What is it about?
Many patients are told that they are going to have "non-invasive" investigations or treatment - but on the day get probes inserted into their body orifices or needles jabbed into them. Firstly - we looked at how certain terms are defined - "non-invasive", "non-surgical", "minimally invasive", "minimal access", "pinhole" and "keyhole" - to find that there are no set definitions and these can vary widely. Secondly - we looked at how doctors in research papers, and how patient-facing medical websites define and promote certain procedures - transvaginal ultrasound, sclerotherapy, botulinum toxin injections, dermal fillers, endovenous thermal ablation for varicose veins and laparoscopic gall bladder removal. Again, we found that different doctors and websites promoted the "non-invasiveness" of these procedures very differently, showing a lack of consensus that confuses the patient. Finally, we suggested a new AI classification - Access and Invasiveness. By using this simple approach, every procedure can be classified - so every patient will know what they are expecting. This would also help doctors to compare different techniques by using a sound basis for the invasiveness of different conditions and help in the planning of procedures.
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Why is it important?
Medicine is advancing so fast that patients are now being offered ever more advanced investigations and procedures. While the efficacy is being assessed in each, the drive is to reduce the invasiveness and hence pain, hospital stay, risk of complications and time of recovery. Although this is all for the patient's good, communication by enthusiasts or marketing departments may overstate the lack of invasiveness and trauma for each procedure, resulting in unrealistic patient expectations. Hence a highly successful procedure performed with many advantages over the previous "open surgical technique" might still result in angry patients who were expecting less trauma than is possible. By using the AI Classification, all research and marketing for a procedure can be uniform, allowing honest and accurate communication between medical device companies, doctors, nurses and patients.
Perspectives
I realised the need for such a classification of medical procedures when I sat on a medical committee. I questioned why the term "non-invasive" was being used when talking about sclerotherapy injections for leg veins. I pointed out that if I were told a procedure was going to be "non-invasive", I would be upset if I then had multiple injections using a hypodermic needle. In response, I was told that this is how sclerotherapy had been classified elsewhere, and so it was correct to do so. I then looked elsewhere and found that many investigations and procedures were being called non-invasive when they clearly weren't. This might increase interest in an investigation or procedure in the research world, or get more patients from marketing. But it also leads to expectations that cannot be met. By developing this simple classification, medical suppliers and professionals can communicate to each other, giving a real assessment of the invasiveness of an intervention. In the same way, patients can be given honest information and so their expectations should be set correctly from the outset, and not need to be "managed" later.
Professor Mark S Whiteley
The Whiteley Clinic
Read the Original
This page is a summary of: The AI classification (access and invasiveness) of medical procedures to clarify non-invasive from different forms of minimally invasive and open surgery, August 2023, Center for Open Science,
DOI: 10.31219/osf.io/pvgwb.
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