There is much talk about ways we can reduce the costs of health care and to ‘streamline’ health care. There are some conversations that are happening about people putting symptoms into machines to generate diagnoses and then generate a treatment algorithm instead of seeing a doctor. This would of course make the cost of health care cheaper by eliminating the role of the physician, but is this really the best practice of medicine?
Can computers and algorithms really replace the role of doctor, or even nurse?
Even if it would reduce ‘costs’ by eliminating the personal contact in medicine, is this really the way forward in medicine?
Would it offer better patient ‘care’?
Would it even offer better patient ‘diagnosis’?
Many patients come to see me having put their symptoms in a symptom checker online only to be freaked out by the potential of multiple serious diagnoses, only to then find when they see me that they have something quite simple and nowhere near as severe as the symptom checkers had lead them to believe.
It takes skill, connection and experience to diagnose what is happening in a person as no two people have the same presentation of an illness and disease.
Any clinician will tell you that the people that they see daily do not fit the ‘text book’ criteria to diagnose any illness and disease and that it is the personal ability to inquire, to connect and discern and relate the observations and information with collective knowledge and experience that leads to a diagnosis, and a refinement of a diagnosis as needed.
It is the personal skills and connection, the physician-patient interpersonal relationship that leads to the ability to refine treatment as needed. Each person responds differently to treatment, not everybody wants to take the initial recommendation due to personal preferences, and conversations need to be had with sensitivity and understanding to explore treatment options with people.
A computer cannot have the needed conversations or explore fears, concerns or trepidations.
A computer can only generate what it has been programmed to do so, and is unable to take into account the personalised nature of each patient presentation.
People when they are ill, seek care. We don’t truly seek a prescription, we seek care AND a prescription as needed.
We seek the attention and care of a physician, or at times a nurse when needed. We crave being cared for when we are ill, and indeed, it is an important part of healing and health care. After all ‘care’ is a key part of the term ‘health care’.
Are computers and algorithms able to provide the ‘care’ that people are seeking and indeed that care that is an essential part of health care?
In short, computers and impersonal generic algorithms are not able to even offer an accurate diagnosis, but they are definitely not able to provide the personal care that is an essential part of health care.
We may be focused on ‘saving money’ in health care, but eliminating the physician and care from health care is not a way forward in health care, but rather the destruction of health care.
As physicians we are trained to follow algorithms and are pressured to follow algorithms, called clinical guidelines, which are changing as ‘the evidence‘ ‘changes’. We are being encouraged to follow these prescribing guidelines and diagnosing guidelines blindly, to then be able to categorise people as a ‘label’ of a disease or, a ‘billable item’.
It is vital that we do not lose sight of the importance of our role as physicians, our role as people, connecting with people. There is value in who we are and our role in connection, care and observation that goes beyond the potentially intransigent nature of clinical guidelines/algorithms and ‘billable items’.
We need to ever affirm and claim this important part of healing, this important role that we have in medicine, lest we be cast as human computers, unfeeling, and unable to discern, leaving people bereft of not only accurate and true diagnosis and personalised treatment, but care as well.