Friday, July 13, 2012

A Child Died - Could A Computer Have Helped

I am a physician. A physician's job is to obtain information from a patient using various techniques, then to input the accumulated data into his brain, and finally arrive at a diagnosis via mental algorithmic analysis. But we physicians are human! We err. We err as a consequence of these human variables.

I feel quite certain that a medically sophisticated Watson (Dr. Watson, I presume) will outscore the diagnostic acumen of the physician in the near future, and will become the physician's most valued "partner." Dr. Watson will "outdiagnose" all of us. Not only outdiagnose - but "outmanage" as well, because the management of a medical problem is also an algorithmic conclusion. We physicians won't accept Watson, at first. Like so many advances in medical management, we will have to be dragged to it "kicking and screaming," but eventually accepting it in the end.

The above is taken from a Feb. 17, 2011 Blog entry discussing the value of computer-aided diagnosis (Watson) in medicine.

An Infection, Unnoticed, Turns Unstoppable (Jim Dwyer, New York Times July 12, p. A15) describes the shocking story of Rory Staunton, a 12 year old boy who was not properly diagnosed, and who consequently went on to die of an overwhelming bacterial infection, causing complete failure of his bodily organs (liver, kidney, etc.) to function.

I think that many physicians may have initially missed Rory's diagnosis.  We physicians are taught to think of the most obvious answer to a diagnostic problem, and tend to relegate the outside possibility of the the very infrequent, or improbable  diagnosis to the "back of the brain."  But, we are to be faulted if we do not critically consider all of the "differential diagnoses" and take reasonable steps to eliminate the rare ones.  But we err.  We are human.  Though I am unaware of all the details of Rory's case (I wasn't in the ER), it certainly raises a serious question of diagnostic error and associated medical mismanagement.

Could 'Watson' have assisted in preventing this unfortunate outcome?  A properly programmed computer would have alerted the physicians and demanded accountability for the abnormalities detected in Rory's blood tests relative to the signs and symptoms which he presented.

Future use of these electronic assistants may not totally eliminate this human tragedy, but should certainly help in avoiding them.

1 comment:

Debra Turner said...

You have convinced me, doctor.