
Doctors and nurses need to be replaced by computers and robots - spec
http://www.city-data.com/forum/great-debates/2010126-doctors-nurses-need-replaced-computers-robots.html
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na85
No, they really don't.

I'm married to a physician and I can tell you that Medicine is an incredibly
nuanced profession, and though doctors and nurses can benefit greatly from
computer assistance, they cannot be reliably and safely replaced by computer
algorithms. The single data point of Watson diagnosing lung cancer is not
enough to generalize over the entire profession and range of ailments.

Medicine is a great deal more than differential diagnoses, doctors are a great
deal more than "professional diagnosers", and nurses are a great deal more
than morphine dispensing diaper-changing automatons.

Most medical schools (in my country, at least) have moved to an entirely
evidence-based and patient-centred-care model years ago. The problem of course
is that evidence is not always easily gathered because of ethical issues (e.g.
most hypothermia knowledge comes from Nazi human experimentation on POWs and
Jews. Also it's hard to conduct a study on OB/GYN topics because you could
potentially be putting infants, fetuses, and their mothers at undue risk).
Being treated by a computer is not going to change this problem of poor
evidence.

That forum post was written by someone who has only a shallow appreciation
for/understanding of the field of medicine.

~~~
baddox
The fact that the discipline is incredibly nuanced is precisely why I want
computers doing the heavy lifting, at least when it comes to diagnosis. I find
it extremely hard to believe that even the best doctors could come close to
touching the accuracy of an expert system. Now, obviously there is still the
necessity of a trained and skilled doctor. A doctor should always have the
last decision (before the patient, that is), but the doctor should be trained
to understand how expert systems work. And of course, doctors and nurses will
be needed to gather information from the patient, both through medical tests
and verbal questioning.

The fact is, every time I have gone to the doctor for anything other than an
obvious diagnosis (e.g. I need stitches in the hand because it is cut and
bleeding), I have been appalled at the experience. I experienced fairly
serious chest pain at the age of 26, with no history of health problems. I
quickly read online about all the things it _could_ be, ranging in seriousness
from reflux to a heart attack, and I expected a doctor to have some sort of
academic methodology, or do something vaguely resembling _science_ , but
instead, they x-rayed me, said everything looks fine, and prescribed me extra
strength Tylenol. I wish doctors would at least pretend that they're doing
something that a walk-in x-Ray booth attached to a computer system couldn't
do.

~~~
grey-area
_I wish doctors would at least pretend that they 're doing something that a
walk-in x-Ray booth attached to a computer system couldn't do._

They are doing more, but won't always feel the need to show their working for
minor illness. That doctor will probably have gone through a few checklists in
their head, deciding whether this could be a serious illness, and clearly came
to the conclusion it was not. Presumably they also asked you a few questions
about the location and nature of the pain?

Also, doctors do use computers already, when they're not sure on symptoms,
need to look things up, etc. They have the equivalent of expert systems at
their fingertips for when that is necessary, but most of the time it won't be.

 _I find it extremely hard to believe that even the best doctors could come
close to touching the accuracy of an expert system._

Accuracy is not what is required, given our extremely poor and fuzzy knowledge
of the human body, diagnosis and treatment is more like a tradeoff between
different possibilities based on partial symptoms (not all symptoms will be
obvious or noticed by the patient), tests which are not always accurate and
sometimes harmful, and treatments which are not always effective and have some
bad side effects.

An expert system would help with none of the above.

~~~
baddox
> Accuracy is not what is required, given our extremely poor and fuzzy
> knowledge of the human body, diagnosis and treatment is more like a tradeoff
> between different possibilities based on partial symptoms (not all symptoms
> will be obvious or noticed by the patient), tests which are not always
> accurate and sometimes harmful, and treatments which are not always
> effective and have some bad side effects.

I don't understand. That scenario is a perfect example of something an expert
system would excel at.

~~~
grey-area
Not really no. _Some_ steps are suitable for codification in an expert system,
indeed doctors already use expert systems in some cases. Some things which are
hard problems and are not currently solved better by expert systems:

Translating what the patient _thinks_ is happening into a set of symptoms,
sometimes those two are far apart

Finding problems the patient came in for but is too embarrassed to talk about
or is even unaware of

Explaining risk to patients in terms they will understand, and then choosing
an appropriate treatment based on their often fuzzy and emotional response

Weighing patient risk against an individual patient's needs or other ailments
which an expert system is not going to be able to query about or be aware of.

etc.

There's certainly a huge and growing place for expert systems in healthcare,
but suggesting they can replace doctors is pretty absurd at this point in
time.

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gfodor
Of course, they won't be replaced anytime soon, but will be augmented via
technology, just like the rest of us. Hopefully sooner rather than later.
Every field is disrupted by software in the same fashion: massive resistance
where practitioners claim the human element is crucial, then of gradual
swapping out of manual for automated where it helps, to in the long run
largely automated.

I see a big parallel here with education: I am related to teachers and of
course they will swear up and down that hand-crafted, personalized lesson
plans are key, and teacher-student interaction invalidates the need entirely
for automation. I'd imagine in the long run 80% of these "only humans can do
it" tasks will be shown to be performed better by expert systems and data-
driven algorithms.

Of course the catch is that nobody wants to be told that a large part of the
skills they've developed over a lifetime have been made obsolete or relatively
worthless through some code and electrons. Software engineers, and many
engineering fields in general are used to the idea that every 5 or 10 years
most practical knowledge is obsolete, that computers are relentlessly
automating things done manually just a few years previous, and to not fight it
but embrace it and try to leverage it. I don't think this is a common
mentality for most professions. Even physicians for the most part, unless they
work in an academic institution, let their reading fall by the wayside and
develop habits and ritual around what they were doing when they finished
residency.

~~~
zarify
I'd agree about the parallel with education (I'm a teacher and a number of my
family are doctors). Both are fields where the metrics for success (lives/gets
better/graduates/etc) come along a road paved with soft skills.

I'm not too interested in getting into (yet) another argument over automating
education (or medicine), and I agree with you about the long view on it, but I
really do think that it's going to be a lot harder than many people with a
"let's solve it with technology!" point of view would like to think (and I
came into education with this exact mindset.

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EGreg
I hear people saying that medicine can't have doctors be replaced by computers
and it's more of an art than a science. I'd like to get more information and
see why they think that and if their reasons really hold up. It intuitively
seems to me computers can do a better job. Here are a few reasons:

1) When you think about what a doctor does, they use a combination of their
memory, experience, knowledge and judgment.

2) Computers can remember a lot more relevant facts and wonmt forget them.

3) A doctor's experience is just with their own patients and what they hear at
conferences and the literature they read. A computer network can literally
aggregate experiences of many different doctors and cases around the world. A
new superbug coming out, for instance, may have a treatment that few doctors
know, because it's more prevalent in another country -- but a person using the
network will be made aware of this treatment. The network will have much more
experience than an individual. It will aggregate the outcomes of many
therapies and studies.

4) The knowledge of the network can be extracted from the experiene and be
much more extensive. Both beause the experence is extensive and because
various methods of statistical analysis can be employed. A doctor isn't going
to sit there and cross reference worldwide statistics on the success of using
remedy X given factors of race, gender, age, etc. The computers can.

5) Finally, the judgment. Here is why the computers can beat a doctor's "gut"
overall. They can cross correlate the knowledge from all around the world and
find the most major factors. Then given the symptoms, race, age, location,
etc. they can suggest the possible diagnoses given realtime epidemiological
statistics and the additional tests that need to be done to establish which
diagnosis is most probable. In many cases this establish a path to just one
diagnosis with statistical accuracy exceeding what one doctor can produce. It
can also list the next several possible diagnoses and the tests to establish
them. After the diagnosis is established, it can find the therapies along with
risk factors gleaned from all the relevant outcomes from around the world.

And this is just for conventional medicine. When we get into genetic
therapies, computers and information science will become a huge part of
medicine.

~~~
vacri
There's factors you're completely missing. One of the things doctors do is
ferret out information that the patient doesn't volunteer - they socially
manage the patient to divulge information. Until we have diagnostic computers
that can pick up on non-verbal cues and other such nuances, we'll have
doctors.

~~~
dagw
I think we need two classes of doctors. One that is a diagnostics and medical
computer systems experts and never actually meets patients and one who's main
focus is human and social skills that actually talks to patients, gets the
data to feed into the computers and then interprets and explains the results.

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Gatsky
I'd like to make two points.

Firstly, before anyone builds an AI that can look after people, maybe they can
fix the software for looking at Xrays WHICH ALWAYS STOPS WORKING IN THE MIDDLE
OF A BUSY CLINIC.

Secondly, I challenge someone here to put a number on how much it would cost
to produce an AI that can operate robustly in a clinical environment. This
includes the costs of developing such a thing, deploying it as well as testing
it. Testing it would arguably be one of the most difficult and complex
software testing problems ever. Now whatever that number may be, I hazard to
guess that it's a lot. So what you are proposing is to spend a lot of money,
so that we can practice medicine... slightly better... MAYBE slightly better.

The greatest improvements in healthcare come from the development of novel
therapeutic technologies (antibiotics, vaccines, anaesthesia) or public health
measures that change behaviour (sanitation, seat belts, quit smoking campaigns
etc).

All of this frankly makes me sceptical of the wisdom of spending zillions on
building medical AI, even if such a thing were possible.

~~~
Brakenshire
I think in some ways we're thinking of automation in the wrong way. That
doesn't have to mean having having an AI doctor, with, you know, a lovely
bedside manner. Reducing the cost of blood tests so that you can do a sweeping
diagnosis of 50 problems at once rather than just 10 is a sort of automation -
the doctor no longer has to carefully navigate their way through "there's a
chance that it is this, but the blood test is expensive, so we'll try
something else first". It's automation to analyse blood tests in combination,
and look for profiles for diagnosis. It's automation for a patient to have
their own smartphone-connected blood pressure monitor, which will alert the
surgery if the read-out is dangerous. It's certainly automation to use
software image analysis to pick up the presence of cancer cells in tissue
biopsies. It's a step-by-step process, it doesn't have to be all at once.

~~~
Gatsky
As other people have commented, augmentation is a very good idea, and
automation is part of that. The title of this submission indicates something
entirely different to that however.

As an aside, the really interesting part of image analysis is not that we can
automatically detect tumor cells, but that machine learning can extract
features from pathology specimens that a human could never see:

[http://www.ncbi.nlm.nih.gov/pubmed/23100629](http://www.ncbi.nlm.nih.gov/pubmed/23100629)

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aeberbach
I feel like a sucker for responding to such obvious self-serving link bait,
but full of gratitude to the very human staff at the hospital where I had a
minor procedure last week I will anyway. Here's the simplistic refutation that
is all the simplistic premise deserves:

Until you pass a Turing AND a Voight-Kampff test, stay the fuck out of my
health system.

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pinaceae
absolutely.

case in point: automated call centers. so much better than a human being.
instant recognition of what i need, how to help me - simply awesome.

i can see it now - press 1 if you're stomach hurts, 2 if your leg hurts ...
OPERATOR!

machines work great when steering and diagnosing other machnes? the fuzzy and
subjective human condition? not so much.

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lostlogin
I work on a supposedly state-of-the-art GE scanner. If I let it select
parameters it wants there are real, measurable negative consequences. It is a
buggy, bad piece of hardware. Sure, there are better machines out there, but
codifying the processes the human operator has is not going to happen anytime
soon I don't think - hell, GE don't know how to get a user selection of a bool
parameter right (it has a text field for the user to type in 1 for on, 0 for
off. No toggles, buttons etc). Still, the craptastic system spurred me to
learn a bit of coding to make stuff happen that the scanner can't/won't do.
Don't rush in to replacing the humans too soon.

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BadassFractal
At the very least we can get started by having doctors be thoroughly assisted
by computers. Transition from humans to full automation is always difficult,
so it's good to start with the computer being a very accessible and very
powerful resource that helps inform the doctor's decisions through data.

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vacri
Ha! Nurses need to be replaced by computers and robots? The only mention of
'nurse' in the rant is 'the uniforms carry bacteria'... because a robot
wouldn't? Every surface in a hospital carries this stuff. I'd like to see the
pricetag on a robot (or range of robots) that can do all the physical skills
of a nurse, let alone the social management.

I remember having to hold onto a patient's leg for a nurse to put in a needle
in a tiny vein in the foot, as all the others had collapsed. The patient was
in an altered conscious state and was moving around - I was keeping the leg
_relatively_ still. I'd like to see a robot succeed that task without being
explicitly designed for that exact use case. It would be genuinely impressive.

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zackbloom
Medicine is no longer an intuitive game. The best results come from following
rigorously tested algorithms, not intuition. Research, on the other hand, is
where the creativity is and that should continue to be done by humans.

~~~
bigchewy
source?

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bobowzki
I'm a physician and software developer.

Diagnosing is a actually a rather small part (but very important) of my daily
job as a physician. Doctors can't be replaced by computers and robots at the
moment because much of what I do is listening, comforting, reassuring,
educating, managing, administrating etc etc.

We urgently need better computer support tools. Will doctors be replaced my
robots? When you feel comfortable being comforted by a robot they will.

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lignuist
Just imagine a robot holding your hand while you are dying.

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lifeisstillgood
Enhanced by, assisted by, supported by, reminded by, taught by - yes, sure

Replaced by? Do me a favour.

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jastevenson
Other posts by this author:

"Programmers need to be replaced by computers...no more buggy code!"

"Lawyers need to be replaced by computers--no more sleazy ambulance chaser
ads!"

"Money needs to grow on trees! No more financial problems!"

~~~
Suncho
I know this is sarcasm, but law seems like a great candidate for automation.
The law is literally a set of rules. And in the process of automating legal
stuff, we might be forced to clean up some existing instances of ambiguity and
vagueness. Wouldn't that be nice?

Regarding programmers, much of their job already _is_ to replace themselves
with computers. Once a task becomes routine, you should automate it.

Regarding money growing on trees, that's not going to happen in the literal
sense. But perhaps the only way to provide for everyone is to institute a
universal unconditional basic income. Without jobs, people won't be able to
"earn" their livings anymore. But that's okay. They'll be free to spend their
time doing things that only humans can do and that nobody may have ever
thought to pay for.

How many geniuses out there are spending their time being doctors and lawyers?
How many of them will generate the next innovations that propel the human race
forward once they're no longer trapped spending so much time at work?

There's only one way to find out!

~~~
crdoconnor
>I know this is sarcasm, but law seems like a great candidate for automation.
The law is literally a set of rules. And in the process of automating legal
stuff, we might be forced to clean up some existing instances of ambiguity and
vagueness. Wouldn't that be nice?

Lovely. Unfortunately, most of the practice of law is arguing over its
interpretation.

If we can automate product management (giving vague instructions to a computer
that can figure out exactly what you want from it), we can automate law.

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otikik
Simplistic article to say the least.

