Letters to the Editors

See an Ophthalmologist, Please!

As a lifelong Wolverine (B.S. 1995, M.D. 1998, and Residency at Kellogg in 2002), I was happy to see you highlighting the importance of getting your eyes checked. Suggesting that people should see an optometrist, rather than an ophthalmologist (an M.D.), was not as reflective of the University, its trainees, and our profession as it could have been. U-M has a long history of medical school graduates going on to be leaders in ophthalmology, and the Kellogg Eye Center remains one of the top ophthalmology departments and training programs in the country. —Sunir Garg (M.D. 1998, Residency 2002)


Remembering a Classmate — and Bandmate

As a member of the rapidly disappearing medical class of '58, reviewing the obituary page is a regular ritual for me. It should be noted that Marvin V. Anderson held the position of principal cornet in the Michigan Symphony Band, a prestigious rank that often led to major symphony orchestral appointments. —Thomas F. Higby (M.D. 1958), Michigan Marching Band 1952 and 1953


Kudos for the Summer 2021 Issue

I just finished reading the summer 2021 volume. The breadth and depth of articles covering medicine, racial equity, disability, narrative, history, and research kept me engaged perhaps more than any other issue over the prior six years I've been receiving it. Please keep this up — the diversity of voices and topics was fantastic. —Justin List, M.D., M.A.R., F.A.C.P. (M.S. 2014)


Will Extended Reality Create More Problems Than It Solves?

Note: The following are a letter, and response to it, that we received regarding last issue's cover story, "The Future Is Now," on virtual reality technology being used in a hospital setting.


I read your last issue of Medicine at Michigan with interest. I was struck by the contrast in topics which, on one side, relayed the importance of improving health disparities, while the other- the cover story- reported the development of "extended reality" (XR) technology in medicine.

While not necessarily at odds, the interface between cutting-edge medical technology and disparity in health care seems precarious [1]. The potential for this device to reach remote areas and consult distant experts seems enticing, but what would be lost? Will it remain out of reach or increase economic pressure in poor communities? Will it empower patients and practitioners or make them more dependent on a central source? With all due respect, is this what the world really needs? This question deserves some serious consideration, as 'every cause produces more than one effect' [2] and here the effects would be far-reaching.

Undoubtedly, answers to these questions will be complex and nuanced. I am heartened to read Dr. Mahajan's counterbalancing questions and admonishment to approach carefully. After all, in the face of a problem, people are compelled to solve it- that is, biased towards action. We must stop and consider deeply what that problem is, whether it is worth the trade-off, and whether this is the best way to approach it.

Kind regards,

Adrian Pichurko, M.D. (Fellowship 2016), assistant professor of anesthesiology at the University of Wisconsin School of Medicine

(1) Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities; Board on Population Health and Public Health Practice; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington (DC): National Academies Press (US); 2016 Jun 22. 2, Technology and Health Disparities.

(2) Ramón y Cajal, S. (1999). Advice for a young investigator. Cambridge, Mass: MIT Press. (attributed to Herbert Spencer)


Response from Mark Cohen, M.D., professor of surgery:

I thank Dr. Pichurko for raising the question of the intersection between new technology and improving health care access and disparities. In health care education, we have witnessed a widening of the inequity gap around student's access to patients and to how students are able to learn clinical skills at the bedside. The very nature of the pandemic forced many medical student experiences to the virtual world, taking them out of the clinics and the patient's bedside and onto a computer or laptop screen. This not only created a "less than ideal" form of patient interaction and learning that did not easily facilitate evaluation of physical exam findings, but also hindered their ability to learn from and speak with patients in the clinic, the emergency room and the wards.  Additionally, while virtual access to providers has helped break down access barriers to a number of patients, it is true as Dr. Pichurko also notes, that this has added some complexity to health care delivery, especially in the setting of patients having resource constraints.

One of the exciting aspects of mixed reality technology, is that it really does allow virtual learners to be more fully immersed in the bedside experience [1]. So in terms of medical education, it has the ability to address the "bedside learning gap" that current telehealth strategies are having challenges meeting. With new tools like mixed reality headsets, the clinician at the bedside wearing the headset can truly bring the virtual student from home right to the patient's bedside to interact and converse with the patient, and see the physical exam or procedure in real time, re-engaging the learner to the experience as if they were standing in the room right at the bedside. The potential to bring medical expertise from around the world to the bedside in real-time also breaks down access barriers related to management of complex cases across multiple specialties and providers — which is often challenging in current clinical care delivery models.

Finally, the issue of patient engagement and access will be a critical area to explore and understand more fully [2]. We are exploring ways to have these tools in several hospitals, emergency rooms, and clinics around the state to better connect providers in smaller towns with specialty expertise to help with clinical management decisions and resource utilization in order to improve access to specialty care earlier in the course of their illness, as well as more opportunities to manage some conditions better locally, avoiding in some cases travel and transfers that can increase health care costs and potentially effect outcomes. It is certainly a problem worth solving, and exploring new ways to break down some of these clinical access barriers will certainly improve some areas of disparity around access to providers. This is a complex problem however, and in no way will one tool or technologic advance solve such a problem, but it is important as health care providers, that we can utilize all the tools available to us to improve patient care.

Our multidisciplinary and collaborative efforts around mixed- reality applications at Michigan Medicine are exploring how these new tools can be leveraged to improve education, research, simulation, telemedicine, telesurgery, and clinical care delivery [3]. As such, we want to understand their limitations as much as their benefits to our providers, our learners, and our patients. Together we are being innovative, collaborative, and mindful with the applications of these technologies in how they can be thoughtfully used to advance healthcare. The future of healthcare is now, and while the problems in medicine today are complex indeed, we hope that this overview of some of the exciting new tools being explored at Michigan Medicine will provide readers with encouragement and resolve that we are working diligently to improve health care for ALL of our Michigan Medicine community.


[1] https://www.forbes.com/sites/bernardmarr/2021/06/14/extended-reality-in-healthcare-3-reasons-the-industry-must-get-ready-for-ar-and-vr/?sh=f1a8c5273a41

[2] https://www.healthcareitnews.com/news/extended-reality-holds-incredible-potential-remote-care-applications

[3] https://medicine.umich.edu/dept/surgery/news/archive/202101/applying-extended-reality-technologies-innovating-rounding-educating-removing-barriers

More Articles About: Letter to the Editor virtual reality extended reality opthalmologist
Featured News & Stories eyes close up green blue
Health Lab
Treating dry age-related macular degeneration: 6 things to know
Answers about the treatment of age-related macular degeneration, otherwise known as dry AMD, from a Michigan Medicine ophthalmologist.
Medicine at Michigan
Extended Reality Is Radically Changing the World of Medicine
Michigan Medicine is at the forefront of the technological revolution.
Medicine at Michigan
Letters to the Editor
Letters from our readers