Suggestion

Vatican

“My new EMR saleslady told me how the new system makes recommendations when you go through your pathology results. Haughtily I told her that only a board certified dermatologist is qualified to do this. She told me to just try it. And dammit the computer is right every single time and it saves me tons of time as I no longer have to type anything. And dammit I am mad about it.” — a colleague 

A complex computer algorithm will do a better job than a real, live physician in the not so distant future. Soon, physicians, nurse practicioners, physicjan’s assistants will be passé, superfluous, an anachronism. The only thing that will save medicine as a profession is a collapse of modern society because of something cataclysmic like a zombie apocalypse.

But then I see patients getting treated with antibiotics for “sinus infections” when they have only been ill for one day and I think maybe artificial intelligence is a good thing.

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98 thoughts on “Suggestion

  1. With patients being rushed in and out of doctors’ offices like they’re on an assembly line, it only makes sense to take things a step further and turn the doctor into a robot. And this might even work well most of the time. But something about it makes my skin crawl.

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  2. Ummm, interesting Victo. You know in transportation we have had struggles with the daily activity that most affects profitability and efficiency and that is dispatch. Good dispatchers are like a cross between a medium and a computer – always juggling a myriad of details while trying to predict what will happen next so as to have equipment in place to deal with it. And it is dynamic – meaning that the whole puzzle changes minute by minute – each change a function of what went before plus the introduction of new information..

    A great deal of effort has been put into computerizing dispatch for a number of reasons – partially the huge amount of data that has to be considered with each decision and the fact that each decision has an impact on every other decision. Computers are good at that. The oil companies have the most advanced (as you would suspect) computers to do this and they have discovered some serious limits to making this work well. There are aspects where the computers and their algorithms are blindingly efficient – predicting with jaw dropping accuracy when and where trucks will be required. I’ve personally seen a delivery to a huge retail service station that had predicted the remaining fuel quantity at the station to within 10 liters – this at a station that sold 100,000 liters of gas per day.

    That said, it is people who are driving the trucks, people who are calling with their problems , people who are ultimately the customers who have to be satisfied. No one will work for a computer – they just quit and go else where. It is a profound truth that people do not work for companies or for computers or for brands – people work for people. That is when they do their best and thrive. And it is inevitably the actions of people that confound the computers – buying habits on holidays, in bad weather, when price differentials drive buying. And for the drivers, the kind of day they are having, their work style, motivation, etc. When it comes to understanding people computers are terrible.

    In the end – and this process is still evolving – the best results were attained by having smart people use the computers to make the routine decisions and suggestions and then have those decisions checked., refined and implemented by humans. Much like using a calculator to help make a decision on which home to purchase. Have no fear Victo – for the best doctors computers are no threat – for the mediocre and the worst, computers will eventually make them redundant.

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    • It is a blow to the ego, realizing you are not particularly special when it comes to knowledge and decision making. I have touched on that before with the teledoc services. In fact, a computer with AI would be much better than those stupid doc-in-a-box clinics or teledoc. I will be the first to admit that there is no possible way for a human being to be in top of all of the drugs out there and their interactions. We need some help with that for sure!

      Liked by 1 person

      • You know when it comes to science fiction, the strategy of the future that most fascinates me is the concept of a human inside a machine – i.e.a fighting machine, a flying machine, etc. To hook the human decision making process into the memory and speed of a computer would, to me , be the way for humanity and computerization to go. Imagine Victo if you could have a mental interface that would allow you to query the absolute latest, to the second, data on the efficiency of each drug for it’s use in treating the particular patient you are helping. Or an immediate list of all the possible side effects and drug interactions possible with each option. Think about how much more time and energy you could devote to each patient if you could give a mental order for the computer to follow and record all you did so you never had to spend time charting. If all the drudgery of your job could be done automatically – think about the increase in efficiency. Or if you could give the computer a mental list of symptoms and it would return a list of possible causes in order of probability for you to explore..

        I really think that computerization used to enhance human abilities is the right direction for the future. I do not think computers will ever replace humans in decision making – or at least not the decision making of the best.

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      • I love the show Sherlock. One of the things that strikes me about his character is how logical he is, how removed from human emotion he is for the most part. I have known a number of brilliant people who have the same personality. They can process huge amounts of minutia and data but they lack the caring clinical side that makes them connect with other human beings well. IF I could have that but retain the feeling, emotional side I feel that would be huge. However, I will probably need a port inserted into my head for that and I am not sure my vanity could live with that!

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      • We need to develop a human/computer mental interface – kind of like a brain wiFi hook up. That way you could retain your beauty and still utilize the enhanced options. 😀

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  3. This reminds me of the book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. I was flipping through channels one night, and came across a CSPAN “Book TV” interview with the author. He was talking about this exact thing!

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  4. If the computer-with-snazzy algorithms is 100% on whatever scale we’re dealing with, and a live physician with imperfect knowledge but a caring, human attitude is 90%, I’ll take the doc every time. Heck, I might even go for 85%. If I have to go back to living like great-grandma did on the frontier to avoid the brave new medical profession, that’s fine. After all, she lived to the ripe old age of 65. (Oh, wait. I’m 68 and going strong.)

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    • I can think of patients who I am certain would feel much like you and would prefer an imperfect human and other patients who would be more inclined to see a nonhuman. There are some who need pelvic exams but I cannot get them to do it with me. They would probably do it with a robot or machine just simply because of the psychological/emotional stress of having a human do it.

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  5. Hmmm… having experienced misdiagnoses and indifferent doctors, I think I’d rather have a machine that says, “Based on your symptoms you could have advanced osteoarthritis in the hip.” I don’t think a machine would be as likely to be swayed by irrationalities such as, “You’re too young for osteoarthritis of the hip, therefore I’m not sending you for hip X-rays.” Since then, I have to admit, my position vis-a-vis doctors is a combination of hope, need, and skepticism. My vet would’ve been more on top of my situation back then than my doctor was! BUT a good doctor with a sincere interest in his/her patients and an open mind to possibilities can never be replaced by a machine. You’re safe.

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    • We all get trapped by those fallacies! The too young for a heart attack or stroke or arthritis…. Or you are too old for it to be anything else…. How I feel about a specific patient also affects how I treat them no matter how much I try to be completely bias free and objective. You hit the nail in the head there where assuming knowledge level and skill is the same, our humanity makes us both better and worse than a machine.

      Liked by 1 person

      • My doctor didn’t like me and I didn’t like him. Once I had a good diagnosis, he didn’t like the fact that I didn’t WANT a hip replacement but I WANTED hip resurfacing (which was, then, somewhat beyond the pale). I was willing to go to Belgium to get it. NOW hip resurfacing is common and everyone is aware that active people might get osteoarthritis at a younger age. He never asked me about what I did, how I spent my free time, nothing. I still have complete contempt for him. But who knows what was going on in his life. Maybe his wife had left him and he had an axe to grind against women his age.

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  6. I think I would choose according to each situation. For example, I have to wait three weeks for an appointment to get my prescription changed for diabetes. An AI fix could do the same thing and I wouldn’t have to wait three weeks and pay $267 plus lab work. The doctor didn’t listen the first time around. I told them I reasons to combination drug therapy, not a single drug. I told them what worked, which druids and which disagrees. They only gave me the lowest dose of the midst common diabetes medication. Of course, my fasting glucose is advice 300 daily. So now I have to wait and pay and hope they will do as I ask this time around.

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  7. Except it takes jobs and human interaction .:( I’ve often wondered how Docs feel about Nurse Practitioners? Are they helpful? Do they take a huge weight off your shoulders or are they otherwise?

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  8. Artificial intelligence is great for tools. For interaction with users and patients you still need a person who can work with the hardware and software.

    Add the drawback of maintenance of A.I. tools. The hospital is either fully or partially responsible for how the A.I. tool functions. The technician can only do so much and then hope that the medical professionals do not compromise the A.I. tools performance. So many variables…

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    • Actually, it is an interesting thought…. Who develops and is in charge of the AI? What if one system is better than another? What if you get price gouging over systems like what you see with pharmaceuticals? Hmmmm. Would make a great book…..

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  9. I don’t know, letting a machine decide is a very reductionist approach to anything. There are protocols defined for most medical issues in the US, or so I’ve heard but I still think medicine is more an art than an exact science.We haven’t reached that level of complex understanding of every human system to let a machine decide on all medical issues…

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  10. I agree with a lot of the people here, a lot of healing is in that in-between space, because not all, maybe even most, illness is not just one cut-and-dried issue. A doctor is like a teacher–the connection multiplies the results. Which is also my issue with turning to all-online learning.

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  11. Funny you should say that last reply because that was what I was going to say. No way a computer can measure real feelings…. like failure to thrive, suicidal or even the big one: adherence to plan. I doubt we will ever see total computer analysis replacing assessment. But as an aid….. why not?

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    • Certainly would be useful for cut and dry stuff. I imagine going to a kiosk, inserting your medical card (which contains your entire medical history), typing in your upper respiratory complaints, having a quick and automated strep or flu test and then apply the algorithm for a diagnosis and the treatment is administered right there on the spot….

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  12. This reminds me of a funny story. On a plane trip over the speaker I heard. “Any doctors on board?” After the third time I offered my help though I was a paramedic at the time. Another man offered to help too telling me he was a doctor. I assessed the patient and while I did I asked him to use the planes cuff to get a blood pressure. He looks at me with fear then whispered out of the corner of his mouth “I don’t know how to do that on a human arm, I am a doctor of animal medicine”

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