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Most newspapers, magazines, as well as the electronic
media these days regularly carry reports extolling
the virtues of the newest technologic tools in medicine.
The wide range of technological advances can leave
many patients feeling completely confused. How is
a patient to make sense of which technology may
be useful for his particular illness? New technology
can be dazzling, and undoubtedly, when medical technology
is used properly, it can save many lives. However,
technology can be a two-edged sword; and we need
to remember that every rose has its thorns! For
example, the introduction of antibiotics was very
quickly followed by their misuse, leading to rampant
antibiotic resistance amongst bacteria and an ever-increasing
rate of hospital-acquired infections. We need to
remember that new does not always mean better, and
that time-tested medical procedures are often better
than the latest gadget on the market !
It is very easy (and very tempting) to misuse medical technology. For example, MRI (Magnetic Resonance Imaging) scanners represent the latest advance in technology and these machines can undoubtedly provide very useful information about the human body ! However, MRI scanners are very expensive and need to be used to do at least 10 scans a day to be made cost-effective. Private hospitals buy them because they represent the 'latest technology ' and are in vogue; for example, eight units have already sprung up in the city of Mumbai! Ironically, there are not enough patients to satisfy the needs of eight units, even in such a large metropolis, with the result that many patients are subjected to unnecessary scans, simply to keep the machines financially viable. Paradoxically, patients also pressurize doctors to misuse the new technology. Many of them go 'doctor shopping', and demand that the 'latest whole body scan' be done to prove that they are healthy!
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You need to be aware of
the following inappropriate uses of medical technology.
- Excessive use of technology, even when it is not required. A prime example of this 'folly' is ultrasound scanning during pregnancy. While no one will dispute the fact that ultrasound scanning has provided an extremely useful window to the foetus and can yield invaluable information, 'cosmetic' ultrasound scans to provide 'pictures' for the baby's 'first album' are hardly appropriate.
- Unethical use of technology. While pre-natal diagnosis (using ultrasound scanning) has been a very important tool for reducing the risk of birth defects, using this inappropriately has become a major scandal in India, especially when it is misused for foetal sex selection, by performing female foeticide.
- Use of technology which is not suitable for a particular patient. An example of this would be advising IVF ( in vitro fertilization) for all infertile patients, just because the equipment and expertise are available and because the procedure is technically feasible. However, for most infertile patients , there are many simpler treatment options available, which should be fully explored before considering IVF.
- Misuse of technology by unqualified persons. A common example is the use of lasers or endoscopic equipment for complicated surgery. Just attending a two-day workshop and acquiring a certificate does not make a doctor sufficiently expert in using this technology; and a number of mishaps have been reported because of operator inexperience.
- Use of technology as defensive medicine, i.e., to protect the doctor from being sued, rather than using it because it is needed for the patient's welfare. This trend is becoming increasingly common in India now, with the passage of the Consumer Protection Act, which covers medical practice too.
There are many reasons for the inappropriate use
of medical technology.
- The major factor, of course, is money or the need to generate income. Doctors need to justify the purchase of expensive capital equipment, and as hospitals have become profit-oriented organizations, doctors are becoming increasingly answerable to the management regarding the profitability of their services. Nowadays, once a piece of equipment has been purchased, it needs to be 'utilized' to make it 'cost-effective'. Woe betide the doctor who does not generate enough money through the latest gadgets! He may find that his contract is not renewed!
- The glamour and the dazzle of the latest gizmos tend to lure most doctors, just like driving the latest model car! One gains prestige by being the first to adopt the latest technique; or by being the only one in the world/country/city with the latest and newest 'toy'.
- The pressure from manufacturers to buy the 'latest and newest'. 'New and improved' versions prove attractive , not only to toothpaste consumers, but also to doctors, and the medical industry (both equipment manufacturers and pharmaceuticals) has developed powerful tactics and techniques to induce doctors to prescribe and use their newest products. The companies involved can afford to spend large amounts of money on advertising, and they use this very effectively to maximize their profits.
Thus, the crucial question arises: what can you
do to protect yourself from being a victim of medical
technology misuse? The answer is: make sure you
are well-informed, so that you can judge the technology
and its relevance (as it relates to you) for yourself.
For example, the National Institutes of Health,
USA, produces consensus statements in which leading
medical experts from all over the world are invited
to discuss the pros and cons of all the technological
options available for dealing with a particular
medical problem, essentially in order to guide doctors
as to the appropriateness of the latest technologies.
Using the information gleaned from such statements,
or obtained from other sources intelligently, in
cooperation with your doctor, will ensure that medical
technology is utilized appropriately to provide
the best possible care for your problem!
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