IBM’s increasingly famous new computer, Watson, may be opening a new era in U.S. healthcare. Here is the way CNN Money began a September 12th article:
NEW YORK (CNNMoney) — IBM’s Watson computer thrilled “Jeopardy” audiences in February by vanquishing two human champs in a three-day match. It’s an impressive resume, and now Watson has landed a plum job. IBM is partnering with WellPoint, a large health insurance plan provider with around 34 million subscribers, to bring Watson technology to the health care sector, the companies said Monday. It will be the first commercial application of Watson, which is a computing system that aims to “understand” language as humans naturally speak it. IBM (IBM, Fortune 500) has been working on Watson for more than six years. The goal is for Watson to help medical professionals diagnose and sort out treatment options for complicated health issues. Think of the system as an electronic Dr. House.
(Link to article.)
So, at first blush the event signals an entry of computers into the health care diagnosis arena. But it is more significant. It is the beginning of a major reformation in the way health care is delivered, and even the definition of “doctor”. For those of you who like to think about how things might operate in the future here are a few brief thoughts about problems in health care and how the future might unfold.
Watson’s entry into the realm of diagnosis is needed. New health care information is being published at an astounding rate. Medline, the National Library of Medicine’s citation index of nearly all medical literature, publishes approximately 500,000 new citations per year according to Bioinformatics. That’s about 2000 per working day. Who can keep up – even with the basic material, let alone how it all fits in?
A few decades back doctors began to feel the pinch of too much information. Coupled with a need to focus in order to be good at things, this drove specialization. A few decades ago it was routine for U.S. patients to have only one doctor (maybe occasionally using another for a special circumstance). Now patients routinely cite having several doctors – one (or more) for each of several conditions. Not only did this drive complexity in itself, it was an important factor driving us away from a nurturing “doctor-patient relationship”. But this trend can’t continue. Future patients can’t have a hundred specialists covering every tiny situation. So, Watson portents a shift in the trend – keeping up with the flood of new information will be aided by computers and this will (eventually) allow patients to have less doctors.
Watson also portends a solution to the “malpractice crisis”. Humans are not perfect, and there is no perfect human; so, the hypothesis that doctors can practice error-free medicine is foolish (and primarily a service to lawyers and insurance companies). Humans will make mistakes. But, it’s going to be hard to sue a computer which scans all of the world’s medical literature on a daily basis and recommends diagnosis and treatments based on dispassionate analysis of the information. The computer will determine – by definition – the standard of care. So, a solution to the “malpractice crisis” is to let future Watson’s call the shots, particularly if the computers are run (directly or indirectly) by the government.
So, what happens to “the doctor”? We’ve already seen huge changes in the concept of “the doctor”. Patients used to choose a doctor who worked near their home and they would plan to see that doctor as their main health care source for years to come. Now U.S. patients go wherever they need to in order to get a doctor “who works with my insurance”. When they see that doctor they have services which are “covered by my insurance”. When they need another doctor they are referred to another doctor who is “on my insurance”. So, right now both patient and doctor are focused on utilizing services that work with insurance coverage. However, future Watson’s will not be owned by insurance companies (because that will be dangerous and challenged as a conflict of interest). Rather, future Watson’s will be owned or regulated by the government because the computer will be the de facto standard of care, and government will be the only agency up to the task of managing this responsibility (which will include such things as making the judgment that a highly expensive procedure does not provide sufficient benefit to justify its cost).
Computers need data input according to certain rules; but, patient’s see the doctor not knowing those rules and not knowing how to comply with them. The computer does not (currently) know what to do with emotive sentences “I don’t feel well”. Likely it will be another human being who looks through the words, and the way the words are said, in order to understand what those words might mean. That human being, one type of future doctor, will convert the patient’s endless variation in circumstance into pieces of data that fit within the computer’s requirements. (Indeed, at some point the computer can do this too, but now we’re moving much further into the future.)
In the coming era we can anticipate that doctors will evolve to two types: people who convert the patient’s situation into information which can be provided to the computer for analysis, and people who do medical procedures (like a surgery, an invasive diagnostic test or an invasive but non-surgical therapy). The concept of a split has been around a long time, and is recognized in licenses which define the doctor as “Physician and Surgeon”. The split has had differing meanings. It is still changing. In the age of specialization most doctors provide only a very limited spectrum of treatment (either not wide, or not deep). Medical providers currently tend to be either non-surgeon (diagnosis and medical treatment) or procedurist (including surgery or invasive tests/treatments). We can expect the segregation to continue to evolve. New meanings are likely to be relevant for medical students now in training because major change in health care delivery is likely even during their tenure in active practice. People now entering the medical field cannot expect that their career will proceed according to the rules and perspectives now in place.
Each type of medical provider will have his/her own benefits and drawbacks. The provider who talks to the patient will be the one who likely has the deepest relationship with the patient. While advancing technology has thrown the emphasis away from relationship and toward use of technology, we are coming to realize the hidden pitfalls of this approach. Medicine which is all technology, with no relationship, is unsatisfying. Further, people rightfully fear the situation where medical providers become excessively interested in the procedures they do. Newsweek, for example, recently showed a front-page image of a scared patient covered in surgical drapes, lying anxiously under a canopy of gloved surgical hands holding scalpels. The article title was, “One Word That Will Save Your Life” (Newsweek: Aug 22/29 2011). The one word was “NO!”. Increasingly society worries that the health care industry has excessive interest in using its resources.
So, unless human beings change a lot, the person with whom there is a relationship is the individual the patient may increasingly see as his/her doctor (in the cherished sense of that word). The medical provider who does procedures may be the one who makes the most money (as is generally true currently); but fears of excessive use could drive that pendulum the other way.
Watson’s entry into the medical field as a machine of diagnosis signals the beginning of a new era. Health care will change a lot during this coming era. Much of the change is likely to be good from the perspective of broad society. When the computer increasingly “calls the shots” according to rules established by government (which operates with broad society in mind) then health care costs can begin to be controlled. Also, the “malpractice crisis” will go away. This will allow health care to become more efficient. Also, there actually will be providers whose specific goal is to relate to the patient – to connect with and understand the patient as a human being who is in pursuit of illness management. This is what “the doctor” used to be. Procedurists tend to center on the specific procedures they do.
This is enough for now. Of course, none of us knows the future with certainty. This is simply a projection of known factors into probable consequences. Watson’s entry into health care is an important event.
If you’d like to know more about Watson, see PBS Video The Smartest Machine on Earth.