A conversation with Surgeon and Digital Health Expert Rafael Grossmann, MD
We were honored to be joined by Dr. Rafael Grossmann for an interview spanning a range of fascinating digital health topics, from mixed reality, telehealth and artificial intelligence to maintaining the human touch of medicine in an increasingly technology focused world.
Read the transcript below
Lauren: I am so pleased today to welcome Dr. Rafael Grossmann. He is an internationally recognized surgeon, and he is a disruptive innovator, and also one of our digital health experts to follow on LinkedIn. I’m very, very pleased to welcome him today to answer some of our questions about digital health. So let’s launch right into it. Dr. Grossmann, what is the biggest impact of artificial intelligence that you see in healthcare?
Dr. Grossmann: It’s good to be here, Lauren, and thank you. Well, I think artificial intelligence is really the background for a lot of things that we do in healthcare, and we have been doing for many, many years. Now, obviously, artificial intelligence is getting a little bit more of hype and people are noticing it more, talking more about it. There is no question that algorithms are helping us make better decisions. And I think that the future is really going to be much brighter.
If we think about how these AI and machine learning algorithms, natural language processing, are getting more and more sophisticated, I think that we’re going to depend more on those algorithms to do those parts of medicine that we are less equipped to do, compared to devices, compared to machines, compared to computers and algorithms. A more objective analytic processing is better done by machines, while some of the soft skills and more of a subjective and humane, empathetic, compassion, all those are qualities that are so, so important in medicine, that machines certainly cannot, at least for now, do.
I think the machines are going to sort of liberate us in a way to be able to connect, to interact in a much better, more direct way with patients. From knowing what the best drug is, or the best treatment is, or alarming us when the trends for a certain particular physiologic status is changing, I mean, the limit is really the sky for what AI can do in healthcare.
Lauren: Amazing. Yes, thank you so much for that kind of leads perfectly into another question that I had about, in the past, you had said in an interview that you want to focus on the importance of the human touch of medicine. So, you know, technology obviously is often seen as kind of the antithesis of the human touch. You know, it’s machines, it’s less personal. How do you see the technology in healthcare converging to maintain or even advance that kind of human side of healthcare?
Dr. Grossmann: You know, that’s perfect because I love talking about this, how technology is seen as the antithesis of really humane behavior. And I think that it really depends on the technology used. It’s not the technology itself. I say, you know, AI can kill or cure, depending on the use you give to it, and it is the same for any piece of technology. I think it’s about how we think about using the technology.
Using the technology in a smart way can certainly make many things, including medicine, more empathetic, more compassionate, more humane. There’s no doubt that there’s fear out there, but again, the fear, I think is really based on lack of knowledge. I think that there are many, many examples of how smart use of technology can make us more connected with our patients, how the experience can be better for us, better for the patient, better for the whole team involved in the care of that particular patient.
I always talk about Google Glass, right? You know, I was the first surgeon who ever used Google Glass in the operating room. And it was just an intuitive use of that device to improve, to enhance, the experience that my students had learning how to do surgery. You know, that was years ago…Everyone had to do with it and talk about it, and I got a lot of excitement out there. But to me, it was really a pretty easy use of that technology to improve my experience teaching and their experience learning.
And if you see companies like Augmedix, for example, that is a company using Google Glass or other devices, they have a remote scribe that is documenting the interaction between the doctor and the patient. Rather than the doctor being away from the patient, asking questions in a computer, that a doctor can be connected face to face, eye to eye with thatparticular patient while the scribe, situated remotely, can be watching, can be listening, can be documenting the Electronic Medical Record, so liberating the doctor from that sort of painful task that we have. Instead of connecting with our patient, we have to be connected with the machine, documenting for billing purposes and regulatory purposes.
So, in a way that technology is making that interaction more empathetic, more direct, more humane interaction. So that’s one example of many of how the technology, used smartly, can really improve upon that side of medicine that we, in a way, have lost because of the wrong use of digital health.
Lauren: Fascinating, You know, when you go to the doctor, and they’re looking at the computer screen, you kind of lose that connection with them, and that’s a very interesting application for that. I’m glad that you mentioned Google Glass because I actually had a question about that. As you mentioned, you were the first surgeon to use Google Glass during surgery back in 2013. So, how would you say that the XR, or augmented reality, or mixed reality, whatever you want to call it, how do you think that has changed since? And where do you think it still needs to go?
Dr. Grossmann: Well, wow, that’s a great question also because we have seen a very fast progression. I guess we could call it exponential progression, because really from the first devices out there in the 60s, right, the first AR device at MIT to what we are now, we have really gone very, very far in a matter of 60 years or so. But if we think about Google Glass, I always talk about Google Glass being the pioneer device out there. Because in the operating room certainly that I know, there hadn’t been any other devices like head-mounted smart glasses that were used before.
So, that use of Google Glass kind of set the first step in the use of smart devices like Google Glass for healthcare, and especially in the operating room. From Google Glass to devices like Vuzix and all the iterations of Vuzix, which is a great device, to devices that are a little bit more complex in the way they function. You know, Magic Leap, obviously, I’m a healthcare advisor for Magic Leap, then HoloLens 1, HoloLens 2, the Pico device, from VR to AR to MR.
This whole gamut of devices that are enhancing the experience in healthcare, enhancing the experience for the patient and for the provider, from education to diagnosis, to even therapeutic management of someone or a particular disease in the case of VR, of virtual reality, the potential of those devices. If we see for example what Brainlab has been doing with Magic Leap and the Mixed Reality Viewer. Yesterday I spent the whole day with Brainlab setting up all the software in my Magic Leap device.
And it’s not a matter of looking at the images, right, in the device. It’s a matter of changing the choreography, the dynamic, of how we use the data, the images that we have on a particular patient, for a particular case, for a particular solution, how do we interact with that data. And seeing the ease of…and the marvel, really, of the design of that platform, from the side of the hardware, Magic Leap to this magic software from Brainlab, to be able to interact with those images in ways that we were never able to interact with before, it’s really phenomenal. And to see, to even imagine how that can enhance that act of surgery or of medicine in general, it’s really fascinating to me.
Lauren: Yeah, I love that idea, the way that it’s choreographed, as you mentioned, you know, it really does communicate the kind of poetic nature of this software because I do think that it’s really…it’s taken a step above just, you know, the software that we’re used to and taking it really to almost an artistic level.
Dr. Grossmann: It is. It is and really it’s…there’s so many elements in there that is really almost like a dance. But it’s a dance, that it’s obviously not a dance that we have done with this level of sophistication before. We would go to that monitor and look at the image and, you know, with a mouse, you know, move the image and look around and then go to the patient. Now, everything is sort of integrated, as in the beauty of spatial computing, right, the beauty of XR in a way, of the hardware and the software is that, that it has been integrated in a way that makes everything flow naturally.
And I tell you, I had the device on my head, the Magic Leap, and I had already the software in my Magic Leap and in the computer, and it just took me one second to navigate, to push around, to go into the image, to flip it around, to enhance it, to bring it smaller, to peel the layers off like an onion… it was really really amazing stuff. While I was doing that, I was just thinking,as a trauma surgeon, we get a patient in the trauma bay, someone who’s about to die, and you try to stabilize them, and then maybe they need to get a CT scan, and they go to the CT scan, and then you have to wait for the image and go to the computer and sit and look in the images.
I was thinking, you know, a patient comes in, goes to CT scan, I’d have the Magic Leap on, patient comes back, my images are there, I can look at the patient, look at the images, and basically keep that line of sight, or that optical correctness if I were to do a procedure in there, but most importantly, you know, I can make a decision immediately and I can expedite and make the whole act of medicine more efficient, and potentially decrease morbidity and potentially even save a life rather than having to wait, or go to the computer, and separate myself from the patient.
I can be with the patient, and again in a way making that experience more empathetic. Let’s say the patient was awake, or the relatives were there, you can be there, you can be looking at everything you need to be looking at without having to leave a way to look at images and, you know, take yourself away from that particular situation. So I think that the potential is really indeed fascinating.
Lauren: Yeah, thank you so much for sharing that. It’s really invigorating to see your passion for this technology. And obviously, we are very excited that you have such a great response to it. So, okay, if we have time, one more question.
Dr. Grossmann: Yeah, absolutely. All the time.
Lauren: Okay. So, the pandemic obviously has increased the use of communication technology for everybody, not just in the healthcare field, but, everyone uses this in their day-to-day life. What impact do you think that kind of mass adoption of communication technologies is going to have on telehealth in the future?
Dr. Grossmann: A great impact. I think if anything that the pandemic has taught us how to behave better. At least our approach to technology has been radically, I would say, changed. For example, telemedicine, we’ve been trying to do telemedicine for decades. You know, we went from doing telemedicine the old ways here in Maine, where I am, with bigger computers, very expensive, hard to maintain, a lot of IT support needed, to then in 2011 when the iPhone 4 came out with FaceTime, we started a pilot using iPod Touch devices and tablets on FaceTime, but on an encrypted version of an app to connect by video to do acute trauma consultations remotely, right, with a device that cost $220 rather than a big computer, a device that need no maintenance.
So, we grew with that. Then the vision of what telehealth, telemedicine should be was not really present in this health system. So they kind of let that drop. And then we were trying for years to reinvigorate telemedicine, but, you know, regulatory barriers, administrative barriers, cultural and educational barriers, were all there.
And then for years, nothing really happened and things actually got worse in regards to the use of telemedicine. Then the pandemic comes and within a week or so everyone says, “Well, there’s really no other way to do it, so we either connect by video, or we just don’t see patients anymore,” right? And then the regulatory barriers, you know, relaxed in a way…in a safe way, the administrative barriers and especially the culture, the education.
Everyone was doing everything by video, you know, connecting with relatives, teaching, learning, even doing medicine. So, when that flipped, I think that sort of, in a way, awakened the potential of technology to be another tool, not a substitute to how we do medicine, physically, a patient and doctor together, a patient and provider together, but to give us another tool in the armamentarium of the healthcare provider to then when needed, when appropriate, then use this type of communication that we’re using right now.
It’s just smart. If you look at education and teaching, if you see platforms like FundamentalVR, for example from the U.K., where they use virtual reality to enhance how one learns at a distance. That doesn’t mean that you’re going to do a practice, a simulation in surgery in VR, and then you’re going to operate on a patient, no. But then you could be at home and you could have someone thousands of kilometers away joining you in surgery.
They have a multi-person scenario where in virtual reality all can be operating “in the same patient,” kind of getting the skills built to be able to, like a pilot, then fly a plane full of people, right? So the potential of that, for example, that platform, that have many people in different areas, geographically unbound, you know, with no barriers to work, and learn, and increase their performance is really fascinating to me.
You have platforms like GIGXR in Australia, that they have photo volumetric patients, actors, and they can connect many people from all over the world with any device from a HoloLens to a smartphone, you can connect and they can all see the same patient, a real human. I had the human here in my living room yesterday. The guy was in Australia, and I was here, and we were looking at the same patient, and the vital signs were recorded, were displayed, and the patient would change, and you had to like assess the patient. What an amazing learning and teaching tool, using the potential of technology to connect and enhance how we communicate. It’s just fascinating.
Lauren: Yeah, absolutely. Well, this whole conversation has been fascinating for me. Thank you so much for joining us and taking the time today to meet with me. And I’m very excited to share this interview with the world and let everyone see your thoughts on these really pressing topical topics. Thank you so much, Dr. Grossmann. Thank you.
Dr. Grossmann: Thank you very much. You have a good one.
Lauren: Bye.
Dr. Grossmann: Bye.
The views, information and opinions expressed in this interview are those of the speakers and do not necessarily represent those of Brainlab.