F032 Tech advancements in surgery, VR and the healthcare crisis in Venezuela (Rafael Grossmann)
Rafael Grossmann is a Surgeon, Educator, Healthcare Futurist, known in the digital health community as the VR surgeon. Originally from Venezuela, Rafael has been practicing medicine in the US for more than 15 years.
He’s been sorounded by medicine since his childhood — his father and great grandfather were both medical doctors.
Rafael Grossman started considering studying medicine when he was in high school. Several factors contributed to his interest. Because his father is a surgeon, Rafael was able to assist in surgeries very early on during his medical studies.
All this enabled him to get a direct insight in the medical profession, which future medical students often don’t have access to.
In this episode of Faces of digital health, Rafael talks about several topics:
changes in medicine as a profession,
technological advancements in surgery,
his passion for digital technologies, telemedicine, and VR,
and in the end comments the national crisis currently happening in Venezuela, and its effects on healthcare.
Listen to the podcast in iTunes, Podbean or Stitcher.
Being a surrgeon
Long working hours, unpredictable patient workload and constant new challenges are only a few things that demand high resilience from doctors. Rafael believes working conditions in medicine are improving. While work shifts of surgeons can last several consecutive days, support mechanisms exist to ease the pressure — from resting rooms to workforce backups that can intervene in the case of a doctor’s exhaustion. Workday dynamics also differs from day to day: sometimes a surgeon would mostly work in the operating theatre, other days he would spend most of his time with the patients on the wards, or manage phone calls and bureaucracy. Some days are spent on training, which are an imperative in the current progressive technological advancements age in medicine.
Advancements in surgery
Grossman is an advanced laparoscopic surgeon and was one of Maine’s first practicing robotic surgeons. After deployment across the US, a lot of negative publicity fell on the Da Vinci robot, especially with Netflix’s documentary The bleeding edge, which highlighted the complications occurring with new medical devices due to the lack of training some surgeons undergo when using the Da Vinci Robots.
As commented by Grossmann, lack of training standards is a problem, and it varies from institution to institution, even more from country to country. Nonetheless, robotic surgery is one of the next steps in the evolution of surgery.
Another important innovation in the profession is minimally invasive surgery, which allows for procedures to be executed with smaller incisions and unnecessary tissue damage. This results in shorter recovery time for patients.
Rafael believes medicine will improve to the extent where the need for surgeries in some cases will disappear altogether due to advancements in therapies and disease treatments.
New technologies are always ahead of their time
One of the first digital health solutions Rafael tried in his career was Google Glass, which he used to stream the execution of a surgery to his students. Instead of having students around him in the operating theatre, they were able to see the surgery “through his eyes” in a nearby room, since he was wearing Google Glass and streaming his viewpoint. At the time, this was a revolutionary new way to teach, and has by today been further developed with VR, HoloLens and MagicLeap.
Another project Rafael likes to talk about when discussing the potential of technologies to improve healthcare delivery, is the use of iPod touch to extend the trauma center services. When iPod touch and FaceTime were introduced, Rafael used them to connect to local doctors that needed guidance or second opinion about their patients in real time.
This was done 2011, however, unfortunately the project is not alive today anymore. The problem new technologies often suffer from after their initial introduction, are the complication caused by the time needed for the establishment of new management and reimbursement systems to support innovation.
We’ve come a long way since 2011, says Rafael, and emphasizes that technology, when useful, will need time to get adopted, but will eventually get into clinical practice, if it brings improvements.
For example, telecommunication tools that can improve access to medical experts and reduce unnecessary long drives of patients to reach their doctors, are becoming increasingly normal.
“Technology could ease the situation in Venezuela”
Coming from Venezuela, Rafael observes the current political and humanitarian crisis the country is in with great sadness. In the past, extensive inoculation programs and the availability of low- or no-cost health care provided by the Venezuelan Institute of Social Security made Venezuela’s health care infrastructure one of the more advanced in Latin America. However, by 2015, the Venezuelan health care system collapsed. At the moment, Center for Disease Contol recommends that travelers avoid all nonessential travel to Venezuela, due to a breakdown of the medical infrastructure in Venezuela. There are shortages of food, water, electricity, medicine, and medical supplies.
Reuters reports on violence cause by enraged patients, when they are told there are no medical supplies, there’s robberies and shootings, the report showed, in the latest sign of how Venezuela’s five years of recession have left the country’s hospitals, once among the best in Latin America, in dire straits.
To make matters worse, the Venezuelan president refuses to admit there is a healthcare and humanitarian crisis going on, so when humanitarian aid from the United States entered Venezuela via the Colombian border in February, he claimed the aid was a ploy to humiliate the country.
Rafael says the current problems in Venezuela represent the lowest point a society can reach in the 21st century. Nonetheless, he’s positive that technology could play an important role in improvement: “Venezuela has good natural and human resources in and outside the country. The vast choice of tools for remote education and telemedicine could help in the current national crisis,” he says.
Listen to the whole disccussion in iTunes, Podbean or Stitcher.
About VR, listen as well:
F018 Can Bolivia become the global digital health role model? (Shafi Ahmed) Listen in iTunes.
F010 and F011 How does VR treat PTSD, ADHD and addiction? Will it decrease drug expenditure?
with Albert Skip Rizzo — Listen in iTunes.
with Walter Greenleaf — Listen in iTunes.
Some questions addressed with Rafael Grossmann:
What are the latest advancements in surgery?
Most people know you by your passion for VR and AR, you’re known as the Google glass surgeon. Live transmission of a surgery: doesn’t that make you nervous? What if something goes wrong?
You were one of Maine’s first practicing robotic surgeons. How long does one train before doing the robotic-assisted surgery on patients? The da Vinci robots got a lot of negative publicity in a Netflix documentary last year, because supposedly doctors use them too quickly on patients, without adequate training.
One of the improvements in surgery in the last decade is the appearance of minimally invasive surgery, which allows for procedures to be executed with smaller incisions and unnecessary tissue damage, which consequently shortens recovery. To which extent do you think surgery can be optimized even more? What’s the next thing in line?
What is the difference between HoloLens and Magic Leap?
How do you see the current crisis in Venezuela? How does it affect healthcare?