It’s Time to Re-Read Player Piano

“The main business of humanity is to do a good job of being human beings,”

said Paul, “not to serve as appendages to machines, institutions, and systems.”

If you have not read Player Piano, it is a good read. I read it many years ago along with many other Vonnegut novels and listed to Player Piano for part of a trip to Kansas from Chicago last year for railfanning and prairie dog hunting.

“Those who live by electronics, die by electronics. Sic semper tyrannis.”

Earlier this week, during a rapid onsite evaluation (ROSE) for a thyroid fine needle aspiration (FNA) I saw something I had never seen before. Not the anesthetic, or gauge of needles or quality of the smears, but the use of voice recognition for the ultrasound machine.

Instead of a licensed ultrasound technician changing contrast, magnification, and capturing images of the “needle in the lesion”, the interventional radiologist instructed the machine to “View 2x”, “Acquire image” and “Record” after saying “Activate Voice”.

We have been using voice recognition for 2 years now and while I still miss “talking” with our three highly skilled transcriptionists, I am forgetting how it used to be. The foot pedals of the past 30 years are in a landfill.

How long will it be before the fluoroscopy technician, responding to “Flouro on” and “Flouro off” for navigational bronchoscopies and ERCPs, will be replaced by software that understands “on” and “off” and makes a mechanical action happen.

Automated grossing and microtomes combined with automated stainers and cover slippers, clinically validated algorithms for at least screening and ultimately diagnosis are here and now. Manual tasks of the past have long been replaced and more are going to be.

As a pathology resident, I can still remember having coolers of dry ice for immunohistochemistry and later more methods for antigen retrieval. Heck, I can remember labor intensive processes to make grids to diagnose mesothelioma vs. adenocarcinoma by electron microscopy.

This latest pathology epoch reminds me of liquid based cytology 25 years ago and telepathology about the same time. Cytotechnologists and pathologists were concerned about job loss. At the time, there was a cytotechnologist shortage; there still is. And we have a critical pathologist shortage.

While pathology and pathologists are here to stay, many vocations and skill sets, may not. And the way in which we do our jobs, as it has over time, has changed, mostly for the better, but as Player Piano points out, at what cost?

“If it weren’t for the people, the g-d-d*mn people’ said Finnerty, ‘always getting tangled up in the machinery. If it weren’t for them, the world would be an engineer’s paradise.”