Could Augmented Reality Restore Human Connection in Medicine?

The augmented reality video game Pokemon Go won five Guinness World Records in August 2016.  In its first month, it was the highest grossing, most downloaded, and most broadly chart-topping video game ever.  Despite the fact that by mid-September, it lost a startling 79% of its players, Pokemon Go’s success remains a testament to our fascination with Augmented Reality: a real-world environment whose elements are augmented by computer-generated sensory input, like sound, graphics, or GPS data.  AR’s closest cousin, Virtual Reality, in which the surrounding environment is entirely digital, has been subject to criticism regarding the “unhealthy escapism” inherent in living life outside the physical world.   In medicine, virtual reality can certainly improve health, as I’ve written about before.  But when one envisions an entirely virtual, artificially intelligent doctor – a concept within the realm of technical possibility -  the prospect of virtual reality in healthcare becomes uncomfortable.

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Doctors and Coffee: The (surprising) facts

Coffee drinking seems to be an inextricable aspect of medicine’s culture.  Watch any TV medical drama and, undoubtedly, at least one physician will be seen guzzling a large paper cup of the good stuff. 

 The field of medicine seems so fueled by coffee that at times, it becomes an official recommendation. A health system in Queensland, Australia has suggested, in a formal report entitled the Fatigue Risk Management System, that on-call physicians should take in up to 400mg of caffeine per shift to maintain a level of alertness that lends itself to safe patient care. 

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The White Coat: Should Doctors Hang it Up for Good?

There are many raging controversies in medicine.  Physician attire, however, is almost never one of them.  There is but one exception:  the quintessential and ever-recognizable white coat.

The white coat has been a symbol of the medical profession since it was borrowed from laboratory workers nearly 200 years ago.  The white color, in fact, was chosen to associate physicians with purity and cleanliness.  But infection control buffs, like Philip Lederer, Infectious Diseases Fellow at Massachusetts General Hospital, who wrote a persuasive piece last year calling doctors to “hang up the white coats for good,” assert that the coats pose an astronomical infection risk.

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Overcoming the Roadblocks to Medical Device Innovation

In September 1952, American surgeon Charles Hufnagel implanted the first aortic “assist” valve into a 33-year old woman with rheumatic heart disease.  Although the rudimentary ball valve clicked loudly enough to be heard by others, the woman – on the brink of death prior to the operation – was able to live a normal life for almost a decade.

Eight years later, in 1960, the Starr-Edwards Silastic ball valve, an artificial valve of almost identical design, was brought to market, and was sold by Edwards Lifesciences as recently as 2007.  

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How Virtual Reality is Already Disrupting Healthcare

Last week, the Oculus Rift, the premier virtual reality headset in development since its Kickstarter campaign in 2012, debuted in UK stores.   Even at the time of its US release earlier this year, the Rift entered an already erupting VR market. Google had released its smartphone-compatible Google cardboard in 2014, Samsung introduced the Gear VR in late 2015, and in April 2016, HTC and Valve Corporation released the Vive, which won 22 awards at CES the same year.  Venture capitalists injected $658 million in virtual reality start-ups in 2015, and $1.1 billion in the first 3 months of 2016 alone.

Media outlets from the Bloomberg to Fortune have wondered if 2016 will be the year of VR.  From a sales perspective, there may be truth to this claim: according to Deloitte estimates, 2016 will mark the VR industry’s first billion-dollar year.  

Needless to say, virtual reality is having a huge moment.  And while the video game industry remains the market leader, other industries – including healthcare – have also made significant strides in the VR space. 

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This is the history of simulation in medicine and surgery. It may surprise you.

In 1927, when Edwin Link first pitched the idea of a flight simulator that could be used to train new pilots on the ground – a device he dubbed the “Link trainer” – the US Army Air Force flatly rejected it.  The device was conceived in earnest.  Link, an electrician and amateur pilot, was unimpressed with amount of real-life flight training available to him.  Fueled by his dissatisfaction, he built a ground-based simulator, which featured a pneumatic motion platform, an electric motor, and a fully functioning replica cockpit.   Despite the novelty of such a device in 1927, Link couldn’t convince anyone in the industry – not just the military, but also private aviation schools – that the simulator would ever serve a meaningful purpose in pilot training.


But in 1934, something changed.  The US Army Air Force won a contract to deliver mail by aircraft, a duty that required pilots to fly daily, rain or shine, in optimal conditions or dangerous ones.  After dozens of pilots were killed in the first few weeks of the contract, the Air Force remembered Link and his flight simulator.  Seven years later, they understood the value of the Link trainer: It was an opportunity for pilots to practice life-saving skills in a low-stakes, ground-based model before venturing into often threatening skies.

The rest, of course, is history. 

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Rethinking the Morbidity and Mortality Conference: Time for Reform?

Whether you’ve been to a morbidity and mortality conference – M&M for those on the inside -or simply watched a fictional version on TV, the ritual is unmistakable.  A junior physician, usually a resident, presents the relevant facts of a case in which a patient suffered a poor outcome.  Snapshots of the history, physical exam, labs, imaging, and the hospital course are displayed on a power point presentation.  The presenting resident is visibly unnerved.  The attending on the case may share a few details, but largely stands back.  Faculty shower the resident with questions about his knowledge of the case, and sometimes his knowledge of the pertinent medical literature.  Invariably one person asks a question that has already been addressed in the presentation.  A senior attending shares an anecdote of a loosely related case, ending with an even more loosely related teaching point.  

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It's the start of residency for 30,000 American Physicians. Let's appreciate nurses today.

It’s July 1st. 

For decades this day has marked the most meaningful transition in an American doctor’s career: the first day of residency training.  Today, over 30,000 freshly minted physicians are thrust into positions of power and responsibility, expected to be primary providers for often critically ill patients.

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The patient safety innovations you need to know about

After the 1999 release of To Err Is Human, the landmark Institute of Medicine report that revealed that hundreds of thousands die each year from medical errors, the problem of patient safety was elevated to the level of an epidemic. The wake of increased public awareness about patient safety has led to thousands of initiatives across various healthcare systems attempting to heal not only patients, but systems themselves.  The good news?  High-quality data has shown that patient safety initiatives are effective in reducing preventable adverse events.  But with a recent CDC report revealing that medical error causes over 250,000 deaths annually - making it the third leading cause of death in the US - we face an urgent need to create disruptive innovation to finally make hospitals safe for patients.

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Why Right-to-Try Laws Fail Patients

On March 12, 2014, a critically ill 7-year old boy, Josh Hardy, received an experimental anti-viral treatment that ultimately saved his life.  Prior to receiving the treatment, Josh, who was severely immunocompromised in the wake of a bone marrow transplant, spent weeks in the ICU of St. Jude Children’s Research Hospital battling an overwhelming adenovirus infection. 

The drug, brincidofovir, was a promising antiviral treatment in the midst of a Phase 3 clinical trial conducted by its manufacturer, Chimerix, a North Carolina based biopharmaceutical company chaired by Kenneth Moch.  It was Moch who ultimately made the decision to provide brincidofovir to Josh.  Shortly thereafter, Chimerix fired him. 

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Physicians as Innovators: 6 Ways We Help - and Hurt - Ourselves

The US health care system is the world's top in health care spending per capita, but in terms of performance, we're dead last among developed countries. As a young physician embarking on a career in this landscape, it's glaringly obvious that we need disruptive innovation to create better health at a lower cost. Physicians are uniquely positioned to make critical contributions to medical innovation, but even among my young colleagues, a minority of physicians perceive themselves as innovators.

Contrary to popular thinking, the creativity possessed by innovators isn't a genetic gift. In twin studies, only 30% of creativity could be attributed to genetics. When it comes to innovation, nurture eats nature for breakfast. To build innovation skills, doctors can recognize 3 surprising advantages they have in the innovation game, and 3 skills to develop in order to make disruptive change.

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