George W. Sledge, MD, FASCO

Feb 17, 2011

Does anyone other than me find what happened on Jeopardy! this week somewhat freaky? For those of you not up with the cultural zeitgeist, an IBM computer named Watson absolutely destroyed the two best Jeopardy! contestants in a three-day contest, answering question after question correctly in an almost human voice. Host Alex Trebek interacted with Watson as if it were a real person. IBM donated the week’s winnings to charity: I suppose we will have to rely on the kindness of strange computers in the future.

I stopped playing chess a few years ago when I realized that I could never play as well as the software on my computer. I had thought Jeopardy! relatively unassailable: while programming a computer to know a lot seemed possible, the wordplay that went into Jeopardy! clues seemed a tough nut to crack. I’ll never enjoy the show as much again, knowing that the best human competitor is now second rate.

It got me thinking about our own profession. Certainly much of medicine, particularly medical diagnostics, is programmable. How far beyond what happened this last week on Jeopardy! is the following scenario? A patient walks into an office and starts interacting with the quite life-like machine voice of Doctor Watson, sharing the symptoms that prompted the visit. Doc Watson asks questions, uses the answers to generate a differential diagnosis with some probability function. “Stick out your arm, please,” says Doc Watson, and blood is drawn (let us hope by a living med tech or nurse). The blood work is analyzed, Doc Watson’s algorithms kick in, and a prescription is sent to the pharmacy.

Far-fetched? I think not. IBM already has plans to “use Watson's linguistic and analytical abilities to develop products in areas such as medical diagnosis,” according to an article in the Guardian today. And I imagine it would do pretty well as a diagnostician: there is a decent literature suggesting that rules-based expert systems outperform the average practitioner in many fields. If you want to see an interesting take on this from the IBM folks, you might wish to see the YouTube video.

And not just diagnosis: DARPA, the U.S. Department of Defense’s research arm, devoted considerable resources to the creation of an “autodoc” capable of performing battlefield surgery. While this hasn’t happened yet, the work was part of the intellectual basis for the da Vinci robots that are proliferating madly everywhere.

So is the medical profession in Jeopardy? Probably not this week. The IBM spokesmen are quick to state that “Of course you can’t replace doctors and nurses.” Well, we’ve heard that “you can’t replace” line before, attached to every professional group affected by the digital revolution.

What’s that you say, Watson? Don’t bother coming back from vacation? Only if you do my dictations.


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Anees B. Chagpar, MD, MPH, MBA, MSc, MA, FACS, FRCS, FASCO

Mar, 01 2011 8:42 PM

I, for one, actually am excited about the opportunity to have Watson and his colleagues join us in the medical’s kind of like having the smartest kid in your med school class, with a bottomless photographic memory and an uncanny ability to synthesize the latest data, on your team...

And it’s already happening. EMRs with “Decision Support” pop up and ask about whether your 52 year old female patient has had a recent mammogram, PAP smear or colonoscopy. Some may even warn about potential drug interactions, and prompt you to order bloodwork for drugs that require monitoring. We already get EKGs that come with computer-generated diagnoses, and get flagged on abnormal lab results.

One could imagine the day when you go to order a PET scan on a patient with DCIS, that Watson would pop up and say “There are insufficient data to support this decision. Are you sure you want to proceed?”. Such technology could have a tremendous impact in terms of reducing costs and improving patient outcomes, not to mention being a valuable asset in terms of minimizing “defensive medicine”.

So is the medical profession “in Jeopardy”? I think not. No computer could ever replace the kindness of a warm smile, or the compassion of a healing touch. Even DaVinci needs a surgeon to guide its robotic hands, and even the most sophisticated machine will need a human mind to understand the social context in which a patient is treated. A recent study found that without further improvements, computer aided detection for mammography was not as cost-effective as a good radiologist, so clearly technology is not the be all and end all. Furthermore, there are a lot of other things we do in the medical profession that technology cannot replace: Computers may teach, but they cannot mentor; they can recall and synthesize data, but they cannot ask the truly imaginative questions that move our field forward. And George, while Watson could likely finish your dictations with auto-filled templates, even the smartest Watson, cannot lead, inspire or motivate like you do...and as for writing an outstanding blog like this one every week, Watson couldn’t hold a flame to you. So much for not coming back from vacation...

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