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Introduction

High-technology devices have had a profound impact on the evolution of modern medical practice. Many of the medical subspecialties are defined as much by technology as pathology or physiology. Yet physicians are ambivalent about technology. They receive extensive training in the biochemistry and physiology of drugs, followed by clinical training in therapeutics, and they regard themselves as experts in the use of drugs. This is reflected in the legal theory of the learned intermediary. Given the pervasive role that devices play in medical practice, it seems reasonable that physicians would receive comparable training in the theory and application of biomedical engineering.

This is not the case. Physicians are not routinely taught biomedical engineering and electronics. As discussed in Chapter 34, the legal standard for physicians' knowledge of medical devices is little more than that of the average lawnmower user. This leads to the misuse of devices, the inappropriate substitution of instruments for human judgment, and an uncritical acceptance of machine-generated data as accurate and objective. This chapter discusses the problems posed by medical instrumentation and special problems of critical care medicine.


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