you work as a technologist you aren't aware of the latest innovations in radiology occuring around you. Then I had a chance to see where the magic happened.  

I attended the Radiological Society of North America's (RSNA) conference in Chicago. It was an overwhelming experience. There were exhibitions in halls so vast you could get lost in. The big vendors are always there - GE, Toshiba, Agfa and Cerner - name brands I'm familiar with just from going to work. 

I felt like a kid in a radiology candy store. 

Every year radiology vendors display patient tables with now digital X-ray equipment and portable radiographic equipment that's lighter, smaller and calculates the correct dose just by calling up the patient's information.There are patient tables that can lower - allowing easier transfer of the patient to the table and lessening the chance of staff injury. 

More fluoroscopic equipment, CT and MRI tables are designed to accommodate heavier patients. I saw an MRI with an open bore that eliminated the problem of claustrophobia and allowed patients to sit during scanning. There also was the newest software in CT that helps eliminate the noise (graininess) on radiographic images so they are more diagnostic and drastically reduces the radiation dose to the patient.

Perhaps the greatest treat, however, was meeting entrepreneurs who came up with a novel solutions in diagnostic imaging. I saw equipment that used a computer to calculate the angle and depth of a needle in delivering steroid injections during pain management. 

I met a physician who developed a device that would lift the breasts out of the way, thereby reducing the amount of radiation to the breast tissue during an X-ray or CT scan. There even was a cream that could be applied to gloved hands that would reduce the radiation received to the extremities during a fluoroscopic procedure. 

After leaving the RSNA, I wondered why I didn't see these innovations at hospitals and clinics everywhere. How come these inventions are the exception more than the norm in treating patients? 

Part of the reason is money. New equipment and the latest software is costly, but some of these entrepreneurs are not charging the top dollar the big companies are demanding for the latest diagnostic equipment. In the end, it all comes down to marketing.

How successful were these vendors at creating a demand for their services and equipment? Often I saw brochures at the conference that truly didn't sell their products and services. Most of the marketing literature consisted of long spec sheets or densely-worded case studies. Were these effective? Did they bring in the new clients?

If not, how could they have done it differently? Is there a better way?

The short answer is Yes. And here's how.