BrazJOtorhinolaryngol.2015;81(5):455---456
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
EDITORIAL
The
physician
and
the
world
of
technology
夽
O
médico
e
o
mundo
da
tecnologia
It isno longernews thatsciencehas evolvedat an expo-nential rate over the past 100 years, providing far more significantprogressinknowledgethanobtainedinthe pre-vious 150,000 yearsof our species. Littleis known about whatoccurredintheperiodbeforeclassicalantiquity(4000 BCtoapproximately450 AD)when thebasic foundations, writing and mathematics, were developed, allowing the compilationofknowledgeandtheprogressofthought.But it was only in the 16thcentury that the world witnessed the formalizationof science asan academic activity that requiredarationalsearchfornewknowledgeandits math-ematicalconfirmation.Still,it’samazingtoimaginethatit was only in the 19th century that Darwin formulated his theory on the evolution of species, because until then it wasbelievedthateverythingwasimmutableinthebiology field.
In theevolutionofthis process,the last50yearswere dramatic ones. My generation has witnessed the incredi-blespeedwithwhicheverythingunderwentchangesaround us:communication,transportationfacilities,integrationof peoples,shorteningofdistancesanddisseminationof infor-mation.Itisobviousthatmedicinehasincorporatedallthese changes, greatly improving our understanding regarding human physiology and pathophysiology, and at the same time,impressivelyrefiningourdiagnosticmethodsaswellas medicalandsurgicaltreatmentoptions.Takingintoaccount only my time as an otorhinolaryngologist, it was impera-tive that I adapt to the incredible advances in genetics, investigativeimagingmethods,surgicaltechniquesaidedby microscopyandendoscopyand,morerecently,thefieldof roboticsurgery, whichis stillan incipientin otologyfield, butalreadya reality inmany casesofpharynxand larynx tumors.
However,despitealltheseextraordinarychanges,wecan saythattherehasnotyetbeentimetochangetheessence of modernman.Ourfears,uncertainties, and theeternal
夽 Pleasecitethisarticleas:CruzOLM.Thephysicianandtheworld
oftechnology.BrazJOtorhinolaryngol.2015;81:455---6.
pursuitof understanding of where we areand fromwhat we came are not still definitively settled, in such a way thatthecurrentrealitystillpermitsustobesusceptibleto beliefsofvariousshades.Evenwithallthisnewknowledge, thereremainsroomfor intolerance,religiousandpolitical fanaticism,segregation,war, and other flaws in ourdaily life.
Asphysicians, wemustalways keepinmindthatthese fears and uncertainties common toour species are exac-erbated when someone gets sick. It’s amazing how the informationofadiagnosis,eventhemosttrivialone,canbe receivedinanabsolutelydifferentwayamongpatients, con-tributingtopositiveorverynegativechangesinthephysical andmentalstateofsomeonealreadyweakened.Thereisno pointinhavingaccesstotheentirearsenalatourdisposal,if welosethehumansideofourintervention.Becauseofthese fearsanduncertainties,acarefulcollectionofdatarelated todisease---ourgoodoldanamnesis---isanexerciseintheart ofunderstandingourpatient.Justastheconceptiscritical thattechnologydoesnotreplacepersonalhumanrelations inthemedicalpractice,itis alsological andfundamental thatwekeepinmindtheconceptthattechnologydoesnot replacelogicalclinicalreasoning.Thisisreflectedmainlyin theformulationofdiagnostichypothesesandinthe selec-tionofsupplementarytests,whichshouldbebasedonour knowledgeoftheclinicalexpressionandpathophysiological understandingofalldiseasesofourspecialty.
Unfortunately, the reasoning has become increasingly commonthatitwouldbemoreefficientandfastertorequest countlessclinicaltestsandthenthinkaboutthediagnosis. Inadditiontoreversethelogicofouraction,thisbehavior exposesourpatientstoriskssuchasirradiationand unnec-essarystress,anddramaticallyincreasesthecostsrelated todiagnosis, which leads to a counter-reaction by health insurancecompaniesandbypublicadministrationinterms ofcontainmentofcosts.
Inthisway,Ithinkweshouldenthusiasticallycelebrate thenewknowledgeandincorporatenewformsofdiagnosis andtreatment;butitiscriticaltokeepourbestpostureasa physician:someonewhoseekssolutions,efficientlyandwith
http://dx.doi.org/10.1016/j.bjorl.2015.07.001
456 EDITORIAL
kindness,helpingotherpeopleinelucidatingtheirproblems andguidingtheminthebestpossiblewayinthetreatment oftheirdiseases.
I do believe that good medical schools and efficient services in otorhinolaryngology residency still base their teachings on these principles, and I advise everyone not toforget it because, in this modern technologicalworld, eveninWikipediawecanread:‘‘Theroleofthephysician andthemeaningoftheworditselfvarysignificantlyaround theworld,butasageneralunderstanding, medicalethics requires that physicians show consideration, compassion, andbenevolencefortheirpatients.’’
Therefore,inthepracticeofmedicine,technologyand humanismalwaysmustgotogether.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
OswaldoLaércioMendonc¸aCruz
