THOUGHTS ON HEALTHCARE | INTEGRATION | AI
Science has its basic tenets: Observation, objectivity, seeing the entirety & honesty. Medicine being a science MUST have these on top of that, it also must incorporate “the art”.
As we are moving at a rapid pace towards AI (Artificial Intelligence) in health care, our era of doctors have to be careful in what direction we take the AI. We doctors(any pathy, any speciality) are essentially clinicians and healers. Though we have to be OBJECTIVE & UNPREJUDICED in our evaluation and understanding the diseased state of our patient, we have to be SUBJECTIVE in the approach to each individual’s treatment. Since we deal with individual humans who react differently, we have to keep our HUMANE, INDIVIDUALISTIC, SUBJECTIVE touch in health care delivery. This is essential for the long term and overall betterment of the treatment of human diseased states.
We have the evidenced based medicine (EBM) helping us get better & better – BUT we should not forget that:
- New evidence is not the only evidence:
Eg. – Fractures of radius ulna treated by square nails or fractures of tibia fibula treated by conservative Sarmiento’s method are now “out of fashion”, but what about their old evidence of thousands of fractures that healed well for decades across different centers?
- The basics of anatomy, physiology, pathology and healing processes have not changed in humans overall and that honesty towards what is working on a day to day basis over a long period of time cannot be disregarded.
Eg. – Lot of acute inflammatory episodes in musculoskeletal disorders are given “Neuromodulators” because they are “safe” – whereas NSAIDs which are actually needed for the pathology are not given because they are “unsafe” (though it is very easy to monitor their use & side effects).
As I said before, we humans needed a subjective human touch for getting treated. These days we tend to disregard anything that is NOT new/modern or NOT from our branch/speciality or NOT from our pathy. Lot of evidence from basic sciences, paramedical sciences, other pathies’ scientific offerings are not known or not given any importance because it is not in the mainstream literature. We are becoming speciality fanatics more like the religious fanatics. The need of the hour is the INTEGRATION & ASSIMILATION of ALL these human body related knowledges, data, research from different specialities and pathies – along with individual experiences of clinicians. These accumulated data should be put into a COLLECTIVE CYBORG KIND OF AI; which will drive human healthcare to a truly higher level.
The WISDOM of humans (especially in medical management) cannot be murdered because of mere collection of information touted as EBM.
Eg. – Recent “Evidence” says DO NOT give calcium and Vit.D because it blocks heart arteries & does not help bones. But how about going to the basics which tells us that bone physiology cannot work without calcium and Vit.D metabolism being intact? In Osteoporosis, if all drugs are to work well, they have to have a system replete in Vit.D and calcium. If you do not treat Osteoporosis well – where calcium & Vit.D supplementation is integral – you end up with high health care cost of bedridden morbidity/mortality from fractures. So, it is like the old saying: Information is that tomato is a fruit & wisdom is not putting that tomato in the fruit salad.
Availability of information as sole evidence is detrimental to healthcare delivery – as all of us have experienced from the “google doctor” patients we treat. YouTube videos of exercises CANNOT ever replace the expertise, individual tailoring, supervision and guidance of a trained discerning physiotherapist. The individualistic, humane healthcare delivery here is important, if the patient has to get really better from proper physiotherapy.
When the AI will replace a pathologist &/or a radiologist, then who will write the newer advances and imaging algorithms, who will be able to give a clinico-pathological/clinic-radiological correlation?
Eg. – An Otrhopaedist talks to a MRI consultant on correlation in a case where minor information & clinical hunches are settled on discussion (that will be missed in the AI).
Not allowing the stupidity of following AI algorithms blindly is important to prevent disasters in healthcare delivery – Disasters like the ones created by AI in Boeing plane crashes & Tesla’s (car) autopilot feature. Remember, the AI is only as good as the person who programed it.
So the COLLECTIVE CYBORG should be the center of future AI – if it were to be of real human help. And if the healthcare delivery starts becoming like an “app” (Eg. – Tours/Travels app), then it will need a human interface to upload patient information & download/deliver healthcare in the correct, individualized format. That AI end point deliverer of healthcare will be the GP. The original FAMILY DOCTOR, who is now on the wane – WILL HAVE TO BE REBORN & REVIVED in a fresh avatar. This GP of AI will coordinate, give the humane touch, individualize the treatment & deliver it to the patient.
We are presently at the edge of the cliff of AI in healthcare. The next 25-50 years will show whether we fly off to way beyond our human potential by using COLLECTIVE CYBORG MODEL of Star Trek or hurtle down crashing into the abyss of healthcare by following the STUPIDITY of non-human computer algorithms as in the movie Idiocracy.
I am an eternal optimist & a huge fan of Star Trek.
-Dr. P. S. Mamtora
Orthopaedic Surgeon