5 ms·

> bedside manner + being able to remember a lot of things My impression is that accompanying a patient is super important, it helps to understand illness, to h

• chromatin 5y ago
  It also helps to have a relationship with a patient (or person). There are some people who will never, ever complain about anything. When they complain of severe abdominal pain, for example, you pull out all the stops immediately to figure out what's wrong, because it's probably really bad. On the other hand, there are hypochondriacs and people will low pain tolerance. While they can certainly also become seriously ill -- and one must never forget this -- the tempo and pace of workup and order of intervention is markedly different, absent other information that shifts the pretest probabilities.
  • Aeolun 5y ago
    > On the other hand, there are hypochondriacs That’s me. I really, really appreciate a GP that both understands that I’m not doing it on purpose, and can reassure me that nothing is wrong, or figure out that we actually do need more testing this time. Unfortunately it’s been years since I had one like that :/
  • KerrAvon 5y ago
    Sometimes a relationship is bad. If you think someone’s a hypochondriac, but in fact they’re unusually sensitive, you’ll dismiss a lot of what they say and that can be quite damaging over time. (Especially if they’re female https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562 https://www.health.harvard.edu/blog/women-and-pain-dispariti...). I wouldn’t eliminate GPs from the process, but many people actually would like to hear what the robots have to say about their medical conditions. Having second opinions of this sort available might lead to better patient outcomes.
    • Spooky23 5y ago
      Lol. Maybe people who don’t have any medical problems. There isn’t enough humanity in healthcare to begin with. Replacement of doctors with AI sounds pretty horrific. General practice isn’t where healthcare costs are going bonkers, and it seems weird to want to cost-cut something that actually kind of works in favor of bullshit. Know what would be a great use of AI? Something real like analyzing all of the telemetry in EMRs to provide better guidance to doctors to proactively guide people. Some CVSHealth chatbot telling me whatever is a waste of time.
      • Elof 5y ago
        I think the person was suggesting using the results of the AI to inform the doctors, not replacing them. Which is something I would like as well
        • nradov 5y ago
          Automated diagnosis applications have existed for decades. They have proven useful in limited circumstances for certain specialties and rare conditions but for routine medical care they're more hassle than they're worth.
    • nradov 5y ago
      There is no evidence that diagnostic robots would actually produce better outcomes. The hypochondriacs are already able to Google their symptoms and make themselves sick with anxiety.
• HaZeust 5y ago
  Knowing the ontology of your patients and their risk is also a tenet of a doctor's job, but we can do it with AI too. Hell, ontological engineering had a revamp specifically so that we could have a standardized model to describe any and all "parts" of a "whole" in a way that machines could understand.
  • nradov 5y ago
    No we really can't do that with AI yet. Current AI technology is nowhere near that level.
• telxosser 5y ago
  What data is being collected on you? Once a year blood test if that even? I actually suspect it would be trivial to beat my doctor after 5 years of higher frequency full blood panel data collection. 10 full blood panel samples a year, have 20 million people do that for a data set we can do classification on. I think my doctor is kind of out of business then. Will never happen in my life though with health insurance and health bureaucracy.
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  • nradov 5y ago
    Beat your doctor on what? You can already get 10 full blood panel tests per year if you want. You can just pay for it and don't need insurance. But what will you do with the data? For most people the results won't tell you anything useful. https://www.ondemand.labcorp.com/lab-tests/comprehensive-health-screening https://www.ondemand.labcorp.com/lab-tests/comprehensive-hea...
  • zo1 5y ago
    It won't happen primarily due to government regulation. Medical information has "dangerous, don't touch this" written all over it, and everyone is scared to try.
• derefr 5y ago
  “Super important” — more like “super nice-to-have.” Hospitals don’t have any single person on staff who stays attached to particular in-patients. Who knows you? Your chart. Yes, of course, hospital care would be better in many ways if we did have somebody who statefully understood particular patients’ needs. But what I’m saying is, the GPs in hospitals could be replaced with stateless diagnostic AI without making hospital care any worse than it is now. And hospital care is a large part of the medical system, so only replacing diagnostics there (while leaving primary-care GPs alone) would still be a major optimization, freeing many doctors to provide better care, go into specialties, etc.
  • nradov 5y ago
    That's simply false. You obviously have no idea how hospital care is actually delivered. To start with, every admitted patient has an assigned attending physician who is responsible for coordinating the care team. Some things can be documented in the patient chart but there are always gaps. Clinical decision support systems for partially automating diagnosis could potentially be helpful in some limited circumstances but the ones built so far mostly don't work very well.
    • robbiep 5y ago
      I’ll second how misguided that view of hospital care is. There is ALWAYS a treating team, always an admitting consultant/attending
      • derefr 5y ago
        Then where exactly does the oft-cited kafkaesque nightmare of being "lost in the US hospital system" come from (with patients put in the wrong wards and forgotten for sometimes months; given inappropriate medications that doesn't end up recorded; tested repeatedly for the same problems because the test results were "lost"; etc.)?
        • robbiep 5y ago
          Just because someone is responsible for you doesn’t mean the system works competently enough to make sure you receive only what you need in a timely manner
• kilburn 5y ago
  What many people don't realize is that medicine as a whole is already some sort of expert system (i.e.: a flavor of AI). There are researchers that conduct experiments to produce meaningful data and extract conclusions from that data. Then there are expert panels that produce guidelines from the results of that research. Most diagnostics and treatments are prescribed following decision diagrams that doctors themselves call... algorithms! There are several limitations that prevent us from applying other AI techniques to the problem. Off the top of my head: - We do not have the technology for machines to capture the contextual and communication nuances that doctors pick up on. There can be a world of difference between the exact same statement given by two different patients or even the same patient in two different situations. Likewise, the effect of a doctors' statement can be quite literally the opposite depending on who the patient is and their state of mind. One of the most important aspects of the GP's job is to handle these differences to achieve the best possible outcomes for their patients. - Society at large is not ready to trust machines to make such intimately relevant decisions. It is not uncommon for patients to hide relevant information from their doctors, and to blatantly ignore the recommendations from them. This would be many times worse if the doctor part wasn't human. - We cannot apply modern inference techniques (e.g.: deep learning) to the global problem because we have strict rules that prevent medical data collection and analysis without a clear purpose. Furthermore, these techniques tend to produce unexplainable results -which is unacceptable in this field-. As a result, there's not enough political capital to relax those rules.
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  • sjg007 5y ago
    > We cannot apply modern inference techniques (e.g.: deep learning) to the global problem because we have strict rules that prevent medical data collection and analysis without a clear purpose. I mean, China will likely do it, as long as they can capture high quality data, so there's that.
  • shadowofneptune 5y ago
    The attending physician in a modern hospital system is primarily a manager. Their main concern is treatment of the patient's medical issue, but their role isn't limited to that. This patient is refusing care but also refuses to leave, what do we do? How should we schedule care around a patient who requires the entire floor to assist in daily activities of living? They may not get the last word on matters outside of their responsibilities, but being the physician their words carry weight. This role has remained pretty much constant through the modern medical system, even as medicines change and nurses and technicians gain more responsibilities. A computer cannot perform that role with the current paradigm of AI, even the worst and most arrogant doctor is more qualified leader than any computer.