It is vital for those pimping the New Medical Revolution to insist that doctors are opposed to meaningful reform for selfish parochial purposes.
That “New Revolution” is merely the same story that has gone on since Medicare and insurance came on board, and the testing and utilization question became adversarial between doctor and payor. But that is a long and somewhat tangential story.
You touch on a vital point with AI and diagnosis, although it is not the medium itself – reading Harrison’s is enough to get one well into any subtleties of rare and arcane diagnoses.
Medical IT is balanced on a huge quantity of spectacularly bad assumptions that will crash the system as surely as all the bad ideas of Marx, followed as gospel by those who half-understood his theories, crashed the Communist system.
There are axioms of the scientific method which are ignored – if even understood – by the HIT mavens. The first of this is that there is an infinite amount of information, but it never expresses MEANING until it can be used to answer a question. No matter how vast a pile of data is, it is finite.
It is up to the human mind to develop the context in which the data takes meaning. Scientific method is based on logical positivism – until the question is properly asked, the data has no value. Human minds express methods and algorithms by which the universe can be ordered. Computers, no matter how clever, are not algorithm-generators, but are algorithm-appliers. The insistence that the computers are “more right” than humans is a terrible expression of technopathy. The “algorithms from above” are not implanted by the computer; rather, they are laws created by men and women who consider themselves the wisest, and codified into an electronic format. No doubt they are wise; but they are not all-seeing.
Algorithms do not span the space of the human condition. At best, they provide a bijective map between ideal clusters of symptoms, and ideal diagnoses. They are “mile-markers,” no better.
Real medicine is determining what is in between. The worrisome trend I see in medicine is the concept that what the patient expresses is not identifiable in reality. Skill in medicine is the ability to close the lacunae of diagnostic understanding in the care of the individual, the Actual Patient. Nowadays, chronic abdominal pain is treated in the format – “I checked everything on the algorithm, and came up empty. Therefore, the chronic abdominal pain does not exist.” That sort of approach is unsophisticated, unintelligent, and horribly expensive.
The definition of an instrument or tool is that which can be used to do a thing. A useful instrument is one that allows one to accomplish something easier, quicker, more efficiently, etc. In the New Revolution, tools are not offered to physicians, but rather as a threat to physicians – something that anyone can wield that can replace the physician. EMR/EHR is not a tool for medical care. It is a $30 Billion Dollar make-work slush that pretends to be the electronic bridge between IT and Medicine.
I am fascinated that, as a physician, I get into argument with HIT people who insist that they can offer me a swath of historical information on a patient – much of which is not interesting to me, and much of which it is inaccurate. I say I do not need it; they say I do. It is tremendously useful, though, for someone compiling centralized records of people – such as a “citizen database” in some mythical totalitarian country – to track its own people.
I have just completed a job application, and filled out 18 pages of paper, much of which reduplicated the 11-page electronic on-line application for credentialing; which in turn repeated a pre-application, all of which contained my life in sequence since high school. I am over fifty now, and I have told my life history so many times.
I received a phone call from the people with whom I had corresponded. They also had my resume. They asked me for my home address, which was on the CV, medical license, and probably in 12 different places elsewhere. The computer can multiply useless redundancy faster than we can keep a lid on. IT may well accelerated the grinding of American Medicine to a rusty and demented halt by the end of this decade. Schade