We recently had the chance to chat with Dr. Rafael J. Grossmann MD, FACS, Attending General and Trauma Surgeon at Eastern Maine Medical Center, healthcare futurist, and Google glass Explorer (he was the first surgeon to use Glass in the operating theatre). He frequently is featured as a keynote speaker at conferences across the world (including TEDx) and is a thought leader in the medical technology space. Dr. Grossmann recently authored the new Laparoscopic Appendectomy surgical simulation on Touch Surgery (available for free download here), and kindly agreed to share a bit about his development as a surgeon, as well as his truly unique insight into the future of surgical care.
Touch Surgery: What was your first surgery?
Dr. Rafael J. Grossmann MD, FACS: Well I went to medical school in Caracas, Venezuela and my father was a surgeon, so my first surgery was probably very early during medical school. I can’t remember exactly what it was – it was an open surgery, probably for a gunshot wound. I was assisting a surgeon and a co-surgeon – I used to help my dad quite a bit with his surgeries, learning and helping. During residency, my first surgery, I think, could have been an Open Appendectomy.
Touch Surgery: How did you feel during that experience?
Dr. Rafael Grossmann: I think that when you’re working inside a human body, there’s this amazing feeling. You can do the operation and what you need to do with the structures and organs, and it’s almost like playing a game or being in a movie. But then you realise that this is a real human being, and what you do can really harm this person. I would say I felt a great deal of responsibility and empowerment. As a physician and surgeon, I feel truly grateful to have the permission, granted by another human being, to invade their privacy, perform an operation, in order to hear and help them in some way. It’s really a great blessing, and I think that surgeons and physicians in general should have a great amount of respect for the fact that patients entrust us with such a significant responsibility. The trust established between the patient and the doctor is quite humbling.
Touch Surgery: You had mentioned that you attended Medical School in Venezuela – can you elaborate a bit on the differences you’ve seen in the education and health care system there in comparison to other parts of the world?
Dr. Rafael Grossmann: It really depends on where you are – systems can be radically different from country to country. In Venezuela, we have a very U.S. oriented organization style, but a lot of the medical teaching is very European-based, particularly French and German. For example, most of the anatomical names in our anatomy books were based in French and Latin. But also in the daily routines and processes, you don’t have the same level of regulation you have in the USA. You don’t have the same privacy protocols, role definitions, or outlining of liabilities. There is much more oversight in the United States. As a med student, I would often jump into cases and procedures because I had a strong interest, which was extremely beneficial for my medical education; it would be much more difficult to gain that experience in the States at such an early stage.
Touch Surgery: So you were the first surgeon to use Google Glass in the operating theatre. Can you tell us a bit about what sparked your interest in technology?
Dr. Rafael Grossmann: Well I’ve always been a bit of a tech-geek. I really didn’t and don’t play video games. I generally limit the use of gadgets for productivity (although we did have an Atari set growing up). I have always liked technology, electronics, and hands-on projects. I would play to build basic radios and figure out how to jam TV signals. I was always fascinated by the power of technology to help us accomplish tasks in a better way. Then becoming a physician, you get exposed to a lot of gadgets and tools. I did my training in the early 90s, which was kind of the beginning of Laparoscopy. I watched the transition from surgeries requiring multiple incisions to being now where they can be performed through a single incision. I’ve always been interested in this sort of progress. Then robotic surgery started to emerge as another alternative in minimally invasive surgery and I’ve always been into that – I do advanced Laparoscopic and robotic surgery.
More recently, I’ve always been passionate about communication process in medicine, particularly telemedicine. In one of my TEDx talks, I talk about my experience as a medical student in the Amazon, and how difficult it was not being able to really consult anyone even via telephone. Video conferencing applications in medicine is something that has a great deal of potential in my eyes. When I came to Maine 11 years ago, I thought Maine had the right geography, infrastructure, and need to benefit from telemedicine. We started upgrading and introducing telemedicine in a few hospitals, and brought it to nearly 20 hospitals. When the iPhone 4 came out, and I had this idea to use FaceTime for teleconsults, and I did a TED talk on that.
From that moment, it was a natural progression. I got involved in the world of TEDx and started doing conferences across the world. After that, I started using healthcare social media more and more to connect with colleagues and healthcare interested people. Subsequently, I was exposed to the idea of Exponential Medicine at Singularity University (futuremed program) and saw some incredible technologies including Google Glass. I went up and talked to the inventor of Glass, got a pair very early, and then performed the first ever operation with them.
I continue to talk on these ideas across the world, and truly believe they can be used to improve healthcare and medical education across the world. Touch Surgery is the perfect example of that.
Touch Surgery: So you’ve been extremely tied in as technology has been incorporated into medicine. How do you think technology will continue to be integrated into healthcare in the future.
Dr. Rafael Grossmann: Everyday, technology gets exponentially smaller, cheaper, and faster, with more potential. Breakthroughs are happening, increasing the computing power of the devices we use. Miniaturization will allow us to achieve almost magical feats in medicine. I think it’s about using that technology in a smart way to solve problems that we currently see. In the field of surgery, For example, nanotechnology is going to be extremely interesting, Micro-robotics will be amazing. Scarless surgery will become common use within the next 5-10 years, I have no doubt about it. Single incision, multi-head robotic surgery platforms will be the future, very soon.
Touch Surgery: Switching gears a little bit, can you tell us a bit about why you wanted to author a surgical simulation on Touch Surgery?
Dr. Rafael Grossmann: Being a surgeon, early on, I was always looking at surgical technique atlases. One day, I came across Touch Surgery and put it on my phone. Then, one night about a year ago, I had a patient with appendicitis, in the middle of the night – a little kid – who was really freaked out in the preoperative area. So I took my phone, opened TS and showed him what I was going to do. He saw the operation on my phone, and then started doing it on the stretcher. Immediately, this 10 year old kid, who was accustomed to using smartphones and tablets for playing, calmed down, relaxed, and had a better experience just through simulating the procedure before I did it. I thought that was a really cool experience in using handheld technology to empower a patient to feel comfortable before their surgery. I think Touch Surgery really has the potential to change surgery and the way we teach it. It’s much more intuitive than using big, traditional atlases and textbooks, and the quantitative feedback and ability measure your progress and how you learn is extremely valuable. It really empowers the surgery or trainee to learn.
I truly believe that sharing my expertise, through Touch Surgery, as a surgeon and as a technology advocate , is not only an honor, but also a responsibility.