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‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

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71–75 of 75 posts

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#71

Earlier quoted context omitted.

The trick is whether the cases of disagreement were themselves predictable! Given a fixed number of oncologists and deploying Watson only to support those oncologists, yes, you're correct that its only useful if it outperforms them. But I think of it more like Watson is a single hive-mind team of like a thousand med students near the end of residency: they get most things right but there are a few places where more e…

I think part of the problem for Watson is that it needs someone to gather the data, which is usually a doctor. So if you're pairing each patient with an oncologist for intake anyway , it's not clear that "examination plus enter all data into Watson" is a benefit over "examination plus make a decision". I guess the ideal outcome for Watson (if it doesn't outpace expert oncologists) would be something like "experience…

Let's look specifically at mammograms. (Stats from CTFPHC, a division of PHAC, part of the Canadian government.)

https://canadiantaskforce.ca/tools-resources/breast-cancer-2...

Wider screening isn't great. Essentially, people with medical problems self-select pretty alright already, and wide early-screening initiatives for most cancers introduces as much or more false positives (that persist through screening!) than actual cases of cancer it catches - and moreover, it's not even clear that the early screening is effective - the false negative rate is high enough that the overall incidence of advanced cancer is unchanged even with early screening. (Bleyer and Welch, NEJM, 2012)

Basically, we need better screening, not more screening at our current levels, and it's not clear whether watson can provide that.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#72
post #70
post #65

Earlier quoted context omitted.

I think this is directed at me. If not, I apologize. I work on developing computational models for hospital infection control - both in human and veterinary settings.

Yes, it was :) Interesting, public or private ? How closely do you work with practitionners ? Is their knowledge of value regarding your job ? I ask because I happen to be a veterinarian who somehow ended up being a developer.

Public - I work for a state university in the vet. college. I sometimes get to work with practitioners, but I'll admit I have better contacts for that on the human side of the equation, though we're working to build it for vets as well.

I'm faculty, so the notion of value is sort of a funny one, and it's less obvious than it might be at medical schools, but it's getting there. The biggest constraint, as with everything in vetmed, is money.

I believe my email is in my profile - feel free to reach out if you want to chat more.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#73

Earlier quoted context omitted.

I think part of the problem for Watson is that it needs someone to gather the data, which is usually a doctor. So if you're pairing each patient with an oncologist for intake anyway , it's not clear that "examination plus enter all data into Watson" is a benefit over "examination plus make a decision". I guess the ideal outcome for Watson (if it doesn't outpace expert oncologists) would be something like "experience…

Let's look specifically at mammograms. (Stats from CTFPHC, a division of PHAC, part of the Canadian government.) https://canadiantaskforce.ca/tools-resources/breast-cancer-2... Wider screening isn't great. Essentially, people with medical problems self-select pretty alright already, and wide early-screening initiatives for most cancers introduces as much or more false positives (that persist through screening!) than…

Precisely - since mammography is the standard "counterintuitive Bayes rule" primer, I remembered those numbers don't support wider screening.

I'm not discounting the possibility of a useful role for Watson in wider screening, but it's not clear to me where it would be. If it happens after any kind of extensive examination, doctor-hours are being committed regardless and there's little gain. If it happens at a population-level screen like mammograms and colonoscopies, "almost as good as oncologists" isn't enough to add any value.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#74
post #72
post #70

Earlier quoted context omitted.

Yes, it was :) Interesting, public or private ? How closely do you work with practitionners ? Is their knowledge of value regarding your job ? I ask because I happen to be a veterinarian who somehow ended up being a developer.

Public - I work for a state university in the vet. college. I sometimes get to work with practitioners, but I'll admit I have better contacts for that on the human side of the equation, though we're working to build it for vets as well. I'm faculty, so the notion of value is sort of a funny one, and it's less obvious than it might be at medical schools, but it's getting there. The biggest constraint, as with everythi…

Cool ! It's not actually that's why I asked here.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#75
post #74
post #72

Earlier quoted context omitted.

Public - I work for a state university in the vet. college. I sometimes get to work with practitioners, but I'll admit I have better contacts for that on the human side of the equation, though we're working to build it for vets as well. I'm faculty, so the notion of value is sort of a funny one, and it's less obvious than it might be at medical schools, but it's getting there. The biggest constraint, as with everythi…

Cool ! It's not actually that's why I asked here.

Apologies - I went on vacation right after you posted this. Eric Lofgren wsu.edu if you're still reading this.
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