No Hoverboard, but a Robot Doctor?

I was a big fan of The Jetsons when I was growing up. Well, who wouldn’t be? They had a talking dog and lived in the sky. Now that I’m bigger of course, I’ve had to deal with the disappointment of my completely earthbound car that refuses to fold into a briefcase. There are no robots dressed in an anachronistic maid’s outfit in my house either.

That particular fantasy comes to mind whenever I read something like this. Bit of a longread that one, but it actually describes the very real present day phenomenon of computers, big data and robots. There are some very cool projects covered in it, but to me it still reads like the insular hyperventilation of a zealot conveyed via the reporter’s typescript.

A Brave New World

Those raised on early sci-fi might find the notion of robotic health care a little unappetising.

Actually, they're not talking about the caring touch of this lump of metal. [via scifimusings.blogspot.com}

Actually, they’re not talking about the caring touch of this lump of metal. [via scifimusings.blogspot.com]

They’re really talking about something slightly different. The most interesting bit relates to the role of supercomputers in managing and responding to data. The example given is IBM’s Watson, famed for conquering the insular world of Jeopardy in the US (for a first person account of the experience check out this TED talk by Ken Jennings).

When discussing the possibility of these forms of computerised systems enhancing health care and safety, the article is on firm ground. Even allowing for the delays in cool ideas that are par for the course (*ahem* hoverboard soon please), you’d hope we’d see that within a decade in developed health systems. In fact, most of the cool ideas covered sound like the sort of thing I’d take a look at more than once.

That’s not where the problem lies. The whole article talks about revolutionising the world of health from an entirely American perspective. I get that it’s an American publication. But some of the folks in there don’t seem to get how ridiculous it is to focus on super expensive technological advances to try and save money in the world’s most overpriced and wasteful health system. It confirms the lack of insight in that whole discussion.

Rather than focus on a rich geek doctor’s wet dream, it would make a whole lot more sense to talk up stuff that would definitely improve outcomes and reduce costs associated with complications. Like making sure people wash their hands.

Not quite as cool, but effective and cheap. Far better to get the supercomputer I guess. It can probably stream your playlist at work and stuff.

Although it’s a little beyond the scope of this piece, it’s worth seeking a bit of context too. The vast majority of the world’s population isn’t dealing with problems that require a supercomputer or robots. They need drinking water. Or vaccines. Or food. Or antiviral medications for HIV. Or access to education. They don’t need better access to Angry Birds adapted for rehabilitation centres.

The Human Interface

My more general gripe with those breathlessly promoting the idea that doctors will be replaced by robots (and this isn’t about the Atlantic article now) is the implicit suggestion that it’s the technical elements of healthcare that are most important. Sure, you want anyone looking after you to be exceptionally good at the facts, but anyone can do the facts.

What I want as a patient, and what I strive to provide as a practitioner, is a shared recognition that at the centre of everything there is a person whose humanity needs to be acknowledged. I don’t want to be involved in a reckoning only of facts, figures and statistics. The doctors I admire are the ones who practice from the personal and apply the evidence correctly but with empathy at all times. Because as a practitioner, personal experience can be vital to being better at what you do. How about an example?

The Personal in Practice

Those who have had kids no doubt recall it as a profound experience.

I remember so clearly the drive to the hospital for our first son. I remember the sunlight cutting through the car. I remember the wait to be seen.

I remember the ultrasound, so large on the wall-mounted screen.

And I remember his heart.

Still. Resting.

In my memory I feel my wife’s howl, more than I hear it.

Then the long gloaming of labour. The final flickers of hope of some miracle finally dashed.

***

The full story of Alexander would require much more than this. What is pertinent to this discussion is how that experience colours my practice.

Weeks later I returned to work as a senior anaesthetic trainee. Inevitably, the middle of the night Caesarean section came up. I had prepared myself for this and the technical aspects of the job presented no challenges. It was a different situation anyway.

I remember acutely though that the Dad involved was horrible. In insulting everyone involved in the operation and more particularly his partner he provoked in me true quiet anger. I’d never experienced anything like that before. I have never had it happen again. And although there may have been reasons for my extreme internal response, I’ve not been able to do that sort of anaesthesia with the joy and generosity that the situation warrants. So I don’t do it anymore.

Patients deserve more than that. To have the trust of people as they hand over their very self is an extraordinary thing, and you’d better be prepared to turn up with all you’ve got. And while I’m no fan of the manner in which I gained the experience, I have ended up as a far better doctor through the insight of true grief.

It influences what I expect of my own doctors too. The time came when we needed to decide what to do for our next child. Change it all up and avoid any associations or return to the same obstetrician?

In the end, we went with the same doctor. Part of the reason was she understood us and took onboard the grief we carried. It’d be fair to say that she was the next most stressed individual to us throughout the pregnancy, and the next most relieved when it was done. It was a tough thing to do as a practitioner.

But that’s what I want from a doctor, and it’s why I think claims of robotic doctors being on the frontline are an overreach. I want a doctor to care about as much as Dr Ian Haines (look around the 5:20 mark) an oncologist featured as part of 4 Corners the other night.

Anyway, maybe I’ve got it all wrong. Perhaps I should welcome my robotic doctor overlords. Which do you prefer – Robin Williams in Bicentennial Man or Robin Williams as Patch Adams? Actually forget that, those are both horrible thoughts.

Let me know though – is a friendly face a key part of the equation, or should I get some qualifications in robot maintenance?

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