Shortly after I heard about Watson the super computer’s debut on Jeopardy, I was talking on the bus with Abe and he asked what I thought about Watson’s next big challenge: medical diagnosis. I appreciated Abe’s assessment that I wouldn’t be upset at a question that cut directly to the issue of whether a human being is necessary in a typical medical visit, and had to admit that it was a disconcerting prospect. Adequate as I like to imagine my information processing capabilities are, I am not, at the risk of stating the obvious, a super computer. My constant connection to my BlackBerry doesn’t allow me the same level of internet search that Watson commands, and familiarity with statistical software and electronic medical records do not an instant meta-analyzer make. In spite of the nagging fears at the back of my mind that Watson would make a much more useful companion on rounds than I would, I couldn’t shake the sense that it had to be useful to have a human physician (or for that matter, a human nurse, physicians assistant, etc) for something. At that point I remembered a recent New York Times article by Abraham Verghese. Recently profiled in the NYTimes for his dedication to history taking skills and the physical exam, I knew that if anyone could justify a human presence in the consult room, he could. And he did. He pointed out that much of the value of a doctor’s visit is in the human interaction, noting:
I find that patients from almost any culture have deep expectations of a ritual when a doctor sees them, and they are quick to perceive when he or she gives those procedures short shrift by, say, placing the stethoscope on top of the gown instead of the skin, doing a cursory prod of the belly and wrapping up in 30 seconds.
He chastised the medical establishment for being “glued to [computer] like piglets at a sow’s teats.” He describes the creation of an “iPatient,” the collection of clinical records and test results that stand in for the patient, and emphasizes that “complaints…from patients, family and friends are never about the dearth of technology but about its excesses.”
We have yet to create appendages for Watson that function as well as the physician’s hands, ears, and eyes for assessing the physical state of the body, and it seems unlikely that he will develop the ability to empathize and connect with a human being anytime soon. Ultimately, it seems that although Watson may, in fact, make an excellent companion on the wards, he is unlikely to truly replace a skillful (human) history and physical exam.