During my years of practicing medicine, a great number of technological advances have been made in the diagnosis and treatment of diseases. Many of these advances have been very helpful in the treatment of patients. To let you figure out how old I really am, diagnostic ultrasound was just becoming the standard way of diagnosing gallbladder disease when I was finishing my training program. Just think about how many new technologies have been added to the physician’s diagnostic and treatment options since that time. For better or worse, the introduction of these technologies has implied that the “old ways” of doing things are no longer important and should not be learned. However, a recent situation has shown this may not be entirely true.
Surgical staplers used in resection of the intestine for gastrointestinal problems were introduced in the 1970s and have been very helpful in these operations. I had the opportunity to test some of the early intestinal stapling devices and appreciated how their use could shorten operations and provide other benefits when dealing with bowel resections. Even in the early days, these devices were not without problems that could result in serious complications. If the device did not function properly, the surgeon completed the procedure by hand-sewing the anastomosis in the intestine as has been done by surgeons since the institution of intestinal surgery. Unfortunately, it appears so much reliance has been placed on this technology that few surgical residents are taught how to hand-sew an intestinal anastomosis. They totally depend on the “machines” to connect 2 segments of intestine together. In 2019, events occurred that showed the fallacy of too much dependence on technology.
In 2019, the US Food and Drug Administration published a report1 showing that since 2011 there had been 110 000 complications reported from the use of surgical staplers, including 412 deaths, 11 181 “serious injuries,” and 98 404 instances of stapler malfunction. As a result, the manufacturers recalled the stapling devices, leaving the surgeons with no “modern” way of performing an intestinal anastomosis. The only way that the needed operations could be executed was by hand-sewing the anastomosis. Since very few of the younger surgeons knew how to do this, many of the operations had to be cancelled and delayed, awaiting the updated staplers. Only the older surgeons trained to perform intestinal anastomosis by hand-sewing could provide the appropriate operations for their patients.2
This reliance on technology to practice medicine is not only a problem when we experience equipment failures or unavailable products here at home, but it limits our surgeons’ abilities to help care for patients in under-resourced countries around the world. In countries where resources are limited even common problems have to be approached with a low-technology solution that many of our current surgical programs are not teaching. This leaves many who want to help unable to provide any assistance at all.3
This does not only apply to surgeons. Unfortunately, all medical and surgical specialties are learning to take care of patients only using modern technology. This includes diagnostic scans and tests and therapeutic procedures, such as interventional radiology services. There is no question modern technology helps us manage complicated medical problems, but I would suggest not learning the “old ways” may occasionally leave a practitioner stranded with no idea how to manage a medical problem even in the best of practice locations.