I was visiting one of our customers recently. I admit that this is a favorite pastime of mine.

When we started this company, I was the first salesperson, product manager and marketer, all at the same time, and for years I had been around customers constantly. I have enjoyed that tremendously. However, as Biotronics3D is growing, I find myself increasingly distant from our customers in my day-to-day activities. I do not like that at all. When managing a rapidly growing technology company, it is easy to focus on improving products, systems, operations etc. Sometimes you act as you ignore why and who you’re improving these things for. And answers to those questions are only can be found “out there”, where our customers work, in hospitals and imaging clinics, and definitely not within the walls of the Biotronics3D office, were I work.

Seeking this unfiltered and candid feedback, I stepped through the doors of the fore mentioned customer. And once more there were very important lessons to be learnt. I was very surprised and overwhelmed with the vast amount of work our customers had to do during their day. All the information they needed to understand before they take any action in a very busy, sometime rather chaotic environment. A heap of hundreds of radiology examinations to be interpreted and the heap looked like increasing constantly and not going down. 5 minutes for interpreting a CT study which I would consider a minimum before my visit, I realized that it was a luxury. They were under immense pressure to do more, much more, spending less time, which was once more a big surprise for me. Most of them were at a crisis and breaking point.

But how can the quality of the clinical outcome can be protected when you are asked to operate in such an environment, were meeting targets and increasing throughput is the name of the game? How can you target clinical excellence? Moreover, has our 3dnetmedical.com technical innovation, something that we are so immensely proud off, created this problem for them? Have we given them the tools they needed to get greater access to information only for them to discover there is too much of it? Are we the catalyst that multiplied their problem?

As it happens, I am reading these days an excellent book called “Descartes, Spinoza, Leibniz: the Concept of Substance in 17^th Century Metaphysics” by Woolhouse, a retired Prof. of Philosophy from the University of York, UK. My visit to our customer reminded me of what I was reading the night before.

Prof. Woolhouse in his book revisits one of the great philosophical battles of all time between seventeenth-century philosophers Rene Descartes and Baruch Spinoza. The debate centered on how people perceive, and at what precise juncture a person decides whether to accept or reject a proposition. Put simply, Descartes suggested that first we comprehend a notion, and then we either accept or reject. In contrast, Spinoza suggested that we first simultaneously comprehend and accept a notion, and only afterward, if we have time, are we able to reject it. Thus Spinoza implies that the rejection of a notion is a secondary psychological act. Prof. Woolhouse argues that intensive psychological testing has proven Spinoza to be correct.

Hold on, let’s think about it for a minute. It seems that my dear Professor’s finding is of critical importance in the context of accurate clinical diagnosis and medical imaging, because under conditions of cognitive overload, Radiologists rarely have the time or the focus to go back and question their initial diagnosis. Mistakes thus are inevitable. Thinking deeply cannot be done when they are (over)loaded. The implications of this for the medical community are extraordinary. Radiologists are almost certain to be increasingly more vulnerable to data solicitation that potentially can lead to making the wrong decisions.

Should our Radiologists celebrate when the next generation CT scanner able of producing few thousand of images per scan arrives in their hospital, or should they seek a different discipline? I am not sure.

If Descartes was living today he could claim that our technology, 3Dnet, not only reduces the amount of time it takes to do any one medical task but also leads to the expansion of tasks that healthgivers are expected to do safely, with a given working day. And assuming he had a different dress sense, I would even had given him an offer to join us in our Sales Department. Actually I saw that “expansion of tasks” phenomenon in action during my visit and it was an eye opener. This is what happens to people when they get computers, faxes, mobile phones and other new technologies. In essence, computers are our modern taskmasters, constantly picking up the pace. When humans can’t keep up in certain tasks, computers simply replace people altogether. If you don’t have the right skills, computers and technology may be your enemy.

I was talking to my ex-wife about that, a brilliant Research Psychologist, and she had some very interesting insights to volunteer for the problem of the intense information overload that our Radiologist have to cope with in their everyday work. She said that recent psychological research in the clinical profession reveals a wide variety of effects from information and stimulus overload:

1. Overconfidence: as Radiologists are given more clinical information to digest, confidence in their judgment increased, but accuracy did not.
2. Decreased benevolence: a Doctor’s response to someone needing assistant decreases in likelihood as his environment increases its input bombardment.
3. Impaired judgment: As clinical information load increases, integrated decision making first increases, reaches an optimum, and then decreases. The old law of diminishing returns applies.
4. Frustration: Background noise in the form of unwanted clinical information lowers frustration tolerance and cognitive complexity.
5. Confusion: Radiologists are simply unable to effectively and efficiently process the information.

What is the solution then? Moreover, is there one? Do we switch off our computers and go back to the good old days of film? Do we pretend that this heap of data on our desk does not exist? Nothing is perfect. The good old days definitely were not. The future won’t be. And certainly there is no such thing as technological innovation without tradeoffs. It is not only the luddites that find that hard to accept. The inevitable question thus is how do we negotiate the tradeoffs of the innovation and evolution in Medical Imaging?

Please allow me to list some thoughts in my next blog.