Interesting Enemies For a Diagnostic Database 409
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.
Well.. (Score:3, Interesting)
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.
Re:Well.. (Score:2)
Re:Well.. (Score:2)
Also consider malpractice lawsuits. If a physician badly misdiagnoses something and the correct answer is listed in a widely available database, that could mean big trouble for the doctor in court.
Re:Well.. (Score:2)
Boo. Hoo.
Perhaps the doctor should look in that same database...
Re:Well.. (Score:2)
Re:Well.. Let's give it a try (Score:2)
Re:Well.. (Score:3, Interesting)
A new technology is adopted if and only if there are valid scientific - which now means 'able to stand up in court' - studies to support it (or, more cynically, a drug company paying the doctor to use something as part of a 'study'). A new process ... such as not having interns work 48 hours straight ... just isn't going to happen anytime soon. That's part of the old-boys hazing mentality ... we had to do it, so we'll inflict it on those below us! The recently proposed bill to legislate the maximum number of hours an intern could work per week had 100 hours suggested!!! Does this sound like a group who would gladly acccept a 'new' technology just because it _could_ help?
To be fair, many doctors get into the field out of an honest desire to help people ... and this could help adoption of the technology. BUT there are so many forces and traditions against change in the profession, it will be a long time, if ever, before such a technology sees widespread use.
Doctors are using Palm Pilots now ... but it is my understanding that that is for note taking only ... when asked, every company that does software (including some medical software) has so far declined to do anything like the article suggests. The fear of lawsuits has been cited by a couple.
Actually its all about Re-Imbursement (Score:2)
Remember, lives are on the line here (Score:3, Interesting)
Medical license is technical / vocational training (Score:3, Insightful)
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.
Typical unthinking replies.... (Score:3, Insightful)
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.
Re:Typical unthinking replies.... (Score:2, Interesting)
Why in the world would you give someone's (here, a doctor's) views and outrage NOT be contemptable if he has not even evaluated the software package and looked at a printout? We are not dealing with programmers and their software, so your claim that we should give "leeway" is utterly ridiculous. Physicians deal with human lives, and they screw them up--they should be open to tools that assist them.
The physician gave a standard knee-jerk response which IS stereotypical. And that stereotype is very justified.
I've mentioned to medical colleagues in the past that "our responsibity is to put ourselves out of business." They were shocked and outraged and they WILL alieniate your sorry ass. Tell something controversial to a prof, even a slight challenge, and watch your subjective evaluations hit the floor.
The role of medicine and health professions is not make money but to heal and alleviated suffering. It IS to put itself out of business and the sooner the better. But it is in the business. It is a clear conflict of interest that the majority of doctors (not all) clearly and knowingly participate in.
Your very own analogy taken back to medicine would be like someone coming up with an all around cure and then the medical profession demanding a regulatory backlash so only they can administer it. It's ridiculous, greedy, and monopolistic. And you just stated you support it because you want to give them "some leeway". Please. If the technology is there and it gives benefit to the individual, not the industry or the profession, the better.
Having been to medical school and have MPH training, know several doctors personally in both academic, research, and in practice, taken health law as well as health econoics courses, I probably am far better versed than your insulting, cow'd comments.
Re:Typical unthinking replies.... (Score:2)
I really have no wider issue about this type of database, but i was commenting on a very biased attack here from people who tend to think that all doctors are in it for money, are snobbish and all doctors behave like that one mentioned in the article.
We had viewpoints from a handful of doctors, and one case of a doctor not accepting the proper diagnosis. While that is lamentable, I would still venture that it is in a small minority.
Irregardless of that fact, anything that is a new idea or concept, especially when, as you yourself pointed out, dealing with humans and the potentials of life and death, should be treated with suspicion. While it certainly sounds successful, you will also have to remember a lot of doctors (yes im generalizing) probably are not too well versed in technology, and probably have a limited understanding of what it can or cannot do in a large spectrum of cases.
My original post was nothing more than a comment on the stereotypicalisation of doctors, and to try and express that they should be given a chance for a full explanation, as well as a study, results and discussion on the database. None of this occured (typical slashdot), and there were a lot of anti-doctor posts, mainly harping on the fact their unused to having a database.
The issues at large are still to be completely resolved, and the great-grandparent or this post took it upon themselves to blast the establishment. Personal attacks get nowhere, as my original post shows, as you responded with a knee-jerk reaction, not one that i would hope facilitate discussion (partly my fault).
Try to address my post more directly last time, and without little reasoning, posts do not stick. Im not sure who modded your post up to insightful, but I purport they typically acted in haste, much like yourself.
Having been to medical school and have MPH training, know several doctors personally in both academic, research, and in practice, taken health law as well as health econoics courses, I probably am far better versed than your insulting, cow'd comments.
This quote is pure gold. You attack the doctor's establishment for allegedly being holier than thou and snobbish, yet you hold the same attitude. You proceed to list what you have done (my, is that all?) and then shove it in my face as this therefore supports your arguments, and discredits mine. Pot and Kettle, perhaps?
If you are going to respond, respond to what my post is talking about, not a tangent to it.
Re:Typical unthinking replies.... (Score:3, Insightful)
We already have these. They're called compiler-compilers. The hard part about programming isn't the writing the code which matches the requirements, it's getting the requirements well enough specified. Similarly, the hard part about a doctor's job isn't the 'standard' symptom & disease matching, it's the individual differences that we all have, which mean that every disease has to be treated individually.
Re:Well.. (Score:3, Insightful)
Not anyone can waltz in and become an MD, thankfully and obviously, nor should they be able to, but still, well qualified people are turned away.
This is where the AMA's arguments about keeping the highest possible professional standards start to get them into trouble.
The public's expectations are built up to the point where MDs are practically worshipped.
Then, one of them makes a mistake (hey, it can happen, people are fallible).
Compounding the problem is that the colleagues on the state accreditation boards will close ranks and do everything possible to prevent a fellow MD from losing their professional reputation. In the worst abuses, the MD will have to go to a different state. [I won't tell you how angry I get about other problems, such as doctors with strange sexual hangups abusing their patients.]
It's little wonder that you find more and more work being done by P.A.s (Physician Assistants) and by RNs, who can do 90% of the same work but get paid only about 20% of the salary as an MD. [Kind of like a good legal secretary can do 90% of the lawyer's job for for 20% of the salary.]
Not to rag on all doctors. There are many good ones who take their responsibilities seriously, who know what's going on, who care about their patients and take the time to explain medical conditions to them. And, it takes a lot of endurance to get malpractice insurance and to fill out all the fscking forms the HMOs require for payment. It's just that the current medical establishment has built up a system that is broken.
For example, I never see anything like a consumer reports rating of doctors available to the general public. Ratings are avaiable to other physicians or only gotten by word of mouth.
For starters, I wouldn't mind seeing the class rank, GPA and school where my physician got his or her degree.
What I'd really like to know is: which physicians' are most frequently or least frequently used by their colleagues (including the RNs)?
Too bad for MD's. (Score:3, Funny)
Re:Too bad for *all* geeks (Score:3, Funny)
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.
There is other problems with this sort of thing... (Score:4, Interesting)
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.]
Re:There is other problems with this sort of thing (Score:2)
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.
used a damned large paintbrush didn't he? (Score:3, Insightful)
"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.
Re:used a damned large paintbrush didn't he? (Score:2, Informative)
Re:used a damned large paintbrush didn't he? (Score:2, Interesting)
Re:used a damned large paintbrush didn't he? (Score:2, Insightful)
Devil's Advocate Here... (Score:2)
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
Re:used a damned large paintbrush didn't he? (Score:2)
The real training most folks get for the MD is not hard-core sciences. Sure, there is some... but most of the training in the people skills. A lot of time is spent learning how to interview and deduce what is wrong. (minor rant) The liability issues have not helped things any, but that is another issue. I suspect the I'm never wrong bit is due more to lawsuits.
Re:used a damned large paintbrush didn't he? (Score:2)
Time for Doctors to embrace the techology (Score:2, Insightful)
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
Re:Time for Doctors to embrace the techology (Score:2, Insightful)
It's not regulated now. Why should it be just because it is in a MORE useful form?
You sound like the damn RIAA and MPAA. I buy a CD, and when I stick it in my MP3 player, they throw a fit.
So somone takes Robinson's, linearizes it, and now only doctor's are allowed to have access? Good lord.
What you say is essentially that same as "It's fine as long as their monopoly on a profession is not undermined". Doctors are great and deserve fair compensation, but doctors do not deserve a monopoly on access to health information or software usage, esp. when such non-personal/non-private information is paid for by taxpayers dollars (most medical reserach comes from government funded grants; most residencies rely heavily on Medicare and Medicaid payin; most hospitals were constructed from tax dollars).
I do not want another Intellectual Property fight. Music, patents, movies, and now medical databases? NO, NO, NO. It's fair if the database company wants to be paid, but such a database should NOT be regulated to only MDs in the field. There would be no check for such information to be correct. And physician's have a sorry record for verifying their data.
Example: I have to go to a doctor, dish out $140 twice a year, just to renew a prescription on a drug I know I will have to take for the rest of my life. I don't do that, I die. And no, they can't be sued, based on the practice of law in every state (common law, regarding the right of a physician to turn away a patient, even one that needs help and has had up to then continued contact with (known as continuity in the med profession). And no, unless I'm an MD, I cannot do it myself even though I know more than my doctor does about my disease family.
Now you want to give them more through regulation? Enough is enough. One of the many reasons why health care in this country costs so much is because of the strict regulation to enhance doctors (and drug companies) entering the profession. I don't want the information or software also to be restricted because you're scared what might happen. *I'm* the one scared because I know *will* happen.
Confidence vs. Arrogance (Score:4, Insightful)
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.
MDs ARE poor diagnosticians (Score:2, Insightful)
It's all just EGO (Score:4, Interesting)
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.
Re:It's all just EGO (Score:2)
I don't think it's all just ego. Expert systems (the article calls them "knowledge couplers") have been around for years. In the vast majority of cases they aren't all that helpful. For example, your typical computer phone support uses an expert system because that way the company can employ $10/hour inexperienced phone jockeys. You describe your problem and the phone jockey clicks his/her way through the menus of questions until you reach an "answer". In practise this means you're up the creek if your problem is something that a reboot cannot solve. Can you imagine putting your life in the trust of the medical equivalent of phone support?
Re:It's all just EGO (Score:2)
Re:It's all just EGO (Score:2)
Which is entirely my point. The expert system is useless. You talk to the expert anyway.
Sounds like MD workers share a lot in common with IT workers.
you know jack about doctors (Score:2)
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!
it seems to me (Score:2, Insightful)
Most visits easy to automate (Score:5, Funny)
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
Re:Most visits easy to automate (Score:4, Insightful)
Re:Most visits easy to automate (Score:2)
6. Profit!
Re:Most visits easy to automate (Score:2)
No, the Codeine is usually for the parents. Kids are a whiney pain when they are sick.
Evil Ass Bacteria. (Score:2)
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
Even if. (Score:2)
Second opinion (Score:2)
If I want a second opinion, do I leave the Oracle office and drive to Sybase?
One doctor's view (Score:5, Insightful)
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.
Re:One doctor's view (Score:2, Insightful)
Re:One doctor's view (Score:3, Insightful)
Every time the doc at the local OPD wants to shove anti-biotics in my system, I have to literally fight then and ask him / her WHY? The answer is usually
Re:One doctor's view (Score:2)
Re:One doctor's view (Score:4, Interesting)
I lost both my parents because of physician error, and I can assure that malpractice lawsuit payouts do not ease the pain, nor did the physicians testimony that they in one case they hadn't considered the correct diagnosis because it was so unlikely, or in the other case, that they hadn't considered the correct diagnosis because they weren't familiar with the condition.
I've been aware of this software for a long time, due to research done in order to show that a doctor was guilty of gross negligence in his misdiagnosis, and I never cease to be amazed at the number of doctors who really, truly believe that they can get everything right, every time, or that having a computer help with diagnosis is somehow different than reading an article in JAMA.
I have a serious question. Will you feel guilty when a patient dies, who would've been saved had you consistently used a system such as this, or will you be glad that you didn't waste 10 minutes to consult a computer?
I may be posting anonymously, but I'm not trolling. I understand there's more to medicine than diagnosis, but I don't understand why doctors can't admit that the 'I'll just remember everything' system that's currently in use is criminally irresponsible.
Re:One doctor's view (Score:2, Interesting)
The ideal system would be a situation in which doctors collaborate (the killer P2P app?) to share information and build complex disease and treatment models.
Re:One doctor's view (Score:4, Interesting)
You seem to be a GP. I would assume your patients routinely report with nonspecific back pain, or with headaches.
The data I've seen suggests that these two symptoms in particular are both pervasive in the patient population and routinely undiagnosed or misdiagnosed. It would be interesting to run a double-blind comparative study of diagnostic efficiency of physicians and laypeople with and without the database...
Re:One doctor's view (Score:2)
Re:One doctor's view (Score:2, Insightful)
My personal affliction is celiac sprue (autoimmune disease and allergy to grains). No doctors could identify it and finally we heard through the family grapevine that an old relative had had this sort of disease. A few experiments (going on/off gluten-free diet and seeing symptons) and we had a diagnosis.
A half-dozen doctors couldn't diagnose it, but my family did. Turns out most of the people in the Kansas City celiac sprue chapter made their own diagnoses after doctors completely failed to.
The reasons doctors think their diagnoses are so good is that the frustrated patients with undiagnosed symptons get frustrated, do research, and diagnose it on their own.
Re:One doctor's view (Score:2)
Re:One doctor's view (Score:4, Interesting)
Indeed, too much focus on just reaching a proper diagnosis can lead to poor care or worse.
Although I'm not an MD, I once had a very interesting case study in an operations research class (management science, statistics, expert systems, etc.). We used decision trees to study different diagnostic and treatment procedures in an actual (although somewhat simplified) healthcare setting. The model considered the results of appropriate/inappropriate diagnosis/treatment, the cost and latency of tests, false positives and negatives, and the differing goals of each key stakeholder.
From memory, the doctors were assumed to be most worried about correct diagnosis and treatment regimen, patients were most interested in the safest and most effective prognosis, and the hospital administrators were concerned about costs and legal liability. We found that optimizing the model for these different goals produced very different outcomes.
The results were somewhat counterintuitive: increasing the accuracy of diagnosis or ordering the most tests did not necessarily increase the probability of a cure, and could even increase the probability of death depending on the role of false positives/negatives, waiting periods, and drug side-effects.
That being said, the software in question seems to be more than a just a simple diagnostic tool. Combined with a patient centric outlook, I see medical expert systems becoming obvious (and essential) reference tools as long as they provide the MD with an ability to tweak the level of detail for minor ailments and to consider clinical experience, risks, local expertise, access to equipment, patient preferences, and so on.
Re:One patient's view (Score:4, Interesting)
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.
Re:One patient's view (Score:3, Interesting)
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.
Re:One patient's view (Score:2)
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.
Re:One patient's view (Score:2)
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?
Re:One patient's view (Score:2)
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. :)
--
Re:One patient's view (Score:2)
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.
Re:One patient's view (Score:2)
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.
One Mechanic's View (Score:2, Informative)
"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
Re:One doctor's view (Score:2)
He used a virus as the reason. Assuming the virus isn't Marburg or Ebola, it really doesn't matter _which_ virus is causing the problem. Therefore you treat what you can and let the virus run its course.
You can't fix a virus. You can try to prevent a virus but once its there you deal with it. Like a canker sore.
It takes 14 days for a Canker Sore to go away untreated, treated it takes two weeks.
They are right to be afraid... (Score:2, Insightful)
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
Some patients are panicky morons. (Score:4, Insightful)
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.").
Comment removed (Score:5, Insightful)
Re:Some patients are panicky morons. (Score:2)
After having what turned out to be a chronic illness misdiagnosed for several years (and suffering considerable amounts of pain in the process), anything that helps doctors not miss possibilities is a good thing in my book.
A little knowledge can be a dangerous thing (Score:3, Insightful)
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"
Re:A little knowledge can be a dangerous thing (Score:2)
However the corollary is, "But a complete lack of knowledge can be fatal."
I want as much information as possible, if that means it is only partial information, then inform me of that at the time and let me make my own judgements.
As others have mentioned, you can't trust your doctor anymore (you probably never could, society just figured it out after too many, "oopses"). Everybody's got a horror story or two of a doctor who couldn't diagnose is way out of a paper bag. Any patient who is serious about their health is already doing their own research and attempting to validate their doctor's statements. To do otherwise is just too risky.
In my own experience, in a number of areas of more obscure medicine, I've found that a dedicated amatuer (as in the person who has the actual ailment and who's life is on the line) can easily get up to speed and become more knowlegable than their doctor, specialist or not, on the specifics of their own affliction. The support groups on the net as well as online databases and general "web sites" are hugely beneficial in this kind of search. Of course there is plenty of chaffe that needs separating from the wheat, but that's just part of the job of doing your own research.
Re:A little knowledge can be a dangerous thing (Score:2, Funny)
I guess what I'm saying is that people can be stupid once, but after a while, they'll either learn, or they'll go nuts. Then when the computer tells them that they've gnoe nuts, they'll learn to ignore the computer, who is, after all, just out to get them.
It's worse (Score:5, Interesting)
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.
Re:It's worse (Score:4, Interesting)
Yeah, I'm surprised how much this has been discounted. Although PKC makes a point about calling recommendations "primary options" to distinguish from hard advice and transfer responsibility to the provider, there is still a high degree of editorial decisions that the software publisher is making.
It's unclear from the story or their website [pkc.com] as to how conflicting research is treated. Are different journals or studies weighed differently? How about incorporating common clinical practice that might not show up in the published articles? Or academic theories that are widely used for diagnosis and treatment but have not been conclusively proven?
In their FAQ [pkc.com] they state that "Every question contained in a Coupler is there because an action recommended by the medical literature depends upon its answer". What if there are no conclusive actionable recommendations, but results can be inferred from related studies? Does that mean that there are any gaping holes in their content? Is this counter to a systemic approach?
Good software should be able to handle all of these questions, provide a usable and adaptive user interface, avoid unnecessary data entry, provide for local input and overrides, and maintain primary responsibility with the MD. So far, besides some good results, we have no evidence as to the quality of their program (although a tour [pkc.com] is available on their site). And what happens if PKC is so widely adopted that it becomes the Microsoft of medical software or the AOL of medical content?
As they are currently positioned they shouldn't so causally brush off their legal exposure. They might be better off repositioning the same service as a faster and more accurate method of accessing research and best practise rather than as a guided decision making tool. This might alleviate the fears of certain doctors while also stressing that the decision lies with the practioner and the advice comes from third parties.
A MD's perspective? (Score:4, Insightful)
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.
Re:A MD's perspective? (Score:3, Informative)
I don't think this is a technological problem as much as a usability issue.
Re:A MD's perspective? (Score:3, Insightful)
We might also want to look at med school pricing. $300K seems a tad high to me.
But then, all medical costs seem high to me nowadays. I remember when, as a child (1960 or so), I had a broken arm and my father paid the doctor out of his pocket, and it wasn't a budget-breaking amount. When my kid had a broken arm in the 80s -- a crappy greenstick fracture I could have set myself -- the total bill was well over $1000. I have no idea how much a doc would charge today for reducing and casting a simple fracture, but I bet it would be huge.
We really need radical changes in how medical treatment is provided. It's a whole system, from medical school to insurance, that is draining the rest of the U.S.economy. If the tech tools will help, I say, "Bring them on."
- Robin
Re:A MD's perspective? (Score:4, Interesting)
The bills are so high now, because they need to offset the lowball payments that the HMO's give them. I just had a visit to the ER two months ago, and got a notice in the mail from BlueCross that the hospital bill for that day (had an EKG, CT scan, and an MRI) was over $5,000, though they only paid $1,200. Subsequent tests over the next few weeks were paid at even lesser rates (than the 20% from the ER visit).
Re:A MD's perspective? (Score:2)
Range of debt (Class of 2001): $2,500 - $218,544
This would seem to nearly support his claim. Especially if you factor in 4 years of undergrad work.
"Money Grubbing" (Score:4, Insightful)
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.
As an MD, too late to the discussion perhaps. (Score:3, Interesting)
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..
Re:As an MD, too late to the discussion perhaps. (Score:5, Insightful)
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.
Re:As an MD, too late to the discussion perhaps. (Score:2)
Re:Statistics and disruptive technologies (Score:3, Interesting)
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.
Re:As an MD, too late to the discussion perhaps. (Score:2)
I'm excited... (Score:2)
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.
This sort of resistance is sillyness (Score:3, Insightful)
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."
How does it work? (Score:2)
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
IANAD (Score:2)
I'm sure many comments will start this way...
The probability of branches (Score:2)
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.
Re:Not just threatened... (Score:4, Insightful)
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.
Re:Not just threatened... (Score:2)
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.
Re:Not just threatened... (Score:2)
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.
a little more than that (Score:2)
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.'
Re:Not just threatened... (Score:2)
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.
Re:Indeed (Score:4, Insightful)
Re:Human Factor Still Valuable (Score:2, Interesting)
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
Re:Database vs Doctor (Score:2)
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.
Re:Database vs Doctor (Score:3, Interesting)
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.
Re:Database vs Doctor (Score:3, Informative)
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.
Re:Randomised controlled trial (Score:2)
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 democratization of knowledge (Score:2)
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...