Before creation, there was time but without memories

I was once walking through the forest alone. A tree fell right in front of me, and I didn’t hear a thing.” Steven Wright, comedian

It never ceases to amaze me how our perceptions dictate our sense of reality. Even more so, our memories of those perceptions ultimately dictate how we experience our lives. It seems strange to refer to our memory as fallible, in that we cannot remember a phone number from yesterday, but we can still clearly see the face and remember the name of our first grade teacher. One could easily argue that this is simply a failure of evolution to properly assign priority to various memories. And to be blunt, what did a caveman really have to remember outside of his cave-wife’s birthday. But it is more likely that we simply do not yet understand the incredibly amazing capability of humans to remember.

Perception of time passed is one of those things that many people agree is very unreliable. It is hard to believe that the Challenger disaster that killed so many unique and special people who dared to breach the skies, happened nearly 30 years ago. I remember where I was, and I remember thinking that I would never forget where I was. It really doesn’t seem like 30 years. Perhaps that is because of the emotion that was and still is so associated with this event.

Contrarily, I just saw a reference to an article that I had read in the New York Times, and was surprised to see that it had only been three weeks since I had read it. As I remembered, this was an old article. But once again my personal perception of time was definitely flawed. Some say that the benefit of forgotten memories is the ability to experience previous events with a whole new perspective. In fact, upon reading the first few lines of this article, it struck me that there was a message in it that I had not considered before.

The article is named “Doctor, shut up and listen”. Not surprisingly, this article deals with the very important issue of getting doctors to hold back from interrupting patients while the patients share critical elements of their history. There are formal studies that demonstrate how doctors rudely interject new questions within seconds of asking the previous ones.

Despite the endless tirades by physicians about the dying unique and very human value of the doctor-patient relationship [which is of course being killed off by technology], it seems that very few doctors truly devote the necessary time to developing such a relationship. Of course, there are endless reasons for this, none of which having to do with the doctor. No doctor says that it is his or her communication skills or personal sense of importance of really listening to the patient, that is the cause for missed key information. It is always because of limited income per patient, and demanding patients who want same-day appointments, and Obamacare and so on. I have been quite vocal about  my opinions regarding these issues in the past, so I will not rehash them now.

There are already real technologies that can interact with a human for as long as necessary, garnering the necessary information for diagnosing a problem. As AI advances, and computer understanding of human speech becomes better and better, computers will be able to dissect human responses to medically oriented questions, in order to focus in on the clinically important information. In this reality, an older patient who may somewhat stumble while they speak or have occasional memory lapses, will be allowed as much time as necessary when asked the question “how are you feeling”.

The computer will allow the patient to speak for a  straight hour, if that is what the patient wishes. All during this time, the computer will extract details about the patient’s primary complaint of, say, shortness of breath. Even without asking, the patient will detail how climbing stairs has become more and more difficult over the last three weeks. The patient will describe occasional nausea which even wakes the patient at night.

The computer will of course access the patient’s personal medical record and come to a very reasonable conclusion that this patient may be suffering from poor blood flow to the heart. It will still be necessary to rule out other conditions like asthma or gastric reflux, and a computer will deal with all of this as well, perhaps simply by asking more pointed questions. The key is that the computer has all the time in the world. Even if this interview takes literally an entire day to complete, the computer won’t mind. And when the physician gets the report, it will be half a page long with only the pertinent issues listed.

Computers could definitely assist physicians in history taking in another way. Imagine a doctor wearing a nearly invisible inner ear-piece that constantly feeds information to the physician from the computer system. If a doctor interrupts the patients after only 15 seconds, the computer could whisper that the doctor has not allowed the patient sufficient time to elaborate on important aspects of their condition. The computer could even assist the doctor by suggesting appropriate further questions to be asked. I think it is clear that many doctors would be offended by the concept that they must be guided through a complete oral history of the patient’s condition. But the simple fact is that doctors notoriously fail to devote sufficient time to uncover key diagnoses.

I remember reading an article about the number of patients who are incorrectly diagnosed with chronic lung disease, when in fact they have congestive heart failure. As it turns out, these two very different diseases can have very similar presentations. It is possible, in just a couple of minutes, to ask the patient the necessary questions to distinguish between these two entities. Far too often though, this does not happen. It may be because the doctor simply does not have the time, or doesn’t even think of the possibility of an incorrect initial diagnosis. In time, computers will be developed to such a point that they will not make such mistakes. And when that happens, how will doctors defend their poor track record relative to the machines?

For the patient who feels that no one is willing to take the time to listen, their perception is one of endless days of needless suffering. For the doctor who feels that there is no time to answer “silly” questions, the perception is that people do not value his or her time. Since neither the doctor or patient are traveling near the speed of light, it is most likely that this relativity of perceptions is not due to some strange physical event. Instead, it is about how we all value our own time and that of others. As it seems, we all value time very differently, and it may only be when AI has sufficiently developed, that we will all find the time that we have been so desperately looking for.

The answer to Mr. Wright’s observation of the tree not making any sound, is that apparently there was no one around who was interested in listening.

Thank you for taking the time to listen to me

My website is at

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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