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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.
but certain doctors seem to feel threatened by this sort of database.
If you just payed a TON of money to goto medical school, would you then want all your education flaunted all over a network of information? Probably not, it's the fact that you know something others don't is what makes you money. This applies to specific fields, and research as well.
Things like this are why I firmly believe in having no discernible useful function within my organization other than to slack and criticise others -- lets see some computer database duplicate *that*.
Every year during my review, I just pray the words "slashdot.org" aren't mentioned.
Is that people tend to live the symtoms that their medical complaint suggests. That's why you have to run blind and double blind tests, to weed out people who unconciously fake what they know to be the symptoms.
Something like this could comprimise the blind tests.
[On the other hand, a lot of subtle bugs in software come from analysing the blind elements. Ie, trying to understand subtle behaviour.]
OS/2 - because choice is a terrible thing to waste.
from article:
"But, according to Cross, the neurologist who originally diagnosed the case as an REM sleep disorder had a very different reaction to the use of the software. When the plumber and his wife handed that doctor the PKC printouts, he shuffled them, left the room, and, Cross says, "returned with a very hostile, angry disposition." Viewing the results as computer-generated quackery, he refused to back down from his original diagnosis."
I read the article. This was the only example I saw...I'd say that's painting a very broad generalization. I also happen to know many doctors that EMBRACE technology.
Sounds to me like this was just one guy he was pissed because his diagnosis was proven wrong, and (like anyone) didn't like it.
Other than that, decent read.
Sent from your iPad.
Doctors are just technicians that happen to work on people. They are no more perfect than the grease monkey at the car dealership. Using a computerized database of information to research the very complex organisms we are is just common sense and is perhaps why computers became popular in the first place. Sure, some doctors will manage to make mistakes using a tool like this, just as some high school kids still can't seem to use a calculator correctly.
Suing for bogus information? One always has to consider the source of information. A dabase like this can be considered only as a helpful tool. Tools help find a working solution, but it takes experience to make it happen. A good doctor is someone who is responsible for using his tools properly, not pushing buttons.
Doctors need to think of this as a tool and not as a threat to their job. Just because I can try to diagnose my problems online dosn't mean I don't see a doctor. I am glad when I visit the doctor and he uses the computer or medical books to check the current best treatments or for other conditions with similar symptons - this shows the doctor is not oblivious to the fact they can't know everything.
As long as the software is properly regulated, just as docotors are, then there really shouldn't be a problem. The doctors can use the software to "help" and then make the final decision on the best course of action, as the computer cannot do that.
- HeXa
After reading this article, I am reminded of a good friend of mine, an M.D./Ph.D. student at Duke University, and some of the stories she tells me. I've heard of doctors that take advise even from an intern as a threat, much less advice from a computer.
The doctors that dismiss this type of aid out of hand are suffering from arrogance of the worst sort... they are dismissing a tool that can be used to further their patients health.
A person who has confidence in their own abilities can evaluate a tool and use the results as they see fit. While they need not use the tool as a crutch, they will use it as it is meant; as an aid to diagnosis.
They hate this because like everyone else they hate to be proven wrong let alone QUESTIONED. OTOH HMOs love this stuff because it represents one less person they have to hire.
Even herbal treatments in the absense of a proper amount of research can be troublesome. People tend to let themselves think that because it is natural, it can't be dangerous.
(* Things like this are why I firmly believe in having no discernible useful function within my organization other than to slack and criticise others -- lets see some computer database duplicate *that*. *)
In a recent slashdot forum on an AI topic, I concluded that it is easier to automate "rational" things than it is irrational [1] things, like marketing and PHB's.
Thus, techies will probably be automated out of a job before PHB's and sales. (That is if H1B's don't do it first.)
Geeks are Doomed! Eat, drink, and skydive from space, for tomarrow you are unlayable gutter meat.
[1] I don't know whether they are irrational, or just very hard or impossible to ascertain the rules for.
Table-ized A.I.
As the article points out clearly and several times, doctors are (usually) humans. This means they have personality traits that affect they way they accomplish their work.
In this case, it's ego. Of course no one wants to see a printout handed to them by someone who isn't a professional in the field saying "hey, this computer said you're wrong!" For chrissakes!! I wouldn't either. Of course there should be some level of interest and consession by the professional to review the information and test its validity. A doctor with an ego problem should be avoided just like a network engineer/administrator who thinks he already knows everything he needs to know about any given subject.
So yeah, it's fun to take the immortals down a notch back to Earth reminding them that they're still human. But it should also serve as a reminder to anyone who lives in the ever-growing world of science and technology (this does include medical science) that there is always something new to learn and never to stop challenging the "facts" that have been layed out before us. Oddly, there is no "spontaneous generation" as was once suspected and those "wandering stars" (aka, planets) aren't like other stars for more reason than the fact that they don't move like the rest.
And of course, let us never forget that "science" isn't about proving anything "right" so much as it is about proving things to be wrong. It's never easy to know the truth. But we get closer every time we eliminate that which is untrue.
This could be an extremely useful tool. Why any good doctor would be opposed to it is beyond me. A truly professional doctor should be completely willing to defer to specialist or some sort of well-researched body when he is any less than 100% certain of his own work. Really, the only doctors I could imagine this would hurt are the bad doctors.
Most doctor visits that my kids and I have been to follow a rather simple algorithm:
1. Get swabs of patient mouth and ass
2. Perscribe patient antibiotics and
Codene.
3. Politely send patient away
4. Send swabs to lab
5. Play golf
Table-ized A.I.
Even if that information were detailed and free for anyone with an internet connection, part of going to medical school is to learn to accept responsibility. Any fool can read a car manual and learn how to fix his car, but if he is wrong and breaks the car, who has to pay to fix it? Also, do you think that us non-doctors can prescribe medication for ourselves? Doctors should not feel threatened at all.
Job? I don't have time to get a job! Who will sit around and bitch about being broke and unemployed then?
If I want a second opinion, do I leave the Oracle office and drive to Sybase?
Table-ized A.I.
I personally would like it if both the doctor and database agreed on the prognosis.
It would also be interesting to add some sort of artificial learning to the system. Recognizing patterns such as, "people at this clinic seem more likely to display these symptoms, which means that cancer based on the local environment is a strong possibility." or "This patient has a genetic predisposition towards disthymic disorder, and now seems to be showing some of the symptoms. Normally, it would be diagnosed as a sleep disorder, but with the genetic predisposition in mind, we should be weary of that."
ObDisclaimer: IANAMD
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.
...because their expertise is knowledge based and any knowledge based profession is vulnerable to the same thing that is currently happening with the programming profession: It's being shipped to other countries in order to lower costs while raising profits.
For example, a hospital/HMO combo needs to watch costs, so has local technicians to do the local non-surgical stuff. Information on the patient is interpreted by an MD in India for low bucks, and the local technicians do the final, hands-on work if needed. Only time the hospital/HMO needs a "real" doctor/surgeon is when the patient really needs that level of hands-on work.
Hospitals/HMOs stand to make much bigger profits from this scenario and you can bet your doctor's bottom dollar they know it.
I repeat: Any and every profession which is knowledge based is vulnerable to this type of exporting.
"Sorry kid, I hate giving good people bad news." -- The Matrix
Everything in the Universe sucks: It's the law!
No, make sure you tell your colleague doctors are more than databases. This is a tool, probably capable of making doctors more effective but not a replacement.
Try not. Do or do not, there is no try.
-- Dr. Spock, stardate 2822-3.
Too much information is bad for some patients. For example there are books available to doctors which compile every medication available and what the results of the clinical trials were. Every result - from effect on symptoms to side-effects to placebo effects (the side-effects that the people given placebos developed) - in brutal detail. If you prescribe Foo(tm) for illness bar, and the patient looks and sees that a patient given a placebo Foo had a heart attack, what do you think they will do? The rare individual will say "Wow. Weird." and understand that Foo is perfectly safe. But the majority will run away screaming to another doctor and refuse treatment with Foo for the rest of their lives.
Everyone thinks that doctors are just data libraries and that anyone with the same information could do just as good a job. Not true. Most of the job is interpretation. That is why different doctors make different diagnoses. The doctors most respected by other doctors are those that consistently "see" things that others don't ("Well this looks like bar at first, but it reminds me of baz for some reason. Let's do some tests to check that out.").
Serve Gonk.
It's not at all uncommon for people to stop taking prescription drugs when they feel better. And to give the rest to friends or family members with similar symptoms, despite the fact that doing both of these can be very dangerous. Why? Because people "know what they're doing". If someone has the same symptoms as you, they must have the same illness, right?
Isn't it common for medical students, at the very start, to go looking for zebras when they hear hoofbeats? Well when you hear hoofbeats, chances are it just a horse, and doctors know that. But many times the students at the start go looking for odd diseases. All we need is for normal people to type "headache, sneezing, aches, tiredness" into a computer and see things like Bubonic Plague, Ebola, Haunta Virus, and other such things. Nothing spreads panic and fear like a little knowledge.
As the saying goes: "A little knowledge can be a dangerous thing"
Comment forecast: Bits of genius surrounded by a sea of mediocrity.
It's actually frequently worse than this. (I work currently with 8 doctors, four pediatricians, three internists, and one FP. I've worked with.... Problem two dozen over the last few years. What I say doesn't necessarily reflect on the ones I currently work with.)
Doctors have bad egos. Really bad. Many of them refuse to acknowledge the shear drudgery of their average daily workings. Like another poster said, every one of her kids visits were the same. Yeah, no kidding. 90-95% of the visits to our office are within a few categories. Colds, heart problems, diabetes, and checkups of various sorts. (There are a couple of others, but not many). Yet it is not at all unusual for doctors to rail at this sort of technology for even these cases. They cling to an absurd belief that each patient is different. That, to put it bluntly, is bullshit. Most patients are the same. This sort of tool would make the routine stuff go MUCH faster, and would help narrow down the weird stuff to where you are doing real tests to really differentiate between two different (or five, or whatever) diagnoses. Of course, when those weird cases are programmed...
Others in this topic have mentioned that docs embrace new tech. Kinda. They embrace new diagnostic tools that they can play with. But they are not as in love with decision making/helping tools. It undermines their education. It undermines the fact that most of them just have incredibly good 'wetware' databases.
I would also discount the actions/thoughts/ideas of younger docs. They frequently change by the time they hit their mid-30's. I've seen it before, I'll see it again. They love the idea when in school/fresh out, but come to believe in their own manifest godhood over time. No mere pile of silicon could be greater than I.
Another problem that I actually do sympathize with is that this is grounds for serious lawsuits. You could claim your doctor did nothing/wrong thing based on what some stupid machine said to do. Any rational person knows the doc shouldn't automatically trust what the machine spits out, but you and I also know that there will be at least one or two docs who, when these things gain wider use, will take an extra martini at lunch, counting on the machine to catch his stupidity, ignoring the fact that the man and machine have to work in concert.
Given the decision support software (the drug interaction databases are one example. The only problem is that EVERY reaction is typically flagged, so you need to know what's going on to interpret the data. Kinda like the discussion of SQUID and other NIDS the other day) I can forsee this making strides. But it will be some time. Twenty years? There are two scenarios where this will happen faster:
First, HMO's and other insurance companies use this software or something similar to find out how quickly their docs are zeroing in on diagnoses. If they find something that lets them diagnose in one visit instead of four, they'll use it. And that's good for them and good for the patient (cheaper, quicker, more accurate care). The other scenario is one wherein the government mandates this sort of testing. Likely it would manifest similar to the HMO model, and be used to cut costs of state-subsidized healthcare. Again, not a bad thing.
The better docs I have spoken with (and being raised by a physician, I've likely spoken with more physicians than the average slashdotter knows) wouldn't mind getting to deal with the tough or fringe cases. That is a challenge. That's interesting. Pap smears and kid shots are rote drudgery.
I hope we'll see this gain prevalence soon, but don't count on it. And, as the article says, docs are more likely than ANYONE to dig in their heels.
Jesus was all right but his disciples were thick and ordinary. -John Lennon
As someone who will be graduating medical school in about a year, I can point out what my biggest hope/fear is with this kind of software -- and its not what readers have been suggesting in this thread up until now.
... time management. Most patients don't seem to realize what ridiculous time constraints we're on -- the massive patient load we need to see just to tread water and keep the HMOs/hospital adminstrators/etc happy.
The thing that makes me both intensely interested and worried about this method of diagnosis is
One of the most important parts of our training is learning how to balance diagnostic thoroughness with constant efficiency, and we learn all sorts of methods to do this. Any system like this software could seriously disrupt our breakneck pace, and its value is entirely unproven. Since the healthcare system is already stretched to its breaking point in the US, I worry that any changes that lower efficiency will send us into a tailspin.
Conversely, the idea that we could add such a powerful new tool to our arsenal seems like a dream come true. I would be thrilled to spend more time with each patient, to have a system that makes our diagnoses even more accurate and more focused, and to always be able to encompass the latest literature's suggestions and results.
The big hurdle to overcome in testing and implementing a system like this is getting the necessary volunteers. I'm not sure that I would be comfortable (when I'm about $300,000 in debt from medical school) being trained in such an unproven method of diagnostics. I suspect that most other medical students/schools, when faced with the uncertainty of the situation, would be equally reluctant to commit their money and their years to take such a risk when practicing modern medicine is already such an uncertain proposition.
I really take offense to the people here who state that "The AMA are just a bunch of money grubbing..." whatever. These people have no clue as to how much the average doctor gets paid these days.
As a resident ~ $37,000 a year for ~100 to 110 hours of work per week.
As a Primary care physician ~$180,000 for ~80 to 100 hours a week (of course this figure really depends on how much you want to work)
As a specialist ~ it really depends. Usually not above $300,000 a year
And that's after 4 years of college, 4 years of medical school, 3 years of residency, 3 years of fellowship and for some a couple of years post fellowship. And, remember that most people are in the hole ~$180,000 - $200,000 (including interest) after medical school.
So, in my particular case I'll be seeing $300,000 a year after 12 years of getting under mimimum wage. If anyone wanted to cut it more than that, well, then bye, bye medicine. You can go see the baseball players that get $5,000,000 a year (and still want to strike for more money) hooked up with a medical database.
That said, I think that the database is a good idea. Technology is our friend -- already my colleagues and I use software for the Palm platform which finds obscure drug interactions. The PKC is an extension of this kind of functionality. Change is good.
Comment removed based on user account deletion
Doctors used to taste urine to diagnose diabetes. No kidding!
There was also a well-developed technique of thumping parts of your body while listening with a stethoscope. A skilled practicioner could learn a surprising about about what was going on inside your body from this (very valuable in the days when there were no CAT scans, or even X-rays, and exploratory surgery meant almost certain death from massive infection).
New diseases would presumably be entered in the database the same way that they get into the wetware databases that doctors use now. Patients present with symptoms that don't quite fit anything they know about. They try a treatment, then another, then another.... Over time the pattern of symptoms gets recognized as a new disease, and the treatment becomes standardized.
The difference is that with an expert system this process could be much, much faster than it is with the old-fashioned word of mouth method, or even with journal publications.
Doctors are just technicians that happen to work on people
In the John Varley "Eight Worlds" fictional universe, automated medicine has become so perfect that (e.g.) movie stuntpeople actually do get shot in the head or leap off a building. They're modded such that their pain centers are turned off, and they have replacement parts like titanium skulls with shock-absorbing mechanisms. As long your skull doesn't get crushed, and as long as they get you in the tank in time, the autodoc can fix anything
In one of the stories a small boy is watching a human medico fix up an accident victim using the automated equipment. "Think you might like to be a medico when you grow up, son?" "No thanks. My teacher told me I need to go to college so I can get a good job."
Heh.
What I hate about techies is that they think that eliminating the human part of the equation will make it flawless. "Nothing beats pure Data".
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, can you sue the database for misdiagnosing or missing something. NO, because you didn't give it the relevant data.
The issue here is that the combined use of the physician's skills and a database like this would be very powerful. Unfortunately filling out a LONG list of questions is time-prohibitive unless the patient does it for themselves.
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.
Wait, wait you have to fill out the database.. the computer is better, your HMO says so...
FIX HEALTHCARE by fixing the mundane problems.
1) insurance
2) tort law
3) staffing
4) prevention
5) research
6) records / IT
7) education of doctors and patients
8) money
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.
I hate hearing anecdotal bullshit that this database helped solve my rare sleep disorder that only 1 person in 5 million has. GREAT!
Does it make healthcare faster, more accurate and above all *CHEAPER*.... doubt it..
I can easily picture myself querying the expert and finding out that I need a lobotomy. Without even questioning the answer, I still need someone to perform the cut, don't I? Moreover, if I am the least serious about my health, assuming that I work daily with computers/databases, I would not let the machine have the final word. But that's just me... Now, you can argue that very soon we could have the mechanical arm that would perform the operation right away... Why not? Are you a volunteer for the early tests? ;-)
This is a concern for sure.
Another is privacy. Imagine your employer
getting access to your medical record or
simply noting a few things about you,
running an internet diagnosis and seeing
that there is a small probability you
got cancer/hiv/paranoia/...
Just seeing that as an option will raise
flags. Or imagine the rumors that will
circulate in the workplace behind your back
for no good reason. Anyhow, like anything
else this has its downside too.
I'm not surprised that your friend made an off the cuff remark like this which portrays physicians simplistically as a walking database. But I think it would be closer to the truth to call them walking neural networks which are constantly learning and which use databases (reference books) to affirm their suspicions, and also who are cerified by a board and licensed by the state to be responsible, ethical, and competent.
Doctors must also take into account that the person describing the symptoms may have more than one condition simultaneously, that the patient may be exagerating something common or normal as a symptom because he believes it is related to the other actual symptoms. As others have pointed out in this discussion people can unconsciously pick up symptoms based on information they have read. It is rare to have a doctor these days that knows you for very long and who has treated you and your family for many years but that would give the doctor more insight into what the problem could be.
The article starts off with an example where Dr. Cross had an unusual case for which he did not recognize the symptoms and which turned out to be a condition he hadn't even heard of before. This is a situation where using this program makes sense; it merely computerizes the literature search. But I disagree with you that doctor's could easily be replaced. This program can only be a helpful tool used in conjunction with all the physicians other tools.
The doctor must be the one who diagnoses. He can not become just a technician asking the patient questions and entering the response into a computer form. Physicians are licensed for the same reason that Professional Engineers are licensed. When human life hangs in the balance, someone must be accountable to make sure things are done right.
One of the things that get me excited about this is that the PKC could (but doesn't yet) have all sorts of information that normally would be out of the realm of your average doctor's personal knowledge base. On the other hand, I would think it wonderful that the doctor could pull up normal diagnoses--and the computer also say what a person who was a trained homeopath would say, or a trained doctor in traditional chinese medicine, or someone who was an Ayurvedic doctor, et cetera. The doctor could then leverage all that knowledge into more advanced solutions--even if their training wasn't necessarily in that field.
Having said all that, I think one of the main uses of a doctor is their intuition--and that isn't exactly replaceable by a computer.
Interesting analogy. I'm a technician. I repair machines and its best to see what's wrong when they are actually running. Replacing parts during production is often desirable since I get to see closely how it is performing. Sure, there's 600 volts for the motors, 110 for the control lines, hydraulics, and pneumatics, but being aware of energy sources makes informed decisions on how to make the best repair.
When we could lose $10,000 in scrap for shutting things down, its less of a hassle to keep things running. It takes too long to get things started up again, so I just fix it when it runs. That way, I can get it over with, head back to the office, lock the door, kick back in the recliner, and browse slashdot all night.
Try to replace a human brain with the human alive. That I'd like to see.
To put this into a perspective the /. crowd will understand (no, it doesn't involve first posting or Natalie Portman and hot grits). What doctors do today is the equivalent of reading a programming language reference manual and then coding in that language using only memory and using compiler messages to work out when you get something right. Sure, after you have been programming in a language for 10 years you could do this but you'll still need to refer to the reference manuals occasionally when venturing into unfamiliar territory.
Using computers to do this is much more effective than trying to write programs that do the diagnosis. Computers can't reason, humans can (well most can ... ok some). To quote Dijkstra, "The question of whether a computer can think is no more interesting than the question of whether a submarine can swim."
Nerd: Derogatory term typically directed at anybody with a lower Slashdot ID than you.
At a tertiary or quaternary medical center, the case could reach the world's expert.
That's fine, assuming that the patient doesn't die before he gets there, either through the passage of time or because his primary physician misdiagnosed rare-but-deadly condition A as common-and-nonserious condition B.
You know better than I how much of medical school is essentially nothing but rote memorization. Why waste several years of the most productive portion of a bright young person's life with that?
Especially since the amount of medical knowledge greatly surpassed the amount that could be held in one person's head many, many years ago.
It's like the programming job interviews where they ask you questions about the parameter order for some obscure library function, but never seem to test you on whether you can actually write a program that runs and produces the correct output.
The only advantage of rote memorization is that it's easy to test. It fails miserably at measuring whether the person is actually competent in his or her domain of expertise.
The article was completely bereft of technical information...
Naive Bayes? Pure Term Frquency/Inverse Doc Freq IR techniques? Knowledge Based?
The earliest expert systems I know of was in the medical domain (EMYCIN), yet as far as I know it was regarded as very brittle.
I'd be a little less skeptical if there was some information on its basic operation....
Winton
Anyway, of those four diagnoses, three were wrong. Based on that, it sure doesn't sound like diagnoses are easy to me! Add to that the fact that I'm pretty good at troubleshooting and I'm one of the few that I know of. Most people flail about trying things at random and, as far as I know, training isn't much help for most of those people. Yes, it's easy to memorize a few pat answers to the most common problems, which is why many people who visit the "doctor" wind up seeing a PA, who forwards to the doctor only those cases whose diagnosis is in doubt, but that's exactly why this sort of thing is important. As time goes on, doctors are going to be less and less likely to see the simple cases.
You mention psychiatric diagnosis, so I'll talk about those. A quick check of my local DMDA chapter shows that some 70% of those suffering from some serious mental illness were misdiagnosed at least once. I can't help but think that a computer program that prompts the asking questions about typical symptoms of mania and schizophrenia would reduce that because most of the misdiagnoses start as a diagnosis of depression because it's what people complain about. I know the doctors don't ask those questions because in the sample that I have (8 so far) none have asked the right questions to make what we (that is, myself and the ill person) now believe is the correct diagnosis.
In any case, since visiting a doctor (and I spend a lot of my time in doctors' waiting rooms so I know this quite well) is something like an hour waiting to see the doctor followed by maybe 10 minutes of answering questions I don't understand, filling out the forms while I wait can't do me any harm even if the diagnosis is not remotely in doubt or irrelevant to the treatment, can it? I mean, it becomes part of the patient history just like the temperature and blood pressure check you're going to do whether I come in with a fever or with a splinter, right?
Heck, I suggest you put terminals tied into that database in the ER waiting room so there'll be something to do while you're waiting the 4-6 hours (on average) it'll take to get to the head of the line.
"IAAI (I am an idiot)"
You certainly are. What were seeing here is stereotypical attacks on doctors, due to the strict way the medical profession and services are dealt with.
Imagine for a moment that there was a database created that contained almost every single set of expressions and solutions for (insert your programming language here).
So instead of having software companies and hordes or programmers, companies can get their own software by feeding in to the requirements to this database, and it spits out the necessary code.
Now imagine the outrage you would have amongst programmers and software houses around the world, since they are now effectively redundant.
Just because some doctors are highly paid, and have strict controls on the medical services, doesn't mean their views and outrage should be held contemptable, until you have fully assessed the pro's and cons. You bet your bottom dollar slashdot would give programmers the benefit of the doubt in above situation, so why can't we give doctors some leeway and a reduction of ad-hominem attacks here?
Slashbots: Jealous, selfish and unreasonable. Get over yourself.
Think nothing is impossible? Try slamming a revolving door.
You hit on two very important things (IMO):
1. Obscure/remote health issues. People who have spent even a week in a different part of the Unites States than where they live may contract illnesses that a doctor back in their local hometown may never have heard of, and hence can't diagnose.
For example, here in the SouthWest (Arizona, So. Cal, Nevada) there is a soil/dust borne fungus that when inhaled can cause flu like symptoms. Unless you are from the area a doctor is very unlikely to diagnose Valley Fever properly. If left untreated the fungus can disperse to other tissues, the blood and bone. Death is not uncommon if left untreated. A computer system would be able to take travel history in to account and offer Valley Fever as a possible diagnosis. The doctor then steps in and orders the proper labs for a complete diagnosis. As a partner to the health professional such a database/expert system could 'save' many lives.
2. Doctor's power issues. I can't tell you how often a doctor grimmaces when I call them by their first name instead of "Dr. Important". They are people and I am people, I refuse to cower to their concentrated training in a particular field. I certainly don't expect them to call me Mr. Important when I meet them in a business meeting in my field of expertese.
Not all doctors are like that I know. All of the docs I see on a rgular basis are well grounded and have no problems with a first-name basis relationship. In my personal experience they are also much more likey to make me an interactive part of the heath care process instead of treating me as an object or a mere disease to be cured. The catalyst for more doctors to give up that power-centric relationship is for the patients to not tolerate it. Either explain to your existing doctor what relationship you want to have, or find another doctor.
I've just about gone to court several times with doctors. I'd (for example) have a 2pm appointment. I'd show up at 1:50pm, sign in and wait. At 2:15pm if I was not being seen by the doctor I got up and left. Often the office attemtped to charge me for the appoitment, or a cancelled appointment fee. I told them I had a 2:00 appointment and that the doctor was the one who cancelled the appointment by not showing up on time. If they don't respect my time, they don't respect me and I don't do business with them.
Article X: The powers not delegated... by the Constitution...are reserved...to the people
"If a diagnosis is the easy part of medicine, then how come it's so often wrong?"
1) Because every single person is different. Every disease can present differently is different people.
2) Lack of time. An average family doc spends about 8 minutes per patient. This is due to a number of things. You actually have to earn enough money to pay for your practice and have a salary on top of that. There are way more sick people than there are time and resources to treat them. Obviously it would be great to meet with every patient and their family for an hour, but it's not practical, so there is a trade off. In this short span of time things will be missed. That's a shortcoming of the system not the physician.
3) Lab tests are expensive and these costs are born by the indiviual, insurance companies, or the government, all of whom have a vested interest in keeping costs low. You don't test for rare diseases, unles there is an overwhelming reason to do so, simply because the above groups cannot or will not pay.
4) There are bad physicians. Fact of life.
Personally I think that this database would be useful, although I doubt that there would be much in there that doesn't exist in the literature already.
What I object to is the portrayal of physicians as bumbling buffoons bent on preserving their undeserved elite status at the cost of proper health care.
People expect too much from a family physican. They cannot possibly know enough to accurately treat and diagnose every problem. The database described already exists in the form of medical encyclopediae and internet databases and colleague's advice. Using these resources physicans are mostly right most of the time. It is unreasonable to expect more than that.
Indeed. But perhaps having information "in the literature" isn't terribly useful if the doctor doesn't have time to look it up. If the doctor has only 8 minutes to spend on each patient, I imagine a program like this could be very helpful -- sort of like a quick check for something on Google instead of having to trek down to the library for an hour or two.
Using these resources physicans are mostly right most of the time. It is unreasonable to expect more than that.
Given that a physician only has so much time in his work day, the less time it takes to look up things in the literature, the more queries he can make, and therefore the better quality his diagnoses will be.
I don't care if it's 90,000 hectares. That lake was not my doing.
Expert systems are nothing new. MYCIN (a drug interactions expert system) was developed in the 70's. Essentially, they're huge checklists developed by picking physician's brains, to create a system that would model a doctor's diagnosis procedure. However, it looks like only now, with the widespread use of computers, and a way of hooking them all together, is this technology getting into the mainstream.
Keep in mind though, real doctors have to keep updating the system to reflect new technology and new research (something real doctors have to do for themselves.) As such, there will still be demand for the best and brightest - and for the rest, they can use an expert system to help cover the bases (for liability reasons, I envision that final diagnosis will still need to be made by a real, certified doctor.) Too bad real AI, the kind that could make decisions and adapt to new situations (self-learning, possibly self-aware) is still a long ways off...
Personally I think that this database would be useful, although I doubt that there would be much in there that doesn't exist in the literature already.
Ummm, one of the main points is that "the literature" is so huge that no one human being can be expected to know it all and apply it, and there is lots of evidence to back that up.
What I object to is the portrayal of physicians as bumbling buffoons bent on preserving their undeserved elite status at the cost of proper health care.
I didn't see anything about "bumbling buffoons", merely human beings reacting instinctively to something new that may affect the status quo to an uncertain degree, mixed in with healthy "show me the proof/evidence" type reactions.
People expect too much from a family physican. They cannot possibly know enough to accurately treat and diagnose every problem. The database described already exists in the form of medical encyclopediae and internet databases and colleague's advice. Using these resources physicans are mostly right most of the time. It is unreasonable to expect more than that.
Now this I object to. First you say that they can't know it all and diagnose everything, then you say they can with these other resources and the literature, which evidence shows one individual can't possibly have fully covered since it becoming so extensive.
No, I don't expect a simple human being to be perfect. But I strongly expect, nay DEMAND that you adopt any proven method that increases your effectiveness, and I object to anyone who obtusely reacts with gut feelings and animal instincts to change as a "threat".
If in major case studies this tool is proven to be a significant help when used in a specific way, would you adopt it?
Or would you insist on the continued use of leeches for those with fever?
I work for a Medical Practice Management Group, we do outsourcing for medical offices. The reason that most of these applications (which BTW have existed for years) do not get used is that: 1) A system like this requires lots of GOOD data (remeber crap in = crap out) and 2)there is no-re-imbursement for the physician for paying to have someone input all this data into a system of this type. Its all about re-imbursement, that is what drives the system, if docs don't get paid for it from either insurance companies, medicare, or patients, then its not going to happen.
Rule of Life Number 2: Remember, it can all go to hell at any minute. --Jimmy Buffet
My first thought upon reading this was, "Damn, I wish they'd make something like this for the cantankerous mid-70's Volkswagen I torture myself with." But then, I've written expert systems before, and I know their capabilities (and limits).
My second thought was, "Damn, it's a pity that doctors -- possibly the only class of people on earth more computer-illiterate/phobic than public school teachers -- are responsible for our health care, because they'll never adopt this."
To be fair to doctors, this kind of paranoid fear of "thinking machines" is borne of a very widespread ignorance about how computers work. Everyone here is, of course, immune to this fear for the simple reason that we all know the difference between computation and thought. But we also know -- as I wish to hell the general public would learn -- that computation is something that thought can emulate very, very inefficiently, and it's just plain wasteful to have valuable brains performing mechanical data-retrieval and simple logic when machines do it millions of times faster and more accurately. Let the machines do the grunt work and save the brains for intelligent thought.
Proud member of the Weirdo-American community.
Are you sure those are really antibiotics??
There are plenty of placebos that a doctor can describe, and they look exactly like antibiotics to the patient, right down to the patient information leaflet inside.
I would hope that doctors who need to give patients a prescription to keep them happy are giving them a placebo and not an antibiotic.
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What doctors? In only one or two more generations they'll (hopefully) be mostly out of work thanks to the "miracle" of the Artificial Immune System and self-repair nanotechnology.
Any virus, bacteria, pollen, spores, molds, drugs, unwanted sperm, smoke, etc., would be neutralized the instant it bumped into a SuperWhitey(TM) if it wasn't on the trusted whitelist (Palladium for your body--parents could even prevent their kids from getting high).
And if you break your (non-reinforced) leg? Why wait for your normal body functions to repair the damage when it can be fixed by an "intelligent swarm" on the molecular level in no time.
Another few generations and humans should have finally ditched their frail wetware anyway.
Thanks for providing the trigger for my mental masturbation. :)
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Power to the Peaceful
I'm sure many comments will start this way...
Amazing magic tricks
"Bar." Your car is here for scheduled maintenance. Example: Oil change.
"Bar, on the face of it." While inspecting your car, I found the following condition. Example: bad brake light bulb.
"Bar, that's going to get worse." Example: That squealing means you need to have the front rotors turned and new front brake pads replaced before they start grinding.
"Bar, I've seen that a hundred times." This will fix a particular problem. Example: That grinding noise means you need to have the front rotors and pads replaced right now.
In the first example above a good AI remembers that exactly x quarts of oil are needed so the mechanic can do it as quickly as possible and the bill reflects it seamlessly. Doctors already do their accounting by computer. Results already come back from the lab with the data checked against norms and anomalies highlighted.
In the second example, we start looking for things. The better the checklist the better the inspection. A good AI list includes checking all the usual things, checking all the known odd things about that particular car, and leaving out items known not to be an issue. Example: Car model A is subject to a fuel pump recall. The first time the car comes in the item is on the list, check fuel pump. If it is old we change it, if it is new we note it, and in either case, it will not be an item again. No mechanic can remember all this.
The third example is the hardest one. This is where the human judgement factor is strongest, selling brakes preventively and talking about driving habits. There is room for AI in situations like this, but not as much. This is the customer service stuff mentioned in the third paragraph above. It isn't easy being a mechanic either.
In the fourth situation, the diagnostic part of the AI is exercised. Maybe the problem isn't the most common one. Example: The car has a bad ball joint which causes it to pull to the right when the brakes are applied and a bad brake caliper which causes it to pull to the left. Net pull is zero. If it isn't caught, an inadequate repair will be made. A good mechanic will find it most of the time. A good AI will help almost every mechanic find it almost every time. It passes on knowledge to the young and reminds the old. What I wouldn't give for a decent program like this. I think that it would reduce errors of cognition. "It looked like bar to me, boss." Who among us has always looked for and found the colons among the semicolons?
FWIW, When you take your car to the shop, make sure you describe the symptoms you are concerned about more than your theory or preferred solution. Leave a note on the passenger seat with the same information and a five dollar tip for the mechanic and you will get better service. Trust me on this.
In conclusion, a good AI assistant is useful at every step and most of the kinds of things one can do are already being done. It will make a doctor faster, more accurate and richer. From a patient's perspective the most important thing is a timely correct treatment. I don't see how this can hurt the process. What seems to be wanted is better AI and I have no doubt that writing the good stuff will require brilliant doctors. It will make me feel safer. Patience.
SingCP@yahoNOSPAMo.com
All your database are belong to U.S.
As the article noted, the idea behind the modern differential diagnosis is to look at the branches of the decision tree that are very highly probable or very serious and rule them out. What isn't ruled out is treated. This approach maximizes the effectiveness of the limited human memory in treating disease, and it has evolved over many years in the medical profession.
Your doctor's ability to get the diagnosis right on the first pass is dependent upon the following:
his/her knowledge of the latest research
his/her willingness to consult colleagues or books or articles when in doubt about something
that he/she didn't forget any piece of knowledge relevant to the situation
Dr. Weed's tool does several things:
it increases the probability that the diagnosis will be accurate on the first pass
it logs the specifics of the course of diagnosis and treatment taken, in order to allow the medical profession to learn from its mistakes much more quickly than before.
Imagine what mankind would learn if all of this information were documented. Everyone's medical records and the questions/answers/tests behind every diagnosis. This kind of technology has the potential to truly revolutionize modern medicine, both in terms of cost and effectiveness. Dr. Weed has created a tool that will feed this database and make its insights readily available to any physician. It is like a bionic arm or xray vision. This won't replace doctors, it will empower them like never before in the history of mankind.
Doctors: Don't worry about this replacing you, worry about how you can use it to change the world.
Amazing magic tricks
Medical science is evolving very quickly. One big problem is that by the time something is published, some of the information is already outdated. Medical textbooks are revised numerous times before they reach students' hands.
Alot of doctors would love to have a high quality database. Yet in the US, doctors are very strapped for time. They often are cramming as many patients into their schedule as possible. They have the conflict of wanting to help as many people as possible vs giving quality care (doctors are often compulsive, so wanting to work less to have a life isn't as big a deal for them as you might think). My point is that if they use this database on each patient, it will mean that they see fewer patients per day. That would definitely be a 'bad thing.'
"Never, never suspect the dreams within the dreams of dreaming children." ~The Amazon Quartet
Yes, doctors do have egos. They also study for the rest of their lives. You can't legally be a doctor in the US without taking classes etc. each year. While there are some doctors who try avoiding learning anything new, most want to keep up with the latest and greatest research... kind of like how computer nerds like to keep up with the latest and greatest in computer science.
The biggest problem with this database idea is that using it takes time. In the US, there are more patients than doctors can handle. Using this database on each patient takes up more of their time, which means that the can see fewer patients per day, which means you have to wait longer before being seen by a doctor when you need medical attention. Something like this should be used by nursing staff, not the actual doctors. Even then, the nurses are also pressed for time.
The second biggest problem is keeping the thing up to date. Such a database would be vast and rapidly changing. I am sure you grossly underestimate what this undertaking is.
So don't post wierdness when you don't even know what the issues are!
"Never, never suspect the dreams within the dreams of dreaming children." ~The Amazon Quartet
Making a diagnosis is usually following a decision based on observed symptoms. Expert systems excel at this, but you still need, for the time being, someone with enough skill to correctly find and identify the symptoms. That's where the human skill is needed, but studies in the 1980's showed that when fed symptoms, computers were better at identifying more uncommon problems.
A lot of medical school is learning to act like a doctor: to dog the interns and to be just appropriately arrogant with the patients, secretaries, etc. The same can probably be said for most other professional degrees - a large amount is socialization. So of course the MDs don't like it. It doesn't invalidate their actual medical knowledge, but does risk pointing out how much is theater.
Beta is broken and the link to classic doesn't work. Stop wasting our time or there won't be anybody left here.
Of course, some of them are hostile because the patients that question their judgment are frequently fidiots.
Bob: Doctor, I've seen a lot of ads for this "Proboscum" pill, and I think I need to start taking it. It'll make my life better.
Doctor: Bob, "Proboscum" is for pregnant women.
(That's paraphrased from a Non Sequitur strip, I think.) Especially in poor areas, doctors see a lot of people who are falling apart because they don't take care of themselves. It's quite likely that, while these people may have opinions, they're more likely to be the cause of than the solution for the problem.
This isn't to say that a good doctor isn't open to suggestions. A good doctor, if they're not sure what's going on, will send the patient to get diagnosed by the right person. This doesn't always happen, unfortunately.
--grendel drago
Laws do not persuade just because they threaten. --Seneca
Nope.
Did you ever see the "Miracle of Life" special on PBS? Remember when the blastocyst (original ball of cells) folds in at both ends? The outside becomes the skin, the folded-in parts become the gut, and what's in the middle becomes the organs.
Your digestive tract is lined with epithelial cells; it's very much like skin. It is, in a sense, actually on the outside of your body---that is, there's a path through your body where the munchies pass through, like a tube going from mouth to anus, that nutrients are absorbed through the walls of. This means that very nasty stuff can be stored in your digestive tract: hydrochloric acid in your stomach, bacteria in your intestines.
If your intestines get punctured, the bacteria that live in there, which are good when they're in your intestine, wreak havoc on your system. This kind of infection is called peritonitis (you might have heard of it) and it's life-threatening, above and beyond the "hey, I have organ damage!" level.
Hope this has been enlightening.
--grendel drago
Laws do not persuade just because they threaten. --Seneca
Yeah, a drug company bought my wife and I a steak last year. I don't quite think we're ready to sign over our first-born child to pay back that debt.
Dewey, what part of this looks like authorities should be involved?
No, the entire society pays and due to the payment being filtered through "I don't care" bureaucrats, the aggregate cost of medical education is generally higher there than in areas where such costs are easily identifiable and people can fight for cost savings.
The fact that the beneficiary of a service doesn't pay for that service increases the likelihood that the service is actually more expensive and will be more often wasted.
More to the point, it's called 'I didn't' syndrome.
"I didn't go to Medical School for, what, 8 years, internship, residency, all that crap, just to have some goddamn machine tell me how to do my job."
Which is, of course, silly, because these things aren't doing the Doctor's jobs; they're helping the Doctor's do their jobs. It's just as valid to say that keeping a copy of that lovely Physician's Desk Reference, or Grey's Anatomy, or any form of paper references, is 'telling them how to do their jobs.'
Vintage computer games and RPG books available. Email me if you're interested.
Let's say a computer did the same thing. It's hard to argue that anything else should be done. There are millions of diseases, so it's good to have a computer remember all of them. Unfortunatly for the computer, those diseases all exibit the same few symptoms. Uh oh, the computer now has to decide which disease really is before it or be forced to print out more information than the doctor can read, store or act on as the treatments may be diametrically opposed. The process, if perfect, may diverge because it is both over and underdetermined (imagine that!). Perfect practice is impossible and we should not expect machines to save us, despite the fondest wishes of accountants and insurance agents.
Doctors don't kill patients, disseases kill patients. Doctors do what they can to not harm and provide all aid and comfort. How many people have you comforted today?
Distractions can kill. Doctors will adopt computers as they become more practical, ie non M$ impared, better form factors and I/O, etc, so they can spend their time thinking about medicine NOT a silly program. Until then, expect doctors to rightly refuse to adopt the impractical to achieve the impossible. The results will be greater harm. Are you willing to be responsible for that harm? Are you ready to stand up to the entire medical community and force change on them that they refuse as less than best practice? If not, shut up with that "crimminally irresponsible" bullshit.
DMCA, Hollings, Palladium. What might have sounded like paranoia is now common sense.
Actually, thumping and listening are still practiced in a lot of other countries where the money isn't plentiful to order these kinds of tests at the drop of a hat. The insurance companies would probably reduce their costs tremendously if they had annual competitions on stethescope/other old(cheap) methods of diagnosis. A few million yearly in prize money would be chump change compared to reducing the number of diagnostic tests performed because these basic skills were once again emphasized.
The key to breaking down computer phobia among doctors is husband/wife doctor/technologist teams. The technologist will go mad listening to the bitching and moaning coming from the doctor half of the marriage and will push technological useage forward just to make the pain stop.
btw: I'm the technologist half of such a marriage
B-)
The day computers have common sense they will make great doctors.
Consider the task, millions of diseases with a few dozen symptoms. The problem is over determined and does not yet compute. In the best of all worlds, the computer will have to do exactly what the doctor does: treat the most probable problem and watch out for the most severe consequences. It too will make mistakes, but won't know till someone types in a big long form. It's just not there yet.
Now quit trolling the doctors. They will tell us when they see an improvement.
DMCA, Hollings, Palladium. What might have sounded like paranoia is now common sense.
We (at PKC) are a bit overwhelmed by the discussion at Slashdot.com regarding our software. We have been building the philosophy, technology, and content for over 15 years now - all the while accepting the fact that the industry of healthcare didn't welcome our efforts. The most discouraging part (don't get me wrong, we are a generally very cheery and optimistic group) was the unwillingness of our detractors to offer much in the way of truly thoughtful dialog. The discussion we have seen spring instantly at Slashdot.com has been largely serious, thoughtful, and fearless. Thanks
I'm still trying to figure out if he meant stool as in a seat or stool as in poop. It's funny either way, though.