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Neema Aggarwal

Electrical Engineering Student, The Cooper Union for the Advance,

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Do we rely too heavily on technology for medical diagnosis?

This week in my bioelectricity class, we discussed electric fields that can be measured on the body (eg the brain, skin, eyes) and the ability to interpret signals for diagnosis, lie detection etc. Currently, there exists clinical decision support systems (CDSS), which are interactive computer software systems designed to aid doctors with medical decisions. Various test results and other data from the patient is inputted into a CDSS which then processes it and provides a list of possible diagnosis and options for treatment. The problem is, like all machines, they can often make crucial mistakes.

Dr. Lisa Sanders, a physician at Yale School of Medicine, and technical adviser for the popular TV show, House, wrote a book called “Every Patient Tells a Story” dealing with the uncertainty doctors face when analyzing a patient’s symptoms. Sanders says that misdiagnoses account for as much as 17% of medical errors. She discusses how despite the many technological advances made recently, sometimes these diagnostic tools are to blame. Relying too heavily on machines and lab results can result in symptoms being missed. Or on the other hand, sometimes exam results are normal; blood tests, electrocardiograms, CT scans, all may suggest a healthy body even when that is not the case. It can take a trained, experienced eye to notice small details in the patients’ behavior to unravel the mysteries of an unknown illness. Sanders states, “For all the data they collect, machines lack important components for diagnosis. They cannot hear a patient’s story, touch a patient’s skin, or look into a patient’s eyes.”

My question is, have we become too dependent on machines and technology to make medical decisions for us? Have doctors been lured into a false sense of security by allowing tools like CDSS to provide answers? How can the value of intuition which comes only from experience be balanced with technology without being lost? Can machines ever be a good enough substitute for doctors?

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  • Mar 27 2013: "Can machines ever be a good enough substitute for doctors?"

    The key to this topic is "good enough". Diagnosis is never good enough. No one would have considered building a machine to help doctors with diagnosis decisions if doctors were good enough. Fortunately this is a question that can be answered by the scientific method. If you ask one of the people who sell these machines, I am sure s/he could provide you with the research studies that demonstrate that the machines improve the diagnosis results.

    With all of our advances in medical knowledge, you would expect that medical practice would now be a very scientific process, and that misdiagnosis would be rare. Unfortunately, diagnosis is still, often, a doctor's best guess. In medical school they teach doctors that when in doubt, the more common diagnosis is usually right, so most doctors will never diagnose an uncommon condition.

    The bigger and more important question is, why is diagnosis still more art than science?

    IMO, the answer is the love of money. In the USA doctors are paid by the procedure. Diagnosis is not nearly as profitable as many other procedures. So diagnosis does not get the resources needed to get a quality diagnosis. The most critical resource is, of course, the doctor's time. Hence the critical economical opening for a machine to do the doctor's job. I am a big fan of capitalism, but it does have its down side.
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      Mar 27 2013: Hi Barry,
      Very interesting! I hadn't even considered the economic side of this, but I do think you are right. The way our system is set up now, the amount of time and money required for an excellent diagnosis is probably not available or entirely profitable for doctors. I just hope it does not come to a point where diagnosis is reduced to completely depending on a machine's output with little effort on the doctors part for the sole reason of being more profitable for the hospital or physician.
    • Apr 3 2013: I agree with you on the diagnosis by the physicians is dependent on how much time and effort s/he could devout to a patient visit. However, this problem is actually more critical in Canada, and also in the U. S, because the physicians have generally either be "hired" by the government, or by the hospitals so that they are not allowed to spend too much time on a single patient. In the U. S. many physicians who take the Medicare patients will be paid by a fixed amount regardless of how much time you spend on him. And of course in 2014, almost all patients are being insured by the government programs. But the diagnoses by the machines in laboratories will be billed by the labs directly so the physicians don't have to worry about the restriction imposed on charges on lab tests. This certainly put a disincentive for more physicians' personal observation of the patients and instead to order lab tests. .Therefore this bad situation may or may not be caused by capitalism, and in my view this could be worse than a free-market medical practice system.

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