Blog | Thursday, June 8, 2017

Artificial intelligence + physicians


Some enthusiasts believe that computers are the answer to diagnostic errors. As I have written before, the biggest problem with artificial intelligence (AI) comes from data entry. Who collects the data and who picks which data to enter?

Siddhartha Mukherjee, MD, has an interesting article in the New Yorker about AI, that states, “The most powerful element in these clinical encounters, I realized, was not knowing that or knowing how—not mastering the facts of the case, or perceiving the patterns they formed. It lay in yet a third realm of knowledge: knowing why.”

AI does wonderful work when paired with a clinician who understands which data the computer needs.

Our most important skill involves taking a history. Experienced expert clinicians get so much more from the history than novices. This fascinating article may provide some insights, “Language: Why We Hear More Than Words“. It states, “… we decode more than the words spoken to us. This is inferential communication, and it means that we understand not only the words spoken, but the context in which they are spoken. Contrary to the languages of other animals, which are decidedly less ambiguous, human language requires a lot of subjective interpretation.”

This subjective interpretation follows from experience. The same words from patients of different backgrounds can have very different meanings. History taking really requires understanding the patient's context, how they describe things, and what questions we should ask to better define that history.

History taking also depends on our posture, our body language and even that most human activity of touch. Often our history taking improves when we are holding the patient's wrist or taking the pulse. When we appropriately touch the patient we tell that patient that we want to help them.

The physical examination still has value. While many patient exams reveal little, we all have stories about how the exam changed all of our thoughts about the patient. The exam can stimulate further questioning.

While AI can help us, developing an AI in a robot (think Star Trek) to function as a physician seems very far away. We clinicians will have important roles for the foreseeable future. We can interpret the words and the body language. We instinctively understand the context. And we can comfort. Patients desperately want us to show our humanity. Patients expect us to care and make that clear. And generally we do and patients appreciate it.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.