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Will a robot replace your doctor?

Written by Dr. Daliah Wachs
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The University College London Hospital (UCLH) in Bloomsbury London is launching a pilot program replacing some A&E (Emergency Room) physicians with robots.

In response to staff shortages and long wait times, the initiative launched by UCLH and Alan Turing will utilize artificial intelligence to triage patients and reduce wait times.

Robotic technology is already being used in the operating room, rehabilitation centers and for pharmaceutical dispensing.  It’s just a matter of time that they become our main caregiver.

But will patients be pleased?

The Robot Is In…

 

Where’s there’s demand, there’s supply. Patients tired of wait times, crowded waiting rooms, loss of sick leave hours to sit around a medical office or emergency room for half a day will want speed and efficiency.  Kiosks may replace front desk clerks, taking your initial information (chief complaint, name, insurance info.), scanning it and offering you a number, like one given at a bakery.

Robots Don’t Judge

 

Those embarrassed by having symptoms suggestive of having an STD will have less of an issue conveying this information to a machine than a human being.  Gas, discharge, odors may be easier to discuss with someone or something that won’t wince.

 

Doctor-and-patient

 

The Doctor Doesn’t Examine Me Anyway

 

Many patients cite seeing a medical provider and not being examined or asked to undress before an exam. Time constraints, or avoidance of being accused of wrongdoing, have caused some providers to refer out for heart, gynecological, and rectal examinations. Primary care providers who enter the room, say a few words and then promptly leave saying they will “bring in the nurse to review instructions” may not be missed by the patient receiving similar service from a robot.

They can always answer my questions

 

We use Google, Wikipedia and Siri to answer our health questions currently.  No wait time, no office visit, no cost….so a robot answering our questions in layman’s terms will be an easy task.

 

However, and this is the kicker……

Robots Lack Instinct

 

There is no way to replicate the sixth sense humans have when it comes to something being wrong with you. Artificial intelligence cannot provide a “gut feeling.”

Let’s take a urinary tract infection, for example. I have had patients who were new to my office complaining something “felt funny” when they urinated and cited blood in their urine.  A urinalysis may show inflammatory cells, and a robot may correctly diagnose the patient with a bladder infection.  But I as a clinician may be suspicious that this new patient has something that is leaking blood into the urine, from the gynecologic tract maybe? And I’ve diagnosed endometrial and cervical cancer in cases where patients thought they were merely having bladder infections.

One patient presented to me in the emergency room feeling “odd” and suspecting a “UTI.” She was in her 60’s and started to complain of nausea.  Her urine had inflammatory cells so while a culture takes 3 days to complete, I gave her a prescription for antibiotics in case the infection would spread during that time. But her nausea was concerning. The patient requested an injection of nausea medication prior to leaving so I obliged, giving her Compazine.  While observing her for a few minutes, post injection, she began to have shortness of breath.  We decided to look at her heart and came to the conclusion after more testing that she had suffered a heart attack in her sleep the night before and the “odd feeling” she felt the next day wasn’t due to her UTI (which she coincidentally had) but was from a heart attack. She was treated immediately and recovered nicely.

Would a robot have picked up on that?  Multiple web resources include nausea in the list of symptoms associated with a UTI, so could be “blown off” by a robot bundling it with the patient’s urinary complaints. But I learned that nausea could be the first sign of a heart attack, especially in women.

Another case I had as an urgent care physician was the following:

A gentlemen came in saying he “felt fine” but his wife made him come in because he was burping the night before.  Multiple bouts of eructation jogged an ancient memory of mine…..when as a little girl I saw a movie where the pilot was burping multiple times before he passed out and died.  So I came to learn that chronic bouts of burps, or hiccups for that matter, could be a sign of an inferior MI (heart attack). I ran an EKG and blood work, and my instinct was right.  Again I was looking at a patient who unknowingly had a heart attack the night before but thought he had something benign the next day.

So gut instinct, thinking laterally, tapping in on past experience, and acting on hunches is not something a robot can do.  Humans may be satisfied with shorter wait times and receiving antibiotics when they demand them, but the education and intervention a medical provider can provide is priceless.  Too bad cost gets in the way of real medicine.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.