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Interesting Enemies For a Diagnostic Database
dlh writes: "Boston.com is carrying an article about Dr. Lawrence L. Weed's Problem Knowledge Coupler software. Apparently the medical profession is not exactly thrilled at the idea." Seems access to information is a positive thing, but certain doctors seem to feel threatened by this sort of database.
As a practicing physician (and software engineer since 1978, so don't get in a hissy fit), I have very little use for the program. Not that I don't find the idea of an expert system for diagnosis to be interesting, but it's clinically useless for most of us.
It may come as a surprise to most people, but diagnosis is not the hard part of medicine. Oh, sure, there are the occasional wierdies like the one in the article (and then I'd love to have the program), but mostly the diagnosis is either (a) not remotely in doubt, (b) irrelevant to the treatment (I don't care WHICH virus gave you diarrhea, I just care about hydration and mental status, and I don't need a computer program to help there), or (c) not something I need right now.
Clinical medicine is not mostly about diagnosis. It's mostly about disease management, triage, clinical efficiency, relationship building, and a huge dose of having to deal with every person that walks in the door, regardless of IQ, regardless of psychiatric diagnosis, and regardless of what I personally would like to do with them. Where excatly some peculiar expert system fits in with all that is something of a mystery to me.
(Oh, and surgical medicine is all of the above, plus time-critical eye-hand coordination, plus the routine inability to diagnose anything until you're in the OR, and the expert system is stone useless about then.)
New and better tools to solve problems that don't come up very often are interesting, but hardly something that will revolutionize medicine.
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It's interesting that most of the doctors responding are doing so much emothion and so little logic (and this one didn't even read the article carefully). Let's go through the rebuttal...
:). Despite the stereotype, many IT professionals (such as myself) are fit, healthy individuals who exercise regularly, drink plenty of water, and enjoy a proper diet. And those of us who stayed out of the dot-bomb industries (or got out early enough) can afford the best cardiologists money can buy, and don't have to whine and scream about it.
1) "Nothing Beats Pure Data" - Nobody that I'm aware of has posited this idea in the discussion, because it's absurd. Pure data on its own is fairly useless. It's the interpretation of the data that is important. What this tool seems to be designed to do is to make sure that the data is thoroughly collected and at least adequately corrolated against certain rules.
2) "I'd bet that a very small fraction of the people on the board would trust their mother's care to a database." Of course we wouldn't, but I would feel much better knowing that her condition was subjected to a thorough and complete analysis; this tool could probably assist in that. I'm sure my mom would agree - she's an experienced RN and regularly has to catch and help fix doctor's mistakes. This is not to say that doctors are incompetent (though some clearly are), but that they are human and fallible just like the rest of us.
3) "The great thing is that most people on this board are not representative of the world. The rest are not willing to forego a physician's care because of their superior intellect. Once the techie is in the emergency room with his twinkie-filled coronary arteries and a ten-ton elephant sitting on his chest - he'll be screaming for the best cardiologist money can buy." - This is an hysterical, stupid, cheap shot at eduacted technology professionals not even worthy of a response. But in the intrests of being thorough, I'm giving one anyway
4) "Wait, wait you have to fill out the database.. the computer is better, your HMO says so..." - I don't think it was ever suggested that this tool be used in situations where seconds count.
5) "FIX HEALTHCARE by fixing the mundane problems: [blah blah blah]" - Yes, insurance and tort reform are well-known needs in many industries, including healthacre (at least until they allow us to start hunting lawyers to thin out the herd, prevent overgrazing and starvation, protect the species, etc.). Money? Yeah, let's just throw even more than the current 1/7th of our GNP (at least here in the US) down this rathole...
6) "stop belly-aching about egotistical doctors, for every high-profile bastard physician there are twenty doctors who work very hard, destroy their own families and life to care for your families." Dude, you're not exactly helping your cause here. And most well-adjusted people don't go around bragging about destroying their families and their lives in pursuit of their careers. I would think that something that could potentially reduce the amount of work that doctors do would improve their families and their lives (unless said doctors are egotistical assholes and their families are better off not having them around).
7) "I hate hearing anecdotal bullshit that this database helped solve my rare sleep disorder that only 1 person in 5 million has. GREAT!" - I bet that girl who almost died would have been thrilled. But that's just me. For all I know she's a masochist.
8) Does it make healthcare faster, more accurate and above all *CHEAPER*.... doubt it.. - And if your reaction of unwarranted hysteria, fear, suspicion, hatred, and loathing of any new tool that may challenge your fragile ego is representitive of your profession, then we'll probably never know. It's a tool to assist in diagnostics. It doesn't trivialize the doctor's contribution to medicine. It doesn't remove you from the process. It doesn't steal your lunch out of the refridgerator. It doesn't make your dick smaller. It's here to help you. Give it an honest before you dismiss it.
And finally, my $.02. I'm a very healthy person (no ongoing medical issues other than bad eyesight). My limited experience with doctors has been mixed. My impression is that there is a bit of a correlation between doctors and experienced IT professionals: they both have to perform complex analysis with limited and often incomplete and inaccurate data. Some approach problems in a thorough and disciplined manner, some are highly intuitive (gifted, or just plain lucky), some are sloppy, rushed, and prone to snap judgements (that no one dare question), and some simply don't give a shit. Unfortunately, most that I've seen seem to fall in the last two categories. Maybe I'm just unlucky, but I seriously doubt it.
Personally, I think the problems are mainly systemic - doctors are spending far too much time performing tasks better suited to nurses and nurse practitioners; they get burned out because they can't do their jobs properly, and thus the downward spiral begins. Most HMOs would be better managed by any four monkeys from our local zoo (of course, the San Diego Zoo has some exceptional monkeys, but still). The number of improvements that could be applied to the health care industry (and schools and universities feeding it) can probably only be expressed using some highly esoteric mathematics. But if something reasonable shows up, you should probably give it a shot.
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