Is Practicing Medicine Virtually Impossible?

June 24, 2011
Over the past decade, there has been a tremendous increase in the number of new applications of virtual reality technology in the healthcare field.

Over the past decade, there has been a tremendous increase in the number of new applications of virtual reality technology in the healthcare field. However, when compared to other industries, particularly aviation, the healthcare industry seems to lag behind, especially in the areas of utilization and a comprehensive, forward-looking strategy for implementation of such systems and as these systems relate to safety.

Along with the increase, there has been a similar increase in the terms used to describe newer medical ventures and institutions employing such technology, with terms like virtual ICU, digital hospital, virtual care, etc, becoming increasingly popular. A steady trend has emerged promoting and marketing wider, more sophisticated, further-reaching and more automated virtual reality technology applications in different disciplines of medical practice.

This trend has been driven, for the most part, by three main factors. One is an increasing awareness and vigilance for safety and the prevention of errors in the medical field. Complementing this is an increasingly mobile and more health-conscious population, with higher standards demanding wider, unhindered access to quality medical care.

And finally is the chronic shortage of healthcare professionals, especially in areas involving high-stress, wide-impact specialties. These factors are coupled with a continued increase in the level of technological sophistication in equipments, procedures and resources.

Of these three key factors, the emphasis has mostly been on a safer and error-free environment for medical practice. An oft-cited parallel is the civil aviation industry, which has managed to maintain an impressively low level of accidents, disasters and errors, partly due to having a longer track record of implementing virtual reality technology — particularly automated systems —throughout the different aspects of the industry.

Citation of that complex, multi-faceted industry's successful reduction of error/accident/failure rates by the Institute of Medicine, in its 1999 report, "To Err is Human," has generated more interest and momentum towards a similar experience in the medical practice, with the goal of similar results.

Capturing the essence

Virtual reality technology has emerged, at least partly, as the technical answer to the existential question of how to define reality. It highlights the differences between perception and reality. This perspective has led various researchers to identify, correlate and manipulate the pertinent, objective data and factors about a given subject, observation or perception and made it possible to construct a complete environment that does not exist.

One of the advantages of virtual reality technology is the improved control of the environment, thereby providing better understanding, manipulation and prevention of the causal pathways for errors or failures, which directly translates into improved performance, improved safety, reduced errors/failures and overall improved outcomes. For nearly half a century, the civil aviation industry has relied heavily on virtual reality technology in the design, development and maintenance of almost all aspects of its environment. This has resulted in a remarkable reduction to the accident/failure rate for this industry.

In contrast, the healthcare industry, specifically the area of medical practice, has been lagging in terms of the extent, comprehensiveness and reliability of virtual reality technology. Only fairly recently have such systems been increasingly implemented, and so far the majority of these applications have been limited to one or two elements within a conceivable virtual reality environment.

Recently, however, as the practice of medicine has become increasingly complex, trans-disciplinary and involving an increasing number of manpower-hours, there has also been an acute awareness of the incidence, nature and causal pathways of medical errors.

This drive to have virtual reality technology play a more central role in the practice of medicine, so far, has not had the expected results. This can be attributed to the differences and limitations characterizing the healthcare industry, as opposed to the civil aviation industry.

Expanding the promise

So far, virtual reality technology has only been implemented in limited areas and aspects of the healthcare industry, mainly those involving medical imaging, medical education and bedside as well as remote monitoring. One of the most important yet least discussed aspects of implementing virtual reality technology in medical practice is the vision of its role in the healthcare industry.

There is still a lack of consensus regarding a total or near-total, automated virtual medicine environment versus utilizing virtual reality as an adjunct to traditional medical practice. Until the medical community acquires a clear goal of implementing virtual reality technology, its role will continue to be limited to areas where it will have minimal impact on the overall performance of the healthcare industry, including patient safety.

One of the reasons for the lack of such consensus is that the current vision of medical practice is still based on William Osler's dictum that 'medicine is learned (and presumably practiced) at the bedside,' with its attendant issues of human connection; emotional, ethical and moral considerations, all of which significantly limit a totally automated practice of medicine. As such, medical professionals — and often patients themselves — have always had an inherent distrust of machines in the context of taking care of patients. Meanwhile, and for the reasons discussed above, truly comprehensive virtual reality ("robotic") applications have not yet demonstrated the efficiency, predictability or reliability needed to be accepted in mainstream medical practice.

Refining the art

The practice of medicine is still an art. It continues to be individually-led and -driven, often in the tradition of a master artisan/apprentice environment. As such, it has concepts, ideas and propositions that do not readily follow mathematical proof. Subsequently, the standard of care, which defines the predictable, reproducible, safe and effective decision-making (mathematical) pathway, is continually being defined and/or revised. This places a significant limitation on developing a reliable logical system at the core of a total or near-total virtual reality medical environment.

In the seminal 1999 report, the Institute of Medicine defines the ideal healthcare system as one providing safe, effective, timely, efficient, equitable, patient-centered delivery system of healthcare. The basic elements for such a system are safety, up-to-date clinical practice and patient satisfaction. Such an optimally designed system will provide the best performance with the least error or failure rate.

Virtual reality technology provides an invaluable and endless resource towards reaching this goal. This, however, requires a thorough understanding of the nature and elements of virtual reality systems, as well as an improved insight into the basic principles and foundations of medical practice.

In our endeavor to further incorporate virtual reality into the practice of medicine, we should be mindful of the limitations and peculiarities of each environment, in order to optimize the utilization of such technology in an ideal, judicious manner and with realistic expectations, leading to a safer practice of medicine with the best outcomes.

Hisham Sherif, M.D., is a cardiovascular surgeon in Newark, Del.

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