Gizmo Idolatry

This page is a summary of Leff and Finucane, 2008

OVERVIEW

Excerpted from Leff and Finucane, 2008:

  • Gizmo idolatry refers to the general implicit conviction that a more technological approach is intrinsically better than one that is less technological unless, or perhaps even if, there is strong evidence to the contrary.
  • A particular technology may be a gizmo in one clinical context and not in anotheru
  • Seven overlapping categories of incentives encourage clinicians and patients to favor the use of gizmos

INCENTIVES FOR GIZMO IDOLATRY

  • Common sense appeal (face validity)
    • e.g. drug-eluting stents
  • Human love of bells and whistles
    • e.g. nebulisers vs MDI for asthma; IV fluid vs ORS for gastroenteritis
  • Exploits versus uneventful diligence
    • e.g. the allure of surgery – e.g. for low back pain, when simple measures are just as effective
  • Gizmo Utilization as Proof of Competence
    • e.g. the mantle of expertise from being first or ‘cutting edge’
  • Gizmo as Source of Objective, Quantifiable Information
    • e.g. pre-operative tests, even though they don’t improve outcomes; MRI for vague neurological complaints
  • Proof Against Negligence
    • belief that use of technology presents a higher standard and more defensible level of care
  • Channeling Money
    • business models created around gizmos, e.g. prostate irradiation therapy techniques

HARMS FROM GIZMO IDOLATRY

  • early adoption alters perception of expertise and may delay proper evaluation (e.g. pulmonary artery catheter use)
  • manipulation of practitioners to perform well reimbursed gizmo-based procedures instead of low-tech equally or more effective measures
  • adopting expensive gizmos makes healthcare less affordable for the patient and the health care system
  • early adoption may be difficult to ‘unlearn’ or reverse (see Unlearning)

PERPETUATING FACTORS

  • Fee-for-service rather than value-based funding (rewards the use of procedures, often with fancier gizmos, rather that outcomes aligned with patient values)
  • Publication bias (less likely to publish negative studies, such as those showing lack of benefit from new technologies)
  • Confirmation bias, cherry picking, logic chopping fallacy (selective appreciation of the evidence base, including excessive nitpicking of counter evidence)
  • Golden hammer fallacy (suggestion of the gizmo as the solution to every problem that needs a solution)
  • Thought leaders and personality cults (need to remain “cutting edge” to maintain status, have existing networks where they exert influence)
  • Social media (rapid and widespread dissemination of ideas regardless of value)
  • Industry influence and advertising (on journals, funding agencies, clinicians, and the public)

WHAT TO DO?

  • recognition and education of gizmo idolatry
  • promote critical thinking
  • tort reform (in the USA especially, to limit legal liability from poor outcomes resulting when ‘cutting edge’ technology not used)
  • promote health care organisational structures that foster effective care delivery
  • detailed strategies to improve the quality of patient-physician decisions regarding treatments in which patient preference should play a role
  • promotion of more conservative practice styles
  • establishment of Comprehensive Centers for Medical Excellence to implement these changes

References and Links

Journal articles

  • Leff B, Finucane TE. Gizmo idolatry. JAMA. 2008 Apr 16;299(15):1830-2. [PMID 18413879]

FOAM and web resources

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

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