Hacker News Reader

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.

> 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.

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.

If an expert system prescribed you extra strength Tylenol would you feel better? I think you are taking a too simplistic view of diagnosis and put to much faith in AI. I have also noticed Watsons good results, but I do not trust them yet, there is a lack of evidence supporting the claim that Watson can make 90% correct diagnosis.

Medical imaging is a big part of diagnosis, especially in many cancer patients. There is a huge effort to automate the segmentation of tumors, and even though algorithms often have higher inter- and intra-observability agreement than radiologists, they often fail miserably for "non-standard" tumors. A fully automated system that scans the patient, make the diagnosis and treatment plans and provides treatment is very far future.

A completely different issue is that the specific combination of a highly developed brain and opposable thumbs are sometimes necessary. Consider cardiac response teams in hospitals, but also general patient care where the ability to fluff a pillow can be just as important as placing a quick IV drop.

I won't argue that machines can't do amazing things. Technology definitely has helped us to live longer and diagnose more accurately.

I don't have any source to backup my arguments and claims, but for many older medical practitioners, including my family (we have been a medical practitioner for several generations), we feel that the younger doctors lack of confident and knee knowledge because they rely on machines. I have a hard time to put my family's words into English because they are Chinese (they are Western medicine practitioner btw), but the basic idea is that they learn to use their fingers and their sensory inputs to gather empirical information about the patients. I won't say they can diagnose a tumor at a precise location or detect the type of cancer precisely, but experts can diagnose to a very good estimate. Back then they didn't have x-ray in every hospital. Only the major one has x-ray in China and my grandma and my father had to use their fingers to determine the location of the tumor, or the type of tumor. When my dad first saw the x-ray machine back in the 70s when he was still in China, it was amazing to him what he could do with him, but he said practical experiences and hands-on experience matter.

Ask how many new practitioners can do that with confident? I supposed few. Because most of them rely on machines.

What if machine is down? What if the machine is not capable of telling the truth? It has limitation.

I am arguing that machines can't help, but doctors should never rely on machine. They need to rely on their experience and knowledge and this is what distinguish an expert from an average practitioner.

To be honest, getting people x-ray all the time is largely because of suing medical mistreatment and then good part of just being efficient (or lazy if you want to be harsh). Hospitals are scared of getting sued so they'd put everyone through an x-ray machine.

Interesting you bring up the chest pain scenario. In 2003, when I was 32, I had crippling chest pains, and, simultaneously, (this is what scared the crap out of me) my entire left arm went absolutely numb - I was certain I was going to die of a heart attack, and so I immediately called Kaiser (in hindsight, 911 would have probably made more sense, but I was overly sensitive to calling 911 for anything other than murder in progress, somebody not breathing, or house on fire).

I was patched through to an intake nurse, described my symptoms, and she asked a grand total of three questions:

"Are you having any shortness of breath" "Do you feel any nausea or light headedness" "Can you press your fingernail on your left hand, and tell me how quickly it goes from white to red"

After I answered those three questions (No, No, right away) - she then said, "It probably isn't anything, but we'll want you to come in some time this week" - and set me up for an appointment a couple days later.

Total interaction time - less than 5 minutes, and that was with an intake nurse, not even a doctor.

Clearly, an expert system had done the assessment, and had decided, based on some baysean weighing (32 year old is almost certain not to be having a heart attack) plus a few expert-tree questions, that it wasn't really an emergency.

(As it turned out, I was starting to suffer from some RSI in left arm - Doc made the assessment in 90 seconds of prodding my arm, suggested an ergonomic keyboard and less typing - His analysis of the chest pains were, "Likely stress related, nothing to be worried about.")

BTW - my doctor didn't even suggest x-rays. Just a standard stethoscope/Deep Inhale test. When I asked a physician friend of mine later, why they hand't run any tests, his answer was, "You weren't in pain when you visited, had no trouble breathing, - there were no obvious indications of distress, you are 32 years old - there was very low return on running tests, and doctors (particularly at HMOs) are taught not to engage in "fishing" (testing for the sake of testing)

I can't see the part in your story where you found out what the chest pain was and that any form of diagnosing entity [sh|w]ould have picked it up.

That's a big part of the frustration. The doctor's conclusion was essentially that it was nothing.