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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.
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Interesting Enemies For a Diagnostic Database

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  • Well.. (Score:3, Interesting)

    by iONiUM ( 530420 ) on Sunday July 14, 2002 @09:46PM (#3883490) Journal
    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.
    • No, a doctor, plumber, electrician, etc, don't make money from knowing more, in all those fields a regular person could do the research and solve the problem themselves. The reason people pay them is their expertise. I know it's possible to replace the transmission on a car, and i could look up how to, doesn't mean that i could do it as well as someone with expierience. In research, top scientists get paid more money than newbies because they have years of expierience to back up all the knowledge that they got out of school.
    • 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?

      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.

      • Boo. Hoo.

        Perhaps the doctor should look in that same database...
        • Well, remember that the doctor has to make a diagnosis, for all his patients, in a limited time. Someone looking to sue has time to do as much research as they want, looking for something. I can definitely see why this could be frightening to the doctors (Although I don't think that's any reason not to allow it do go on.)
    • 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? ;-)
    • Re:Well.. (Score:3, Interesting)

      by lrichardson ( 220639 )
      The money is one issue but ... way more important is the fact the medical profession is Conservative to the point of absurdity. There are numerous factors ... but the two most important are fear of lawsuits, and the ever popular old-boys syndrome.

      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.

      • 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.
      • The money is one issue but ... way more important is the fact the medical profession is Conservative to the point of absurdity. There are numerous factors ... but the two most important are fear of lawsuits, and the ever popular old-boys syndrome.
        We have to also remember that the medical profession is not like programming for most of us, or like banking, or like journalism, or most capitalistic pursuits. When I mess up as a Systems Analyst, I waste someone's money and make some people annoyed. When a doctor messes up, it is often a matter of life and death. This is why they are so conservative - not just because of lawsuits or "old-boys syndrome" or pride. The lawsuits exist and are so out of hand, because a very simple human error (exhausted doctor proscribes the wrong dosage by misplacing a decimal point) results in permanent damage or death.
    • Medical doctors and many other others licensed to practice medicine do not like to be reminded that they are merely technicians.

      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.

  • by Skyshadow ( 508 ) on Sunday July 14, 2002 @09:47PM (#3883493) Homepage
    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*.
    • (* 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.
  • by os2fan ( 254461 ) on Sunday July 14, 2002 @09:50PM (#3883501) Homepage
    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.]
    • 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.
  • 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.
    • Doctors that have their professional judgement questioned by patients are FREQUENTLY hostile. Many of them suffer from expert's disease: "how can you possibly have a valid opinion about this matter, you're not the expert, I am!" Which is not to say such attitudes are acceptable, only that they're prevalent.
      • A perfectly good example is in Richard Feynman's "What Do You Care What Other People Think?" Feynman's girlfriend (this is the awsomest love story I've ever heard, real or fictional) was misdiagnosed. Twice. The first time, Feynman called the doctor on it, but the doctor didn't listen.
      • The same holds true of many professions : Have you ever had two "expert" programmers with diametrically opposed viewpoints who have each other's word used against each other? The outcome can be very ugly.
      • 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
    • The The truth is even more frightening... most physicians, or heath care providers if you want to use a more derogatory term are some of the most technical luddites out there. I've worked for companies where they gave doctors PC's, another company gave the doctors handhelds -- all with software that really gives you a leg up on helping the patient. Most never even turned them on. As a younger crowed moves in, it is not quite as bad as the boomers practicing.

      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.
  • 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
    • by Anonymous Coward

      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.
  • by Roarkk ( 303058 ) on Sunday July 14, 2002 @10:01PM (#3883534) Homepage Journal
    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.
  • It's all just EGO (Score:4, Interesting)

    by erroneus ( 253617 ) on Sunday July 14, 2002 @10:08PM (#3883553) Homepage
    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.
    • 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?

      • You have a limited grasp of the situation. THe fact is, if the system can not help you, rather than suggestin a reboot it will suggest "go see your MD", which you would have done anyway... so what is the problem. I would trust this database more than i would trust as regular MD. Except for the few at those free clinics, every MD i have met was an arrogant prick. - just my limited experience, but enough for me not to go back!
        • THe fact is, if the system can not help you, rather than suggestin a reboot it will suggest "go see your MD", which you would have done anyway

          Which is entirely my point. The expert system is useless. You talk to the expert anyway.

          Except for the few at those free clinics, every MD i have met was an arrogant prick.

          Sounds like MD workers share a lot in common with IT workers.

    • 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!
  • it seems to me (Score:2, Insightful)

    by Megahurts ( 215296 )
    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.
  • by Tablizer ( 95088 ) on Sunday July 14, 2002 @10:12PM (#3883565) Journal
    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
    3. Politely send patient away
    4. Send swabs to lab
    5. Play golf

    • by armb ( 5151 ) on Monday July 15, 2002 @05:22AM (#3884726) Homepage
      6. Find increasing numbers of patients have antibiotic resistent infection as a result of widespread routine over-prescription of antibiotics.
  • 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.

  • If I want a second opinion, do I leave the Oracle office and drive to Sybase?
  • One doctor's view (Score:5, Insightful)

    by TheMohel ( 143568 ) on Sunday July 14, 2002 @10:28PM (#3883614) Homepage
    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.
    • by databum ( 592922 )
      What a narrow-minded doctor-centric point of view. Here in New Mexico MDs are leaving in droves for higher pay elsewhere. There is a severe nurses shortage. Rural clinics are crying for help. I can see the day when a nurse in a remote community will use something like PKC as a partial substitute for MD the who isn't there. I can also see where a nurses aid in a hospital will use PKC along with vital signs, lab results and new symptoms correlated with the patient's known diagnoses to evaluate the current patient condition and to have the MD called to report if there is a decline in condition. If private MDs turn this down, there will be plenty of government, military and HMO clinics and hospitals which will use this out of necessity and economics.
    • by shri ( 17709 )
      I agree with you when I say that you've got the job description right. Where I disagree with you is the level of competance. There are an increasing number of doctors (specially in Asia and other parts of the world) who are barely competant and a tool like this would serve as a good second opinion and also as a good sounding board.
      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 ... "precautionary". I'd love to have a system which could give me a 'threat level' of my symptoms (yeah .. with all the standard disclaimers attached) without having to pay a bomb for the second opinion (usually would have to be at another OPD / physician).
      • I couldn't agree more. EVERY time I go to a foriegn Trained/born doctor I get the same treatment. Strong antiboiotics, and lots of them. So I did the only smart thing and did some research on various doctors in my area and finally one who knows what the hell she's doing. please note that I am note trying to sound racist in any way this has just been MY experiance.

    • Re:One doctor's view (Score:4, Interesting)

      by Anonymous Coward on Sunday July 14, 2002 @11:54PM (#3883881)
      That's great, but you guys don't know everything and you need to realize that. I know you spent a long time in college, it doesn't make you infallible, omniscient or particularly reliable. You know enough about our bodies and minds to know that yours is unreliable.

      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.

    • What really needs to happen is a basic rethinking of a physician's role. Modern doctors are taught to be expensive pattern matching machine's that input a patient's symptoms, process it through the Physician's Desk Reference, and spit out a usually symptomatic treatment based on the drug of the month. Very little is actually done to treat the underlying disease.
      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)

      by po8 ( 187055 ) on Monday July 15, 2002 @12:13AM (#3883972)

      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...

    • It might not be relevent to diseases, but there are things people should be able to find out about easily. Like being about to tell the diffrence between a vericose vein and a break in the collogin due to changes in excercise habits. This might not revolutionize 99% of doctors visits from the doctors perspective, but for the large numbers of people who understand how to deal with a cold but occasionally want to know if a skin blimish is malignant, expert systems could be useful.
    • by KingPrad ( 518495 )
      And the problem is the patients who slip through this lauded diagnosis system. It's the rare and not-so-rare but very serious problems that are misdiagnosed. Anyone on the street can diagnose a cold or the flu.

      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.

    • Let me see if I get it: You're more than a walking database. You're a nurse with a database.
    • Re:One doctor's view (Score:4, Interesting)

      by WEFUNK ( 471506 ) on Monday July 15, 2002 @12:35AM (#3884040) Homepage
      It may come as a surprise to most people, but diagnosis is not the hard part of medicine...

      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.
    • by jguthrie ( 57467 ) on Monday July 15, 2002 @12:37AM (#3884045)
      If diagnosis is the easy part of medicine, then how come it's so often wrong? I mean, I've seen perhaps four diagnoses in my life that were of any real importance. By that I mean I have been in or around four situations where I wasn't suffering from a runny nose or other similar thing where the appropriate thing to do was to tell me that I would get better and to send me home. (Note that I have never gotten that treatment. You doctors usually prescribe antibiotics and a decongestant for runny noses. Stop that, it's counterproductive. The runny nose is most likely a viral infection or an allergic reaction to something so antibiotics aren't indicated and I don't like the side effects most decongestants have so I won't take them. That is, in fact, why I've long since stopped seeing doctors because of runny noses.)

      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.

      • "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.
        • 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

          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.

        • 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?
    • One Mechanic's View (Score:2, Informative)

      by aoeu ( 532208 )
      I am a good diagnostic mechanic (automobiles, unfortunately) and I think that there is a big future in this kind of thing. Consider the four following situations.

      "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.


  • ...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

  • by JonMartin ( 123209 ) on Sunday July 14, 2002 @10:38PM (#3883655) Homepage
    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.").
    • by danheskett ( 178529 ) <danheskettNO@SPAMgmail.com> on Sunday July 14, 2002 @10:51PM (#3883700)
      Giving more information to patients may do harm in the short term, but in the long term, it will elevate the people - just as giving people more information has *always* elevated people over time.

      Knowledge is power. It's clichque, silly, stupid, and all that but it's true. Almost every person who has been given a "you have six months to live speech" has gone home and researched the crap out of their ailment. The reason is of course power.

      I am always skeptical of my doctor. I try to poke holes in his case like Perry Mason or Matlock would. If he tells me I have XYZ then I want to know details. Yes, he thinks I am an SOB; but hey, you know what, too bad. I treat my doctor, my mechanic, my priest and my boss the same way: don't just tell me, convince me.
    • If you read the article, you'd see that this system is designed to help with exactly the situation you describe - basically, throwing up possibilities that the doctor might not have originally thought of for further investigation.

      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.

  • Yes, this could save time, make doctors lives easier, lower your HMO bills, etc. But everythings NOT comming up roses. There is a negitive to this kind of thing:

    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"

    • A little knowledge can be a dangerous thing

      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.
    • 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.
      And nothing calms people like routine. After I've had bubonic plague five times and Ebola twice, and always recovered after about a week, I don't panic anymore when I find out, "Oh darn, I've got flesh eating bacteria again?"

      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)

    by gmhowell ( 26755 ) <gmhowell@gmail.com> on Sunday July 14, 2002 @10:41PM (#3883667) Homepage Journal
    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.
    • Re:It's worse (Score:4, Interesting)

      by WEFUNK ( 471506 ) on Monday July 15, 2002 @01:39AM (#3884213) Homepage
      Another problem that I actually do sympathize with is that this is grounds for serious lawsuits.

      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.
  • by Lurkingrue ( 521019 ) on Sunday July 14, 2002 @10:45PM (#3883681)
    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.

    The thing that makes me both intensely interested and worried about this method of diagnosis is ... 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.

    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.
    • The article already mentioned this. But an obvious answer, for cases that aren't situations where the patient will die in 10 seconds, is to have intelligent non-doctors input information beforehand, in the waiting room. (There IS time there for this.) Then the doctor can make a diagnosis and take a glance at the expert system's diagnosis. If the two jibe, and there is little likelihood of weird possibilities, then little time wasted. If complications happen, the doctor can check the expert system's results, and even choose to manually answer the questions again.

      I don't think this is a technological problem as much as a usability issue.
    • by Roblimo ( 357 )
      Hmmm... sounds to me like the routine data collection for this system would be done the same way it is now, by nurses and clerical employees, and that access to what really amounts to a sophisticated troubleshooting guide would free doctors from a lot of routine drudery and give them more time to treat patients.

      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

      • by Maditude ( 473526 ) on Monday July 15, 2002 @12:45AM (#3884071)
        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.

        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).
  • "Money Grubbing" (Score:4, Insightful)

    by HoaryCripple ( 187169 ) on Sunday July 14, 2002 @10:46PM (#3883682) Homepage
    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.
  • by Anonymous Coward on Sunday July 14, 2002 @11:09PM (#3883753)
    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..

    • by ErikTheRed ( 162431 ) on Monday July 15, 2002 @04:25AM (#3884609) Homepage
      It's interesting that most of the doctors responding are doing so much emothion and so little logic (and this one didn't even read the article carefully). Let's go through the rebuttal...

      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 :). Despite the stereotype, many IT professionals (such as myself) are fit, healthy individuals who exercise regularly, drink plenty of water, and enjoy a proper diet. And those of us who stayed out of the dot-bomb industries (or got out early enough) can afford the best cardiologists money can buy, and don't have to whine and scream about it.

      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.
    • Well, I have to say, I trust most machines more than I trust any doctor who acts like you.
  • 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.

  • by hayden ( 9724 ) on Monday July 15, 2002 @12:12AM (#3883964)
    People who resist this sort of inovation on the grounds of "computers can't possibly do x as well a person" are absolutely correct and completely missing the point of the technology. The goal isn't to replace humans but to give them a tool to provide them with relevant information. Computers are good at finding something provided you give the search critera in the right format (and there isn't any pr0n sites trying to attract your attention).

    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."

  • 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....

  • by rnd() ( 118781 )
    IANAD, but...

    I'm sure many comments will start this way...

  • 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.

Have you ever noticed that the people who are always trying to tell you `there's a time for work and a time for play' never find the time for play?