KNOWLEDGE and TECHNOLOGY
are two comets that we are trying to ride at the same time. Both are fast and
we have no control over them. We are holding on, with great difficulty, to the
searing tails of these two Comets, hoping that they will take us to the right
place at the end of the ride. Sometimes we pray that we can hold on for the
entire ride. Sometimes we find ourselves praying that Almighty God will be
merciful and just let us fall off. What we shudder to think is what will happen
the next time the two Comets choose to move in opposite directions as they have
undoubtedly done in the past.
While it is so true that we cannot hold on to the
older proven techniques and should continue to strive for excellence at all
times, the reality is that all that is new and available is not invariably good
and useful. There is a lot of market driven euphoria and baseless jingoism with
quite so called new gadgets, hence our reluctance to succumb to them. When
confronted with a new machine / technology we should ask whether we are the
masters or the slaves of technology. Once we understand that we must be the
master, the rest is fairly simple. The ultimate purpose of any technology is to
help its master to do his or her job better. Our job is to cure patients,
improve the quality of recovery and patient's well being, and reduce the
sufferings of those we can not cure. We also must make treatment efficient and
cost effective. If a product of the new technological boom does not meet these
criteria, we must ask “Why are we doing this?”
State of the art technology is no substitute for state
of the art knowledge; in fact it is quite useless and on most occasions
downright harmful without it. Technology has not always taken us to the crest
of success. The moment we have allowed it to lead our knowledge, with our
subconscious connivance, it has led us astray, or more correctly we have
allowed technology to lead us astray. Extracorporeal Shock Wave Lithotripsy
(E.S.W.L.) has broken millions of stones in the kidney, ureter, and bladder.
Thinking it to be a stone breaking machine, a few amongst us tried to crush
stones in the gall bladder expecting them to disappear like magic. We
conveniently forgot to compare the anatomy and physiology of the two organs -
in one clear urine washes down the debris through a straight ureter and in the
other thick viscid bile slowly finds its way down across a serpiginous course
and through a valve. The result was a disaster of enormous proportions - all
because we did not do our homework well. The marriage of knowledge and
technology is a very turbulent one as both are highly ambitious and growing
rapidly. A postal delay in the delivery of two journal issues leaves one fairly
behind in patient care and ignoring seminars and conferences makes one antique.
If necessity is the mother of invention, then strategy
should be its father. Technology should not evolve spontaneously. Its evolution
should be our responsibility. Where do we go from here? What technologies are
on the horizon? How do we open our minds without closing too many doors?
Surgeons are looking at various technology that could enormously improve
patient care and even put them out of business; technology that can fix things
without touching them, and touch things without seeing them. These are weary
yet exciting times!
The future very often arrives faster than expected. In
1996, a renowned biologist, Lee Silver of Princeton University, wrote that it
is impossible to clone mammals via cell-nucleus transfer. His book had not even
reached the bookshops when scientists of the Roslin Institute in Scotland
announced that they had succeeded in cloning ‘Dolly’ the sheep. The best way to
predict the future is to invent it. Delightfully mesmerizing visions of the
future created by research laboratories, think tanks, science fiction authors,
other visionaries and clairvoyant sooth-sayers not only form a matrix for the
social perception of tomorrow's world but also open up a plethora of
opportunities. Such futuristic thoughts are known as memes, which propagate in
society like a cultural gene. Mass media dictates the collective expectations
of society, hence they can analyze the memes. Cinema can project new
technologies as being real even if they are in the developmental stages and
society will accept it, at least in the subconscious mind. The most radical
ideas from science and fiction may find solutions to problems that we face in
real life. On the other hand, consumer expectations are also programmed in this
way. Microvascular transplants of severed limbs were seen in comic strips half
a century ago; today they are a reality in a general hospital near you!
Human life might also become programmable. Families
will be designed and children selected according to catalogs. The gender of
children might be reversible during the course of pregnancy and the little
brother may be a robot! Thus, our notion of family happiness might be
programmed and human beings would like to make the entire world a theme park
where spectacular experience boosters are available. One-minute holidays and
artificial hibernation of unproductive times will become the order of the day.
In the healthcare sector of the future, less emphasis
will be placed on curing illnesses than on prevention and well-being. Beings
and machines will merge; body and consciousness will be rewired. The new
combination of natural and artificial hardware and software will create
mechanical humans and human machines. Death might become optional with
artificial parts increasingly replacing diseased organs. The secret of
self-healing will be decoded, changing the treatment pattern of today. But
human evolution will continue and result in new intelligent beings.
The future belongs to those who tell the best stories
about the future; in other words, only creative thinkers will get an
opportunity to contribute towards future professional needs. Plastic Surgery is
generally considered to be a skill-based specialty but we have begun to
establish our knowledge base. As a knowledge-based specialty, adoption of new
technology is a natural extension of our commitment to patient care and not to
skill-based bravado. Many new technologies are adopted from other fields viz.
nanotechnology, lasers, etc. With a solid knowledge base, we will not be afraid
of technological failures and will adopt technology as early as possible. Many
technologies are popularized by corporate investments, which may not be
inherently interested in patients but be more of business opportunities. This
profession has to manage the pressures of the market without ignoring the
science because ignoring them totally will be fatal to our future growth. Knowledge
has to remain a step ahead of technology and riding these two comets, though
not easy, has to be done throughout the active professional life of a
professional.
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