Posted by Sam on Sep 15, 2008 at 01:18 AM UTC - 6 hrs
Even though they have a special hero(ish) status, it's a popular pastime (some might say cliché) to complain about medical doctors making so much money when nurses and other supporting cast in the medical industry "do all the work."
The justification for paying out the ass for just a few minutes of your proctologist's time is that they need to pay their insane educational loans. And don't forget about how hard they worked in school that long just to learn their asscraft.
"Still," we always say, "do we really need the doctor? My nurse did everything I needed done, and I could have told you I have strep throat and needed some pennicilin." Even if we don't trust the medical support staff to make the decisions, we have ways of making those decisions without a doctor.
As medical expert systems become better, we might expect the doctor to become obsolete. From my vantage point, I'm unable to see what about a doctor could be better than inputting a list of symptoms to a machine and getting back most likely diagnoses, which could ask questions to further refine the results. It could even consult a list of prescriptions (drugs, therapies, surgeries, et cetera), cross reference it with your medical profile (or DNA, when we have medicines tailored to individual genomes), and give you advice on what to do next.
Some people might even think an application like that would be better than human doctors.
Under such a system, it's unlikely all human doctors would become obsolete. For example, we'll always have a need for the maverick hacker doctor who can think outside the box.
But in most cases, most doctors are going to continue to diagnose the same diseases and prescribe the same (potentially biased) treatments to each patient who comes in. It's a factory, and we're on the conveyor belts.
Of course, even if we were to have the capability to replace most doctors (my belief is that we do), I don't think most people would feel comfortable consulting a machine about their problems. Dr. Sbaitso only gets us so far. We want the comfort of another human telling us what's wrong with our health, not a heartless machine.
Still, I think it would be interesting to see the results of large scale experiments pitting man vs. machine in the field of medicine. How much more successful is one over the other? Is that success due only to non-life-threatening conditions? Would that benefit to society be outweighed if one failed more often on the catastrophic problems of a few individuals?
I'm not a doctor, and I can't tell you exactly what they bring to the table. Could be something I've completely overlooked, or something we're unlikely to know unless we're in that industry. But that's how it looks to me. I'd like to confirm or disprove that hypothesis with a test.
What do you think? How would it end up?
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interesting thought. one thing you overlooked, or at least didn't cover is government regulations. in my state, doctors and nurse practitioners are the only ones allowed to write a prescription. i do believe the nurse practitioners prescription is only valid if under the authority of a doctor.
Posted by shag
on Sep 15, 2008 at 09:55 AM UTC - 6 hrs
Good point.
I actually thought that is the law over the whole US and most countries, but I admit it may be a poor assumption.
With the notorious slowness at which government moves, I'm not willing to say that the laws would change (also, I'm sure MD lobbyists will have quite compelling persuasions for lawmakers should the issue be taken up).
However, I'm more interested in the practicality of the /notion/ and designing the experiment at this point, not the practicality of actually implementing it and all the political BS that one would have to go through. I'll leave that for my lawyer friends. =)
Posted by Sammy Larbi
on Sep 16, 2008 at 12:48 PM UTC - 6 hrs
Hey, Sam!
Man, I hope you are doing alright, post Ike. Do you have power and water yet?
Re this interesting post -- This is likely old news to you, but I thought it worth mentioning that a huge amount of really interesting research has gone into exactly this, under the name of ``expert systems.'' The development of expert systems for medical diagnosis has been a mainstay of AI development for 30 years or so.
(An interesting paper from Stanford Medical Informatics) http://smi.stanford.edu/smi-web/research/details.j... Medical Informatics: Uncommon research, common goals. By Mark A. Musen. MD Computing (January/February 1999). "DENDRAL demonstrated the power of encoding large amounts of domain knowledge for use by an automated reasoning system, and offered one of the first examples of rule-based programming."
(An interesting paper from Archour at el, in the Journal of the American Medical Informatics Association)
By Soumeya L. Achour, MS, DVM, Michel Dojat, Eng, PhD, Claire Rieux, MD, Philippe Bierling, MD, PhD, and Eric Lepage, MD, PhD. Journal of the American Medical Informatics Association 8 (4): 351360. July 2001. Abstract: "Decision support systems in the medical field have to be easily modified by medical experts themselves. The authors have designed a knowledge acquisition tool to facilitate the creation and maintenance of a knowledge base by the domain expert and its sharing and reuse by other institutions. The Unified Medical Language System (UMLS) contains the domain entities and constitutes the relations repository from which the expert builds, through a specific browser, the explicit domain ontology. The expert is then guided in creating the knowledge base according to the pre-established domain ontology and conditionaction rule templates that are well adapted to several clinical decision-making processes. Corresponding medical logic modules are eventually generated. The application of this knowledge acquisition tool to the construction of a decision support system in blood transfusion demonstrates the value of such a pragmatic methodology for the design of rule-based clinical systems that rely on the highly progressive knowledge embedded in hospital information systems."
(One of many companies developing medical expert systems)
Google shows a lot more where these came from. I like your idea of a ``competition!''
sending best wishes your way from sunny Palo Alto, grant
Posted by grant
on Sep 16, 2008 at 09:58 PM UTC - 6 hrs
Hey Grant, thanks for all the research and thoughts. (We're doing fine after Ike - I'm sure you've talked to your family, so you know this side of town wasn't a complete disaster like the other side).
You are right - I do know about expert systems. I was pondering their use as a replacement for general practitioners as opposed to a support mechanism (hard to replace a surgeon, I would think, and specialists are probably the "hacker doctors")
Still, I appreciate the links because I didn't do a good job of providing them (for one), and (another) it looks like there's some interesting stuff in there.
The competition would be to see if we really need the doctors we see on a regular basis for our flus and illnesses. I don't expect it would come out favorable for the doctors, but I want to test that theory, and especially I'm interested in testing the areas where they would refer you to a specialist.
I'm sure a machine could get the majority of diagnoses right. It's the really important ones I worry about.
Posted by Sammy Larbi
on Sep 17, 2008 at 08:46 AM UTC - 6 hrs
@sammy, to your comment on law over the whole us... the federal government usually involves itself in matters that are inter-state. since a doctor only practices in a single state (maybe 2-3 if on a border), they are regulated strictly by the state. i suspected that, but checked with a doc friend of mine (ER, not sure you want to replace him either) just to be sure.
generally speaking, laws from state to state are very similar. usually if a state adopts a new law, its only a matter of time before most other states adopt the same laws.
Posted by shag
on Sep 17, 2008 at 09:59 AM UTC - 6 hrs
The main ability of a human doctor is not working out diagnose and therapy from symptoms, but correctly identifying symptoms: there are dozens of skin injuries, and you need a human being to distinguish between type A blisters an type B blisters. In fact these abilities can only be learnt by example. At least with today's technology, only a human being is able to learn such things with reasonable time and cost.
A similar idea I head was that of computerizing jurisprudence... starting from the codification of laws according to strict syntactical rules. But, also here, there is so much opinion in the application fo law. Assessing of probabilities... often done wrong, I admit.
Posted by anonym
on Sep 17, 2008 at 11:35 AM UTC - 6 hrs
Dr. Sbaitso rules! I think a l... <a href="http://fullreply.com/1f" title="Read the rest at FullReply.com">fullreply.com/1f</a>
Posted by Bob
on Sep 19, 2008 at 03:28 PM UTC - 6 hrs
