Dr. Arunabha Sengupta_pic Dr. Arunabha Sengupta (Surgical Oncologist)

Surgery Sans The mask

The Telegraph, 19th April 1999


In a recent medical meet during the after sessions’ loosening with food and drink our dilatations reflected upon the receding role of human faculties in medical treatment. A news story about robot hands replacing the playful surgical fingers provided the nidus.

Senior people reminiscing about petromax lights and cotton thread sutures, grew nostalgic ruing the end of romantic heroism in medical profession, so rugged and bearing. Young and savvy mouse clickers got excited imagining opportunities to break and be galore, out smarting those past salad days yet refusing to fade away old genre. Banters followed but finally all accepted computers nudging out human frailty as inevitable.

Fantastic voyage, a super hit film of the seventies showed how few doctors , suitably miniaturized , were injected into the blood stream of a patient and they undertook a perilous journey to effect an on the spot repair. To day’s doctor can more conveniently send in robot units, himself safe at the computer console not even donning the surgical mask. Clever cutting controls can virtually let him feel the sensations of real cutting through liver tissue minus the sweats and trepidations. Simulator facilities do away with all learning curve perils and so dies the old adage that to be a doctor you need to kill one hundred and a full thousand to be a healer.

A worried lady afraid of developing breast cancer or a physician wanting to tap better idea than his own mind, each can now shop at computer windows offering products of mathematical models with linear reasoning.

But that is till not enough. Hear is why. Consulted by Mrs. A, a doctor develops his decision on following facts. Mrs. A  is seventy years old, a widow, lives alone, her symptoms denote a probable diagnosis of advanced cancer, requires institutional investigation and treatment, she is physically weak and financially restrained.  To this he adds his own responsibility and likely remuneration (conflict of interest). Mrs. B is admitted in the ICCU in the wee hours of morning. A young but tired medic attends her. He analyses the situation, collates data generated for him by very expert monitoring systems and decides on a resuscitative programme. The validity of both decisions depends upon their data processing capacity toned by experience but handicapped by a limited recall capacity and subjective interpretation of data. But both have the advantage of acquisition of knowledge through constant learning.

One of the aims of the software development for medical use is to overcome the human subjectivity and limited data processing capacity in human decision making. But so long the computers have failed for their stupidity of being able to understand only the syntaxes and not the semantics. In a bid to correct that, Artificial intelligence (AI) is being imparted on computers. Such computers can do intelligent tasks like handwriting matching, semantic analysis of written text and medical diagnosis.

However different systems can individually be made to learn, to solve problems, to apply knowledge. But to be a good doctor a system requires doing all these things simultaneously and continuously. Neural networks have been developed to duplicate the neuron –synapse pattern of human brain. With enough tutoring and after ‘seeing’ how a human expert thinks these neural networks can formulate rules by themselves. Some systems use algorithms capable of suitably altering the network to improve its data management. They also need to grapple with the gray areas that exist in the middle in practical world between the two extremes of black and white which computers restricted with binary vision can not see. Here enters the fuzzy logic of the east. While the doctor on the OR feels dizzy from  constant outpouring of data from expert monitoring systems, the hospital washer man three stories down is having a leisurely smoke because his machine uses a fuzzy logic and determines by itself, depending on the amount of dirt , how it should wash using the common sense rules.

The fuzzy system approach has advantage because it recognizes a 6 as 75% of 8 or 60 % of 10, thereby being able to recognize partial truths.
Soon a computer diagnosed patient, evaluated by another computer programme will have a computer directed operation. This entire operation can be hooked to a global monitoring system which automatically keeps the operator/ surgeon online with international specialists.

And if you think them being costly, just calculate the money saved on soap and water only, hands not being scrubbed any more, and on those masks.
Surely new voyages, much beyond the travails of Thomas Dover or even 2001: Space Odyssey, will have new captains. One however ponders for a moment about all those old ship captains, who used to harangue from the sail mast to keep heads and spirits high, and who in the fuzziness of the real gray world  tried to distinguish between black and white and measured values , middle excluded or not.

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