Grand Rounds, “Dr. Watson” edition, artificial intelligence and medicine, physician perspective

This is the first time iMedicalApps is hosting Grand Rounds, and to those not familiar, Grand Rounds is weekly collection of medical blog posts with different themes — hosted by various blogs.

To be perfectly honest, I had no idea what Grand Rounds was until very recently. When I started iMedicalApps in November 2009, we were a rag tag team of physicians and medical students, and I had no experience with the “medical blogosphere” — I didn’t even know it existed, I just wanted to review medical apps and provide a quality resource for medical professionals.

But in the past year and a half, we’ve seen exponential site growth, and I’ve actually found myself reading content from extremely talented physician writers. Over that period, iMedicalApps has become more than just a review site — and I’m happy to break the news on Grand Rounds that we’ll be re-launching a completely new iMedicalApps on Thursday (We were hoping for earlier, but making a comprehensive and feature laden site takes massive hours).

With that said, in preparation for hosting grand rounds, I read through old editions, and was blown away by the sheer quality and talented writing. I’m excited that our website is hosting Grand Rounds.

In prior Grand Rounds, I’ve noticed a bevy of links, sometimes with a theme, and most of the time without. I decided to have a very focused topic — Watson and medicine — so I could aggregate physician opinion on artificial intelligence and medicine.  Unfortunately, showing my rookie status with hosting Grand Rounds, I only collected links from peers for a span of one day, instead of the usual week.  Thus, I did a miniature literature search, visited some of my favorite medical blogs, and used Google quite a bit..  The results are a collection of varying physician opinions, but many with the same underlying themes.

“Watson”, is an artificial intelligence computer system that answers questions posed in natural language, and is a product of IBM’s R&D department. Much of the buzz surrounding Watson occurred when it handily defeated two Jeopardy contestants.

After the defeat, IBM announced they would be working with Nuance, Columbia University Medical Center, and the University of Maryland Medical School on health care analytics research. The goal of the collaboration is to develop a commercial offering in the next 18 to 24 months that will exploit Watson’s capabilities to aid in the diagnosis and treatment of patients.

Many in the media postulated that Watson could potentially replace a physician all together, prompting me to write an editorial on why Watson could never replace a physician.

No matter how good you are at diagnosing and treating, unless you asked the right questions in a timely manner, all the knowledge in the world won’t be helpful.  I’m sure an artificial intelligence program could produce a rudimentary H&P, but far from a focused and disease specific H&P a trained physician produces hundreds of times a month.  Some would argue it’s why physicians have a minimum of 7 years of post-graduate training (medical school + residency) before we have the sole responsibility of a patient.

Subsequently, Dr. V wrote a post on 33charts about doctors and automation, after witnessing a Da Vinci robotic operating system”:

…..The process of data collection – hypothesis – data collection – repeat. Can this be performed by a machine? Of course, and probably quite well.

The hang-up is with the relational part of what I do. Understanding a parent’s hidden agenda, watching a child’s face during the abdominal exam, observing the non-verbal dialog between a mom and daughter during the history, hearing their experience and, most importantly, processing all of it in a way that fixes a child or helps a mother better understand her child. Perhaps the most important issue that I negotiate with parents: what level of uncertainty can we live with? How far will we go with the technology we have?

Dr. Angienadia, who blogs at Primary Dx, wrote an article on KevinMD titled “Welcome our new (doctor) computer overlords“.  A constant theme in her fantastic piece was how humans and computers need to rely on each other’s strengths. She brought in various social psychology experiments to back her thoughts:

The key is a good process with humans and computers playing to each other’s strengths – computers are better at processing information, while humans are better at strategic planning….The advancement of computers creates an impending shift in how we practice medicine. As we strive to limit human errors and stretch limited resources to expand health care access to underserved areas, computers play an important role. To reduce medical errors, computers can help physicians concentrate on strategic thinking instead of recalling medical knowledge from memory.

KevinMD wrote an article titled, Why Watson makes board certification exams obsolete in medicine.

Watson antiquates closed board exams.  Instead of sitting in a testing room, doctors should be evaluated on how well they can find the necessary information — not how well they can recall something they memorized.  Board certification tests should be open-book, or, at least, provide the resources ready for physicians if they can’t recall an obscure medical fact.  Just like real life.

Kevin went on to speak about the reduction of medical errors, similar to the themes echoed by Dr. Angienadia’s piece.

Dr. Halamka, author of Life as a Heathcare CIO (must read blog from an industry icon), wrote an article titled “Freeing the Data”, where he talked how Next Generation Natural Language processing tools will provide the technology to assign probabilities and deduce meaning from context.

Watson on Jeopardy provided an important illustration of how natural language processing can really work. Watson does not understand the language and it is not conscious/sentient. Watson’s programming enables it to assign probabilities to expressions. When asked “does he drink alcohol frequently?”, finding the word “alcohol” associated with the word “excess” is more more likely to imply a drinking problem than finding “alcohol” associated with “to clean his skin before injecting his insulin”.

Dr. Isaac Kohane, who blogs at HMS – Countway library of medicine – Director’s blog, wrote an article titled The McDonald’s Rx: How Computers Can And Should Change Doctoring. Dr. Kohane does a great job of juxtaposing “evidence based medicine” that focuses on algorithms, with conflicting messages of how physicians are “supposed” to practice:

But suddenly, a sense of wrongness that had nagged at me for years overwhelmed me. What were they thanking me for? All my small services to them had virtually nothing to do with the education and training that had earned me my lofty position. I was doing work that could as easily have been done by a $30-an-hour technician equipped with the right medical software. Were there some cases that required some deeper expertise? Certainly. But those constitute a tiny minority of the patients I see. The vast majority are paying personal-chef prices for food that any well-run McDonalds could cook.

Some of the unifying themes throughout these physician articles on artificial intelligence and medicine:

- Artificial intelligence (A.I) could have a place in medicine, but for tasks considered routine and analytical in nature

- Programs such as Watson could improve safety by taking redundant tasks out of a physcian’s hands, allowing them to focus on more complex issues

- While artificial intelligence can’t completely replace a physician (yet), it can replace many of the tasks a physician completes

We have already have data that shows artificial intelligence has the potential to improve safety outcomes. A recent randomized control trial that used residents showed how their ACLS performance significantly improved with the use of an artificial intelligence aid — an interactive iPhone medical app with decision trees. Interestingly enough, the authors in the study mentioned how the medical community is worried about adopting these types of electronic decision aids due to appearing incompetent. Correlating why many physicians are skeptical about the fusion between medicine and artificial intelligence.

At the end of the day, if artificial intelligence fused with medicine can improve patient safety and outcomes, the medical community would be wise to embrace this technology — albiet — with caution.

The best way to end this grand rounds is with a satire laden video made by Dr. Charles, called Dr. Watson and the 7 qualities of an ideal physician, posted on the theExamingingRoom.

Author:

Iltifat Husain, MD

Founder, Editor-in-Chief of iMedicalApps.com. Emergency Medicine Faculty and Director of Mobile App curriculum at Wake Forest School of Medicine.

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7 Responses to Grand Rounds, “Dr. Watson” edition, artificial intelligence and medicine, physician perspective

  1. Jamie Rauscher April 12, 2011 at 4:26 am #

    Thanks for hosting Grand Rounds and choosing such a timely topic. We’d just like to add that Bedside Manner, the blog of the Schwartz Center for Compassionate Healthcare will be hosting Grand Rounds next week, April 19. Our theme will be revolutionary ideas in patient-centered care. For more information please visit our website: http://www.theschwartzcenterbl

    Jamie Rauscher
    Editor, Bedside Manner
    The Schwartz Center for Compassionate Healthcare

    • Iltifat Husain April 12, 2011 at 8:18 am #

      Thanks Jamie — look forward to it.

  2. Pieter Kubben April 12, 2011 at 8:42 am #

    I completely share your idea on Watson “not replacing a physician”. I told the same thing at TEDxMaastricht on decision making systems (NOT) vs. decision supporting systems (YES). See http://dign.eu/tedx for video.

    • Iltifat Husain April 12, 2011 at 11:32 am #

      Pieter,

      Very interesting! We will have to link this sometime!

  3. thuc April 12, 2011 at 9:41 am #

    great work on your first grand rounds. the articles were very interesting. congrats on the relaunch. looking fwd to seeing the new design on Thursday.

  4. Michael Yuan April 13, 2011 at 12:31 pm #

    Great article Iltifat. To add a perspective from health IT, checkout my article published on IBM website:

    http://www.ibm.com/developerwo

    cheers
    Michael Yuan, Ringful Health

  5. Drcharles April 14, 2011 at 10:19 am #

    Great and creative edition. I think this topic is really going to define a lot of the doctor-patient relationship, and thanks for highlighting my cartoon!

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