Archive for the ‘Miscellaneous’ Category

Robotic Surgery and the Smartphone

Sunday, July 28th, 2013

Recently I was cleaning out a closet and found a box of old cell phones.  Each one was an upgrade in technology and each one was a reminder of how quickly technology can progress.  The collection of cell phones ranged from the Motorola StarTac to a “vintage”  Razr.  The latest edition to the collection is an iPhone 4 which was replaced with the iPhone 5.  The StarTac was once considered one of the 50 greatest gadgets in the last 50 years.  Compared to the latest generation of smartphones, it pales in functionality.

There were multiple reasons why this happened, but there were three leaps in technological enhancement that help to explain this.  It comes down to markedly improved capabilities in processing, networking and apps.  Data processing on laptops alone has increased 1000 fold in the last 20 years and continues to improve.  By 2020 it is predicted that handheld devices will be capable of several 100 Gigaflops (GFLOP), which can be 100 times faster than current home computers.  In addition, the cost  per GFLOP has plummeted from $640/GFLOP in May 2000 to just 22 cents in June 2013.  So what does this have to do with robotic surgery?

In a June 2013 Medscape interview, Dr. Joseph Colella, the Director of Robotic Surgery at the University of Pittsburgh Medical Center commented that one of the advantages of robotic surgery is, it is a computer technology.  We are placing a computer, in the form of a robot, between a Surgeon’s hands and the patient.  As advanced as that technology seems today, it will pale in comparison to what we will see in the coming years.  Imagine the possibilities when that computer’s capabilities in processing, networking and applications is massively increased.  We witnessed it with cell phones over the last two decades and we will likely see it  in robotic surgery.

In a July 2013 Medscape interview, Dr. J. Kellogg Parsons from the University of California at San Diego pointed out that the benefit is dependent on the procedure and the patient population.  While it still remains to be seen what procedures make the best use of robotics and which population of patients benefit the most from its use, this will become more obvious with time, just as we saw with the evolution of laparoscopic surgery.  Cost will need to decrease and this will likely happen with reduced costs of the technology and competition.  It’s hard to believe but we may one day be comparing current robots used in surgery to the old “brick” cell phone.  BTW, the brick cost $3,995 when it premiered.  With a two year contract the iPhone 5 cost $199.  Yes, it can happen.

Miller’s Magical Number Seven and Information Management

Sunday, May 31st, 2009

There was a recent post on the Medscape discussion forum which referred to an article on the use of mnemonics in psychiatry.  The title of the article is: Mnemonics in a nutshell: 32 aids to psychiatric diagnosis.  Many of these memory aids are simple acronyms such as the CAGE assessment which is used to quickly determine a person’s risk for alcohol abuse.  Of note, among the 32 aids listed is the number of discrete units used for each mnemonic.  CAGE is one of the simplest with 4 discrete units and under delirium diagnosis is “Deliriogenic Medications” which has 15.  For those fans of Miller’s Magical Number Seven this may seem excessive.  In 1956 George Miller, a cognitive psychologist from Princeton, published a paper in which he demonstrated the capacity of our working memory was about seven, plus or minus, two elements (for English speaking people).  It is interesting to note that the number 7 is frequently referenced in our language to describe a list of various elements such as: 7 days in the week, 7 numbers in a phone number7 deadly sins,  7 hills of Rome and , of course the 7 wonders of the world. As it turns out the average number of discrete units for all 32 aids is 7.5 and the most frequently occurring value (mode) is, no surprise, 7.  The range is 4-15 which appears to deviate from Miller’s claim of 7 plus or minus 2.  Since we are referring to a memory aid, the aids with a low number of elements are not critical.  Of the 32 aids only four of them appear to violate the upper part of the range.  Fortunately  a simple mnemonic trick is used to facilitate these memory aids.  Each of these is broken up into smaller discrete units much the way we break up phone numbers.  The 15 element “Deliriogenic Medications” is given the mnemonic “ACUTE-CHANGE-IN-MS”.  Even “WWHHHHIMPS”, which lists the life threatening causes of delirium can be seen as “WW-HHHH-IMPS”. With the massive growth in information in healthcare it seems like we are rapidly approaching the point where mnemonics will no longer be adequate to support human memory.  It has served as a useful bridge but the information age is becoming more and more dependent on information technology as the primary memory aid.  Miller’s Magical Number Seven will not go away though, it will become more important in how information technology presents information to us.  This is the realm of information management.  For healthcare to progress we are going to need to become much better at how we manage information.  It is going to take more than mnemonics to overcome our memory capacity limitations, not to mention the other limiting features of bounded rationality.  The information age will allow us to move beyond satisfactory solutions and endeavor toward optimal solutions.  This assumes, of course, we learn how to manage this vast amount of information in a way that compliments our natural capacity to understand and use it.

My New Site

Wednesday, May 28th, 2008

So I finally made the leap.  It’s now official.  After being under “construction” for years my new website is open for blogging.  My previous blog was at  The primary focus of that blog was to describe what I saw as some of the reasons for our current healthcare crisis.  As much as I love discussing this topic there is so much more I also love to write about.  I will continue to comment on this subject but will open it up to a more diverse range of topics.  Bear with me as I navigate the new format.