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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 31 2013: Before there were machines, there was Pulse Diagnosis.
    Neema, this is such a relevant question today, and will continue to be so tomorrow. A small example; I work in the medical field, and operate one of the machines doctors rely on for diagnosis (and love my job), but I work in a small community of people, and when I inadvertently hear back from patients, friends, and even my co-workers in the field, the caregivers that work so hard, about all the medical bills they are slapped with for one ER or hospital or urgent care visit, I can't help but feel extremely guilty about my pay check that comes from the suffering of my friends and co-workers.
    There are good, bad, and ugly scenarios in every situation, and I have experienced doctors ordering all kinds of tests without really spending time at the patient's bedside. I have also experienced patients who rely heavily on medicine to solve all the consequences of an unhealthy lifestyle, with no regard for their own bodies.
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      Mar 31 2013: Hi Jasvin,
      Very interesting perspective. Do you think there could be a way to prevent doctors from ordering multiple tests without first studying the patient themselves? I wonder if any standards be implemented so that a doctor is spending enough time looking for the problem himself balanced with the information received from tests?
      • Apr 1 2013: Dear Neema
        There is no way to prevent unnecessary tests except ethics. But ethics is difficult to define and more difficult to maintain. Speaking of experience in India only there are interesting ways of doing them. One is just in case.... My son suffered from severe headache and the doctor says 'I do not think there is any tumor problem. But just to rule it out please get a scan done'. The other is more direct-I am the doctor and I know what is to be done. Yet another problem sometimes is the routing of the patient.I went for treatment of mild case of spondyltis. The reception directed me to neurologist. After examining several X-rays of cervical zone plus tests in ENT(you have to walk with closed eyes+other tests) the diagnosis is mild spondylitis. The whole effort is costly. Is this all necessary? Suppose my spondilytis has deteriorated how do I know?The other way is first treat it as a mild case as the patient was free of the problem for three years with simple medication like Betavert tablets. Similar dilemmas exist. When should a heart by-pass be done? The interpretation of the level of blockage is the problem. If the surgeon is in a corporate hospital that 'expects' them to do a minimum number per month more bypasses than necessary can happen. Unfortunately good public hospitals that used to serve us well are deteriorating with few exceptions.
        The above discussion is to elucidate the problem involved in developing criteria for ethics. But ethics do exist and the philosophy to promote is to say service first and money next.
        Can something practical be done to check the problem?
        probably internal audit by hospitals to see how effectively treatments were done and whether unnecessary tests were involved is a good starting point.

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