Biomedical engineering: hand in hand with medicine

THIS morning on the train I read an inspirational article by a young doctor, Skye Kinder, who discussed the many facets of practising rural medicine. She argued that the term “pipeline” should be replaced so new interns are given less “binary” choices in deciding to pursue rural medicine. I thought it was a good initiative for a young doctor to write an opinion piece to inform newly graduated physicians.

Another interesting book I have read is Kerry Breen’s guide to becoming a doctor in Australia, So you want to be a doctor? This is a comprehensive overview of admission processes, medical schools and what it’s like to be a doctor. The book is a well informed analysis of the complex facets of studying medicine and is also of immense use to young doctors or those considering a medical career.

While there are various discussions in the medical community regarding young doctors, nurses and allied health professionals, there is little focus on biomedical engineers. So, I thought it might be of interest to young doctors (and other readers of MJA InSight) to learn about some of my experiences as a young biomedical engineer.

Perhaps, at this stage, it would be of use to define biomedical engineer. Sometimes when I tell people my field they say something to the effect of “What’s that?”, or liken it to biomedical science, which is quite different.

Like medicine, biomedical engineering is a vast discipline.

Biomedical engineers have several career options available, ranging from designing devices that run electricity through the basal ganglia (deep brain stimulation), to computationally simulating knee implant forces. The tasks that one biomedical engineer may do in their employment relative to another may vary as much as dermatology does from neurosurgery. Some spend their days modelling soft tissues using computer packages, while others meet with surgeons in theatres to promote their products. Some focus on how to get new medical devices to market through the rigmarole of regulatory documentation, while others go down entrepreneurial routes and establish startups. Clinical engineers work at the coalface of health care, being responsible for maintaining the safety and usability of medical devices in a hospital environment.

Internship in a clinical setting

In most biomedical engineering degrees, students are required to complete internships which give them 3 months or so of experience working alongside senior engineers and performing real-world tasks. While several of my colleagues were able to complete internships with medical device companies, I was fortunate enough to do my placement in a regional NSW hospital, an experience I will remember for the rest of my life.

I walked into my internship as a bright-eyed, bushy-tailed student who had dreams of becoming an academic, publishing papers, papers, and more papers! That’s what I wanted to do, and still want to do. I even suggested working on one with my former mentor at the hospital, but we didn’t get time. He was managing all the medical devices, after all.

During the internship, I was introduced to the true coalface of health care, where biomedical engineering is at its most crucial on a day-to-day basis. Unlike my friends who were working for companies focused on a select portfolio of medical devices, I got to see many devices, across several different departments. I learned how to calibrate infusion pumps used to deliver noradrenaline to patients. I tested electrical leads and patient monitoring systems to ensure they were performing within limits specified by Australian Standards. I even got down on my knees and tipped water from a hydrocollator into a sink, to empty it, water going everywhere.

This internship also exposed me to the people side of medicine – after all, the devices are all designed to help people (trying to avoid clichés). I discussed how deep brain stimulation works with a neurologist, who told me the precise distances that neurosurgeons have to drill into the brain to place electrodes. In the coronary care unit, a cardiologist demonstrated how a transoesophageal echocardiogram is required to screen for thrombi prior to cardioversion. With my fellow interns, I learned to never annoy the nursing unit manager and that we should always introduce ourselves when visiting a department.

All the things that university doesn’t teach you.

There was one experience I vividly remember. I was passionate about renal medicine, so I asked if I could visit the renal ward with the other interns. There I met a man who had renal failure and was undergoing haemodialysis treatment. He discussed how he also had a melanoma on his nose. He talked of having to control his diet carefully so that he wouldn’t, for example, overdose on potassium. He had to come to the ward regularly so excess fluid could be drained from his abdomen by a machine replacing the function of his kidneys.

I was extremely moved by the man’s account of his illnesses, and I was fortunate to have met him. Some biomedical engineers perhaps do not get to have the same experience during their career.

For that man, the haemodialysis machine will help sustain his life by filtering waste every 2 days, for 4 to 5 hours at a time. The amounts of bicarbonate and potassium and the rate at which they are delivered can be determined by mathematical equations. The power supply to the machine allowing it to pump those ions is controlled by electrical circuits. All these fundamental tasks are driven by laws of physics and engineering, integrated with the complex machine that is the human body.

The grand scheme of things

Biomedical engineering is everywhere in hospitals and helps sustain life.

Similar to medicine, biomedical engineering, although achieving astronomical milestones for healthcare, still has a long way to go. This offers exciting prospects for all the other bright-eyed, bushy-tailed young biomedical engineers like me.

In the haemodialysis example, devices can be made much smaller. More could be done to lower infection rates that occur with peritoneal dialysis. And my personal opinion is that although there have been innovations in wearable devices (Victor Gura’s wearable kidney, for example), it would be incredible for patients to have a laptop charger-sized filtration system.

Perhaps in future MJA InSight articles we may see tales from other biomedical engineers. This might help young engineers and clinicians to further understand the ability of biomedical engineers to bring great insight to fighting diseases and developing solutions where otherwise there may be no answer.

Ultimately, clinicians and biomedical engineers, along with all the other staff in the hospital, are essential in delivering the best quality of care to patients – and we must work together to fight the myriad unsolved problems in the medical realm.

Perhaps one day, there will be a publication similar to Breen’s work, but called So you want to be a biomedical engineer? Then, perhaps, more prospective students may seek to become qualified biomedical engineers who will collaborate with other medical professionals to optimise medical treatments for patients such as that man on haemodialysis.

Matthew Taylor is in his final year of a PhD in biomedical engineering at the University of Sydney. He is passionate about rehabilitation engineering, qualitative research and higher education. In the future, he hopes to become a lecturer.

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