It’s a dimly lit office. Four large computer screens come alive with a patient’s mammogram. Dr. Dan Miner ’77, senior radiologist at the Southern New Hampshire Hospital and my externship host, examines several dozen images to see if he can detect an abnormality. A dense mass is identified, the patient’s medical history is pulled open, a diagnosis is dictated into the microphone and there is an intense, short pause. Then, multiple scans of the next patient come up and the diagnosis continues with the same deliberation.
I was not unfamiliar with the revolutionary technological advances in medicine, but I hadn’t really grasped the depth of their effects: the increased accuracy and speed to diagnose, complex imaging techniques that enable us to easily probe the mysteries of human anatomy and the relative safety of treatment. It was only during the time I spent externing with Dr. Miner that the innumerable ways that technology has changed medicine struck me. This thread of thought inevitably brought me to a question that has been vociferously discussed: will computing technology replace doctors?
Vinod Khosla, the famous Silicon Valley entrepreneur and cofounder of Sun microsystems, provocatively predicted in a 2012 conference that computers would replace 80% of all doctors by 2025. Khosla visualized a future where a patient is diagnosed self reliantly with an app, whose database is updated instantly with the release of a new drug, health policy, a revealing case study etc. Combining all this information with the patient’s daily health log, the app can suggest a cost effective treatment plan tailored specifically for the patient’s needs. Only in serious circumstances would the patient need to see a doctor.
Would people rely on such a system? After all, there’s always a chance of error involved with the diagnosis and treatment method prescribed by a doctor. Perhaps that sharp discomfort that you experienced a few years back is not taken into consideration, because you forget to mention it to the doctor. Perhaps the doctor is not aware of the newest drug available which can effectively delay the onset of your disease. Besides the reduction in diagnosis and treatment errors, our increased reliance on computing technology for health care will equalize the nature and delivery of medical procedures globally.
During my externship, I witnessed a lumbar puncture — in essence, a minimally invasive process that involves sticking a needle into the patient’s back to collect cerebrospinal fluid. Dr. Miner, with the effortlessness of an expert, completed the entire procedure in about twenty minutes. As I asked him technical questions, he casually mentioned how this procedure would have been impractical if it were not for the x-ray visualization. But there was another equally important part: the doctor’s touch. The initial introductions, the anxiety of the patient that Dr. Miner perceived and alleviated with a gentle pat on the back, the self deprecating humor that both doctor and patient indulged in, all revolved around a single thing: the patient’s comfort. Can this be replaced by instructed software? Should we try to replace it, as many are trying to?
When I asked Dr. Miner what his thoughts on the matter were, he said, “There is certainly hope that computers will play a larger role with improved performance via the study of outcomes and the meaningful use of algorithms, but the power of the human hand of compassion, of counseling patients and educating them is profound and cannot be easily replaced by a computer.” I can see what he meant.
As a patient I would want to be delivered an accurate, safe and cost effective treatment irrespective of my geographical location. At the same time, I would not want to endure repeated scans by CTs, MRIs and PETs! In the midst of the equalization in health care delivery that technology will bring out, I want to be diagnosed by a human doctor with the ability to understand my emotions. Siri’s great grandchild will probably do this better than most doctors. But then I would feel like a commodity. The sense of being cared for, of knowing that there are others (and not codes of 0s and 1s) who value my well being as much as I do, who are ready to give their time to treat me, is important. And that, for me, comes with the involvement of a human doctor. This may be because I value human ingenuity and compassion more than a machine’s super intelligence.
The trends in healthcare technology are exciting. An exponential advance in technology is required to deal with the incredibly complex problems of medical care and its economics. This advance should ensure that medical delivery is more patient-centric, efficient and accessible. That it revolves around the patient’s physical and emotional state. But in our attempt to do so, we should not reduce the patient to a math problem waiting to be solved.