IBM Watson in a Clinical Setting: Replacing Physicians?

Wondering if a computer can ever intuit as a human, no matter how good the programming…

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ScienceRoll

I’m a geek and you know how much I support the inclusion of digital technologies in medicine, healthcare and medical education. At the same time, I always highlight the fact that doctors will be needed for practicing medicine, robots cannot do their job. I know Vinod Khosla thinks otherwise.

Now, after watching the video demonstration of how Watson could help a clinician, I have doubts about a future. We will see how it gets integrated in everyday medicine. I support the IBM Watson project very much, but I hope medical professionals, humans, will always play the major role in the practice of medicine.

See also the Medgadget report.

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The High Cost of Not Listening to Patients.

This article reminds me of my days as a medical librarian.
If I did not carefully listen to a patron (customer) or ask the right questions, I gave the person the wrong information!

Minutes spent in listening and asking focused questions often saved an hour (or more!) of fruitless searching.

So, when I talk with a health care practitioner, I am mindful to give as much relevant information as possible to so the proper diagnosis and treatment can be given!

It is also necessary that we all do whatever we can so that health care practitioners are given the time they need to listen to patients.
Ultimately this will result in lower health care costs overall.

 

From the 18 January 2013 post at The Health Care Blog

Before we can understand the high cost of not listening, we need to examine in detail the diagnostic process. I am limiting my discussion to patients with chronic or recurring symptoms lasting several months. I am not discussing acute illnesses. They fall into completely different category.

At the front line of medical care, at the first contact between a patient and a doctor, the patient describes physical symptom. Whatever the real underlying cause, a physical symptom is the required ticket to see a physician. The physician, on first contact, has no idea what the underlying nature of the patient’s chronic complaint really is.  At the risk of oversimplifying, there are five broad categories of the causes for complaints.

These are:

1. There is a definable medical disease in one or more organs.

2. There is no definable medical disease but the patient is in contact with an unknown toxic substance causing the symptom (inhaled, ingested, or from skin contact).

3. The patient is in a stressful or toxic relationship at home or work producing physical symptoms or even a definable medical disease. (“What the mind cannot process is relegated to the body.” Dr. William Mundy, psychiatrist, personal communication. )

4. The patient or a companion is inflicting harm. Here, there are several categories:…

 

…

5. There is no definable medical disease but the patient has assumed a chronic illness role in life with multiple symptoms (i.e. hypochondriasis).

Psychosomatic Illness

6. There is a sixth category; patients with psychosomatic disorders. Time and space does not permit a full discussion of this important and very common set of disorders. I suspect they represent more than fifty percent of patients seeking primary medical care. The book“The Divided Mind” explains and defines these disorders and the successful treatment applied to thousands of patients at NYU by Dr. Sorno and his colleagues. At present the medical profession denies the existence of this category. The epidemic emergence of pain clinics comes from lack of knowledge about psychosomatic disorders and their proper treatment.

Of course, the patient can have any of these, and also be suffering from a definable medical disease.

But my experience in primary care over the past 55 years — combined with studies in the medical literature —suggest that between 30 and 40 percent of first contact  primary care visits are stress related or are psychological in nature (#3 and #6  in above list).

It should be obvious that the only way to sort out these causes of symptoms requires very careful listening to the narrative of the patient’s life. Some of these causes can be determined only by listening…..

 

Read the entire article here

More information does not equal better care

 Chalmette, LA, December 16, 2005 – A patient describes his symptoms with a nurse at the Primary Care Clinic in St. Bernard Parish. The facility located in a triple-wide office trailer offers free medical care to area residents, staffed by personnel from the U.S. Public Health Agency and FEMA Disaster Medical Assistance Team (DMAT). Robert Kaufmann/FEMA

A wise, sobering post on the limits of medical/health related information.

Technology is increasingly used to collect and store personal health and medical data. While the amount of personal stored data is rising, this does not necessarily translate into better care. For example, the information stored in electronic medical records is only as good as the data entered.  Medical devices (as imaging and gene testing instruments) generate data that may or may not be useful depending on why they were ordered and how they results are interpreted.

The use of the data is also troublesome. As this post states, medical test results are often misused by the diagnostics industry in over testing.  This leads to unneeded treatments which divert money and resources.  Health care providers, especially those in primary care have less time to listen to and counsel patients.

The money spent on unnecessary treatments is a burden not only on individuals, but also health care facilities and government agencies. Health care facilities become caught in a spiral of justifying diagnostic equipment through marketing and at some point they will find it nearly impossible to recoup their investments. Medicare and Medicaid funds are not used wisely to diagnose and treat, resulting in ever more increased costs to the system.

As this post points out, health care providers would be wise to take a deep look at their role and be realistic about their expectations.
The same can be said about those who consult with health care providers.

From the 1 November 2012 article at KevinMD.com

I have found that this concept is hard for non-healthcare people to really grasp – that a less aggressive testing approach knowingly misses disease, but makes no difference in the overall prospects of the patient. It is crucial that the U.S. culture fights the prevailing scare tactics of the diagnostics industry, or we’ll never lower the rate of over testing. Any administrative tricks to lower testing rates will be subverted by both physicians and patients who assume more tests equal better care unless the underlying culture and conventional beliefs are changed.

The change required is deeper than administrative rules. It has to come from a more humble attitude on the part of doctors, patients, employers, and insurers that just because a patient could be labeled as having a disease, there is nothing to be gained by doing anything about it. More information does not equal better care.

Our American culture proclaims, “Just Do It.” To reclaim resources from the healthcare industry and return them to the general economy, we must proclaim, “Don’t just do something for the sake of doing something, stand there.”

 

Related Resources

• US Agency for Healthcare Research and Quality (AHRQ)- Consumers and Patients
  • Choosing Quality Care
  • Comparing Medical Treatments
• Evaluating Health Information (Health Resources for All Edited by Janice Flahiff)

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More information does not equal better care

From the 1 November 2012 article at Medical News Today

…I have found that this concept is hard for non-healthcare people to really grasp – that a less aggressive testing approach knowingly misses disease, but makes no difference in the overall prospects of the patient. It is crucial that the U.S. culture fights the prevailing scare tactics of the diagnostics industry, or we’ll never lower the rate of overtesting. Any administrative tricks to lower testing rates will be subverted by both physicians and patients who assume more tests equal better care unless the underlying culture and conventional beliefs are changed.

The change required is deeper than administrative rules. It has to come from a more humble attitude on the part of doctors, patients, employers, and insurers that just because a patient could be labeled as having a disease, there is nothing to be gained by doing anything about it. More information does not equal better care.

Our American culture proclaims, “Just Do It.” To reclaim resources from the healthcare industry and return them to the general economy, we must proclaim, “Don’t just do something for the sake of doing something, stand there.”..

 

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•  9-part series on over-diagnosis (short reads from a health care journalist) (jflahiff.wordpress.com)
• Most patients don’t need extra tests for diagnosis (jflahiff.wordpress.com)
• Supplies and Devices Are Biggest Cause of Hospital Cost Increase (jflahiff.wordpress.com)

 

 

Key Trends in the Future of Medicine: E-Patients, Communication and Technology

English: Watson demoed by IBM employees. (Photo credit: Wikipedia)

 

From the 25 October 2012 post at Blogroll

 

…

Robots replacing doctors?

I’ve given hundreds of presentations and I teach at several universities about the use of social media in everyday medicine and I always highlight the importance of 1) doctor-patient relationship in person, and 2) good communication skills for doctors, but if I try to think ahead, I have to agree with Vinod Khosla that technology can replace 80% percent of the work of doctors.

Khosla believed that patients would be better off getting diagnosed by a machine than by doctors. Creating such a system was a simple problem to solve. Google’s development of a driverless smart car was “two orders of magnitude more complex” than providing the right diagnosis.

IBM’s Watson is just the perfect example here. They have been working closelywith oncologists at Memorial Sloan-Kettering Cancer Center in New York in order to see whether Watson could be used in the decision making processes of doctors regarding cancer treatments. Watson doesn’t answer medical questions, but based on the input data, it comes up with the most relevant and potential answers and the doctor has the final call. This is an important point as it can only facilitate the work of doctors, not replacing them…

..So what should we expect to see in the next decades? I think we will see amazing developments in many areas, except medicine in which small and slow steps will mark the way towards a more transparent healthcare system in which decision trees are available for everyone, online content and social media are both curated, patients are empowered, doctors are web-savvy, and collaborative barriers are gone forever. A new world in which medical students are trained to be able to deal with the rapidly evolving technologies and e-patients.

 

A great related graphic at http://envisioningtech.com/envisioning-the-future-of-health.pdf

(WordPress was not responding when an upload was attempted)

 

 

 

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