11 thoughts on “3-D Printing, continued”

  1. I recently participated in a tour of a electronics shop that develops instrumentation for satellites. Space is at a premium and a lot of the design effort is put into squeezing the circuits into the smallest possible space. It turns out they prototype their circuit boxes using 3-D printing, and only when they’ve got it right do they machine the actual aluminum used for the circuit boxes (it helps conduct away the heat from the electronics.) Pretty cool stuff.

  2. I’ve thought for a long time that holograms would be very useful in neurosurgery.

    It doesn’t seem to have panned out. This is the most recent reference. I wonder why ?

  3. Stereotactic surgery is, by definition, robotic and the thought 20 years ago was the holograms, made from MRIs, would allow the neurosurgeon to plan the procedure. He/She could project the hologram in the office and turn it around to see the anatomy. It seems to have stopped developing and I don’t know why. Maybe technical or maybe it wasn’t as useful as expected.

    The Da Vinci robot is used in other kinds of surgery and is currently being criticized as too expensive. My own experience is with the early development and it became popular after I retired from surgery. I know some surgeons have hand tremors and it may help them as the tremors can be damped. I know surgeons who took beta blockers to reduce tremors. Some of them probably should not have been doing surgery but that’s possibly too critical. I knew a lot of surgeons who should have been doing something else. Surgery was glamorous in those days. Now they have trouble filling surgery residencies. Different generation of medical students.

  4. Regarding people not becoming doctors – I don’t think it’s a question of a lazy generation. They’re just being rational – it doesn’t pay to be a doctor any more; if you’re going to work killer hours, far better off being a stockbroker or investment advisor. I come from a medical family – nobody’s going to be surgeons or neurologists or any of the other specialties. It will be very interesting to see what happens when they all start to retire, and there’s simply no doctors to be found. A similar problem has been happening in England, as the doctors there are leaving the highly-socialized medical environment for Australia, etc.

    I would say the single most important thing to do in response to Obamacare: make sure there’s a doctor in your family. Because guaranteed insurance isn’t the same as guaranteed medical care.

  5. The move to private, really private, care is growing. I’m now seeing orthopedists and urologists who accept cash only. I’ve even heard of general surgeons doing so, which would have been impossible 20 years ago, but now with the shortage there are some general surgeons who do not accept insurance for elective surgery. The orthopods I know charge about what Medicare actually pays and can do OK because they have shut down 3/4 of the back office, the part that billed Medicare and insurance.

    Hospitals have begun paying trauma surgeons for work by the shift. The trauma center I organized in 1979 was in addition to our private practice. Eventually, the strain began to show when my partner, who had been doubtful at first, began hiring young associates to cover trauma, which gave us too many surgeons at the time for the paying part of the practice. We were subsidizing the trauma center. Eventually the volume built up to the point that it caught up with the manpower.

  6. Da Vinci is also presently involved in several lawsuits. Inventions and inovations will definitely be one of the pillars that our country builds on for the future, but
    it seems to me as just an interested observer that robotic surgery may be one of those cases where we need to zoom out and really think how this technology fits into the whole arrangement.

    While we’re on the subject, one part of Obamacare that’s really going be destructive is the medical device tax. It taxes sales not profits, so smaller startups will be wiped out while big splash high profit complexes like Da Vinci will be more the rule.

  7. Mike K Says:
    April 28th, 2013 at 3:23 pm

    It goes to GP’s too. Doctors in our town are not taking new Medicare patients, but are keeping their old patients who age into Medicare. That started with the passage of Obamacare. My GP gives a significant discount for cash, and is trying to move away from insurance.

    As quality of care starts the downward plunge, I expect we will see what will come to be considered “American” care clinics pop up in Mexico and Central America if security can be arranged. It will be ironic if the deliberate erasure of the US-Mexican border by the Democrats [and Vichy Republicans] becomes a safety valve for Americans fleeing the Democrats’ destruction of the health care system.

    Subotai Bahadur

  8. “My GP gives a significant discount for cash, and is trying to move away from insurance. ”

    He is running a significant risk of prosecution by the feds. Medicare bans discounts for cash but only pays about 20% of billed charges. Most insurance companies will also drop you from a panel for giving discounts because the panel is based on a “discount” in theory.

    That’s why doctors are dropping insurance and Medicare. So they can charge a lower fee in cash. In theory, they would be OK with Medicare for charging extra for cash.

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