Robots vs. Anesthesiologists | Hacker News Reader

Robots vs. Anesthesiologists

online.wsj.com

39 pointsmarojejian40 comments

"If a patient ends up dying because of preventable circumstances, that's not going to be acceptable because we are trying to save money"

Let's not pretend that every anaesthesiologist has a perfect track record. Machines can make mistakes with horrible consequences, but so can humans. Similar arguments are used against many forms of valuable automation, such as self driving cars. The benefit of using machines is that mistakes are quantifiable and can be fixed en masse. There's no way to know if any given anaesthesiologist is having an off day and there's no one fix for the potential problem. Most automation issues can be fixed with time and more data.

The outlook is grim for automating similar medical tasks because of the same problem that Sedasys is facing: the human inclination towards turf protection. Professional organizations make a lot of dues money from their members, which is then use to purchase enough clout to delay the FDA at least once. No one wants to lose a job that they've committed their lives to and the threat of automation extends across all of society. But we can't afford to be the species that shoots itself in the foot by refusing to reap the benefits of ever advancing society.

I look around and see a world filled with repetitive and mundane tasks. I love it when one of those jobs is automated away. Congratulations to Johnson & Johnson and I wish them the best in their fight against our own backward tendencies.

Also, that quote can't possibly be accurate. Are they really claiming that there is nothing we could be doing to improve patients' odds (however slightly) that are foregone because they're prohibitively expensive? Because that's the implication.

I understand that the value of a human life is both high and difficult to measure. But throwing your hands up and going with $Infinity is not a valid solution.

You have it backwards. They're saying that there are measures that could save money which are foregone because of the unknown but potentially greater risk. An aneasthetist could fuck up a bunch of operations. A design error in a widely-employed robotic anaesthetic device could affect thousands of people. Juries are not kind to defendants in such cases.

I'm not going to dispute what you're saying (that's another conversation), but I really don't see where you're getting that from the quote under discussion.

For the most part, though, errors must be subtle and small to escape notice for very long. If, for instance, Device A kills everyone who uses it in five minutes, this will not go undiscovered for long. Unfortunately, we can not remove the chance of that happening.

Though if I were standardizing this software, I would seriously consider mandating that devices MUST NOT (in the RFC vernacular) have real-time human-calendar clocks on board them. Some sort of calendar-based errors could indeed be highly correlated and impossible to respond to quickly, and if the device simply doesn't have it it can't crash because of it.

(I'd also like to mandate buffer-safe languages that aren't C.)

((Also, I'd like a pony.))

I would seriously consider mandating that devices MUST NOT (in the RFC vernacular) have real-time human-calendar clocks on board them.

I am in total agreement. My experience with gps-based clocks in high-precision hard real-time environments taught me that time is really effing hard to do perfectly, it is full of countless non-obvious corner cases. Some of which will only bite you two years into deployment.

I opted out of anesthesia for my last colonoscopy, so that I could watch. (They still insisted on setting me up for potential sedation, I suppose in case I experienced distress mid-procedure, but it wasn't needed.) The procedure was quick (maybe 15 minutes); the discomfort was on the same order as a prostate exam, plus some pain of bloating that came and went repeatedly as pressurized air is used.

It seems the main dangers the anesthesiologist needs to watch for are those caused by the anesthesia itself, so going without it entirely felt like the safest option to me. And since I wasn't drugged, I could drive myself home and resume normal activities immediately. I suspect far more people could skip sedation for this procedure, and any risks (for example from some patients panicking) are likely outweighed by the extra care taken when a patient is a conscious observer.

A 15 minute prostate exam. That's no party!

To clarify, it was only prostate-exam-like at initial insertion, and total time of instrument-use may have even been less than 10 minutes. (I just remember being surprised how fast I was done and out, but didn't stopwatch-it. Next time, I'll probably time it and might even ask for a copy of the video.)

Is that a normal option? Was there pushback when you requested no anesthesia?

At least in Sweden, no anasthesia is very much the standard option.

It's quite common here in Germany. I know several doctors who routinely do it without anesthesia, to avoid the dangers of sedation. Having seen a colonoscopy done that way a few times, I'd personally insist on sedation. Most people I've personally observed who were awake for the procedure seemed to find it almost unbearably painful, although there was a minority who didn't mind it much.

The unique and worst part was the on-and-off air-bloating pain, but it was comparable to other quickly-passing episodes of intestinal gas/discomfort, and especially bearable knowing that it was very temporary and in service of a goal under expert care. (I've had more painful headaches, scrapes, stubbed-toes, and sprains – which each lasted longer.)

I could definitely understand those with various kinds of medical- and pain-anxiety opting for sedation, but I also think such things are highly suggestible and influenced by social norms about which pains are normal to shrug off and which pains you communicate for sympathy... so it doesn't surprise me that in other cultures skipping sedation could be the casually-accepted norm.

They didn't suggest it, but once I asked the only pushback was of the "most people prefer it, it's very safe, let's be ready to use it just in case" variety. (I hadn't expressed the preference until checking in that day, so the anesthesiologist was already scheduled, and I didn't save any money.)

This kind of brings up something I've thought of for a while...why isn't nitrous oxide (mixed with oxygen) used for stuff like this? Seems to be the best of both worlds... comfort/anti-anxiety for the patient (Nitrous has both pain-killing properties, and it's a dissociative, so it makes you much less aware of what's going on, as well as somewhat sedating), but unlike most sedatives administered via IV, since it's an inhaled gas onset/offset time is very quick - peak anesthesia is reached in 60-90 seconds, and after coming off gas you're back to baseline with-in 5 minutes.

Nitrous causes brain damage in medical staff. It damages cobalamin (vitamin B12), which is no big deal for a one-off exposure but for people to work with it every day causes problems. See:

http://www.anesthesia-analgesia.org/content/60/5/297.short

http://www.nejm.org/doi/pdf/10.1056/NEJM199210013271405

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1418219/pdf/bmjc...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2162364/pdf/anes...

I was awake during colonoscopy, too, no issues. I also was awake during screening of the stomach, where you have to swallow the stomach probe (or whatever it is). Not sure I would opt for that again.

Nice peek at why Health Costs are so screwed up :-) You could ask the patient (use the machine it's covered, use the Anaesthesiologist and pay his fee (up to $2,000)) Of course that sort of approach will be made out to be threatening the poor and those unable to pay with a risk of death.

I've known a couple of anaesthesiologists in my life and something the article didn't mention was that their malpractice insurance premiums go up linearly with their patients seen (I can't verify that directly but believed them when they said it). The argument was that they are one of the 'most sued' doctors on the planet. Hard to sue a machine of course, we'll see.

Why would you expect [Expected Value of the amount of liability per unit time] to be anything but linear in the rate of attempted operations (within the envelope where each operation is routine, non-interfering, statistically independent event)

I am not a doctor. It is explained that each patient they had, added to the total population of patients that might sue them. I don't know if there is a statute of limitations on malpractice to mitigate that pool.

An anaestheologist treating 20 patients per year is going to have fundamentally less experience than one treating 200 patients per year.

I'm pretty sympathetic to anesthesiologists after another WSJ article I read a few years back.

According to that article, anesthesiologists used to have some of the highest malpractice premiums. Rather than lobbying for liability caps as some other physicians have been doing, they did a lot of analysis of their own data, and figured out how have a lot fewer patients die on them. Now they have some of the lowest malpractice premiums.

Link?

I didn't think I'd find it but it googled right up: http://online.wsj.com/article/0,,SB111931728319164845,00.htm...

Nothing says reassuring quite like "supports WiFi" but also "WEP only" http://www.accessdata.fda.gov/cdrh_docs/pdf8/P080009c.pdf [pg. 101, section 5-21]

The Wall Street Journal is losing relevance - because they have made this article inaccessible/difficult to access, I won't read it, and I'll get this same information from another source.

It's a brave, new world.

"Relevance" is perhaps subjective, but the WSJ is the largest newspaper in the US and its circulation is growing--both online and in print.

Side rant: for what it's worth, I'm more of an NYTimes person when it comes to where my premium news app subscription dollars go. However, I'm planning to give WSJ a try, not because I like their style or ideology better, but simply because the NYT app developers have some sort of kamikaze methodology going on, in which they are hell-bent on destroying the value of their IP through poor interface design.

It's amazing (and more than a little silly) to think that the success of a newspaper -- an exercise in pure content if there ever was one -- might have anything to do with the design of its iPad app. But that's what the WSJ's competitors seem to be trying to prove. Some of WSJ's recent success might just be due to screwing up less than everyone else, because I've heard only good things about their UX. The medium may not be the message, but the latter can't get by without the former. The NYT and some other prominent papers simply don't get that, even at this late date.

Really? Last I heard, the NY Times was the largest in the US, and its readership was declining.

"The Wall Street Journal, owned by News Corp NWSA -3.04% ., maintained its position as the country's largest newspaper by average weekday circulation. The paper had an average weekday circulation of 2.4 million, including print and digital subscribers, as of March 31, up 12% from a year earlier, according to the latest figures from the Alliance for Audited Media."

http://online.wsj.com/article/SB1000142412788732448250457845...

The article appears to completely ignore the issues of liability and malpractice and whatnot, which are critical to any discussion of anesthesia. This makes the article somewhat useless.

I was able to view the article through a google search of its title.

this worked for me after googling it: http://online.wsj.com/article/SB1000142405270230398390457909...

That link didn't help me. I think they're checking the referrer.

I just installed a Chrome plugin called "first click free" which does this automatically. Been doing this manually for too long, haha!

I just installed the plugin, but it doesn't seem to be working.

My thoughts: http://marojejian.tumblr.com/post/62339785940/rise-of-the-ma...

On the one hand the benefits of such technology are amazing. On the other, it’s scary to see such high-end professions encroached upon by machines.

But the resolution here is the same as for the cashier or the buggy whip driver. We need this technology, but we need to ensure that:

a) Our economy is flexible enough to rapidly develop new industries that will require human workers.

b) Our workers have the education, the infrastructure, the incentives and the entrepreneurial mindset needed to move with (or ahead of?) the market into new fields without calamity.

But will there always be new applications for humans? Well not always…. but that would imply a situation where AI has truly supplanted us in all respects, and our technology can supply all our needs without us lifting a finger.

Call me when that happens. Sounds nice.

People don't want jobs. They want a good standard of living, and to have a social role. They want to matter to others. Jobs can deliver on that, but it's just one social construct among many.

Because our economic engines have been so focused on human labor since the dawn of agriculture, we now think of jobs as the most significant type of role to play, tied only with "parent", followed by a long tail of non-profit edge cases (volunteering, running a racquetball league, etc.)

But while there will always be significant demand for human labor, its value is steadily diminishing, a trend that shows no sign of stopping, with the lion's share of the benefit going to those own the hardware and/or the patents. (Maybe machines make cheaper goods, but who cares if I can't make any income to buy those goods?)

Maybe we can invent or entrench enough human jobs where a computer can't compete (a Starbucks bot can get you coffee, but it can't smile at you); but to assume that that's either possible or optimal seems like putting the cart before the horse.

While hypothetically our existing political structures could try to solve this problem (basic income, etc.), those processes have been so effectively captured and divorced from anything resembling democratic rule that I'm not very confident in good results.

Ironically enough, this seems like the perfect problem to be solved by software: allocate resources to ensure basics of survival and dignity, incentivize desirable social behavior and wealth creation, and create sufficient negative space for people to also create social value in unpredictable and unmeasurable ways, by having actual free time.

It's a tough nut to crack.

future improvements in anesthetic agents, intubation devices, and monitoring tools will probably allow nurse anesthetists to do more and more what anesthesiologists do today.

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