By David Harrington, PhD
?Just about everyone in the medical field knows that the biomedical profession is at the bottom of the pecking order and that the only time others want to see or hear from us is when they are having trouble with some device or system. It isn’t the optimal use of our skills or experience. And it doesn’t do much for our self-esteem.
But the worst part about being at the bottom of the stack? We are as much to blame as anyone. We are letting it happen over and over.
The Progress of Technology
It doesn’t have to be that way. Look back at what we, as a profession, have done with health care technology. Yes, it is expensive. But without it, we would be much worse off. Consider just this one of many examples: In 1960, a hernia operation required 6 days in the hospital. In 2013, it typically takes 6 hours or less. What made that possible was technology. Through its proper use, we have enabled hospitals to treat more patients per day, reducing costs and improving outcomes. But we have not received any credit for most of this progress, and we probably never will.
When it comes to costs, though, hospital administrators might be able to learn something from technicians. To me, it appears that administrators are afraid to even try to determine what the cost of a procedure really is. When my wife recently had back surgery, the charge from the hospital was $118,000. But Medicare and supplemental insurance have paid the hospital a total of about $9,000. So what is the true cost of those 3 hours in the operating room and 43 hours in a hospital bed? We will not get health care costs under control until the administrators and financial people do their jobs as well as we technical people have done ours. Remember, it is the practice of medicine, but the science of engineering.
Theory Versus Practice
Here’s another example. In the late 1980s and early 1990s I spent a lot of time and effort working with vendors on electronic records, interconnecting devices, and substantially reducing the paperwork that would be required of nurses and caregivers. It looked great in theory, but 20 years later, what is the main result? Manual documentation has increased. Again, the problem is not with the technology, but with the way it has been implemented. If enough large hospital systems would agree on a technology, then our problems with what electronic systems are used and how they are interconnected would be solved.
Or consider the much-discussed problem of alarm fatigue in the hospital. This is not new. We can find articles from the 1970s talking about the problem of too many alarms. But ever more alarms are being heard in hospitals today. Most of them are not even needed for quality patient care. One engineer has reported that in one ICU with 12 beds, there was on average more than 600 alarms triggered each day. With that much noise, alarm fatigue is inevitable, and patients will suffer. As one patient told me, a hospital with that much noise is not a suitable place for an ill patient to rest and recover.
Again, these problems all relate to the practice of medicine and the science of engineering, and now it is time to turn to science.
In this environment, what our profession needs to do is to get back to where we started: working with vendors to develop the best possible instruments. That used to happen all the time, but now most engineers and technicians in hospitals have no contact with the research and development staffs of manufacturers. Likewise, most manufacturing R&D personnel have never been in a hospital except to visit.
No More Rodney Dangerfield
As biomedical engineers, we can continue to play the Rodney Dangerfield role or we can come out of our shells. I believe it is time for us to start pushing the science of engineering and what it can do for the practice of medicine. We have to resist the lure of old ideas that often lead to inferior patient care. It is time for us to use the power of the pen and refuse to sign off on products that do not meet the needs of the patients in our hospitals. And above all, we must learn to communicate effectively, with people in our hospital, in other facilities, in professional meetings, and in journals and magazines. We know a lot more than we will admit to. It’s time for us to speak up. 24×7
David Harrington, PhD, is a health care consultant based in Medway, Mass, and a member of 24×7’s editorial advisory board. For more information, contact [email protected].