Arizona Physician

Arizona Physician

Outcomes: an interview with Bernard R. Bendok, MD

By Dominique Perkins

Technology has become so fully entrenched in our lives that one might wonder why we are still talking about its presence as if it is a debate. Some argue that it is here, it is here to stay, and the only choices we have are to keep up or be left behind.

But, while it is certainly true that technology as a whole is here to stay, we still have a responsibility to ensure that we are using it in the best way possible. After all, what is the advantage of living in an era of such incredible technological advances and discoveries if we don’t use them to make our lives more efficient, productive, and enjoyable? And, rise of-the-machine jokes aside, it is sometimes difficult to tell whether we are putting technology to work for us, or the other way around.

Dr. Bernard Bendok uses some of the most interesting medical technologies in the field, things that seem to come straight from a futuristic space series. And he is no stranger to the struggle of preventing new tech from becoming a distraction rather than a tool.

Beginnings

When Bendok was in high school, he attended a lecture on the pituitary gland that left him incredulous, and fascinated with human physiology. However, while it was this experience that led him to medical science, Bendok said the true seeds of his motivation were planted even earlier.

“The foundations of seeking a career in healthcare were planted in me by two loving parents who cherished books above shiny possessions and espoused empathy towards others above self-interest,” he said.

While attending Wayne State University for his undergraduate degree, Bendok worked in a cutting-edge cancer genetics laboratory and did volunteer work with pediatric cancer patients.

“These experiences cemented in me the passion to combine science and helping people with daunting problems,” he said.

After graduating, he went to Medical School at Northwestern University in Chicago, and chose to specialize in neurological surgery. He completed his internship and residency at the McGaw Medical Center of Northwestern University, and a fellowship at the State University of Buffalo in New York.

“I decided that I wanted to be a small part of a great ongoing revolution in therapeutics and technology that would move brain care from nihilism to giving people new birthdays, and new opportunities for improved quality of life,” he said.

Bendok met many mentors along the way who influenced his choice of specialty, and the rest of his career. Bendok said he was fortunate in working with Dr. David McLone, an internationally recognized pioneer in Spina Bifida and other congenital disorders, with Dr. Hunt Batjer, an internationally acclaimed vascular and skull base neurosurgeon, and Dr. Nick Hopkins, a pioneer in the endovascular treatment of neurosurgical issues.

These mentors also helped shape his views on the role of technology in healthcare. Bendok said of Batjer, “He was skeptical of technologies that did not add meaningful benefit to patient care but he also embraced innovations that made a difference. He had an uncanny ability to understand the implications of technology.”

Science fiction

In 2014, Bendok was recruited to chair the Department of Neurosurgery for Mayo Clinic in Arizona. His practice focuses on the microsurgical, endovascular, endoscopic, and radiosurgical treatment of neurovascular and skull base diseases as well as brain tumors.

In his journey with Mayo, Bendok has had the opportunity to see some incredible technological introductions. They’ve opened the Precision Neurotherapeutics Laboratory, which uses simulation science to make neurosurgical treatments safer, less invasive and more effective. Bendok said he has a strong interest in integrating new technologies with minimally invasive approaches.

“Our goal in the Precision Neurotherapeutics is to, ‘do the operation before the operation,’” he said.

Using simulation science, 3D printing, mathematical modeling, augmented reality and holography they are able to map out the surgery in advance and find the best strategies.

“We are seeing amazing breakthroughs in our ability to deliver new life for patients who would have otherwise died or been severely disabled only several years ago,” he said of the many new techniques and devices in use today.

Indeed, Bendok describes augmented reality used in current surgical suites as something that would have been considered complete science fiction just a decade ago. And the possibilities are just growing more and more fantastic.

“Endoscopic and endovascular devices have raised the bar for what can be done through minimally invasive approaches,” he said.

“Brain computer interfaces are on the horizon and will transform rehabilitation and offer exceptional function to those who have been disabled and likely enhance function for those who need it. Tissue engineering is also on the horizon and will likely usher in a renaissance in the treatment of stroke and neuro degenerative diseases.”

The social factor

As we see a dramatic increase in the popularity of wearable devices moving forward, the implications in the accessibility of patient information and delivery of care are certainly interesting.

Bendok said the general concept of physicians reaching judgements in the traditional way – through the typical history and physical and short interactions in the office – has become inadequate to manage complex neurosurgical diseases.

“In the area of back pain, for example, physical activity and the nature of that activity is very important in determining surgical thresholds and meaning quality of life outcomes,” he said. The opportunity for physicians to monitor various aspects of the nervous system to help guide and individualize treatments is very interesting, and something Bendok said they are actively pursuing at Mayo.

Social media is another popular life tool that has many implications for healthcare use. And, since it certainly doesn’t appear to be going anywhere any time soon, Bendok said he feels physicians should look for healthy ways to engage on social media by partnering with their healthcare organizations.

“The educational potential of this medium is staggering,” he said. “No other medium could reach those with rare diseases in such an effective way.”

A tool, and an obstacle

Bendok describes technology as a tool, much like an artist’s brush. And, while it has the potential to improve outcomes when used strategically, it does not replace the innovation, attention, and care that a physician holds.

“Technology does not guarantee better patient care any more than a paint brush can guarantee a work of art,” he said.

Despite the great advantages it poses, Bendok also said technology does pose some threats to healthcare; two major ones in his opinion.

First, the dehumanizing of the doctor-patient relationship, and also the relationship between doctors and their healthcare team. This threat comes largely from EMRs.

“In my opinion the screen is part of the problem,” Bendok said. “Humans are not wired to socialize via screens. We are wired to gather around a camp fire and share stories.”

This is not to say there is no benefit to an EMR. Bendok agrees that a safe, integrated medical record crossing the medical “borders” has the potential to save a great deal of time and effort.

“Patients should not have to reinvent the wheel every time they see a new doctor,” he said, adding that patients suffer from this sort of fragmented care.

While the current use of EMRs may have made healthcare less personal, Bendok believes this is a detour that can be corrected given the right changes and advancements. Holography, in particular, he feels has the power to change the way we interact with EMRs, making the patient a dynamic partner in the process, and allowing doctor and patient to work together more seamlessly.

“In my opinion the screens have to go unless they become shared screens or, ideally, holograms,” he said. “I always wished Steve Jobs had designed an EHR before he died.”

The second threat Bendok sees is the ease of access to medical information, which he said may sound a bit counterintuitive at first. However, with so much information available it can be easy to get overwhelmed with surface-level data – and the discipline required to search for a deeper understanding could be abandoned.

“Why pull source materials when “Wikipedia” has the bare bones of what you need to know?” Bendok said.

The artist’s brush

Some have argued that technology takes some of the skill out of the physician’s hands, and, as robotics and other innovations take a stronger hold, it’s easy to see how that could be so.

Bendok drew the parallel once again to an artist’s brush. As computers have advanced, in many cases the artist’s brush has now become the artist’s computer algorithm. And while it has been argued that computer animation and other tools like it have made classical painting less relevant, Bendok points out that new generations of artists are finding ways to integrate computing with classical art forms to form something entirely new, current, and undeniably beautiful.

“The key in my opinion is for us as physicians and surgeons to hold on to the fundamental values and principles of healthcare,” he said.

As far as technology can take us, the expertise, judgement, and discernment of the physician still reigns. A Star Wars future where robots rule healthcare delivery will remain science fiction, as no technology can replace the passion and caring that drives our physicians, or the trusted relationship that should exist between doctor and patient.

“It is critical that we insist that our technologies be used in ways that enhance our humanity and not diminish it,” Bendok said. “If a technology makes us less compassionate it should be altered or discarded.”

“Patients will know the difference!”

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