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Editorial - New Technology – A Blessing and a Curse |
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New Technology – A Blessing and A Curse
Emil H. Schemitsch, M.D., FRCSC
Editor in Chief
Toronto, ON
As I sit here thinking about the arrival of the holidays, I wonder if the New Year will allow my holiday wish list to be filled. New technologies are often thought of by many as expensive new toys. Yet these new technologies have the potential to fundamentally change how we practice our specialty. The introduction of new technology is both a blessing and a curse. As we develop new methods to look after our patients, we feel pressure to deliver these costly new technologies to our patients. In many instances, this pressure is rightfully justified. Work is being done with minimally invasive surgery, robotics, computer-assisted surgery, bone substitutes, and bone imaging which will revolutionize the field of orthopaedic surgery. Canadian orthopaedic surgeons have always been international leaders. We must embrace, understand and train with this new technology if we are to maintain our position as leaders and innovators.
There remain many questions regarding new technology. How much of this new technology is based in science? How much evidence is there that we should move towards implementation? An evidence based approach is necessary to replace a gold standard. Certainly, in some areas such as the use of bone substitutes, there is substantial evidence. What about the cost? Can we justify their use? A major problem is that new technology is seen differently when viewed at the hospital level and when viewed from a system-wide point of view. One can make the argument that a bone substitute will decrease length of stay, reduce complications and improve patient satisfaction for the individual patient. Orthopaedic surgeons are then asked if these improvements will translate into the closure of beds to save additional money. There is little incentive at the local administrative level for the hospital to be more efficient in this manner, since a reduced length of stay results in more patients being operated on with each patient perhaps requiring an expensive implant. This can be a tremendous strain on the global budget of a hospital. Yet from a system-wide point of view, this efficiency makes a lot of sense, since more patients are receiving care, often with a similar amount of resource. As a result, patients may return to their jobs and society earlier after surgery with fewer complications, re-admissions and improved satisfaction. This can also have a profoundly positive impact on waiting lists.
An effort needs to be made to get government to understand this way of thinking, since government should have the best interest of society as a whole in mind. It may be as simple as understanding that one must spend money to save money. This is also where partnering with industry to make a business case for new technology can be helpful. A sustained effort in this regard, I believe, will pay off.
In the meantime, as we approach the end of another year, I wish you and your families the happiest of holidays!
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Last Updated ( Monday, 11 February 2008 )
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