The Sherlock Holmes moment

Robots can never replace the subtleties of human interaction, Minji Jennifer Kim explains in her shortlisted essay for the 2020 John Henahan Prize

Jennifer Kim

Posted: Saturday, August 1, 2020

Jennifer Kim MD

“No.” This was the short answer received from my grandmother when I asked if she would ever consider having her cataract surgery performed by a robot. Coming from a patient who had undergone cataract surgery over 10 years previously, her reasoning was simple and straightforward.
She clearly recalls lying stiff on the operating table, waiting for her cataract procedure to start. As her surgeon enters the operating theatre, he immediately picks up on her anxiety from the awkward silence in the air and tightly crossed hands pressed into the middle of her chest. Instead of placing the eye drape, he paused and spoke directly to her. This was unusual in those days and even more surprising for my grandmother, she was asked whether she wanted the radio on! She was reassured that would be okay to move or cough as long as she gave the surgeon a little notice. Throughout the 15-minute procedure he constantly spoke to her and put her at ease. Time flew by which otherwise would have felt like a lifetime to her. Had a robot entered the room that morning her experience would not have been the same. She remains forever grateful to the surgeon even today.
On my operating days, I ensure that I arrive early. Of course, paperwork needs to be filled and checklists completed, but to me this is not the most important part of the preparation that morning. No, to me, the most important part is the few minutes I spend meeting patients and their relatives in person. This 60-second act may seem trivial; however, I believe that this allows me to gather a vast amount of information about the patient and how I am going to tailor the surgery for them; what I call the Sherlock Holmes moment. For example, I once met a patient wearing a faded Rolling Stones t-shirt and upon noticing this asked which particular Rolling Stones songs he would like to hear in the background during his operation, which immediately put him at ease. He finally settled on “It Won’t Take Long”, which I think was a strong subliminal message! Next, I noticed his nicotine-stained fingernails and made a mental note to myself that he may cough unexpectantly and to be particularly careful during rhexis creation. Finally, I spot a small surgical mark on his knee. I explain to him that we will ensure that he is comfortable before we start and will use an extra pillow to help. He is now visibly more relaxed and even manages a smile. Having invested this small amount of time and building rapport prior to surgery, both the patient and I now feel prepared for what is ahead for us both.
Robotic surgery is not new. It has been around for many years, successfully tried and tested in various surgical specialties. Cataract surgery, however, is different. Most cataract operations take place whilst the patient is fully awake, their senses heightened by a mix of fear and anxiety. It is therefore the teamwork between the surgical team and the patient that makes this ‘good’ surgery truly ‘great’. In my grandmother’s opinion, it is the experience of the surgery that is paramount and not whether a robot can make a perfectly-centred rhexis.
Of course, there will be times when robots can be of assistance. The recent COVID pandemic made many of us realise how useful robots can be at times when humans are unprepared. There are currently robots roaming supermarkets, alerting customers to wear masks and maintain appropriate social distance. Some hospitals have adopted robots to take blood samples and swabs. This may become even more topical as there is significant debate whether cataract surgery is aerosol-generating, and if indeed so, how much protection and testing is required for both the patient and surgeon to be safe. It is not unreasonable to assume that artificial intelligence will become increasingly apparent in healthcare in the next few years and become an integral part of it. The reality is, it has never been technology versus humans. The purpose of technical innovation has always been to be helpful as we all play on the same team.
Robots may be capable in polishing the capsular bag to perfection without worrying about catching COVID. What they are not prepared for is when the patient suddenly coughs and asks whether they could use the toilet during surgery. There is no algorithm that could predict this and interpretation of subtle human interaction is currently far beyond their reach, yet innate to us as clinicians and as people. Robots will always need humans and this is why clinicians will never truly be replaced by a robot to perform cataract surgery.

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