My favorite elective in medical school was my genetics rotation. I learned a lot of interesting and obscure facts, I made some good friends, and as luck would have it I was given the opportunity to write my first journal article. Part of what made it so enjoyable was the benign tolerance the staff had for my juvenile sense of humor. For example, in a field chock full of odd terms used to describe unusual clinical findings, a medical student might be forgiven for not getting them all straight in the span of a month. So I coined the term “schmechronekia” to describe any unusual feature, the proper name for which I could not remember. As in “the patient presents with clinodactyly, micrognathia and pronounced schmechronekia.” For some reason, they pretended to find this amusing.
Many years have passed since those salad days of mine, and I’ve managed to shore up my knowledge base a bit. But even within the ambit of my own specialty, it’s still impossible to know everything. It seems IBM wants to render such lacunae in my expertise obsolete. From the AP:
IBM is finally sending its Watson computer out into the working world.
The supercomputer system is best known for trouncing the world’s best “Jeopardy!” players on TV. But now one of the nation’s largest health insurers is hiring it to help diagnose medical problems and authorize treatments.
The insurer, WellPoint Inc., says Watson is a game-changer in health care.
IBM says the WellPoint application will relate a patient’s symptoms and history to textbooks and medical journals. In just a few seconds, it can present several possible diagnoses or treatments.
This does not delight me.
I should admit that I did not watch the “Jeopardy!” episodes wherein Watson made mincemeat of the flesh-based contestants. I gather that it got almost every answer correct (with a few really weird wrong answers thrown in), though I understand that its victory was based largely on being inhumanly quick on the buzzer. Still, it’s indisputable that it can access a vast store of information and come up with the correct answer with dizzying speed.
My negative reaction to getting the Watson treatment is multi-factorial. On its face, I don’t think any of us really relish the idea that a computer could do our professional thinking for us. That’s not to say it’s not true, but I don’t greet that prospect with unfettered joy.
However, this is my cue to talk about the “art” of medicine, which is another way of discussing how much fudging there is. The gray areas show up in various ways. There’s the diagnostic exam, for example. I can certainly think of times when I’ve looked into a kid’s ear and said “not infected” and had a colleague disagree. If you’re plugging information into a computer, it depends a lot on what you call it. Is that rash macular, or is it more of a patch? Is there pain when you press more around the navel, or up closer to the ribs? I wonder how Watson will accommodate that inescapable subjectivity. Or what if a patient doesn’t quite meet the textbook definition of an illness? I’ve had patients whose diagnoses would have been missed if strict adherence to the criteria in the text had been applied. I know my gut instincts aren’t entirely reliable, but they’re served me well enough. Does Watson have a gut?
In addition, any time you’re dealing with people there’s a certain degree of irrationality that has to be accepted. (Not on my part, of course. I’m always 100% rational.) With experience and familiarity with one’s patients and their families, a provider can get a sense of when “unnecessary” treatments really are helpful. Kid X almost certainly has a viral infection, let’s say, but also has really anxious parents. It may obviate a panicked late-night ED visit if I draw some tests I probably could do without, thereby reassuring parents that I’m on the look-out for something dire. Good luck plugging in the numbers for that cost-benefit analysis, yet considerations like those really do play a part in taking care of people. I try to be by-the-book as much as possible, but sometimes fudging is the right decision.
In the end, I wonder what WellPoint, Inc. will really use Watson for. If it’s just a useful way of winnowing down a differential diagnosis or choosing the best treatments for an unusual illness, why should I object? I worry that it may be used more as a way for WellPoint, Inc. to determine what it will pay for. (Call me cynical.) We all need to be paying attention to the problem of rising healthcare costs. But I wonder to what degree Watson will be overriding the human factor in medical decision-making, which can’t be discarded entirely when it’s humans that you’re taking care of.
*without all the money and fame, that is