Dr. House Explains Why We Should Prefer Dr. Watson

by Andrew McAfee on March 17, 2011

In a recent post, I explained why I was looking forward to the day when Dr. Watson, the medical version of the Jeopardy! champion Watson supercomputer built by IBM, started offering diagnoses. I asked readers whether they shared my enthusiasm, and got some very interesting comments back.

Karthick Hahiharan spoke for many when he wrote “With all due respect for Dr.Watson, I am still a firm believer of Human intuition and incomprehensible ability of humans to solve even complex situations. Our Knowledge is certainly not limited to data.” And Massimo wrote “You assume that about medical issues there is ONE truth, which is true for Jeopardy! questions by design, but not for human-related issues. So, finding correlations between hospital cases can be done, giving a diagnosis (except for the trivial ones) cannot. Dr. Watson will not replace Dr. House…”

These folk and many others feel that medical diagnosis is an ineffably human task, one where the best humans are always going to be better than the best machines. This is because, the argument goes, good diagnosis requires a combination of intellect, knowledge, and intuition. The intellect is innate, the knowledge is picked up through long years of study and experience in medical school, residency, and practice, and medical intuition —  the ability to see more than what’s in the test results and patients’ self-descriptions — is the product of both inherent ability and accumulated experience.

Can we replicate and improve on each of these digitally with Dr. Watson? Yes, we can.

Let’s take intellect and knowledge first. As Watson demonstrated so convincingly on Jeopardy!, artificial intelligence is now astonishingly good. As I wrote, we can put all the world’s accumulated medical knowledge in a database, turn armies of algorithms loose on it, and when presented with a set of symptoms arrive at a diagnosis within seconds. No human brain can do this, and the digital ones are getting better at it all the time.

But what about intuition? Don’t human senses, minds, and guts allow us to intuit things that machines just can’t? Won’t the best human diagnosticians notice that a patient’s skin is slightly jaundiced, or that he suddenly breaks off eye contact when stating that he’s been taking his meds faithfully, or that his voice changes tone when he answers questions about illegal drug use?

Yes, the best diagnosticians will do all these things. But as I wrote before, they’ll do them inconsistently and with great overconfidence. These problems are so great that they typically negate the advantages of intuition over algorithm even for experienced clinicians, as careful research has shown. And most doctors, of course, have less than world-class intuition, yet still trust in their own ability to ‘go beyond the data’ and arrive at a diagnosis after face-to-face interactions with their patients.

The best responses to this group come from the fictional diagnostician Massimo mentioned in his comment. Dr. Gregory House, the troubled-yet-brilliant star of Fox’s hit show “House,” has some choice quotes about the importance of listening to patients:

  • “I’ve found that when you want to know the truth about someone that someone is probably the last person you should ask.” [#105]
  • “You want to know how two chemicals interact, do you ask them? No, they’re going to lie through their lying little chemical teeth. Throw them in a beaker and apply heat.” [#113]

Most of us pride ourselves as good judges of character and sniffers of lies. And most of us are kidding ourselves. The world’s best diagnosticians and poker players can accurately sense dishonesty. The rest of us should, like Dr. House, just stick to the facts.

Medical diagnosis is an exercise in pattern matching. The fact that people are biologically and psychologically complex shouldn’t distract us from that essential fact.  Once computers have demonstrated that they’re better at this pattern matching exercise than humans, why would we not give them the job?

One good reason is that, as my former student Humberto Moreira pointed out, people might be more likely to accept a diagnosis given by a person rather than a machine, and so to follow through on the recommended treatment. Human interaction and interpersonal ritual comfort many if not most people, and it’s counterproductive to ignore this fact.

So one approach here is to follow commenter Julius Campbell‘s advice to have tomorrow’s Dr. Watsons team up with human diagnosticians. As he wrote, “I would rather not have Dr. Watson give me a diagnosis instead of a human doctor. I would rather get my diagnosis from a human doctor consulting with Dr. Watson.” This would improve quality and provide ritual, but would also not cut costs a lot (except for the downstream costs caused by lousy initial diagnoses). Everyone agrees that we need to ‘bend the curve’ of health care costs, and having humans involved in all diagnoses keeps us on our current ruinous trajectory.

So we need to do something very different in future health care delivery models. I advocate (probably in futility) that as part of this shift we get over out infatuation with human intuition. Like all infatuations, it’s keeping us from seeing things as they really are. And like a lot of them, it’s costing a lot and leaving us worse off in the end.

I’d love to hear what you think on this topic, so please leave a comment if you’d like. I have to say, though, that I’m really not interested in hearing more expressions of confidence and faith in human intuition in this context. Such expressions are increasingly flying in the face of the evidence. Hearing them is like hearing someone tell me that Boston will have 300 sunny days next year. I’d sure like to believe it, but I know better. I don’t know if Dr. House was talking about diagnosis, intuition, and confidence when he said  “You know what’s worse than useless? Useless and oblivious.” But he might as well have been.

 

  • http://caddellinsightgroup.com jmcaddell

    This is probably a ridiculous analogy, but following these arguments reminded me of experiencing Bill James’ research into baseball statistics in the 1980s. Over the years, a set of conventional wisdom had accumulated around baseball, much of it celebrating the value of the opinion of “baseball men” as to the effectiveness of pitchers and hitters. James (and others) looked deeply into the statistical literature of the game and came up with new individual metrics (runs created, wins above replacement player, etc.), now well-established, that much more closely correlated to players contributing to their teams actually winning and losing.

    I saw these values first-hand when I managed my GTE softball league team in the late ’80s. I used some of James’ metrics to determine our batting order and assess our best players. Shockingly, one of our players was responsible for about 70% of our runs, according to these statistics. Ridiculous! I thought. Another of our players (me), was less valuable than batting average, etc., would lead you to believe.

    Then we took the field, and I watched how things played out, given this information. I realized that our 70% player really was that. He was far, far more effective than anyone else on the team, and he needed to bat third (if only we could have cloned him!). I moved myself to hitting tenth. And our results improved.

    Taking the reams of data now available on medical diagnoses and treatment effectiveness, looking at it dispassionately (as Dr. Watson does without fail), and making decisions with that kind of support is what I would like to see in my own medical care.

    And those who would discount that type of input? Well, they would seem to me the kind of folks that were regularly outmaneuvered by the “Moneyball”-era Oakland A’s.

    regards, John

  • http://twitter.com/roundtrip Greg Lloyd

    I agree with Julius Campbell’s advice to make Dr Watson a trusted, methodical, ever alert, and face saving consultant to the physician or team in charge. Dr W can quietly raise issues, suggest alternatives, or simply state a prefered choice which a human team can validate and accept.

    I don’t really agree with your argument “this will not reduce cost a lot”. It’s not a time and motion Taylorist model on human Doctor billing rates, and I’m not convinced that a human physician would not make a quicker decision with Dr W assisting.

    I believe Dr W would the direct costs by making effective decisions more quickly, avoiding unnecessary tests, avoiding complications.

    You’re not asking Dr W to provide astonishing inductive leaps – just best practice considering current knowledge and all relevant factors, which nicely complements human strengths and weaknesses.

    Sherlock Holmes got a lot of good advice from his Dr Watson and it didn’t seem to curb Sherlock’s imagination!

  • http://twitter.com/dgreller Dan Greller

    Andrew,

    I am in violent agreement with your contention that artificial intelligence can trump human intuition for medical diagnostics. Overconfidence bias, faulty reasoning and a limited knowledge base all put the doctor at a disadvantage to software. This gap will widen as technology continues its geometric rates of improvement and humans make little to marginal gains in ability. I do, however, agree with Julius Campbell that a combination of humans assisted by software will yield the best result. Most people (at this point in time) still want to deal with an empathetic human when discussing matters of life and death. A human is uniquely qualified to help a patient interpret a software driven diagnostic and to walk through different treatment scenarios. In many cases, treatment decisions can come down to personal preferences and philosophy. A knowledgeable physician (with a good bedside manner!) can be very helpful in assisting a patient in making a choice that is optimal for them. However, this implies that the physician has been well schooled in such issues as base rate neglect and the conjunction fallacy. Otherwise, they will simply overlay flawed probability theory on top of a software diagnosis. It will be interesting to see how receptive the medical community will be to the introduction of computers to the task of diagnosis. As Atul Gawande chronicles in the book The Checklist Manifesto, doctors can be extremely resistant to the implementation of process improvements that control their actions. If doctors can be resistant to printed cards that remind them to wash their hands, how will they feel about machines replacing their wisdom? My prediction is that like other advances in technology in the workplace (e.g. Social Media), the younger physicians will be the early adopters.

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  • Anonymous

    I’m sure you’ve seen the Checklist Manifesto http://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0805091742 – therein you’ll find confirmation of your belief in why we *shouldn’t* trust professional’s intuition.

  • http://www.juliuscampbell.com/datawhisperer Julius Campbell

    You may be right that the human-Watson diagnostic team would probably not impact costs very much. However, if we really want to impact health care costs, we have to prevent people from developing chronic, expensive illnesses in the first place, and not just diagnose and treat them once they occur. Could Dr. Watson use those same algorithms to find patterns in medical research data? Could Dr. Watson discover simple, inexpensive methods patients can implement in their daily lives to prevent heart disease, diabetes and cancer?

    I believe Dr. Watson could make these connections given the right inputs and I believe this is the area that would potentially have the biggest impact on lowering costs. However, what will happen if and when Dr. Watson’s prescriptions fly in the face of conventional medical wisdom? If history is any indicator, there will be violent opposition. An example of this is the tragic story of Ignaz Simmelweis.

    http://en.wikipedia.org/wiki/Ignaz_Semmelweis

    I think another important function of teaming Watson with humans is building trust. Without trust, humans will always be able to undermine Dr. Watson’s effectiveness and sadly, Dr. Watson won’t care enough to fight back. If we are able to establish trust in its diagnostic capabilities, we may be able to realize bigger cost savings by expanding Dr. Watson’s function to discover how to prevent sickness instead of just treating it.

  • Karthick hariharan

    Thanks sir for the detailed reply. So, Lets assume Dr.Watson has come to the hospitals.

    Since it lacks subjective consciousness, who will be held culpable in the event of false diagnosis? Also would like to know the legal implications of false diagnosis.

  • Tirthankar

    Hi Andrew,

    In india most people have no access to healthcare. The rural poor have to walk milometers to reach a primary clinic, only to find a semi qualified doctor who is overloaded with huge number of patents. That is a lucky day for him. MOstly the doctor wont show up at all. An automated machine like Dr Watson is a boon in such cases. Atleast Dr Watson will give them some diagnosis (thinking that the machine lacks the human intution). This is much better than having no doctor. Automated diagnosis is the way ahead and if used in moderate amounts sooner or later the machines will be able to replace a doctor.

  • http://massimorossello.myopenid.com/ Massimo

    No doubt Dr. Watson can be of help in considering options that some doctor may not see for overconfidence, and that it can give a competent first diagnosis. But I stick with Julius Campbell opinion.

    Ok, let’s stick to the facts. There are cases where two patients have the same symptoms; the doctor gives them the same medicine; but it happens with ALL kind of medicines that for someone it works and for someone else not. Studies on medicines are statistical ones, and are done against placebo which is a very interesting effect: someone can heal with no “real” medicine at all!

    So, unless it is fed with data WHY some medicine does not work for someone (which would need further examinations on the patient, but also more expensive and deterministic – not statistical – studies for medicines), Dr. Watson will be able to help in diagnosis but not so effective in prescription.

    I agree that most doctors are no better, but we have no interest in matching worst doctors’ abilities, and here we are in non-trivial cases. And, your discussion sticks with a linear paradigm. There are old and new alternative paradigms that look at (most) diseases as kind of psychosomatic ones, which need listening at a different level than mere data. Best doctors apply them by istinct, in the sense that their kind of presence makes the difference even though he and the patients think that what worked was the medicine. If you experienced what empathy and the healing power of human presence is, then you may know that this is a very different task than pattern matching. The right presence helps the body find resources to heal autonomously, and the body may even sabotage the best therapy. If the patient feels a machine cannot ‘listen’ at him, healing is very compromised, believe it or not.

    Therefore, I think that just using data for a diagnosis is not sufficient, does it a doctor or a machine. Dr. Watson will beat just “mechanical” doctors…but it may _help_ (not substitute) the others.
    Would I favour Dr.Watson introduction? Yes. Would I let it work alone? No. Neither I would ‘read the manual and give the medicine’ doctors.

  • Jesse

     Ummm how are those rural poor going to have a phone line or a high speed internet connection to interface w/ Dr Watson?

    They’re going to have to travel regardless of whether they want to see dr human or dr watson. 

    Also, Dr Watson cant do a physical exam.  A rural child in India with cholera cant be triaged effectively without a physical exam.

  • Jesse

     It is in fact illegal in many states to script a new prescription, especially pain meds, without conducting a physical exam. 

    How is Dr Watson going to get around this law unless he has a human partner doing the physical exam for him?

    Again, this idea of Dr Watson treating people over a phone line or the internet with no human partner to do a physical exam is a total nonstarter.  I dont care how good the technology is, it will never happen.  Not in 20 years and not in 200 years.

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