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Computerized Medicine: Fantasy vs the Real World

When I was in medical school, computers were fairly new. They used punchcards and took up all the space in large rooms. Even then people that were enamored with new technology predicted that someday the computer would replace the doctor. Patients would sit down at a keyboard, type in their symptoms, and the computer would spit out a diagnosis. Fortunately that hasn’t come to pass but not for lack of trying by those who want to push medicine in that direction.

The main stumbling block that has kept this vision from becoming a reality can be summarized in a word: JUDGMENT. Good medical practice is a time intensive, hands on, one-on-one business where judgment is often the critical factor that is supplied by the physician. Good judgment comes from a combination of knowledge and experience. And, as wonderful as computers have been in many areas of our lives, no one has ever been able to successfully program judgment. Two examples come to mind that illustrate this reality—one from the medical field and one non-medical.

The non-medical example involves bridge–the card game, not a structure over water.Bridge is to cards as chess is to board games. To play bridge well, one must be able to draw inferences from both the bidding and the play of your partner and your opponents. You have to formulate a plan in order to make or defeat a contract and you may have to modify this plan as the play of the cards unfolds. There are many close decisions to be made during the course of a hand and using one’s judgment as to the best alternatives is crucial. No two hands are exactly the same and this is why devotees of the game find it so fascinating.

There have been computerized bridge games available for about forty years. They have never been completely satisfactory from the standpoint of the serious player. Defensive play has always been particularly poor in these games. But what is most remarkable is that the quality of these computerized bridge games has not improved significantly over all this time. I don’t think it ever will. The reason is that you can’t computerize judgment.

The second example comes from some of my experiences in the medical field. Although I am retired from active medical practice, I still do electrocardiogram (ECG) interpretations for the hospital where I used to practice. I have been doing this for about forty years—as a sideline when I had an active practice and now as my sole medical activity. Currently I read 90-100 ECGs per day. Over the years, I would estimate that I have read well over a million. So I know more than just a little about this one specialized area of cardiology.

There have been computer programs available for about thirty years that provide ECG interpretations. Our hospital purchased one of them when they first became available. The thinking was that this would replace the interpretations that my partners and I had been supplying before. But the diagnoses provided by the computer were so inaccurate that someone in the legal department advised the administration that they needed to be “overread” by qualified humans. That has continued to this very day. So I have been looking at ECGs and the computerized interpretation thereof for many years. And just like the situation with the computerized bridge games, there has been very little improvement in the accuracy of these computerized ECG interpretations. I would estimate that I have to make corrections on at least 80% of the computer readings that I review. Some of these are rather minor but at least 20-30% of them are serious errors that could have some clinical importance.

The problem with the ECGs is much the same as that with bridge. There are many variations of normal that can be influenced by all kinds of factors that have nothing to do with the heart. Nearly identical looking patterns can result from very different pathological conditions. So, once again, judgment comes into play with practically every ECG interpretation. It will always be so and I doubt that the computer programs will ever be able to achieve a level of accuracy much beyond what they offer now.

The same degree of judgment is required in practically every other area of medical practice. That doesn’t mean that the tech enthusiasts won’t continue to push for more computerization and may even succeed. But the quality of medical care will certainly be much the worse for it.

Whole word, look say, teacher malpractice, pedagogical inanity?

I had a little experience as an observer. Look say was not used when I was taught to read–thank goodness.

I learned in the early 50s, but I was in college when lood say or whole word became a rage. Boy, you talk about stupid ideas.

Phonics makes a kid powerful–look say makes a kid a weakling. That’s the way it works–you gots to have the tools.

http://www.americanthinker.com/articles/2014/12/education_cause_mental_health_issues.html

How many bullies make an effective gang?

Here is a little math quiz discussion on cultural dynamics.

Ray Ibrahim asks–when do muslims become numerous enough to intimidate and bully or persecute Christians?

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HPV vaccine discussion–cervical cancer the target, is the HPV vaccine the answer?

Dave Burton has an interest in Human Papilloma Virus (HPV) vaccine effectiveness and provided this research review on the new Gardisil 9 vaccine for HPV.

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Science community lifts head from trough, bellows for more money

Scientific American tut tuts about congressional parsimony on science and some “riders” that it disapproves.

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More evidence of warming–snow cover at record levels in Northern Hemisphere

I thought snowballs would not be a part of childhood in the future.

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The Absolute Last Word on Fructose and HFCS

I initially posted this as a comment to an article critiquing a study that claimed fructose and High Fructose Corn Syrup (HFCS) were major contributors to obesity. I’m not sure that everyone gets to the comments that may come some time after the original posting. So, given the ubiquitous warnings about “toxic” HFCS that seem to saturate the internet today, I felt it worthwhile to repeat this as a regular post. Continue reading