Computers Shown To Be Better Than Docs At Diagnosing, Prescribing Treatment

As an attending physician, I have several issues with this article.

A) the slashdot title is a little sensationalistic....never did TFA mention diagnosis without a physician in the loop.

B) by what standards was the final diagnosis discovered (i.e. the gold standard)? Another physician? Another program? Was the trial blinded?

C) this article mentions only one disease process - depression, I fail to accept, blindly, that their results can be extrapolated - that is the crux of medical versus scientific research....see D. Not all diagnoses are obtained by just talking with a patient, in fact short of a psychiatric diagnosis, most require a physical exam....and a competent one. Suppose someone is obviously malingering and complaining about abdominal pain....this system would not pick up on malingering and would likely recommend an operation....a totally wrong diagnosis.

D) this is a retrospective study...in medicine, this is not adequate proof of effectiveness.....you need to perform a prospective trial, preferably with randomization and blinding to adequately prove your hypothesis for treatment. Actually, upon re-reading TFA...it was _simulations_ that were performed. This is hardly world class evidence.

E) cost savings were mentioned, but not long term outcomes....who cares if I saved 75% in the cost of treatment if the patient didn't get better in the end. (yes, short term were noted, but anyone who's ever been on long term therapy knows that the short term does not dictate the long term outcome.

F) In life threatening situations - those that require the most expedient decisions, often with less than complete information, this system would be useless because the patient would die in the time it takes you to input the facts.

G) not all situations are cut and dry. I am often consulted to make decisions about patients that are not addressed in any book. In fact, there may be only 1 or 2 journal articles about the problem, and often there are none. Making a decision treatment in the absence of an established precedent is not going to be one of this systems strengths...."Oh, I'm sorry, I can't help you....I just got the blue-screen of death from the program that was supposed to diagnose you!"

H) would this program tolerate patient autonomy? What happens when the patient refuses some or all of the initial treatment plan?

So, while I point out flaws, it is not to say that this is totally without merit....I am merely pointing out the obvious short coming of this article. In certain fields this could be very advantageous.

I will tell you that in my field, this computer program borders on useless. There is very little doubt about what my diagnosis is, and when I am in doubt, my best evidence is collected by doing something. And computers are really a long way away from matching my skill set. A lot of my diagnosis is made by touching the patient during the physical exam. That exam can completely revamp my decision that started based on the history. And, since I am the one performing procedures, I also would not have a machine dictate the exact method that I use - I am the one performing the operation, I do it the way that I know will result in a safe and effective outcome. In my case, I just don't really don't know what this system would provide to me for patients.

Source: http://rss.slashdot.org/~r/Slashdot/slashdotScience/~3/bReWgwo8suU/story01.htm

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