The doctor was controlled by a joystick, moved on three wheels, had a built-in stethoscope, and a flat screen as a face. Chico (a far more manageable name than "Computer Hospital Intensive Care Operator") allowed doctors and other medical workers at Miami's Jackson Memorial Hospital to virtually examine patients, speak to them, and access their digital files - even from miles away. As our population ages, and the healthcare professional shortage becomes even more serious, video-conferencing robots like Chico may represent one face of medicine's future.Years ago, when I first joined the staff at Downey Regional Medical Center, I was often greeted by a robot traveling through the halls and in and out of elevators, delivering food trays. That robot is no longer in use at our local hospital, but more sophisticated robotics are finding inroads into healthcare. You may be surprised at some of the applications being used. Certainly, robots have proven their abilities in hospitals to perform relatively straightforward tasks such as washing floors, cleaning equipment, and carrying hot meals to patients' bedsides. Robots are used in hospital pharmacies to count, bottle, and deliver medicines to the wards. Robots are used to lift and rotate bed-ridden patients, saving the backs of nurses. When we think about ideal medical care, most of us imagine a concerned, compassionate and intelligent human practitioner. However, it is clear that some of our jobs can be done better by our non-human counterparts, and that machines can free up humans so that we can do other jobs better. One significant area where robots have exploded onto the healthcare scene is in training. A group of medical students who were trained to perform a pelvic exam on a robotic simulation stood out from their non-simulator trained peers when working with real women. The training made them comfortable with the exam and they were able to focus more on the patients. Haptic (sense of touch) devices are also becoming commonplace in surgical training programs, including simple laparoscopic workstations that allow students to palpate (touch), incise, or suture virtual tissues and organs. In order to serve remote areas and environments such as aboard military ships or rural areas, Virtual Presence Robots (VPR) have been developed and tested. A physician or floor nurse directs the robot to examine a patient while speaking with and viewing that patient on a monitor. Robots have the ability to visit the bedside and to record the pulse, blood pressure, and breathing of patients who require frequent and ongoing surveillance. Telesurgery can also serve these remote areas. A skilled surgeon might assist a local surgeon (tele-assistance), teach the surgeon (tele-mentoring), or conduct critical portions of surgical procedures (tele-surgery). Surgeons utilize tele-strators placed over the operative site to describe a proposed action, much as a sports announcer might use such a device to explain a play or highlight a player during a broadcast! Surgical robots can perform procedures, including general, urologic, gynecologic, lung, and heart. The da Vinci surgical system, for example, can improve a surgeon's performance because it is more stable that the human hand, yet as flexible as the human wrist. The actual surgeon, however, will not yet be found out on the golf course - he or she directs while viewing on a monitor. Robots are used in some orthopedic surgeries to mill perfectly round holes in the shafts of fractured bones, improving the bonding of metal replacements in hip and knee joints. These robots, much like those in a car assembly line, have one specific task. Robots have been tested as surgical assistants. The "Robo-Nurse" dubbed Penelope was developed to hand instruments to surgeons at the operating table, wipe them clean, and make them available for further use. Penelope was also developed to count instruments, so lost instruments and sponges would be a thing of the past. Robots have provided constant and steady retraction of organs and skin during surgical procedures. Although robots have been tested in this area, they have not received wide acceptance by doctors and nurses to date, and Penelope is currently unemployed. Penelope, welcome to the recession… Indeed, robots are diligent, precise and consistent. They create high quality products. Unlike humans, they are tireless. They do not take lunch or other breaks; vacations or sick leave; or incur costs for worker compensation or medical insurance. However, they do cost a lot of money, they break down, and they have no intuition…yet. Human surgical nurses, for example, perform a wide range of critical functions that require advanced scientific training, including monitoring surgical and nonsurgical practice, sterile technique, and the patient's condition; intervening in the case of an emergency; and advocating for the patient generally. Nurses use critical thinking to save lives. Relieving healthcare practitioners of various tasks does allow them to perform more specialized jobs, but clearly, no combination of metallic parts, microchips, and binary files could replace the empathetic touch or clinical intuition of a human healthcare practitioner. At this stage, at least, robots are not replacing humans, but rather assisting them. Please contact my robotic assistant with any questions…just kidding! Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.
********** Published: February 9, 2012 - Volume 10 - Issue 43