Wednesday, February 16, 2011

Computers and Health Reform, What's Missing? It's Elementary, My Dear Watson, Lack of Human Contact

Michael Millenson, author of Demanding Medical Excellence : Doctors and Accountability in the Information Age, University of Chicago Press, 1997), is passionately arguing again how computers will make doctors accountable, will improve care, and will forge a new partnership between doctors and their patients.

In the February 14 Forbes Magazine and the February 15 The Health Care Blog, he offers his thoughts in an an essay on “Health IT: A Tale of Three Watsons. ” The three Watsons are: "Watson", IBM supercomputer now demolishing two human contestants on Jeopardy , the TV game show; Thomas Watson, Jr. son of the father of IBM and its CEO in his own right, and Doctor John Watson, the sidekick of Sherlock Holmes.

It’s elementary, my dear Watsons, Millenson seems to say, widespread applications of health information technologies constitutes a quantum jump forward in improving the quality and outcomes of care as administered by physicians.

Millenson quotes a Johns Hopkins medical student, Yong Suh. Suh wrote in the February 9 in a USA Today op-ed, “Performing well on Jeopardy and diagnosing sick patients have similar prerequisites: a broad fund of knowledge, ability to process subtlety and ambiguity in natural language, efficient time management and probabilistic assessment of different possibilities.”

Millenson cites Thomas Watson, Jr,, who said in 1965,

“The widespread use [of computers]…in hospitals and physicians’ offices will instantaneously give a doctor or a nurse a patient’s entire medical history, eliminating both guesswork and bad recollection, and sometimes making a difference between life and death.”

Millenson comments that the computer does not solve everything, but nevertheless it is the essential central solution, partnering with patients will be important too.

“In other words, however Game Show Watson fares on Jeopardy, partnering with patients — is not just being more smart about telling patients what to do — will remain central to improving health as well as health care. As Dr. John Watson, famous companion of Sherlock Holmes might put it, that truth is elementary.”

In a telling comment on the federal government’s commitment to devote $27 billion to health IT, Millenson says, “The electronic health record, with or without decision support, is centralization’s most impressive victory."

I am not as confident as Millenson that this massive federal largesse is either “impressive” or a “victory.” I am not a big fan of “centralization” as the long-term solution to health care woes.

I agree with Stephen Baker, a physician and author of an E-book, Final Jeopardy: Man vs. Machine and the Quest to Know Everything. In a February 14 Los Angeles Times Op-Ed piece, Baker observes,” Watson is incapable of coming up with fresh ideas, much less creating theories, cracking jokes, telling a story or carrying on a conversation. Its ability is simply to make sense of questions and then scour a trove of data for the most likely answers. It represents a dramatic advance in artificial intelligence, but like another famous IBM computer, Deep Blue, Watson excels on a limited playing field, in a game defined by clear, rigid rules.”

Not every office visit, or hospital admission, is a diagnostic or treatment puzzle. The visit may be for reassurance, consultation with a trusted advisor, affirming or questioning information found on the Internet, addressing hypochondriacal concerns, renewing a prescription, or simply a following up to see how things are going. These things may be trivial, indeterminate, or alimentary to "Watson", the super-computer, but they are vital to the doctor-patient relationship and to human concerns.

Not everything follows “clear, rigid rules.” In medicine, not everything is factual, contractual, or even actual, nor, much of the time, does the computer offer anything “satisfactual” to the patient-physician relationship.

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