Wait, Maybe Technology Won’t Replace Doctors After All!

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Such a good question from my friend David Shaywitz, MD, PhD, (and co-author with me of the book Tech Tonics).  David has spoken and written about this this theme frequently, and most recently at the Health 2.0 conference held last week in Santa Clara, CA. He and I and 2000 of our closest friends were there to talk healthcare technology. Isn’t it ironic that it takes that level of human interaction to talk about the ways healthcare can disintermediate humans from healthcare?

What struck me so loudly at the conference was how easy it is for us all to forget how human the healthcare experience really is. I moderated and attended numerous sessions at the conference, each a twist on the theme of how technology can make healthcare delivery more accurate, more efficient, more effective than anything we have going today.

David participated in a session withMatthew HoltVinod Khosla and Dr. Jordan Shlain, who could not be farther part from each other on the topic of doctor vs. machine (David played the role of moderate guy in the middle), Mr. Khosla backed away or at least clarified his earlier statements about how 80% of doctors will be unnecessary in the coming new age of healthcare technology. His revision was that 80% of alldiagnosis will, in the future, be done by computers, not doctors, because computers are far better at seeing a holistic view of a patient and taking in all of the relevant data. He talked about how certain digital technologies can know everything about you, including when you are sleeping and when you are awake. It made me think that Santa Claus must be worried about being replaced by an app.

Honestly, it is hard to argue with Khosla’s theory on diagnosis (although Jordan vociferously did). As for me, I have recently seen for myself, and not for the first time, the limitations of a physician when it comes to a complex case. I spoke to the doctor of a friend, who asked me to call that doctor and help the friend understand what really was going on. While not a doctor, I play one in my alleged work life at times, or at least try to think the way they might. And when I spoke to this doctor to find out exactly why he was recommending a particularly invasive form of treatment, I found out that it was basically a Hail Mary pass with no obvious receiver—he had essentially no working diagnosis and this was the only idea he had—that surgery might work because he had seen it work before and he had nothing else to offer. Never mind that he was working with an unclear diagnosis. Never mind that there was no clinically obvious indication that the surgery was the solution. And particularly never mind when I suggested that this was a very concerning situation; I got told that he was pretty damned experienced, that his colleagues, with whom he had consulted, were pretty damned experienced, and, while he only implied and didn’t say this, it was clear that he did not think me so damned experienced. When I spoke to my friend afterwards, my advice was “buyer beware,” or caveat emptor for those of you with fancy educations.

Since I have pretty much made a whole career working in situations where there were better ways to do things than relying on healthcare guesswork, I demurred. I said it is too bad we can’t feed this entire patient’s chart into Watson and see what diagnosis pops out the other side. I immediately started casting around for ways to get a more thoughtful second opinion. I found myself personally lamenting the lack of technology to take a broader view than what this one group of doctors had in their own heads. I felt, for just a minute, like Vinod Khosla without the controversial beachfront property. It was exasperating.

On the other hand, I also had a recent experience with a doctor where my diagnosis was pretty obvious (at least to her), but the personal reassurance I got from the literal hug and laying on of hands was the thing that made me feel much better (also some pretty awesome antibiotics that could probably kill an entire colony of Vikings). The doctor called me at home to check on me (as did David Shaywitz and his wife, both doctors who obviously care about people). The doctor asked me about my stress levels and told me how that wasn’t helping. She suggested both the anti-Viking drugs, but also some lavender aromatherapy and warm baths. It was a very human touch and it made me feel a whole lot better. The aromatherapy thing probably didn’t provide an ounce of “real” cure, but it felt damn good and was stress-reducing. In that moment, a machine was definitely not the medical answer for me, but then again, it wasn’t that complex of a situation (and I am all better now, thank you, and it wasn’t Ebola so you can hug me without consequence, at least if you know me and I like you).

While I was at Health 2.0 I learned a new term: DiPhy. It was said by one of the people on my panel about The Business of Healthcare (and Pokitdok’ssolution in particular). Being a nearly native California, when I hear “DiFi” I think Diane Feinstein, one of our state senators, and a particularly good one if you ask me. But this guy meant the digital-physical bridge; in other words, the path between man and machine that we need to walk effectively to make the most out of technology and keep the right amount of humanity in the picture. This was a big theme throughout the conference and one that is so compelling to me.

Bernard Tyson, chair and CEO of Kaiser Permanente, in his conference keynote address, said that “technology will continue to encourage and move that level of innovation out into the hands of consumers who can make different choices” about their care, but will never replace in-person caregiving. “There will always be the need for the human touch, human capabilities housed inside an individual,” he said. “In my vision, hospitals and health centers will have tech-enabled apparatus to help human intelligence make the right choices.” And of course he is right.

This is particularly important in light of the shift in US healthcare to (allegedly) put the consumer/patient/human being back into the center of the process of care delivery. People have learned to trust machines over experts before: we use ATMs instead of bank tellers, we can dispense our own frozen yogurt (with toppings!) instead of waiting in line for the high school kid behind the counter. We buy airline tickets on the web and have even given up bars for Tinder and Match.com. But when the going gets tough, and the machines are out of chocolate or cash or we can’t get from point A or point B, we want a human to help us. Convenience is nice, but it is no substitute for a warm body that wants to help.

I thought this point was brought home particularly profoundly in the always amazingUnmentionables program led by Alex Drane during the Health 2.0 conference. Rather than focus on how technology can improve healthcare, the talk was about how human people really are and how those things that make us human can really screw up our health. Esther Perel, author and relationship therapist, talked about how bad relationships and bad sex can ruin one’s state of mind, leading to poor health. Dr. Vic Strecher, professor at the University of Michigan, talked about finding a purpose-driven life after coming back from the death of a child and how this can amplify stress and poor health; Kent Bradley, President of Safeway Health talked similarly about how important it was to find motivation and a life without regret, particularly in the face of losing a beloved brother. Pulling it all together was Alex’s and Susannah Fox’s (RWJF Entrepreneur in Residence) discussion of a recent Robert Wood Johnson Foundation study called The Burden of Stress in America, downloadable HERE. The study’s key findings were these:

  • When asked if they had had a major stressful event or experience in the past year, almost half of all respondents (49%) reported that they had. More than four in 10 (43%) of these respondents reported stressful events and experiences related to health.
  • People who identified as being in poor health were more than twice as likely (60%) to report experiencing a ‘great deal’ of stress within the past month. Eight in 10 (80%) of those in poor health reported that their own health problems contributed to their stress, and more than half (58%) attributed the health problems of a family member.
  • Close to three-fourths of those polled (74%) identified their health as a sphere affected by stress. The most commonly reported effect on health was poor emotional well-being (63%), followed by problems with sleep (56%), and difficulty thinking, concentrating or making decisions (52%).
  • Only one-third (34%) of those polled who reported having a ‘great deal’ of stress within the past month said that they had a great deal of control over the stress in their life. Four in 10 (40%) said they had some control.
The amazing and talented Alex Drane and Susannah Fox
The amazing and talented Alex Drane and Susannah Fox

Bottom line: major human experiences and traumas that cause stress are a leading cause of poor health, chronic illness, etc. Failure to recognize this when treating a patient will undoubtedly compromise outcome. And my conclusion from this, other than that I want to be Alex Drane when I grow up because she is the 8th wonder of the world, is that we shouldn’t even be striving to replace doctors with machines, but should be striving to do a better job of equipping doctors to be the empathic, intuitive, out-of-the-box thinking half of a duo that includes data and technology and algorithms as the other half. Scientific skills are necessary, but not sufficient for good medicine (I know some of you are saying, “duh”) just as much as empathy and caring are necessary but not sufficient for good medicine. Technology adds a huge advantage to healthcare by feeding the knowledge engine that is man with data that man cannot readily access on his/her own. When that DiPhy thing reaches true balance, we will have achieved healthcare nirvana.

11 replies »

  1. The technology is even better than you may realize, Lisa. See our powerful differential diagnosis algorithm at http://beta.physiciancognition.com. Sleek, fast, and much simpler Android and iOS apps will be available in a few weeks, and a lay-friendly version will come out soon. Let me know if you have any questions or feedback!

  2. You have to look at the numbers and be well versed in statistics which I am not, But i assure that not 1 in 5 diagnosis by trained physicians is incorrect. I would like to someone further analyze this data. Does treating someone with a viral sinusitis with an antibx constitute a misdiagnosis, do “rule out ***” count as misdiagnosis? I would love for someone with a statistic background weight in on this

  3. Robert, agree that patients aren’t always equipped to self-diagnose, but in basic situations it has proven to work (do I have cold or flu?) and given the high rate of misdiagnosis by physicians, it can’t hurt to have the patient engaged in the search for the right answer as well. Lisa

  4. Computer assisted diagnosis is useful for clinicians, in the same way that computer assisted radiology helps the radiologist reduce the number of false positive and false negative interpretation of a medical image, but it can be tremendously misleading for patients who do not have the fundamental knowledge of medicine that physicians acquire over many years of education and practice.

  5. A computer can’t hug you or hold your hand or give you reassuring words.

  6. Like the Di-Phy concept and Dr. Tyson’s observations. This shouldn’t be either or.

  7. the problem with computer generated diagnosis is that the computer believes the input it is given. The one thing I have learned in the past 20 years of practice is that patients like to exagerate symptoms, regurgitate symptoms that they saw on there health related app, or in other words flat out lie. I can only imagine the number of lupus and ms cases that will be generated by computer.