Big Brother is watching…or is it Watson?
I was catching up on my reading yesterday while watching the Celtics lose – again – and I picked up my Atlantic Monthly from March. On the cover: THE ROBOT WILL SEE YOU NOW. Ha! I thought, another robotic surgery article I can rant about. But this piece, written by Jonathan Cohn, talks about a future with a larger and much more pervasive use of technology than just robotic surgery. The future, dear readers, is rather alarming.
Mr. Cohn talks about many incipient technologies that will be coming soon to a hospital or doctor near you. Watson, for one. Watson is a computer that is supposed to help professionals with complex decision-making. Watson can digest information and come to a conclusion or several conclusions to the tune of 60 million pages of text per second. It’s the computer that won Jeopardy a couple of times. Now Sloan-Kettering and IBM are teaching it to be a doctor. Watson is supposed to help eliminate anchoring bias and other forms of human error. Here is what Ari Caroline, Sloan-Kettering’s director of quantitative analysis and strategic initiatives says:
“If you’re looking down the road… You’re going to need a tool like Watson because the complexity and scale of information will be such that a typical decision tool couldn’t possibly handle it all.”
Yes, ladies and gentlemen, we doctors are now “typical decision tools”. Now I am not against using computers to help with diagnosis and treatment. Any doctor who is being honest and responsible looks stuff up if they don’t know, don’t remember, or are unsure about a subject. One of the less useful and more futile activities conducted in medical school revolves around memorizing things that you will never remember later that you can easily look up if you ever need to know it. But I have a problem with Watson. Two problems. A whole bunch of problems really, but here are two: 1. Sounds expensive. 2. Sounds like a lawsuit machine. Watson says “Well doctor, have you thought of this (vanishingly small) possibility?” “Well no Watson because it’s very unlikely.” Next thing you know you’re up on the stand and the prosecutor is asking you why you didn’t take Watson’s advice.
Here’s another technology that will change your world. Companies are developing and selling sensors that can attach to iPhones and collect all sorts of biological data. For $129 you can hook your blood pressure cuff to your phone. You can get an EKG on your phone. One device, called a “Stealthvest” embeds sensors in a vest people can wear under their clothes to collect data. Here’s how Mr. Cohn imagines a device like this helping make you healthier:
“Imagine you’re an adult with a chronic condition like high blood pressure. Today, your contact with the health-care system would be largely episodic: You’d have regular checkups, at which a doctor or maybe a nurse practitioner will check your blood pressure and ask about recent behavior…In the future… you would be in constant contact with the health-care system, although you’d hardly be aware of it. The goal would be to keep you healthy – and any time you were in danger of becoming unhealthy, to ensure you received attention right away…. If, say, your blood pressure suddenly spiked, data-processing tools would warn [health professionals] that you might be in trouble, and some sort of clinician – a nurse, perhaps – would reach out to you immediately, to check on your condition and arrange treatment as necessary.”
Wow, that sounds really – really – well that sounds really AWFUL actually. Imagine you’re a lawyer and you’re standing up doing your oral argument before the supreme court and you’re a little nervous, when suddenly your cell phone rings and someone – a nurse, perhaps – says “sir, your blood pressure has been elevated for the last hour and a half. Have you been taking your medication as directed?” Or I’m in the OR and a patient is in trouble and right in the middle of the resuscitation someone – a nurse, perhaps – calls me and says “Ma’am your blood pressure is dangerously elevated and you must report to the nearest emergency room immediately for further evaluation.” These are extreme examples but even for your average joe this technology sounds like the worst of paternalistic medicine and intrusiveness. The function of the device is to CONNECT YOU EVEN MORE CLOSELY TO THE HEALTHCARE SYSTEM, which is exactly what you don’t want. I can see the utility of the technology in certain cases. I’d rather connect my phone to a blood pressure cuff than have to come in to the doctor every week to get it checked. I get it. If you’re on Coumadin you want a reason not to have to get blood drawn in a lab every other day. I get it. The problem is the assumption that technology can keep you healthy. It can’t. That’s your job. I always tell people to stay away from doctors, but what I really mean is keep yourself as healthy as you can, see a doctor if you really need one, and the rest of the time live your life. Why would a retiree trying to enjoy his later years want a constant reminder that his doctor is watching him? Why would a young person with a chronic disease want to be tethered that way?
These and other fancy technologies are being developed all over the world, and I’m sure it’s really fun and tech-y and cool to play around with this stuff. But people, my EMR system can’t talk to the one across the street. Heck, my online anesthesia record can’t talk to the EMR system in my own hospital. Please. The solution to healthcare costs does not lie in technology. It lies in people taking the best care of themselves that they can and seeing a health professional if they need one. A real person, not a computer.