Re: [ba-unrev-talk] augmented medical diagnosis
On this page: http://www.boston.com/globe/magazine/2002/0714/coverstory3.htm
"Some physicians and patients may be uncomfortable with the direction in
which Weed would have us go. Ten years ago, if we wanted to trade a stock,
we had to go to a broker. Today, we have E*Trade. Could Weed's program be
disrupting medicine in the same way, bringing us closer to the days of
E-Diagnose? In some ways, that will never happen. Patients will always need
trained medical professionals to perform physical examinations, order lab
tests, write prescriptions, and perform surgeries. Some patients will be
too sick (or uninterested) to fill out the couplers. And few patients will
be willing to throw their health completely into the virtual hands of a
computer program. When we are sick, we need to feel as though our suffering
is understood, and computers are poorly designed to show such compassion.
But when the PKC software makes it onto the Web, ordinary people who never
labored through medical school will be able to record their own ailments
and link those problems with a vast store of medical knowledge that is, in
many ways, superior to the physician's memory. Although the software has
the potential to become a hypochondriac's dream (or worst nightmare), it
could cause the doctor-patient relationship to shift dramatically: The
doctor will have to prove to patients that he followed the procedures
called for by science.
As patients know more, they can collaborate better with the doctor in both
diagnosis and treatment planning. Of course, patients who come into the
doctor's office with reams of computer printouts and a newfound sense of
understanding might be terribly annoying to physicians who are used to
making unilateral decisions. But once their bruised egos heal, doctors may
discover that they can leave work each day having cured more patients.
Berwick, the Harvard professor, has considered Weed a hero and "a giant of
American medicine" ever since he devised the problem-oriented medical
record. Berwick sat as chairman of the Institute of Medicine committee that
produced the report that Weed criticized. He has seen the Knowledge
Couplers demonstrated several times and has heard Weed's claims that they
are ready for widespread use, but Berwick is not yet convinced.
Nevertheless, he contends that Weed's basic concept, that physicians need
computers to make up for their brains' limits, is right on. "He's got to be
right that it's computer-based," Berwick says of Weed. "Whether it's his
[program] or not, I don't know. But my guess is, 30 years from now, we're
going to look back on this and say, `How could we ever have thought we
should do it the other way?' "
As I read those, the closing paragraphs of the article, I am reminded of
Rod Welch's argument that knowledge management is hard work. As there are
medical practitioners 'out there' who are, at once threatened, and unsure
of the notion of augmenting human capabilities, so will there be chiefs of
all sorts, (technology, information, finance, etc) 'out there' who will be,
at once threatened, and unsure. Mainstreaming the OHS paradigm is not
going to be easy. (02)
At 09:37 AM 7/15/2002 -0700, you wrote:
>"A computer program that provides vast amounts of information for
>diagnosing and treating patients could revolutionize the practice of
>medicine. So why won't physicians use it? "
>For me, seeing an article on Dr. Lawrence Weed is of great
>interest. That's because, in 1985, I formed a partnership with Dr. John
>Rose and we build a medical expert system (first built on an Apple II in
>Forth, later migrated to IBM PC in Forth and to Mac, under StaxPert
>written by our new partner Dan Wood (StaxPert being an inference engine
>for HyperCard). While doing our "competitive benchmarking", we discovered
>Dr. Weed's PKC -- Problem Knowledge Coupler.
>Our product was first named "First Opinion" and later recast to a more
>generalized "DOC" Decisions On Computers.
>Here's more from the page about Weed's PKC:
>"Cross has a trick, an unusual tool he sometimes pulls out of his virtual
>black bag. The tool is not a stethoscope, which amplifies his ability to
>hear a heartbeat, or an MRI, which makes up for his inability to see
>through flesh. Instead, it is a piece of computer software that makes up
>for the limits of the human brain. The software, called the Problem
>Knowledge Coupler (PKC), was conceived by an old Vermont friend of his,
>Dr. Lawrence L. Weed. Instead of listing the symptoms of a disease and
>asking a doctor to choose the closest fit, as some medical Web sites do,
>Weed's program asks a doctor to first answer a long list of questions
>about the patient's troubles. Then, up comes the most likely diagnoses and
>ways to test them out. The program helps doctors match (or "couple") the
>patterns of a patient's problems with the relevant knowledge that exists,
>perhaps buried deep in a textbook or journal article, to recognize and
>treat those problems."
>Now, is that an augmentation system, or what?