Play … Medicine

I was just reading a fascinating review of the online gaming industry. Yes, at 05:30 in the morning, I am reading about computer games. I don’t play computer games. I actually find them boring. I love watching my son play them, because he is very good at them and the graphics are of movie quality. But for myself, I would rather read an article about the latest medical technology or Microsoft’s future plans, than spend two hours trying to blow up the alien armada. Of course, when aliens do eventually attack Earth, it will be all of these video game players who save us [and yes, there is an old movie about that].

On an individual basis, it is easy to scoff at the whole video gaming industry. It is wasteful of time, occasionally addictive, very expensive and overall, should often be replaced by playing basketball at the closest park. But there is a hidden part to this industry that is very important for everything from the Army to the medical care that you receive.

Once upon a time, it was the military and to some extent general research, that lead the way in terms of developing new technologies. In fact, when a technology would be dropped by the military after a newer technology was implemented, it was the graphics users who would effectively go through the Army’s trash, to find the discarded code. So, what was military grade technology, became the foundation for games and movies years after the military had ceased to use it.

It was around the time of the first Star Wars movies that the entertainment industry began investing in an succeeding with advanced graphics technologies, beyond the capabilities of the military. Back in the day, $100 million was a lot of money. Even the military thought twice about spending this kind of money. But around the time of the first Star Wars movie, Hollywood was already spending tens of millions of dollars on movies, at least partially due to the cost of implementing high-tech graphics.

At a certain point, there was an inflection point and the amount of money being spent [and to research being done] by the entertainment industry in regards to advance graphics, was more than the military was investing. To their credit, the military realized that it was silly to compete with the top artists, physicists, mathematicians, engineers, algorithm developers, testers and more who made movies and games with ever improving graphics.

I remember when the movie TRON came out. I remember how excited I was as I watched this marvel of computer graphics. I remember reading about the way in which certain effects were created and I was astounded at the creativity and the results. The sequel to TRON came out in the last couple of years, which marked the 25th anniversary of the first movie. I went to see it and once again I was amazed at the quality of the graphics. I also enjoyed the movie, by the way.

When I got home, I went online and did a YouTube search for the original movie. And, not surprisingly, I found a number of excerpts. My mouth fell open. The graphics were so limited  in comparison to today’s offerings, that it was almost painful to watch. I thought to myself, how could I have imagined that this was high-end, 25 years ago. And of course, this is a classic example of how quickly we become used to the latest technologies. Movies like the Avengers simply could not have been made five years earlier. The movie Avatar languished in the mind of its creator for 10 years, waiting for a time when computerized graphics would be able to create the imagery and detail required.

In the article I read this morning, the author spoke of a new and serious problem in the gaming industry. Due to competition and enforced schedules for release, games are being distributed before they are ready. Interestingly, the term “ready” is very ethereal in the world of technology. It was a well-known phrase used across IBM that software got released when you “ran out of time or ran out of money”. Software is totally open-ended. It can always be improved on, it can always have new features added – but at some point you have to sell it in order to pay the bills.

The author of the article I was reading this morning, lamented a notable change in the quality of first releases of video games. In some cases, after physically installing the DVD, the gaming machine would have to connect to the Internet and download a series of huge updates  to fix a whole series of problems that had been picked up just in the last short while. In some cases, it took months until sufficient fixes had been made to make the game playable. While this is surely a disappointment to the customer, the game did eventually work. And once it did, the teenager who bought it vanished for a few weeks until he or she had mastered the game. These types of delays have become so expected that they don’t even seem to disappoint the young audiences.

There is a great deal to learn from all of this, in terms of medical technology. Firstly, medicine has to offer a huge thank you to the video gaming industry. Ultimately, many of the same technologies that medical software uses to display medical images, or save huge archives of medical data, or share data amongst multiple physicians, all were born out of the gaming industry. The military definitely makes use of videogame technology for simulations and other “secret” projects. Sometimes, “secret” means that the military engineers are trying to re-create the weapons used in the video games.

Simulations of surgeries and patient management will soon become a standard part of medical training. It truly is absolutely ridiculous [if not even a touch immoral] to practice certain techniques or protocols on real patients. Instead, it is absolutely possible to fully simulate a patient being brought into a busy emergency room, who crashes as the ER doors swing open. Using the same voice recognition that I am now using to write this post, the medical student/resident can bark out orders as if he or she was actually in the ER. Even with a single screen, it is possible to cram in simulated heart monitors and defibrillators and carts full of medications. You can have simulated nurses and other physicians standing around the patient waiting for you to prescribe the next step. And all of this can be run in real time. So even if you order the life-saving adrenaline for the patient with a heart attack, if it is not given in time, the simulated patient dies and you must reconsider a career in Accounting.

Laparoscopic surgery, which is the first choice for most surgeries today, is done using long thin probes and a video screen. This is the classic basis for a videogame style  simulation. Consider it version 20 of the game “Operation”. In practice, no doctor should be allowed to actually touch a patient until they have passed a certain number of hours and succeeded in a set of tasks, on the medical simulator. This is how pilots train. This is how the Army trains. And this is how doctors should train. The tremendous benefits of this approach is that within a single week, a young doctor can run through hundreds of simulated cases. To get this kind of experience in real life, could literally take the span of an entire residency. I personally can’t imagine that doctors will not be using simulations on a regular basis by the year 2025.

One of the biggest pushes for faster and faster CPUs, memory and discs, is the gaming industry and anything else that readily depends on high quality graphical output. These days, the screens on the latest mobile phones are higher quality, and respond faster, then the desktop screens that most people have. And all of this non-medical technology immediately gets picked up by medical technology developers. They are more than happy to make full use of advanced graphics chips to make 3-D reconstructions of CTs and MRIs  fast and fluid. As I have said in the past, spillover from one technology to another is common and incredibly valuable.

Within a few years, it will probably be possible to project full size 3-D images of simulated medical staff [think of a full-size Princess Leia from the first Star Wars movie]. The medical simulations I spoke of before, will take place in any room which will be transformed into an ER facility. You will be standing in the midst of the simulation, watching the virtual patient be rolled in with a gaping chest wound. And if you do not respond properly, the virtual patient will be “terminated” [it’s best to say this last word with Arnold Schwarzenegger’s accent]. But because this is a simulation, you will do it over and over again until it becomes second nature. By the end of a single day, you may very well feel comfortable dealing with the most complicated patients there are. This will be nothing less than revolutionary. And it probably will also be available within the next 10 years.

Perhaps every hospital just start having a sign posted over its entrance that says “let the games begin”.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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