
AI in medicine will help doctors, not replace them - elorant
https://blogs.scientificamerican.com/observations/does-ai-have-a-place-in-medicine/
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godelski
I'm always confused with these types of articles. "Will AI cause job loss" or
"Will AI create jobs" aren't really the important questions. Because those
questions are about net gain and loss, because yes it will cause job losses
and yes it will create jobs. But that's not what's important to the average
person.

If your job is automated away, what are you going to do? Hypothetically let's
say that AI can accomplish everything that an X-ray tech can (or that with the
help of automation a single tech can do what 10 techs do today). What happens
to those people? They spent a lot of time and money getting that training.
Retraining programs suck and are shown to be really ineffective. So do these
people just go underemployed the rest of their lives? What about people who
are 10-15 years from retirement? Even if retrained you go from peak earnings
to starting wages. That's a huge disrupt in life.

Job loss is extremely important to consider ( _assuming you care about people_
), even if the total number of jobs are increased. We've seen this in the past
and we're seeing it today. Lots of automation came into farming and many of
those jobs disappeared. Family legacies were lost. But at the same time it is
inhumane to not allow the progression of technology (like we could even stop
it...).

My concern is that people aren't discussing the transitions of economies. We
all want to live in a post scarcity world like Star Trek. Where food, housing,
and basic essentials are effectively trivially obtained (for the most part in
the show). But transitioning to that kind of society is extremely disruptive
and has a lot of pitfalls on the way. It isn't unimaginable to ask "What if
10% of your population is unemployable?" (several scenarios: jobs just
automated away; only existing jobs require high skill and training; transition
period where those people are trained for jobs that recently got automated
away; etc) What do we do? How do we handle that? We're a society where people
still believe your worth correlates with your wealth ( _diction intended_ ). I
see very few people talking about this, and these kinds of scenarios are
plausible within the next 50-100 years.

Net gains or losses of jobs is a distracting question and the wrong one to
ask.

~~~
DoreenMichele
I basically went through this by getting divorced after two decades as a
homemaker. I spent several years homeless. I previously had a class in
_Homelessness and Public Policy_ while studying to become an urban planner.

Some things that would help a whole lot:

1\. We need to address our housing issues.

This isn't necessarily disastrous if you can move to some little hole in the
wall in a walkable area with good transit so you can still have a life while
living on meager earnings and retraining. The problem is that we've torn down
about a million SROs in the US and the average size of new housing has more
than doubled since the 1950s, so there just aren't enough places like that.

2\. We need to resolve our healthcare issues in the US.

Healthcare costs something like 20% of GDP and disproportionately negatively
impacts poor people, unemployed people and people with chronic health issues
(who are often pushed into poverty by that fact). If you can go to a doctor no
matter how poor you are, these problems are vastly less likely to snowball out
of control.

3\. We need to embrace gig work and figure out how to make it a positive
instead of decrying it and vilifying it.

When I was deathly ill and homeless, gig work was a godsend. My earning
capacity gradually went up and I eventually got back into housing. I still
struggle, but it's better than it used to be.

Gig work allowed me to develop an earned income and marketable skills at a
time and under circumstances where no regular job would have worked, yet all I
seem to ever hear is how evil it is. It's not inherently evil, though
certainly some gig work is handled in a problematic fashion that keeps workers
trapped in a dead end.

~~~
iudqnolq
Just want to say I frequently see your comments not get many replies, and at
least in my case it's because you're so comprehensive and right I don't have
anything to say.

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bschne
I feel like I've read somewhat similar pieces about every single field
affected by automation and AI at this point.

In every other article, there's a dichotomy between "everyone will keep their
jobs and be more efficient and have more time to focus on what matters" and
"everyone will lose their jobs and be replace by machines". This then gets
resolved to "we will never be replaced because 'human factors'", therefore
option a).

I am sure the author knows their field well, but this just doesn't seem to
provide any interesting / new viewpoint on the issue beyond the arguments that
usually come up in superficial discussion of the topic.

~~~
godelski
The bigger question, imo, is how we handle those job losses. Retraining
doesn't really work. So what do we do with those people? Just say "whoops,
your job is automated away. I'm sure you'll find some new equally paying
job."? Because that seems like a good way to start a very bloody revolution.

~~~
tedivm
Somebody has to annotate the data.

Joking aside, I think for a lot of medical stuff the shift is already
happening- there are less people going into certain fields (such as radiology)
due in part to fear that it isn't a long term career. This is driving up
radiology pay as the demand is outpacing the incoming supply.

While I ultimately believe that most things are going to get automated, I do
agree that in the short to medium term were going to see AI augmenting medical
professionals rather than replacing them. This is just the natural progression
of things- the technology can start off with the low hanging fruit and
gradually take on more and more of the work. This provides immediate benefit
while building funding and knowledge that can be used to take the next big
step.

~~~
godelski
I agree with you. But what I'm saying is that this has societal impacts that
we actually have to consider. A job's description drastically changing within
a short period of time (i.e. a small portion of someone's career) is extremely
disruptive. We should be having conversations with how we as a society are
going to deal with these issues. (I don't think we should stop the march of
progress. I don't think we even can -- short of a nuclear war)

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roenxi
The elephant in the room with doctors is that there are many countries where
the supply is constrained by some sort of guild system and only very clever
people do well.

If AI can lower the bar to the point where Ned the Nitwit can type in the
symptoms, read the screen and get a reasonable diagnosis then 'doctors' are
going to be a completely different class of people even if they share the same
title.

~~~
JamesBarney
There are a lot of current doctor work which involves. "Any issues with the
medication your on, ok, can I see your bloodwork, no red values, here is your
prescription."

~~~
dragontamer
Which really should be the job of a nurse or physician's assistant. Doctors
should be reserved for the cases that requires the ~10 years of training they
receive.

Most people probably only need a yearly-visit to the physician's assistant or
a nurse for bloodworks. There shouldn't be a need to see an actual doctor on a
regular basis (unless you have some chronic ailment that nurses / physician
assistants can't handle).

\------------

The prescription is probably the only part of that routine that requires a
doctor.

~~~
aaron425
Might be some sort of liability aspect to this, where the doctor has to
certify in case something goes wrong. Do nurses/PAs have to carry malpractice
insurance? Not super clear on this myself.

~~~
phren0logy
Nurse Practitioners can be sued for malpractice, but despite practicing
independently they are held to a significantly lower standard of care.

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Herodotus38
One boring truth is that so far the most notable universal and true advance AI
has made in medicine (at least in the US) is in NLP with dragon dictate.

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dr_dshiv
What do you think of m*modal? (If you've heard of them)

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Herodotus38
I have not heard of them but from reading their website looks like using AI to
help charting efficiency and to squeeze more blood out of the turnip so to
speak by making sure you get all those HCCs. This is the direction I’ve
thought AI in medicine will go for a while: speech to text, suggested
diagnosis and then suggested treatment plans. When you can get a HIPAA
compliant way to record what the pt is saying and write the note (an AI
scribe, so to speak), that is where I think it will start.

How is m*modal, have you used it?

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rscho
If people and especially doctors were serious about improving healthcare, they
should strive to build reliable data collection means. That's the prerequisite
to efficient 'AI', and would be a far better use of funding than all the
present half-baked 'improvements' and star-system research. We could really do
science, then. A man can dream...

~~~
ivalm
There is a lot of data collection. With everyone using EMRs massive datasets
are available. They just aren't available to people outside the walled gardens
for PHI/privacy reasons.

At Kaiser Permanente, I regularly train models on 10s/100s M patient/dr
encounters. Our transformer language models are fine tuned on multi-billion
word corpuses. Some of our models do real time inference on millions of
patient notes per month.

The thing is, from data governance standpoint our org, and most other health
orgs, just aren't comfortable sharing this data with outside businesses or
even each other. And of course orgs like KP strongly don't believe in
licensing internally developed products to other health orgs.

~~~
rscho
I personally generate several Gbs of healthcare data per day.

I know we generate a lot of data. I also know it's data that's so unreliable
that its business value does not lie in its real-world use for improving
healthcare pathways. It's very valuable politically and from a managerial
standpoint, though. Unfortunately.

~~~
ivalm
I mean it depends. There is a lot of fairly reliable discrete data in
medicine: medications/labs/imaging studies/procedures/flowsheet/etc. ICD10
diagnoses are discrete and fairly reliable. The progress notes have lots of
copy/paste/smart-phrase/macro-generated trash, but at least Epic saves a lot
of rtf markup about the source of the text data. I am pretty optimistic about
data quality, it is availability to 3rd parties that I think is limiting the
AI boom.

~~~
rscho
I remain unconvinced, but let's hope you're right.

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__s
If an AI assisted doctor is 125% more efficient than a non assisted doctor,
you only only need 80 doctors where you'd otherwise need 100. That's 20
doctors that have effectively been replaced

Then consider the amount of not-doctor roles in medicine which can be
automated/assisted

~~~
roberte3
Your looking at it wrong.

A doctor's appointment schedule is crazy busy, with "LONG" appointments being
under 20min per patient. Imagine a scenario where a doctor is able to spend
time with the patient/their medical history etc.

I spend a lot of time going to doctors appointments these days, and a large
number of the doctors that I see, now have an assistant/transcriptionist in
the room to manage the EMR/charting app, because that enables them to focus on
the patient.

~~~
iudqnolq
I've never understood this argument. Right now we have decided implicitly as a
society we're fine with the current level of care. If we can provide that same
level of care cheaper, what makes you think health care providers will decide
to pass those savings onto patients in the form of more care for the same
price?

~~~
Engineering-MD
I would disagree with this statement. Every year, expectations rise, and it is
becoming increasingly difficult to meet these expectations. Furthermore, I
think expectations are tempered by the knowledge that staff are over worked
and time is limited. It is infeasible to practice medicine the way it us
taught in medical school in practice due to time constraints. And like
everything else, the work tends to fit the time available.

~~~
iudqnolq
I hope very much you're right, and that as medicine gets cheaper we get more
of it.

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imvetri
Machines are inevitable.

The concept of sensing and learning from surroundings should survive.

Human's feed AI, AI should go interstellar.

But what we will have to make sure is are we feeding the AI the right things?

Nope, Tech giants, once built by nerds are now ruled by political criminal
minds.

Without living in harmony there is no way AI will serve only good purpose.

If you are a developer, think thorough whom are you helping, why they need
you. The code you write is a part of your brain. Have self righteous that code
should be used for good and good only.

How will you guarantee that? you cant. Then don't innovate!.

Stop being the old school nerd boy and level up. Do not show off and gain
attention unless you fully solve the problem.

Circle back to start. Question again and again how this will be used
flawlessly. If it doesn't its not worth sharing knowledge. Share morals.

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oarabbus_
It'd be a pretty good thing if AI replaced (most) doctors, actually. Not for
the doctors or the insurance companies, but for most everyone else.

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hgjbhujxgjbv
AI is not here for doctors but for insurance companies, to charge you more if
risky group is detected. There is the money and far lower risks than "helping
doctors". I am glad I have forseen this step into distopia and never shared
any of my data with any online bussiness (lineage, xprivacy and netguard help
here).

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oneepic
...yet. Maybe it will be 100 years in the future, but I think there's a good
chance of it.

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throwaway122378
The fact that I could see a doctor today, see a different doctor tomorrow,
give them different scenarios and both will think of it as the truth is a
bigger problem that needs to be solved

