Monday, January 21, 2008

Family doctors, or cyber health?

Several friends of mine have, or have had, cancer.  Some of them are freshly diagnosed while others are old hands.  One recently died.  All these friends have something in common, besides their cancer.  They struggle for answers.  What does my diagnosis mean? What should I do about it? Should I take the surgery right away? I feel like I've been hit with a sledgehammer-do I have time to step back and think?  Who is the best doctor for what I've got.  What have I got anyway?

Some of my friends come to me with these questions.  They know I am a net maven, and they know I'm something to do with the medical field, if not an MD.  Many folks can find information, but they have a hard time sifting through it to find what's relevant.  The stories I hear are amazing.  One doctor says one thing, another says something else, and the web tells a whole different story.  With a little context I can often offer some clarity, but it's also a matter of what people are ready to hear.  They know it's not a good situation when they hear the C word, and sometimes they like to take things a step at a time.  Is there room then, in the future, for a better way to help patients make sense of health information, whether it is preventative care, tending to a kid's bruised up knees, or the decisions that need to be made after the big C diagnosis.  Can our questions be shaped in such a way that the answers are more immediately relevant?  Can our data retrieval systems be such that the solutions coming back actually make sense without having to find a friend who is the the trade, so to speak, to help us understand what the doctor and the internet could not? Can we get better answers by just pushing the right buttons?
The answer, I think, is no.  The singularity is near, Ray Kurzweil tells us in a recent book of his. The time when machines become smart enough to replicate themselves in smarter versions that humans themselves.  If that were true then, for these entities, the interpretation of such complex factors as a medical diagnosis in the setting of our own unique contexts would be child's play.  It would be just a matter of engaging the right algorithms and acting on what comes out the other end.  I think Ray is off the mark though.  Machines can only deal will attributes and relationships that we put into them.  They are no good at predicting the future of an action any more than they are any good at feeling an emotion.  It is only through predicting the future that we can act in circumstances that have never been encountered before.  We can't search our memories for this exact moment because it hasn't happened yet.  However, we can search for similar moments and approximate our response based on that.  This requires a prediction of what might happen if we do 'x' so that we can engage the appropriate action for the situation.  This is one of the research topics at the Redwood Institute in California and suggests that artificial intelligence is not so intelligent after all.  At least, not yet.

So, the future of medicine, probably does not include replacing doctors with artificial diagnostic intelligence, and bedside robots at least for the moment.  My cardiologist and I discussed recently the phenomenon of a doctor's intuition.  We agreed it is hard to explain and even harder to teach.  This is an element of medical practice that all those cancer patients I talked about could really use; an empathic doctor who will use his intuition to engage with the patient and work through the data with them to find the truths they seek.  Often, there are gaps. Always, there are uncertainties.  But what patients need most of all at times like these, is a trusted individual to tell them what they need to know.   Someone to validate their fears, and guide them through the options for treatment and beyond.  In other words, an old fashioned family doctor.  
Perhaps the future will see a return to the past with the family doc acting not just as the first person to go to with symptoms, but as a sympathetic infomediary that interprets and guides in the midst of all those specialists. An internet whiz who can seamlessly bob and weave through the paper and the ether to give us the confidence that while we may not know how it's all going to end up, we can make the best of what we've got given what's known.
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