New Tricks for Old Dogs: The Task Unification Technique in Surgery
Dr. Steven Palter’s patient began to cry. Not because of the sharp pain that suddenly shot through her abdomen—after years of suffering she was used to that—but from sheer and utter relief. The Yale University fertility specialist had precisely isolated the physical source of his patient’s chronic pelvic pain (CPP). “We got it!” Dr. Palter said elatedly, and immediately released the pressure he’d put on the spot inside her abdomen. “And we couldn’t have found it without you,” he told the woman. For years, she’d been in constant agony that prevented her from sleeping, holding a job, or maintaining even the semblance of a normal family life.
After the patient and Dr. Palter together had identified the location and source of her pain, the doctor made a “conscious pain map.” Immediately thereafter, Dr. Palter used this map to guide his surgery on his patient, using a laser to precisely remove the diseased tissue he could not see with his naked eye alone, finally relieving the woman from the endless rounds of physician referrals, diagnostic tests, and failed treatments.
Dr. Palter and his patient had embarked on a new kind of surgery called conscious pain mapping. As a member of the surgical team, it was the patient who identified the area of pathology.
This particular patient was extraordinarily lucky to have found Dr. Palter. Although 20 percent of women suffer from CPP at some point in their lives—with one of every ten outpatient referrals to gynecological specialists due to this condition—only 60 percent of cases are diagnosed accurately. Even fewer are treated successfully. Most CPP sufferers find their lives altered irrevocably because of the severity of the pain, and many struggle to cope with depression on top of the physical anguish.
CPP has also long frustrated physicians. Although some doctors have suspected that factors such as endometriosis and irritable bowel syndrome can cause CPP, it has always been difficult to make a definitive diagnosis. Seemingly diseased tissue would prove benign and vice versa. And without such a diagnosis, CPP is nearly impossible to treat.
Or was. Until Dr. Palter had his idea.
Before Dr. Palter’s innovation, the gold standard diagnostic tool had been laparoscopy. This involves inserting a small video camera through a small incision in a patient’s abdominal wall to get an internal view of her ligaments, fallopian tubes, small and large bowels, pelvic sidewalls, and the uppermost portion of the uterus, or fundus. But since CPP pain occurs often in seemingly normal tissue, it frequently can’t be detected using visual clues alone (the wrong color, unusual spots or texture, and so on). Therefore, laparoscopy results are at best ambiguous, can be a waste of time, and, at worst, lead to the removal of normal tissue that isn’t even responsible for the pain.
Dr. Palter decided to systematically map the inside of a patient’s abdomen by physically touching one spot after another until the patient felt pain. Once he isolated the spot, he could surgically remove the problematic tissue—and end the patient’s suffering once and for all.
What makes Dr. Palter’s process remarkable is that he performs it while the patient is awake and alert on the operating table. Laparoscopy is usually performed under general anesthesia, which knocks the patient out, and so the doctor must interpret the findings without her input. Given that CPP is a condition that is felt rather than seen, this has always significantly handicapped physicians. By using the patient’s own feedback to help with the diagnosis, Dr. Palter solved a medical challenge that has baffled doctors for generations.
Why did it take so long for someone to come up with this idea? In hindsight, Dr. Palter’s solution seems almost ludicrously obvious. He didn’t develop any new technologies. Nor did he take advantage of innovative drugs, or apply the findings of recent research studies. Dr. Palter made this creative leap using only existing tools and ideas.
As it turns out, Dr. Palter’s achievement is a perfect example of the creativity tool we call Task Unification. As with the other techniques, Task Unification allows you to routinely and systematically be creative by narrowing—or constraining—your options for solving a problem. You simply force an existing feature (or component) in a process or product to work harder by making it take on additional responsibilities. You unify tasks that previously worked independently of one another. In Dr. Palter’s new CPP treatment, for example, the patient is both patient and diagnostic tool. By unifying two tasks—requiring the patient to undergo the procedure and help detect the source of her abdominal pain—he achieved a creative breakthrough while staying well inside the proverbial box.
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