Doctors are terrified, and justifiably so

I just read a blog post to which I want to strongly respond. I have absolutely no interest in attacking the writer of the post, but unfortunately, I need to make reference to the blog’s title in order to make my arguments. I will not directly link to the blog post, but I cannot prevent someone doing a search on the name and finding the original. Please appreciate that my comments are directed at the content of the blog post and not in any way or form against its writer.

The title of this blog post that I read effectively asks the question if modern medical technology is negating the joy in the practice of healthcare.

I have a strong problem with the term “joy” being used in this context. I remember an internal medicine resident who was parallel to me, while I was studying surgery in Montréal. He was very animated in his discussion of a case that he was presently involved in. After he finished discussing the case, I asked him if the treatment that was started on the patient was working. Without hesitation, he responded that he didn’t know and didn’t really care. I asked for clarification of the statement because I truly did not understand what he could possibly mean. Once again, without hesitation, he responded that what attracted him to medicine was not curing patients but rather figuring out puzzles. And when the puzzle involves something as critical as a person’s life, the stakes are so high, the joy out of resolving the puzzle is greatest.

I just sat silently. Until that time, I had never met anyone who so blatantly displayed his disinterest in the patient’s welfare, versus his fascination with the practice of medicine. This doctor was truly joyful. He was smiling  and laughing and fully enjoying telling the story of this complicated patient who was seriously suffering from an, as yet, undiagnosed malady. That wasn’t the first time I considered leaving medicine and it wasn’t the last. I guess that at least at that point, I still hoped that such a doctor was an anomaly.

I personally don’t care about joy in the practice of medicine. The only joy that a doctor should experience is when a patient is cured, independent of how that cure was achieved. For the patients, and there are more and more every day, who have chronic conditions, the limited joy should be in restoring the patient to his or her previous level of function, and possibly even improving their quality of life. But to watch a patient leave  the hospital after a partial foot amputation due to diabetes, and to relate to this as the joy of medicine, is just sick.

The author of the blog post I read, also refers to “compassion fatigue”, which is a pleasant way of saying that doctors stop giving a damn. Rather than discuss all of the reasons given for the persistence of this problem, let me just say that it is probably, in fact most probably, a result of the human condition. I’ve heard the same kind of “fatigue” arguments used in other spheres. For example, I’ve heard the argument that human beings are not inherently designed to be eternally monogamous because of “passion fatigue”. At some point, at least one partner becomes tired of the day-to-day “drudgery” of the relationship and begins to seek out another partner. Especially, once the kids are grown, and what is primarily left is spending time with the significant other, it is so easy to argue that it is just human nature, not to be comfortable in this situation.

As an aside, this is further support of a previous blog post I have written, that deals with  human beings’ ultimate inability to provide top-level quality care to other humans. There is nothing wrong with being human and making human-type mistakes. Once again, it is part of the human condition. But no one wants to suffer due to these mistakes. No one wants to deal with a doctor who has compassion fatigue. And yes, there is already literature that demonstrates that human beings are more comfortable sharing very personal information with computers, more than with other humans.

The judgment element is eliminated when confessing to a computer. And the best way to hide the fact that you have an STD is to have a computer diagnose it, write the prescription, automatically send the prescription to a pharmacy program, and have the medication prepared by a robot and then drone delivered to your home. And if you have questions about the use of the medication, you will prefer discussing the issues with your personal health robot, that once again will wrap  all of your medical data in the best available encryption.

The author argues that digital portals, wearables and mobile health technology are to a significant extent, a fad. He then continues to state that a “deeply engaged patient” is based on social interaction, and not on technology.

You can’t have it both ways. If doctors are becoming “compassion fatigued”, and don’t have more than a few minutes per patient due to a whole variety of reasons, most specifically the issue of income, you cannot then come and argue that it is the social connection between doctor and patient that make this relationship unique. It is only via digital portals, wearables and mobile health technology that there is a chance that doctors will have their time  freed up sufficiently, in order to actually spend 5 to 10 dedicated minutes with the patient, versus the computer. Doctors are so inappropriately frightened of technology replacing them,  that they refuse or are at least reluctant to embrace it, specifically in order to improve the doctor-patient interaction. This seems to me to be a losing battle with the doctors.

In my previous blog post, I noted the fact that doctors are ill-equipped to embrace modern technology. And it’s only getting worse. Outside of radiologists, most doctors don’t understand any of the physics behind a CT or MRI machine. In fact, many physicians are not even able to accurately read these studies. Ultrasound was until very recently, a technology limited to the radiology  department. But it is becoming more and more ubiquitous and cheaper to purchase. And there is a reasonable expectation that the next generation of doctors will walk around with very portable ultrasound probes that are either self interpreting [the computer will automatically diagnose the images] or will generate images that are at least understandable to the physician [based on the similar kind of training that a doctor presently receives in reading plain x-rays of bones and the lungs].

What is changing is that we are experiencing the very first stages of computers being able to actually make a diagnosis based on all of the collected information. Until now, a doctor could say that he or she doesn’t need to understand the physics behind a CT, or even how to read a CT, as long as there is a radiologist based interpretation of the CT. With this information, the doctor can then look at the blood results and other types of lab results and combine them all to tell the patient that he or she is or is not healthy. And if the patient does have a disease, then the doctor can decide on how to manage that disease, unfortunately, in almost any way that the doctor chooses. There is absolutely no guarantee that a given doctor will reference the most up-to-date medical literature before prescribing a treatment. And if this sounds frightening, it should be.

The new age of computing speaks to computer assistants that are superior to the human doctors’ diagnostic capabilities. If the doctor says that based on the various radiological and other lab tests, the patient has Lupus, but the computer says that based on the exact same data [and perhaps other data that the doctor did not even consider], the patient has rheumatoid arthritis, who are you going to believe? Today, legitimately, I also would tend to trust the human doctor, but I would definitely want to see a readout of why the computer thought that the diagnosis was rheumatoid arthritis.

Whether it’s in 20 years from now or 50 years from now, there will be absolutely no question that the computer will always be more accurate than the human. Now please note that I don’t say that the computer will be “right”. Ultimately, just like the human, the computer is dependent on whatever research has been done to date, and whatever information is present in the medical literature. However, in an equivalent way to a physician consulting a second physician about a case, one computer system in one hospital will be able to query every other computer system in every other hospital, asking the question “given the following parameters, and based on your experience, what is your diagnosis?”. And the computer in the given hospital will amass the digital opinion of thousands of other major medical computer systems, to come to a summary decision about the diagnosis. And this will be far superior than what any human could provide.

The author speaks of millennial  healthcare workers and their unique challenges. And in my opinion, he then goes on to miss the point entirely.  This coming generation of doctors has to be trained to embrace technology and computer-based diagnoses, and how to work with IT departments and software developers, to constantly improve the quality of the tools they are working with. If a doctor feels that a new kind of data analysis would help diagnose a given condition, then that doctor should be able to directly contact  a representative in the IT department, and then the developers in the IT department should be allowed to create a new module and implement it back into the system.. Of course, this module should be open sourced and made available to every other computer system. Imagine tens of thousands of doctors all contributing to improving the EHR they are working with, on a daily basis. That EHR will quickly transform into a customized tool that is universally accepted as a tremendous help in day-to-day medical work.

I am going to end with something that I may actually turn into its own blog post because of its significance. I personally believe that it will be many years before doctors even come to fully appreciate the power of big data analytics and machine learning [which are still  distinct, to an extent]. In the meantime, there is a desperate, I repeat desperate, need for a think tank comprised of data scientists, and specialists in  health science, general science, engineering and more. Such a think tank could sell its services to many hospitals that do not have the vision and/or the IT infrastructure and/or the funds to set up such a data science center.

The hospitals or medical services or ministries of health would submit data to this think tank and would receive in return a whole variety of analyses that uncover information that is critical to improving health care. Such data analysis can discover health trends that no one has ever noted before. Such data analysis can identify the source of certain illnesses that weren’t even on the radar of health ministries. Such data analyses can find cures to diseases that were thought incurable. I cannot express strongly enough the need  for such a think tank (yes, this is a special nod to investors). It requires  top people, who are extremely well-paid, and who are given every toy that they need, to play with the data. Oh, and I should say that I would want this think-tank to be in Israel so I can hang out there all the time.

There will be many, if not most, doctors who believe that such a system will only generate results that are already known. Considering that most researchers do not even publish their raw data (but will be forced to in the near future), it is ludicrous to think that such a data science think tank could not uncover critical new findings that the original researchers never even thought to look for. Doctors will try to undermine such a think tank because whenever the doctors are unable to determine a diagnosis “beyond a reasonable doubt”, they will be expected to make use of the data science think tank service. And this will diminish the significance of doctors in society’s mind.

All of what I have described is how this future technological revolution will be fundamentally different than the one we are experiencing now. No matter how much data your smart watch collects, or your sleep app sends to the cloud, it is ultimately still up to doctors to make a diagnosis. In this new future reality, any doctor that does not embrace the superiority of the data science approach, will quickly become redundant. Understandably, this is what absolutely terrifies the medical world.

Personally, I can’t wait for this revolution to be upon us.

Thanks for listening

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.