Jarrod Shapiro, DPM PRESENT Practice Perfect Editor Mountain View Medical & Surgical Associates, Madras, Oregon

The Benefit of Technology

I love technology.  Little gadgets, big toys.  They're lots of fun. Like just about everyone in our industrial society, I've progressed my way through various technologies from cellular phones to PDAs to desktop computers to laptops.  I remember fondly my older brother's Commodore Vic 20 computer with a printer that used only ticker tape.  The computer did virtually nothing useful to us, but after a class in middle school, I was able to do simple commands using Basic.  We played Pong on a home entertainment system that was so old I can't even remember the name!  Boy, have times changed!  I'm now almost fully portable with my technology with a laptop, cell phone (unfortunately not a smart phone), and digital camera system.  My home has now become almost completely wireless.  I'm no longer limited to an office and desktop computer.  I can plug my computer into my television and play Netflix movies immediately on demand if I desire.  My wife has a laptop computer.  She's wireless.  My four year-old son can use the Internet (albeit with supervision).  We have three iPods which we can plug into the car (who needs a radio?).  Increasingly, we are connected with the rest of the world through our technology.

	Tonight's Premier Lecture is Nail Pathologies by Myron Bodman, DPM.

I also love technology when it comes to medicine.  Here's a nice example: As I was sitting down to write this editorial, I received a phone call from one of my local ER physicians.  He started telling me about a 66 year-old lady who had suffered a closed, nondisplaced 5th metatarsal fracture but also had questions about a small avulsion fracture from the patient's lateral talus.  During the discussion, I pulled up her radiographs — while at home, mind you — and reviewed them with the physician.  We agreed on a plan of care and I never had to leave my house.  How's that for convenience?  Obviously, if it were a more significant surgical issue, I'd be on my way to the hospital, but I'd be armed with an early understanding regarding what I'd be facing, and could activate the on call OR staff more rapidly if necessary.  I also have the capability to make office appointments from my home as well, although I try to utilize this option as little as possible (that's what office staff is for).

Technology has also so greatly improved our ability to communicate via the Internet.   If I want to find out the new IDSA guidelines on Vancomycin dosing recently published (here  it is if you're interested) I simply need to go to the website and download it.  Simple.  This rural podiatrist can stay abreast of the most recent medical developments through technology.  We've discussed in other Practice Perfect ezines the educational benefits of the Internet, all brought to us a la technology.

Direct patient care is also greatly affected by technology.  Take, for instance, laser treatment for onychomycosis.  This new technology could potentially be quite beneficial for our patients.  Incidentally, the eTalk section of podiatry.com has an interesting discussion thread about this very topic.  Check it out and participate.  Increasingly, previously expensive technology is becoming available to us in the office.  In office podiatric ultrasound and noninvasive vascular testing are offering much more rapid diagnosis of certain diseases at decreasing costs, all to our patients' benefit.

The operating room is also increasingly benefiting by technology.  The simple use of C-arm intraoperative radiography has greatly improved the accuracy of orthopedic surgery.  New fixation technologies have improved surgical outcomes many-fold.  The use of locking plate techniques and external fixation have allowed for complex reconstructive and limb salvage procedures.  Earlier weightbearing and range of motion, allowed by many of these techniques, continues to improve postoperative care and quality of life. 

Now, technology is not a panacea.  It has its pitfalls and irritations.  I find myself bringing more and more work home due to my greater mobility.  Many have complained that computers were supposed to decrease paperwork, but it has not proven to do so yet.  Instead, the improved convenience has allowed many of us to bring our work to the home with its obvious disadvantages (such as less quality time with the family). 
When it doesn't work, technology is the single greatest frustration.  A few months back, I was scheduled to give a diabetes education lecture, only to have my computer crash one week prior.  I had to work hard to have something worthwhile to present.  When my computer crashed, it wreaked havoc on my iPod which had about 700 songs loaded at the time.  Many hours were subsequently spent to fix it.  What happens if that C-arm breaks during a surgical procedure?  What if the K wire driver or your drill breaks?  God forbid my car breaks down!

For me, I'm not sure if my relationship with technology is healthy or not.  However, I have no plans to become a slave to it.  To this end, I try to maintain a clear head about technology by following three rules.  First, I try to have a contingency plan in case the technology fails.  I now back my computer up on a separate drive at least weekly.  I try to keep an alternative fixation method available, in case the hardware fails for some reason.  Second, I'm not becoming overly dependent on my toys.  For example, I keep my schedule in a day-timer instead of my computer.  I keep passwords and important documents in a safe location, instead of scanning them into the computer.  Third, I periodically turn off the technology.  I read paper books instead of eBooks.  My family limits the television usage and schedules a no-TV-day at least once per week.  We take walks outside and enjoy nature.  I rely on my clinical hands-on skills to determine diagnoses, using imaging technology to confirm my diagnosis rather than ordering tests to figure out what's wrong with the patient.

When it works, technology is fun and often life enhancing.  When it's broken, technology can be the most frustrating thing in existence.  A clear understanding about the advantages and limitations of technology in our lives will allow us to be more effective consumers.  iPhone here I come!

Follow this link to the technology related eTalks Join in on or any number eTalk Topics taking place on PRESENT Podiatry, or create one of your own.

Keep writing in with your thoughts and comments or visit eTalk on PRESENT Podiatry and start or get in on the discussion. We'll see you next week. Best wishes!

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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