Health Informatics Discussion Forum

Do We Need Doctors or Algorithms?

Vinod Khosla, a prominent Silicon Valley investor, says that Doctors will soon be a thing of the past, replaced by computer algorithms:

Eventually, we won’t need the average doctor and will have much better and cheaper care for 90-99% of our medical needs. We will still need to leverage the top 10 or 20% of doctors (at least for the next two decades) to help that bionic software get better at diagnosis. So a world mostly without doctors (at least average ones) is not only not reasonable, but also more likely than not. There will be exceptions, and plenty of stories around these exceptions, but what I am talking about will most likely be the rule and doctors may be the exception rather than the other way around.


I think that a lot of the work that doctors do is actually more about solving complex, fuzzy problems and organising care in a way that prioritises emotional issues and causes the least distress for patients. I think that computers will be much more helpful that they are at the moment and will prevent many of the errors that are currently routine, but patients will still need a sympathetic, responsible, knowledgeable person to guide them through difficult and distressing healthcare decisions.

What do you think?

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Replies

  • Doctors for the insured and algorithms for the uninsured. Just need to figure out how to get meds after self diagnosis.
  • I agree. I think that software will be helpful in making medical decisions and performing diagnosis but medical practice is simply more than this. We will still need surgeons etc.
  • in order to see this materialise we will need to get better with evidence based medicine and create more expertise with people who can faciliate the merging of science and computational power.
    • Thanks for the reply Harsha. I agree with what you are saying but I would argue that much of the work of doctors is about helping with difficult personal decisions and helping people cope with painful and distressing conditions. Each person is different, their families are different and their home situations are different. Applying evidence can help in selecting which drug to put them on, but that is only one part of the process of helping patients manage their conditions and cope with the distress of being ill.
  • I think the young people of today make the future how we want it. In 20 years time will we say this is great or will be be the old farts complaining about the world we built. Time will tell if we chose wisely. 
  • I am personally involved in such medical project. CPR & First Aid Guide, Human Atlas, Enhanced medical symptoms, and signs search. The way this application works match with the discussion. I think many people will be interested in to see . For more information visit https://market.android.com/details?id=com.nikolay.arfa&feature=.....
  • I think the guy's right - eek! -  but the future is less about computers more about political definitions of appropriate healthcare, rationing, and cost-control

    maybe something like 80-90% of current primary care medical activity can be (and is) delivered by practice nurses, advanced practitioners, health-care assistants and clerks - mainly working to protocols but no less able or willing to offer the essential and necessary human touch - nevermind salaried physicians who do the dogs work while "higher-level" physicians "manage" the enterprise - not necessarily as expert consultants overseeing the clinical work but as the top 10-20% entrepreneurs who got in/were in there first
    much/most of this medical activity is not directed at the accurate diagnosis and treatment of disease but administrative and political precepts - the computer can diagnose illness better than most doctors - but what is illness etc
    Doctors should be worried if almost everything they do can be done by someone else or a Dr Spock device. I genuinely think we still have something to offer but we urgently need to redefine our value proposition and our art  - (over and above an often not-reasonable "Authority")
    If the computer beats the doctor then we really can't complain - if what's left can be delivered by social workers (who are not without their own problems) or say generic mental health workers then most of us (ie those not approaching retirement) really are stuck
    what's more likely is the computer - like EBM - will determine/deny access to healthcare / medicine according to HMO / Commissioning considerations








  • This claim seems much like those immature expectations in 1960 anticipating that very soon, computers will replace experts. Early trust terminated in so many small technical difficulties that couldn't get solved for 5 decades now. A decade of improvements in our understanding of brain functions in parallel of new findings in Neural Networks and Fuzzy combinations, created new hopes. But a number of main issues are remained yet. As an example we are yet far from capturing of implicit knowledge, creating the right structure and using it in effective way. This means that a competent knowledge architecture is not found yet. Another example, a physician is not just an inference engine with a number of rules, it is a very complex and advance data acquisition, processing and analysis entity(visual, NLP, touch, that is combined of several sensations by itself, etc.) too. Multiple functions that years are needed to get approximated. In my opinion for now it is more ideal than a plan.
  • I believe it there will still be a need for a Clinician but algorithms will make up a big part in the future the diagnosis and treatment of patients. Medical treatment falls into different categories, prevention, detection, investigation and treatment. All of which needs speed of resolution. We are finding now that medical schools rely on classification and standards but will still have to be reviewed constantly. Medicine is still an Art. 
  • Many of my patients make the comment "I feel better after seeing you" wonder how they will feel after seeing the computer.
    I am sorry but software cannot substitute for the therapeutic relationship between doctor and patient. Medicine is not just a science but also an art.
    Eliciting a history is not a matter of filling in a tick box but reading body language and reading between the lines also. Good luck to the computer diagnosing my patient who says "I just feel awful!"
     
    I know my patient's family and social context, I know when the mill has been closed in our town and people are under more stress re employment.
     
    We doctors may well benefit from some decision-making software but software does not substitute what we do and we do it well!
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