Winds of change in medicine - terrific or terrifying?

Piotr Kochan

Winds of change

Times are changing. Not only in medicine.

Economically, climate-wise but also when it comes to politics. What was once accepted to be the "guardians of peace", i.e. the three super-powers balancing each other out, was shattered with the Russian territorial invasion of Ukraine. When you come to think of it - we don't really deserve to be on this planet. Wars, imminent collapse of political systems, overpopulation, inflation, pollution, global warming, Cold War 2.0 as a long passageway to WWIII ̶ it all points in one direction. Should we be sorry? No, maybe this will be a breath for the planet to be reborn some day. Space travel is not as advanced as we would wish for, no matter what NASA or Elon Musk say - we are not ready to survive beyond earth. Robotics is still kept in the labs. The sci-fi films and books were wrong by about 500 years.

When it comes to climate change, a lot is happening, but not enough is done. Switching to electric powered vehicles does not really help if the majority of the power comes from coal-powered plants and the charging infrastructure for cars is so poor in some countries, including Poland, that a huge number of electric cars would be a disaster for the drivers. Also, charging is becoming very expensive due to high electricity prices. In Poland, e.g., you have to sell your solar energy to the power company and buy it back (sic!), which is absurd. Also most of the solar system installation costs are to be paid by the owner, not the power company or government. Also the materials and batteries used in these vehicles are hardly eco-friendly.

So, are our children safe? Probably so, but I wouldn't be so sure about our grandchildren and their children. Humans are becoming more lazy, more selfish, more idiotic and self-centered. Most human interaction is done via social apps. I'm highly bothered by an image of friends sitting at a table in a restaurant and everyone at the table is looking into their smartphones, instead of talking and socializing. It's more important for some people to make appearances on the popular web apps, than in real life. Kids and teens are bothered by what someone says or writes about them in this totally artificial environment. I see such patients on daily basis, that have self-confidence, web addiction and other psychological problems, often as victims of hate on social media. And their web life is usually very different than their real life. On the other hand such kids and teens are totally helpless and can't find their way around everyday activities - despite the availability of such a huge source of information as the Internet. They eat unhealthy fast foods that are advertised and usually do no sports/activities whatsoever. I also witnessed that while working at the university for many years. Nowadays students really need everything prepared for them, they find it hard to look up information and data by themselves. Very different from the inquisitive students about 20 years back. And it's so much easier to find information nowadays than 20 years ago. You can literally find everything on the Internet. A lot of trash, but also a lot of valuable information.

Why are we as humans becoming so stupid?

We tend to applaud inventions that make us lazier. The lazier we are, the less likely we are going to look for information. Why do we love review papers and meta-analyses? Because we are lazy. We don't want to look and analyse all these articles on our own. We want them to be served on a platter, best with a solid conclusion.

We rather tend to be fed information that makes us go in one general direction. Most people are like sheep, they like to go with the flow. Fake news, fake data, false claims - all that sells well online. Very much like the Inquisition, the Internet is a perfect place for modern witch hunts - you can easily speculate or even brake someone's career by making people believe in unsubstantiated accusations. And you are sure to gain thousands of like-minded half-brained followers. According to Richard Lynn and David Becker at the Ulster Institute, the lowest average national IQ is around 43 and the highest over 106 [1]. Some persons will find these data fascinating, others racist, supremacist or discriminating. But the key point is - the more stupid the people - the more likely they are to be brain-washed and exploited, thus controlled.

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Figure 1. Waiting for the Internet connection to return in a GP's office can be a hassle for patients.
[please click on the image to enlarge]

What about winds of change in medicine?
Terrific OR

In my opinion both.

Why terrific?

I had the chance to co-author a small chapter in a book published by the Polish Academy of Sciences (Polska Akademia Nauk, PAN) entitled "Społeczny ruch naukowy w procesie zmian" ("Social science movement in the process of change") edited by Iwona Hofman and Zbigniew Kruszewski. The article published in that book bore the title: Korzyści ze stosowania technik informatycznych dla Towarzystwa Lekarskiego Krakowskiego (Benefits of using information technology for the Cracow Medical Society). These benefits are obvious, from digitalizing historical materials to video conferences and online medical publications. One such excellent example are the publications on the Holocaust such as Medical Review - Auschwitz, done together with the publishing house Medycyna Praktyczna, which are also available in English and consist of 7200 A4 pages, over 1000 articles written by 477 authors on the main topics such as: political, medico-legal and philosophical and ethical issues, extermination system, medical examinations of former camp prisoners, starvation, barbaric experiments, repressions of the intelligentsia, martyrdom of children, Jews, compensation and certification, biographies and reports. The article also mentions cooperation between Cracow Medical Society (pol. Towarzystwo Lekarskie Krakowskie, TLK) and other organisations such as Polska Rada Resuscytacji on their YouTube channel and Facebook account. And last but not least, TLK mentioned their cooperation with the free of charge, full-open access World Journal of Medical Images, Videos and Cases (WJOMI). As a conclusion the article mentions that this cooperation and various information techniques allow to communicate and reveal the wide scientific and non-medical activity of doctors and also present their extra-professional image, also promoting the activity of doctors on the cultural forum. And plenty of such information is available for free on the Internet.

There are so many advances in the field of medicine, esp. in the XX and XXI centuries that it's hard to list all. For example modern vaccines, antibiotics, genetics, operating robots and other medical diagnostic and life support technologies. Life expectancy has improved significantly over the last centuries. In the Middle Ages it was approx. 30-35 years and now it exceeds 73 years. So it has doubled. Will we see another doubling over the next centuries? It's hard to predict but if we harness organ culture/printing, can treat all cancers and infectious diseases, then likely so.

Why terrifying?

Let me give you just two such examples:

No. 1:
Busy general practice morning. Mornings are always very busy in the GP office. Many patients waiting on their visit. Nothing points to a disaster. All of a sudden the Internet brakes down. Resetting the router makes no change. First call to the IT guys and they are caught off guard. No, they know nothing, they will check. They call back after half-an-hour, it's some major problem with the Internet supplier. They suffered a major breakdown.

Now, everything today: the patients' registration for visits, their medical history and current visit are stored electronically. It becomes virtually impossible to do an old school doctor's visit. Why? The data need to be written into the computer, if there is no connection to the internet - the certificates and prescriptions do not work. You may issue paper printed prescriptions but often they are not honoured or refunded by the pharmacies. So the patient comes back unhappy. Secondly, you can't issue e-referrals to specialist care nor write leaves from work - they are also electronic and need live connection to ZUS - the Polish social insurance system network. So the patients are crowding up on the corridor, very much unhappy. And they blame you as a doctor - not the system. So Internet has a dark side, too. It's impossible to run a GP's practice without Internet access nowadays in Poland (Figure 1).

No. 2:
Another hectic General Practice afternoon. The patient is in the doctor's office being examined. She is a Ukrainian war refugee in need of continuous therapy for neurological and heart conditions. It turns out that the electronic processing of her refugee application has not gone through the system, yet, despite her visiting the Home Office earlier that day. It's late Friday afternoon, so the system will not be updated until the next Monday morning. What to do? The pharmacy will not issue her with refunded drugs and want the full price to be paid, ignoring her refugee status and the fact she does not have a lot of money.

Above, are just some of the hazards encountered in modern medicine. Internet can be a disaster tool, augmenting the frustration of modern health-care. And that failure can be extrapolated to many other branches of medicine and common life, in case Internet fails. So, a modern doctor needs to wage the risks associated with modern technologies, no to just blindly follow the online regulations but have protocols in place when that connection brakes down.

[1] World Population Review. Countries by IQ - Average IQ by Country 2022. Access valid on 1 December 2022: https://worldpopulationreview.com/country-rankings/average-iq-by-country
[2] Gościński I, Kochan P, Pyrczak W, Wiernikowski A. Korzyści ze stosowania technik informatycznych dla Towarzystwa Lekarskiego Krakowskiego. [In] Społeczny ruch naukowy w procesie zmiany (Hofman I, Kruszewski Z, eds.), Polska Akademia Nauk, Warszawa 2021.

Conflict of interest: PK is the Board of Directors Member of Cracow Medical Society (Członek Zarządu, Towarzystwo Lekarskie Krakowskie)

To cite this article: Kochan P. Winds of change in medicine - terrific or terrifying? World J Med Images Videos Cases 2022; 8:e85-88.

Published on: 1 December 2022

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