What if robots replace CNRAs?

[Parklife]

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Disclaimer: This is not a fear mongering thread. I am not a med student. I am not an Anesthesiologist. I am simply a student who is just wondering.

Do you think in the foreseeable future(2020), we will see robots replacing CRNAs? This would leave just several Anesthesiologists to oversee these robots, increasing efficiency.

 

[Stank811]

Disclaimer: This is not a fear mongering thread. I am not a med student. I am not an Anesthesiologist. I am simply a student who is just wondering.

Do you think in the foreseeable future(2020), we will see robots replacing CRNAs? This would leave just several Anesthesiologists to oversee these robots, increasing efficiency.

I wouldn't be surprised if robots (McSleepy etc.) took over for CRNAs in certain situations like GI, cath lab, and likely basic ASA1-2 cases in the future. Once medications and technology advances why couldn't an anesthesiologist manage robots that titrate meds to physiologic algorithms all while under close supervision of an anesthesiologist.

 

[yappy]

Once the technological singularity occurs the robots will use their cRNA skills to just put us down. The surgical room will turn into an execution chamber. Mass murder by unionized-robotic-nurses.

Anesthesiologists will carve out a niche maintaining them and making sure the dosage is appropriately lethal. That is until the robots push for expanded practice rights...

 

[sevoflurane]

CRNA's.... Beware of the Cylon takeover :

Grew up as a kid watching the 1970s Battlestar Galactica. Lately, I've begun the more recent TV mini series (2003-2009) on netflix. Good fun.

As much as I'd love to replace malignant CRNAs (not all are) with Mcsleepy, I honestly think we have a way to go before they are automated to a capacity where they will replace CRNA's. A well trained provider in the OR is very hard to replace. GI and offsite anesthesia sites are not exactly safer either... and often far away from a real OR or "central pod".

I don't think I'll see it in my life time...

I also think the thought is a great step in the evolution of anesthesia medicine... If we don’t kill ourselves or get taken over by Cylons, I think one day we may be there.

 

[partydoc]

CRNA's.... Beware of the Cylon takeover :

Grew up as a kid watching the 1970s Battlestar Galactica. Lately, I've begun the more recent TV mini series (2003-2009) on netflix. Good fun.

As much as I'd love to replace malignant CRNAs (not all are) with Mcsleepy, I honestly think we have a way to go before they are automated to a capacity where they will replace CRNA's. A well trained provider in the OR is very hard to replace. GI and offsite anesthesia sites are not exactly safer either... and often far away from a real OR or "central pod".

I don't think I'll see it in my life time...

I also think the thought is a great step in the evolution of anesthesia medicine... If we don’t kill ourselves or get taken over by Cylons, I think one day we may be there.

I would be ok with a cylon takeover if I got a six.

 

[pgg]

No. The very notion is ridiculous. Looking at a vital sign and picking a drug to give or not give is a tiny, tiny fraction of anesthesia.

Even the most marginal, poorly trained, algorithm-driven, sedation qualified RN with a hangover is still a thinking machine that has hands that work and some ability to respond to "not a vital sign change" problems.

I have great faith in technology but meaningful AI is a hard problem, and the amount of progress made in that area over the last 50 years amounts to "not much" ... Then you throw in robotics (another hard problem).

By the time we have robots capable of providing safe anesthesia, those same robots will have long since rounded us up into camps and sent Arnold back in time to govern California or something.


WTF is McSleepy going to do when the patient obstructs? Page a human anesthesiologist 20 seconds after the ETCO2 trace disappears? Reach over with some as-yet uninvented robotic arm to do a jaw thrust? Prompt the GI guy to drop the scope and open the airway? Inject 0.4 mg of naloxone? Print out a $3,000,000 settlement offer through a handy USB capable malpractice-check-printing accessory?

It's ridiculous.

 

[pgg]

I would be ok with a cylon takeover if I got a six.

Why settle for just one?

 

[Bertelman]

WTF is McSleepy going to do when the patient obstructs? Page a human anesthesiologist 20 seconds after the ETCO2 trace disappears? Reach over with some as-yet uninvented robotic arm to do a jaw thrust? Prompt the GI guy to drop the scope and open the airway? Inject 0.4 mg of naloxone? Print out a $3,000,000 settlement offer through a handy USB capable malpractice-check-printing accessory?

It's ridiculous.

That 3 mil settlement line is f'ing hilarious.

Everything else is just spot-on.

 

[Stank811]

"WTF is McSleepy going to do when the patient obstructs? "

If a pt obstructs...the robot would intubate the pt likely via retrograde wire. Fine a machine won't help do a MAC but basic ASA1-2 cases who are intubated why not. I think Mcsleepy has already done this.

 

[Parklife]

Well they've already got this thing.

http://en.wikipedia.org/wiki/Da_Vinci_Surgical_System

 

[dr2b0804]

.

 

[dr2b0804]

I would be ok with a cylon takeover if I got a six.

Baltar... is that you?


# 6 is.... I can get used 2 one of those. 😀

 

[Bertelman]

Well they've already got this thing.

http://en.wikipedia.org/wiki/Da_Vinci_Surgical_System

Which requires like 3 people to operate. And it's not exactly lowering the cost of surgical care. Or helping run your OR more efficiently.

 

[Parklife]

Which requires like 3 people to operate. And it's not exactly lowering the cost of surgical care. Or helping run your OR more efficiently.

Good point.

 

[gasattack3]

No. The very notion is ridiculous. Looking at a vital sign and picking a drug to give or not give is a tiny, tiny fraction of anesthesia.

Even the most marginal, poorly trained, algorithm-driven, sedation qualified RN with a hangover is still a thinking machine that has hands that work and some ability to respond to "not a vital sign change" problems.

I have great faith in technology but meaningful AI is a hard problem, and the amount of progress made in that area over the last 50 years amounts to "not much" ... Then you throw in robotics (another hard problem).

By the time we have robots capable of providing safe anesthesia, those same robots will have long since rounded us up into camps and sent Arnold back in time to govern California or something.


WTF is McSleepy going to do when the patient obstructs? Page a human anesthesiologist 20 seconds after the ETCO2 trace disappears? Reach over with some as-yet uninvented robotic arm to do a jaw thrust? Prompt the GI guy to drop the scope and open the airway? Inject 0.4 mg of naloxone? Print out a $3,000,000 settlement offer through a handy USB capable malpractice-check-printing accessory?

It's ridiculous.

Agreed. And by the time they were able to do robotic anesthesia, they'll be doing robotic surgery (automated, not surgeon manipulated), and they sure as hell won't have GI dudes scoping patients.

 

[yappy]

Basically we'll all be useless. If a physicians job is automatic so will accounting, CEO type duties, banking, and a host of other well paying jobs.

Agreed. And by the time they were able to do robotic anesthesia, they'll be doing robotic surgery (automated, not surgeon manipulated), and they sure as hell won't have GI dudes scoping patients.

 

[medstudent87]

http://en.wikipedia.org/wiki/With_Folded_Hands

 

[sevo85288]

Nurses are robots. So that has already been done. Have you ever seen a RN work. They just follow what they are told, no thinking.

 

[SLUser11]

Which requires like 3 people to operate. And it's not exactly lowering the cost of surgical care. Or helping run your OR more efficiently.

All robot jokes aside, I'm sure robotics will play a role in the future of anesthesia just as it will for surgery. I doubt they will be making any independent decisions, but they may facilitate the ability to direct the anesthesia of a case from a remote location.

I think telemedicine will help provide access to care in remote/rural locations and likely the battlefield. It's going to be an area of heavy research over the next 10-15 years.

As for the Da Vinci, it certainly doesn't help with routine cases that I would otherwise do laparoscopically, but it does provide a technical advantage in the deep pelvis, which I think is worth the extra money.

 

[Bertelman]

All robot jokes aside, I'm sure robotics will play a role in the future of anesthesia just as it will for surgery. I doubt they will be making any independent decisions, but they may facilitate the ability to direct the anesthesia of a case from a remote location.

I think telemedicine will help provide access to care in remote/rural locations and likely the battlefield. It's going to be an area of heavy research over the next 10-15 years.

As for the Da Vinci, it certainly doesn't help with routine cases that I would otherwise do laparoscopically, but it does provide a technical advantage in the deep pelvis, which I think is worth the extra money.

I'm not saying the DaVinci has no role in the OR. Prostates, GYN, I get it. I just don't see how that translates to anesthesia. Better exposure is not a common complaint in my daily job. I don't understand what a robot could do that I am incapable of doing.

 

[SLUser11]

I'm not saying the DaVinci has no role in the OR. Prostates, GYN, I get it. I just don't see how that translates to anesthesia. Better exposure is not a common complaint in my daily job. I don't understand what a robot could do that I am incapable of doing.

They can be places that you cannot.

Telemedicine will allow your anesthesia expertise to be utilized in rural areas, the battlefield, etc.

I just think robotics will have a role in the future of anesthesia. You may have a "technician" intubating the patient and getting IV access, then you manage the case from a remote location.

 

[Bertelman]

If a technician is smart enough to drop a tube in and start an IV, they are more than capable of following my remote commands to push drugs, turn dials, etc.

I know robotics is sexy, but it just hasn't materialized yet, and the cost is much more than just having a human body around. It will be decades before robotics are cheap enough and versatile enough to replace an anesthesiologist, or CRNA, or OR tech at any significant rate.

 

[deleted126335]

Telemedicine will not just apply to rural areas. One anesthesiologist can be available to consult/supervise a dozen ORs anywhere. It is rapidly gaining traction in ICUs.
Just envision it...The CRNA fills out the EMR preop with pertinent medical history already there by the EMR gods. Inputs the anesthetic plan electronically for your review. Turn on the video feed for induction...The anesthesiologist in the box offers advice... Video laryngoscope, ultrasound, whatever toys one may need are in the OR and away we go...The doc in the box occasionally checks in electronically to put out fires and answer questions...Maybe coming soon to a theatre near you.

 

[Mman]

I'm not saying the DaVinci has no role in the OR. Prostates, GYN, I get it. I just don't see how that translates to anesthesia. Better exposure is not a common complaint in my daily job. I don't understand what a robot could do that I am incapable of doing.

The robot works for free (or whatever the cost of electricity is). After the initial purchase, it requires no salary, no benefits, no maternity leave, etc.

That's the lure to a hospital.

Current technology doesn't make it feasible, but that won't stop them from trying to improve the technology.

 

[pgg]

I'm not losing any sleep over the possibility.

 

[SLUser11]

The robot works for free (or whatever the cost of electricity is). After the initial purchase, it requires no salary, no benefits, no maternity leave, etc.

Well, there are many ongoing costs involved with the Da Vinci system. One major cost is the robot instruments which have a limited number of uses.

The robots are coming. That's why I have Old Glory Robot Insurance.

 

[Bertelman]

Telemedicine will not just apply to rural areas. One anesthesiologist can be available to consult/supervise a dozen ORs anywhere. It is rapidly gaining traction in ICUs.
Just envision it...The CRNA fills out the EMR preop with pertinent medical history already there by the EMR gods. Inputs the anesthetic plan electronically for your review. Turn on the video feed for induction...The anesthesiologist in the box offers advice... Video laryngoscope, ultrasound, whatever toys one may need are in the OR and away we go...The doc in the box occasionally checks in electronically to put out fires and answer questions...Maybe coming soon to a theatre near you.

Ask Blade how he feels about running 6 rooms. I'm pretty sure he's not happy doing it. What you describe is actually a fast track to our obsolescence. And who is there to save the undertrained CRNA from airway disasters, codes, etc? We had telemedicine at our ICU in residency. It didn't replace the doc by any means. In fact it was only staffed by an MD at night. Most of the time it was an RN, and she basically helped chart vitals and drugs during codes and admissions. Even when there was an MD "in the box", there still had to be an MD onsite. I will never walk a nurse through a CVC placement over the cloud.

The robot works for free (or whatever the cost of electricity is). After the initial purchase, it requires no salary, no benefits, no maternity leave, etc.

That's the lure to a hospital.

Current technology doesn't make it feasible, but that won't stop them from trying to improve the technology.

The robot will cost hundreds of thousands PER LOCATION. I'm at a small community hospital, and that's 26 locations. Or your facility chooses to lease the equipment, and you run basically the same cost as staff. Then there is the service contract. And you still have to pay someone to induce, intubate, etc. And disposables.

And I'm not buying the enticement of cheaper technology. In the last 20 years I've bought 4 computers. Each have cost somewhere between 1500-2000. Technology is not a race to the bottom price point. It is a race to the fastest, most functional device. The prices stagnate. The DaVinci of today probably costs as much, or more, than the DaVinci of 20 years ago when they were first released.

 

[deleted126335]

Ask Blade how he feels about running 6 rooms. I'm pretty sure he's not happy doing it. What you describe is actually a fast track to our obsolescence. And who is there to save the undertrained CRNA from airway disasters, codes, etc? We had telemedicine at our ICU in residency. It didn't replace the doc by any means. In fact it was only staffed by an MD at night. Most of the time it was an RN, and she basically helped chart vitals and drugs during codes and admissions. Even when there was an MD "in the box", there still had to be an MD onsite. I will never walk a nurse through a CVC placement over the cloud.


.

Blade might not like it. But he does it. Same way that many who supervise feel.
"A fast track to our obsolescence"...you bet. It is even worse. The doc in the box could be in India. Might not even need a U.S. medical license since if the CRNAs achieve their goal they will be practicing under their own license. Just somebody with the skills as a resource person to back stop will do.

You may never walk an RN through a CVC placement over the cloud, but how about a CRNA who has done a few dozen, but not quite ready to fly solo. If you won't do it, how many anesthesiologists will do it to pay the mortgage or maintain the lifestyle? For the ICU how about the ICU nurse practitioner? The problem with the telemedicine ICU has been having someone with the technical skills onsite. Technical procedures don't need to be done by a board certified anesthesiologist or critical care medicine doc. As long as they can oversee electronically and communicate in real time with their cognitive skills to an extender who is trained in the technical procedures- this is all possible.


Check out Atul Gawande's piece in last week's New Yorker. He alludes to some of this. Comparing health care to a restaurant chain:

http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande?currentPage=all

Not this year or next, but within the decade.

 

[partydoc]

Blade might not like it. But he does it. Same way that many who supervise feel.
"A fast track to our obsolescence"...you bet. It is even worse. The doc in the box could be in India. Might not even need a U.S. medical license since if the CRNAs achieve their goal they will be practicing under their own license. Just somebody with the skills as a resource person to back stop will do.

You may never walk an RN through a CVC placement over the cloud, but how about a CRNA who has done a few dozen, but not quite ready to fly solo. If you won't do it, how many anesthesiologists will do it to pay the mortgage or maintain the lifestyle? For the ICU how about the ICU nurse practitioner? The problem with the telemedicine ICU has been having someone with the technical skills onsite. Technical procedures don't need to be done by a board certified anesthesiologist or critical care medicine doc. As long as they can oversee electronically and communicate in real time with their cognitive skills to an extender who is trained in the technical procedures- this is all possible.


Check out Atul Gawande's piece in last week's New Yorker. He alludes to some of this. Comparing health care to a restaurant chain:

http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande?currentPage=all

Not this year or next, but within the decade.

That piece gave me the creeps. But hey, welcome to the future.

 

[Mman]

The robot will cost hundreds of thousands PER LOCATION. I'm at a small community hospital, and that's 26 locations. Or your facility chooses to lease the equipment, and you run basically the same cost as staff. Then there is the service contract. And you still have to pay someone to induce, intubate, etc. And disposables.

And I'm not buying the enticement of cheaper technology. In the last 20 years I've bought 4 computers. Each have cost somewhere between 1500-2000. Technology is not a race to the bottom price point. It is a race to the fastest, most functional device. The prices stagnate. The DaVinci of today probably costs as much, or more, than the DaVinci of 20 years ago when they were first released.

I'm not arguing in favor of the technology. It ain't happening any time soon. But it will happen eventually, whether that's 25 years or 100 years down the road, it will happen.

You note that robots are expensive for each location. They are. But if it lasts for 20 years, the upfront cost is far outweighed by the long term savings. Putting 1 doc in 1 room 5 days a week for the next 20 years probably has a present value cost of about $10-12 million. If you could put a $3 million robot in that room and have it work 7 days a week for 18 hours a day and cost $100K per year in maintainance, that's a huge savings. Multiply that by 20-30 rooms and you are looking at tens of millions of dollars in decreased cost.

That's the allure of the technology. I'm not saying it's a good idea. I'm not saying it will work. I'm just saying that if you could figure out a way to do it, the monetary saving are gigantic.

 

[link2swim06]

On another note I just read an article saying ~5-6 years before your car can drive itself.

The google car already drove 200K miles by itself without any problems. While much easier than anesthesia, driving isn't a binary task. A long list of variables can occur that the cars sensors/computer has to figure out and react to.


Everyone here acts like its going to be "one-time" replacement. But in reality it going to be a stepwise take over. I doubt anyone will be out of a job anytime soon, but lets face it...10 years from now technology/a robot will do things done by a human today.

 

[Mman]

On another note I just read an article saying ~5-6 years before your car can drive itself.

The google car already drove 200K miles by itself without any problems. While much easier than anesthesia, driving isn't a binary task. A long list of variables can occur that the cars sensors/computer has to figure out and react to.


Everyone here acts like its going to be "one-time" replacement. But in reality it going to be a stepwise take over. I doubt anyone will be out of a job anytime soon, but lets face it...10 years from now technology/a robot will do things done by a human today.

What if I figure out a way to supervise rooms with robots in them and no CRNAs. I come in to start the case, intubate, place lines, etc. Then I program in vital parameters and drug choices and let them machine titrate them as I order and to alert me if anything is wrong so I can come in the room and trouble shoot. The computer can monitor all vital signs, vent settings, end tidal gas concentrations, BIS (if needed), and train of four. I come back for extubation at the end.

 

[link2swim06]

What if I figure out a way to supervise rooms with robots in them and no CRNAs. I come in to start the case, intubate, place lines, etc. Then I program in vital parameters and drug choices and let them machine titrate them as I order and to alert me if anything is wrong so I can come in the room and trouble shoot. The computer can monitor all vital signs, vent settings, end tidal gas concentrations, BIS (if needed), and train of four. I come back for extubation at the end.

Plausible, but there will be someone in the room "monitoring" this automation for a long time.

Isn't this essentially pilot's job now? Take off, set autopilot, troubleshoot if needed, and land.

Even "if" machines can do 90% of the job, people aren't going to trust them to be going by themselves. Even if that means a CRNA will stare at a machine for 2 hrs without touching anything (like a pilot..).

 

[Mman]

Plausible, but there will be someone in the room "monitoring" this automation for a long time.

Isn't this essentially pilot's job now? Take off, set autopilot, troubleshoot if needed, and land.

Even "if" machines can do 90% of the job, people aren't going to trust them to be going by themselves. Even if that means a CRNA will stare at a machine for 2 hrs without touching anything (like a pilot..).

Again, not saying it's happening tomorrow. But 20 years ago people wouldn't have imagined buying anything they wanted online without seeing it and trying it in person. 40 years from now it's anybody's guess how much automation people will be willing to accept in their lives.

 

[45408]

You note that robots are expensive for each location. They are. But if it lasts for 20 years, the upfront cost is far outweighed by the long term savings. Putting 1 doc in 1 room 5 days a week for the next 20 years probably has a present value cost of about $10-12 million. If you could put a $3 million robot in that room and have it work 7 days a week for 18 hours a day and cost $100K per year in maintainance, that's a huge savings. Multiply that by 20-30 rooms and you are looking at tens of millions of dollars in decreased cost.

That's overly simplistic, I think. The $3 million has to be paid up front, instead of spreading it out over time for a human employee, and we all know that no advanced technology lasts 20 years. Bertelman's replaced his computer 4 times in 20 years, but I've had a lot more computers than that in the past 20 years, although mine have gotten cheaper as I go...

Telemedicine will not just apply to rural areas. One anesthesiologist can be available to consult/supervise a dozen ORs anywhere. It is rapidly gaining traction in ICUs.

I'm completely underwhelmed with telemedicine in the ICU...

 

[Mman]

That's overly simplistic, I think. The $3 million has to be paid up front, instead of spreading it out over time for a human employee, and we all know that no advanced technology lasts 20 years. Bertelman's replaced his computer 4 times in 20 years, but I've had a lot more computers than that in the past 20 years, although mine have gotten cheaper as I go...

If a machine can do the same job as a person, it's nearly always cheaper to use the machine in the long term. I'm just making up numbers to prove a point. The actual numbers aren't terribly relevant.

Again...I'm not arguing it should happen. I'm not saying it will happen. I'm pointing out what the attraction of it is. If you could find a way to do it safely and effectively...

 

[yappy]

While robots can make things more efficient much of the automation we're imagining is purely hypothetical. We're assuming that ai may reach a level that could rival the CRNA rendering them obsolete. That may or may not be possible, technologically.

Regardless, the key is to be the boss. If you can be the guy/partner that is in charge of the people delivering care or the robots you'll be the one benefiting from any technological advances rather than being unemployed by them. Technology is amazing and it will always be changing; however, it also has a way of not delivering, becoming too costly, structural problems (think perpetual motion), or not advancing in the way that we thought it might.

I think Malcolm describes shortfalls of technology best when he describes the Norden Bombsight:

[YOUTUBE]http://www.youtube.com/watch?v=HpiZTvlWx2g[/YOUTUBE]

 

[chessknt]

If a machine can do the same job as a person, it's nearly always cheaper to use the machine in the long term. I'm just making up numbers to prove a point. The actual numbers aren't terribly relevant.

Again...I'm not arguing it should happen. I'm not saying it will happen. I'm pointing out what the attraction of it is. If you could find a way to do it safely and effectively...

I think that is only true when the machine is more efficient. You can't have one anesthesia robot attending 10 different cases at once or making cases go any faster. You get new costs from machine maintenance and still have to pay techs. The price point at which it would make sense to pick a robot over a person is going to be very difficult for any manufacturer to swallow I would think.

This is much different than an assembly line robot that works thousands of times faster and more accurately than a person.

 

[pgg]

Something something forest and trees ...


By the time we have robots capable of doing safe and cost-effective anesthesia, we'll have robots capable of much more interesting and world-changing acts.

We're speculating on technology so far into the future that the silliest part of the discussion isn't whether robots will ever provide anesthesia services, but rather the implied surety that we even know what tasks we'll want/need those robots to do, or whether those tasks will even exist any more.

I'd place higher odds on surgery itself being obsolete before we can build robots to do it.



This thread's like a Popular Science magazine published 100 years ago ...

Clothing made from asbestos! Mail delivery by parachute! Vacuum tube powered trains with propellers!

 

[Bertelman]

That actually looks more interesting than the water polo offered during the Olympics.

I'm not a huge watercraft aficionado, but my few experiences tell me a lower center of gravity is best. That appears to be the exact opposite of ideal. Add the outboard motor capable of rapid changes in acceleration and vector, and I'm guessing that sport would look more like a log rolling event.