Opinion | The Next Big Shiny Thing

“Ooh, I bet this new thing is really going to be the next big thing.”

It seems I’ve said this multiple times over the course of my professional career. I have a long history of being attracted by fancy doodads that promise to make things better and easier for us as we go through the day trying to take care of patients. Someone will send me a link or an article about a new device, a new piece of medical equipment, a fancy gadget, or a better way of doing things. And I find myself endlessly attracted by the promise of sparkly shiny things — the next big thing.

Gathering Dust

Many years ago, I bought one of the first kits for remote patient blood pressure monitoring, a huge complicated apparatus that included its own laptop computer that was dedicated to processing the data from blood pressure devices that patients took home. One of my partners and I set up the program, and we thought the demand was going to be huge and immediate — practice-transforming. We lent out our one device to a patient, and he disappeared, and we never saw the darn thing again.

A colleague told me they were interested in developing a home visit program for complex patients, and that they would love to be able to do EKGs in the field. I researched the smallest, fastest, best portable EKG machine on the market, and bought one for the practice. He used it once; now it’s gathering dust.

And so far, I’ve been through three generations of point-of-care ultrasounds, and they still haven’t really caught on among us primary care providers. We were so impressed by the sales pitch of the original one we saw, and the incredible images generated, that we never stopped to ask if we really needed this, how often we would need it, and whether it would make a difference in our practice.

During the COVID-19 pandemic, when we were seeing incredibly sick patients with COVID-19 pneumonia that we would never send home under normal circumstances in normal times, we trained in point-of-care ultrasound for detecting pneumonia based on the differential appearance of A and B lines on these devices. But we also already had our clinically trained ears and a portable x-ray machine, and while it was always cool to add this on — to actually visualize the lung tissue and the damage and the extent of it — it mostly didn’t seem to change our management.

As the pandemic wrapped up, one of the partners in our practice expressed an interest in the getting fully certified in point-of-care ultrasound, took a long course that required a lot of time and money, and then fulfilled the certification by doing ultrasounds in the office on a number of outpatient cases. He was convinced that this would one day replace the stethoscope in our practice.

So, dutifully, I bought a number of handheld portable ultrasounds, and invited all of my faculty to get trained and certified. Not a single one took me up on it. They now sit collecting dust on a shelf in my office, waiting for the need and the interest, in the hopes of overcoming some inertia.

I think a lot of folks were worried that if they were going to do a study on potential deep vein thrombosis versus Baker’s cyst, that they would ultimately want the official study done at Radiology across the street. And I think everyone felt pretty confident that they could distinguish community-acquired pneumonia from heart failure.

Overcoming Inertia

I still believe there’s a use case scenario for these devices, that actually seeing the underlying tissue may prove in the long run to be better than our stethoscopes and our hands and our eyes and our ears. But overcoming that inertial hump seems to be a big uphill battle that no one’s ready to take on right now.

About 15 years ago, when one of my mentors retired, he told me he had a medical training device that he wanted to give to me. I was honored to be bequeathed this piece of equipment that he took great pride in, which had always been set up in his office. It was an early contraption that was built to transmit cardiac murmurs, electronic signals that were translated and transmitted to a small pressure plate that medical students, residents, and faculty could lay their stethoscopes on and auscultate the different heart sounds.

He had worked for many years with an engineering team to develop this, and they ultimately created electronic versions of a couple of dozen heart sounds built onto small circuit boards, which were changed up when you wanted to hear mitral or aortic insufficiency, an S3 or an S4, or a Graham Steel or Austin Flint murmur that we’d all read about in the textbooks (but maybe never actually heard…).

Once he retired, I offered this device up to the residents, and we set it up in the conference room for ambulatory morning report, and one by one they took turns listening to the murmurs. But none of them seemed that impressed, and then they showed me a website that had all the same murmurs available for them to listen to on demand, in high fidelity. So, this old piece of equipment now sits in another cabinet in my office — you guessed it — collecting dust, but I don’t have the heart to throw it out.

A New To-Do List?

For many years I’ve tried to find ways to create a To-Do list for myself that I would actually use, and I was an early purchaser of Palm Pilots, PDAs, various small handheld personal computers, and multiple Apple devices, all in the hopes of keeping me organized and helping me get my To-Do list done. Unfortunately, at the end of the day, I would get home and realize that I had been too busy to stop and turn the darn thing on.

Now these things sit in yet another cabinet in my office, collecting the last remaining bits of dust available, and most of them are probably unable to be turned on or even charged ever again. My wife says this is a personality trait I need to overcome, that just because the New York Times Wirecutter advice column says this is the latest and greatest, that I shouldn’t fall for it and buy it that day. My To-Do list is still a 3 × 5 card and a pen that I carry in my shirt pocket.

Someday, the perfect new technology will be there, the right tool at the right time, and AI and fancy gadgets will help us take incredible care of patients. And one day we’ll all have a medical tricorder from Star Trek in our pockets, to instantly diagnose and treat whatever ails our patients. But for now, I think I’m just going to continue dabbling in new toys, hoping to find the next shiny magic bullet that will make everything all better.

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