Why Doctors Reject Tools That Make Their Jobs Easier • Hacker News Board

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#21

Post by DrJaws » Mon, Oct 15, 2018, 10:59 PM UTC

anon4lol wrote: post #9

As someone who has had several CT scans (and paid for CT scans), the idea that a CT scan is better than a physician feeling your abdomen is absolutely ridiculous. Pumping contrast agents into everyone who has pain is a very bad idea. Moreover, enforcing decisions by algorithmic rules is problematic, especially considering who might be making those decisions.

Plus radiation. Every CT scan increases your odds of cancer.

Also, mammography or even colonoscopies have been proved for most of the population to do more harm than good. cochrane is full of meta-studies about it.

The medical industry is very shady.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#22

Post by bastijn » Mon, Oct 15, 2018, 11:01 PM UTC

anon4lol wrote: post #9

As someone who has had several CT scans (and paid for CT scans), the idea that a CT scan is better than a physician feeling your abdomen is absolutely ridiculous. Pumping contrast agents into everyone who has pain is a very bad idea. Moreover, enforcing decisions by algorithmic rules is problematic, especially considering who might be making those decisions.

Can't resist to at least provide some response here.

1) Having CT scans, and paying for them, does not really objectively lead to the conclusion that followed. Let's feel that tumor inside your lungs.

2) CT scans can also work without contrast agents. In addition they typically do not register everybody for a CT scan nor pump them full with contrast agents. There is a process. In US some hospitals are trigger happy as they get paid per case, blame the system not the technology. If anything an algorithm will fix that nasty human behaviour.

3) Having biased humans enforce decisions is not always a guarantee for success either. Every human sees only a fraction of the total amount of cases an algorithm processes within seconds. There are several fields where AI already outperforms elaborate test panels of MDs. Though it is hard to introduce these algorithms for the same reasons Tesla is having issues. Who is responsible when a mistake is made?

3.1) you would be amazed how often MDs do not agree when the same problem is put in front of them. 50/50 and 60/40 are very common cases. AI is typically more in the 80/20 90/10 range which is a huge improvement.

Now, all of this does not mean we do not need MDs anymore. An important aspect often neglected due to time bounds is the interaction of a patient with the doctor. With algorithms saving time more could go to the patient. That's a win.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#23

Post by Fomite » Mon, Oct 15, 2018, 11:04 PM UTC

DrNuke wrote: post #17

The industry is annoyingly conservative but whizzkids pretending to have a better opinion about how to cure insert desease from isolated, mechanistic, non-standard observations of few markers are dangerous.

Yeah - I work a lot in healthcare associated infections, and a good 80% of the stuff I read about "We're from Silicon Valley and we're here to help..." just ends with me going "They're going to kill people."

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#24

Post by Fomite » Mon, Oct 15, 2018, 11:07 PM UTC

An alternative headline is "Tool Makers Make Tools That Don't Help Doctors". I know a ton of colleagues who flinch every time someone mentions that this'll just hook into the EMR system, because they know everything will be broken and tedious for years before another vendor comes along.

At a conference I was at recently, I'm nigh positive "Decision Support Tool" was a dirty word.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#25

Post by Fomite » Mon, Oct 15, 2018, 11:08 PM UTC

Swizec wrote: post #18

derefr wrote: post #12

Earlier quoted context omitted.

Seems like it'd make sense to go into your doctor at some point when you're perfectly healthy and let them measure a bunch of baseline values to put in your medical file.

It's like my bird's vet said once: If you start measuring, you're gonna find stuff. The more you dig, the more you find. Does it mean your bird is sick? Eh look at him, does he look like a sick bird? My girlfriend can be very ... concerned. We spent $1000 in vet bills before a real avian expert was like "Guys, he's fine. Look how happy he is. He just loves the attention." Apparently one of his tests for vet interns i…

"Diagnostic stewardship" is currently a hot topic in infection control and antimicrobial resistance work for exactly this reason. If we look hard enough, we'll find something to give you antibiotics for, even if you don't need them.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#26

Post by QuercusMax » Mon, Oct 15, 2018, 11:14 PM UTC

Swizec wrote: post #18

derefr wrote: post #12

Earlier quoted context omitted.

Seems like it'd make sense to go into your doctor at some point when you're perfectly healthy and let them measure a bunch of baseline values to put in your medical file.

It's like my bird's vet said once: If you start measuring, you're gonna find stuff. The more you dig, the more you find. Does it mean your bird is sick? Eh look at him, does he look like a sick bird? My girlfriend can be very ... concerned. We spent $1000 in vet bills before a real avian expert was like "Guys, he's fine. Look how happy he is. He just loves the attention." Apparently one of his tests for vet interns i…

I've heard similar sentiments around looking at API monitoring graphs when you're not investigating a specific problem. Weird stuff happens all the time, and most of the time it's no big deal.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#27

Post by [deleted] » Mon, Oct 15, 2018, 11:17 PM UTC

nradov wrote: post #14

derefr wrote: post #12

Earlier quoted context omitted.

Seems like it'd make sense to go into your doctor at some point when you're perfectly healthy and let them measure a bunch of baseline values to put in your medical file.

Body temperature for an individual patient can vary significantly based on time of day, activity level, diet, menstrual cycle, etc. A single point measurement taken once every two years doesn't really give a useful baseline and might even be misleading.

[deleted]

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#28

Post by docbrown » Mon, Oct 15, 2018, 11:17 PM UTC

nradov wrote: post #14

derefr wrote: post #12

Earlier quoted context omitted.

Seems like it'd make sense to go into your doctor at some point when you're perfectly healthy and let them measure a bunch of baseline values to put in your medical file.

Body temperature for an individual patient can vary significantly based on time of day, activity level, diet, menstrual cycle, etc. A single point measurement taken once every two years doesn't really give a useful baseline and might even be misleading.

Within the parent comment and beyond, it seems people are putting emphasis on a change in temperature but do not state a deviation from the average 98.2°. Even if we did have it though, I don’t think having a longitudinal look at someone’s vital signs (VS) would be misleading in any sense. It establishes a baseline history of the person and deviations will be put in context with the addition charting notes from that visit.

While I do agree with a single point not being enough information, nobody is looking at body temperature alone when diagnosing a patient— unless they’re reaching internal temperatures of below 95° and above ~100.9 for hypothermia or hyperthermia respectfully. With each diagnosis there are /x/ number of signs and symptoms that go along with it so it is crucial that we gather as much information on all the VS we can, no matter how minuscule the data may seem.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#29

Post by gowld » Mon, Oct 15, 2018, 11:18 PM UTC

pavlov wrote: post #13

tx21 wrote: post #5

Flashy article title clickbait. Doctors are not fools. If a tool truly made their job easier, it would not be rejected out of hand. Job security for physicians is rarely the issue, there are plenty of sick people.

Surgical safety checklists were shown to lower 30-day post-operative mortality by 22%: https://www.cardiovascularbusiness.com/topics/coronary-inter... You'd imagine something as basic as checklists would be implemented as standard procedure in modern medicine -- yet this study was in 2013, not 1963. Most likely the majority of surgeons are still dragging their feet on this. It's a very conservative field with lots of…

Checklists make patient outcomes better; they don't make surgeons' work easier.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#30

Post by onetimemanytime » Mon, Oct 15, 2018, 11:20 PM UTC

DrJaws wrote: post #21

anon4lol wrote: post #9

As someone who has had several CT scans (and paid for CT scans), the idea that a CT scan is better than a physician feeling your abdomen is absolutely ridiculous. Pumping contrast agents into everyone who has pain is a very bad idea. Moreover, enforcing decisions by algorithmic rules is problematic, especially considering who might be making those decisions.

Plus radiation. Every CT scan increases your odds of cancer. Also, mammography or even colonoscopies have been proved for most of the population to do more harm than good. cochrane is full of meta-studies about it. The medical industry is very shady.

>>Plus radiation. Every CT scan increases your odds of cancer.

If the doctor makes money from your CT Scan you are absolutely right to question the need. Conflict of interest and all. Sure you increase the chances of cancer but that has to be weighed by what can happen if you don't do the CT Scan.