Was I supposed to know that?

I spend a number of hours most days reading up on medical, technological and then specifically med-tech news. I used to create a monthly newsletter that was made up of 30 of the most interesting [to me] abstracts or medical reviews that I came across. I got to this information via a set of subscription services that would send me the latest updates in medicine.

I actually did this for years, and I found it to be crucial to my work as a physician. Admittedly, a number of the abstracts were related to medical topics that were quite esoteric. On the other hand, on a relatively frequent basis, I would come across an article that really did change the way I practiced. In some situations, the articles did not affect my practice but clearly were of significance to other specialists, and I would share my findings with them.

I want to repeat that as much as I enjoyed doing this and sharing my newsletter with a large community, this type of reading was absolutely necessary, if I wanted to stay pertinent in the medical sphere. I no longer generate the newsletter, but my reading continues unabated. Given my combined background, I spend an equivalent amount of time reading up on technology, listening to online lectures and then spending time trying to make sense of it all.

For example, I watched the entire Apple presentation from a couple of days ago. Does a doctor have to watch such a presentation to be able to deliver proper healthcare? Of course not. But given my combined medical and tech perspective, this keynote speech was extremely important to me. If someone else approaches me and asks me about Apple’s foray into the medical world, I can speak intelligently on the topic. I can also talk about the unique medical uses of the new Apple watch, beyond even what was discussed during the keynote. Apple is legitimately speaking to a very broad audience. But when I see a watch that is very effective at sharing important notifications, the first thing that goes to my mind is creating an app which will remind users to take the medications.

I’ve spoken recently about Apple’s linking up with major medical service companies. I have no doubt that somewhere, someone is thinking about how to create a secure connection between these independent medical services and Apple’s new watch. For example, a person’s list of medications would be available via one of such services. With a little bit of programming, the Apple watch could review the medication list and remind the patient when ever it was time to take a given pill. The same notification system could be used for keeping appointments, which are far too often missed for any number of reasons.

Apple also introduced a whole new suite of software for research purposes. Very simply, Apple may have finally succeeded in creating a streamlined means for patients and otherwise healthy individuals to frequently submit critical information for medical research. The potential of such a system is astounding. More so, Apple has made this set of software and services, open source. This means that it will be far easier for any developer to build a solution around this research environment. Apple’s contribution to research could very well be the basis of the discovery of a vast number of solutions to critical medical problems.

Let me just say that I do believe that Apple has done to the watch, what it previously did to the phone. I truly hope that companies like Google and Microsoft will spend the necessary billions to get there watches up to snuff. When everyone is walking around with a wearable device that truly becomes a portal for information in and out, even beyond that of the cell phone, our entire society will unquestionably benefit.

As to keeping up-to-date, mobile phones and smart watches and other technologies will be critical to constantly feeding physicians with appropriate information. When the patient walks into the room and starts the conversation with “my Parkinson’s is worse”, I would expect the physician to practically be flooded with the most up-to-date information about Parkinson’s and about how to specifically deal with a worsening of the disease. The doctor should be immediately made aware of any clinical trials that would be appropriate for this patient. And it would be appropriate to have a summary of the latest information about Parkinson’s waiting in the doctor’s email for later consumption.

It is simply impossible for any doctor to know enough about almost any disease, even if that doctor is regularly treating patients with the given disease. there will be doctors who challenge the statement and say that they do sufficiently well via their own reading. I don’t exactly understand the statement considering how many physicians consistently complain about a serious lack of time to spend with their patients. And the same physicians will often complain that their workday extends many hours after the last patient due to paperwork and necessary computer updates.

I will soften my declaration and state that doctors will SOON be dependent on computers to select the most appropriate information for them, that will render that physician most capable of treating the disease in question. For those physicians who admit to themselves that they are not managing to read a sufficient amount to always be up-to-date, their only hope is for computers and artificially intelligent selection systems to feed them the most pertinent information for their specific work.

An obvious question is, if AI is choosing the articles I am meant to read in order to be up-to-date on the topic, how will I ever know if the AI system missed something important? If I never personally peruse the various medical journals, how will I ever know that the AI system missed a paper that is pertinent to my work? In fact, there is a very significant possibility that the physicians will never know.

When any individual types in a search term in Google, looking for trivial information or sometimes for life critical information, that person trusts the Google search engine to find what is needed. Never has Google claimed to be the ultimate source of medical information, especially for people who have serious medical conditions. If I Google “Lupus”, which is a severe disease that can cause life-threatening organ damage, I trust that the search engine behind Google is doing the best possible job. But to be blunt, there really is no basis for this trust. Google search is not fine tuned towards medical information. Google search is tuned to find all types of information that are pertinent to a search term. Searching on the term Lupus will bring up references to wolves and historical references that are inconsequential for the patient who is suffering from the disease.

We have in fact already crossed the line where we trust computers to tell us what we need to know. Very few people take the time to investigate a topic to achieve an expert level, and then make themselves available for questions for all the world. We hope that these experts will record their knowledge in some form [a PhD thesis, a Wikipedia site] so that search engines can read through their data and conclusions. But ultimately, we have already handed the keys to the kingdom over to the computers.

There is no way back. What we need to do is to make maximal use of whatever technologies are available to continuously improve the quality of data searching. We need to constantly improve the way in which data is delivered to the person in need, at the time of need. We need to find better and better ways to generate pertinent data and to add it to the collective of “human” knowledge. Only in this way can we be at our best, using the best information that exists.

It is interesting to think that if and when sophisticated (not just hungry) aliens come to this planet, the best thing for them to do would be to surf the web. There would be no point investigating individual human beings. The collected information on every aspect of humanity is readily available in some data center. Experimenting on humans would probably be a waste of time. In fact, perhaps a far more efficient way of doing things would be to secretly leak the design of advanced technologies to various researchers, and let them over time do all the necessary human experimentation.

I’m not saying that this is how Steve Jobs managed to always come up with groundbreaking ideas.

Thanks for listening

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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