AI is here to stay and those who have robot hoovers know this. I have two, upstairs Euphemia, and downstairs Edgar. Every day they do their rounds. Edgar is Sherlock’s best friend – Sherlock likes nothing better to snuggle up and rest her head (Sherlock is a ‘her’ because we are a gender neutral household) on Edgar’s shoulder. Edgar and Euphemia work their way around the house by always turning left, regardless of the obstacles they face, and eventually this always brings them back to base. In other words they run on an algorithm that tells them to turn left (or right if a right handed hoover) at every opportunity and eventually, assuming you have not let them loose in the street, they make their way back to home base.
Medicine nowadays practises protocols, and guidelines, with no deviation, hesitation and constant repetition. Signs and symptoms lead into flow diagrams that tell you what to do every step of the way. This is a millenium away from the medicine I was taught. It is a medicine that assumes everyone is the same, should be treated the same and that doctors are interchangeable objects.
Artificial Intelligence AI is efficient if not imaginative and works from algorithms. As soon as you see a guideline, a protocol or a flow diagram, you are looking at an algorithm. “When A=B, then do C” was the first program I wrote in dBase III, back in the day. In healthcare, as in most walks of life, efficiency is a reasonable starting position. As far as doctors are concerned, it is useful to be seen, on time, at a convenient location and get what you want. How many people are still sick because they could not get an appointment, tests and scans when they needed it?
In the UK ‘Medically Avoidable Deaths’ are the highest in Europe, but this is not because the NHS is underfunded. It is funded as much as other European Health Care Systems. Rather the NHS is inefficient, ineffective and shackled to the customs and practices of its past.
Protocols and guidelines have benefits, for example, they make even the worst doctors accountable. If you don’t follow the guidelines, regardless of how well or badly the patient fares, you will find yourself in front of the General Medical Council without a barrister or legal representative in sight.
On the minus side, “Guideline Based Medicine” lacks the personal touch. If 51% of the population do better with Drug A than Drug B, the rules state you get Drug A, even though there is almost equal chance that Drug B is your personal cup of tea. AI lives by such rules. It makes the rule bound Dr AI Robot, a “better” doctor, than Drs Smith, Jones and Khan. Dr AI Robot, once built, is more efficient, more diligent, more accurate, scaleable and works 24/7. Thus in the interests of better health care, it is time to upgrade Drs Smith, Jones and Khan to Dr AI Robot.
Such an approach spells the end for General Practice. At present, General Practitioners hold back demand for Specialist Appointments, tests and investigations and in order to do so, employ almost half the doctors in this country. However, because of the technological revolution, expertise is the expensive commodity while technology is cheap. General Practitioners would be more useful, trained as Specialists and meeting the need for Specialist Appointments rather than standing in the way of progress. Prevention is better, healthier and less expensive than cure and “disease management”. By the time you have a medical condition, the writing is on the wall as far as your health is concerned.
Might it not be better to let the algorithmic loving robot doctors look after basic health investigations while training more human doctors to be Specialists and work in areas where humans excel? Thinking outside the box, bringing together a wide range of experience and empathy whilst making sure that people still feel human inside, regardless of what life throws at them.