Dr. Watson, Please Report to the Health Care System

Physician, professor, and novelist Abraham Verghese wrote a recent op-ed in the New York Times in reaction to the news that IBM is working with the universities of Columbia and Maryland to adapt Watson, the Jeopardy! champion supercomputer, to the task of medical diagnosis. Verghese is perceptive and eloquent about the power of a potential ‘Dr. Watson:’

Watson might help me digest the sheer volume of data that is in the electronic medical record and might see trends in the data that speak of an impending disaster. And since Watson is constantly trolling the Web, he would perhaps bring to my attention a case report published the previous night in a Swedish journal describing a new interaction between two of the drugs my patient is taking.

Better still, if Watson could harness data from all the patients in our hospital and in every other hospital in America, we might be alerted to mini-epidemics taking shape. For example, Watson might recognize that the kidney failure in our patient is linked to kidney failure in a patient in Buffalo and another in San Antonio; all three patients, he might inform me, were taking a “natural” weight loss supplement that contained a Chinese herb, aristolochia, that has been associated with more than 100 cases of kidney failure.

Let me expand this scenario, and try to convey why we should all look forward to the day when Dr. Watson starts seeing patients.

Watson works by applying lots of algorithms to a huge body of data. For the Jeopardy! competitions, the data were hundreds of millions of documents on every conceivable topic. Dr. Watson would be much more specialized; its data would be a digital version of humankind’s medical knowledge. As Verghese points out, this knowledge would be constantly updated as new medical facts and findings come in. All of these data would be of varying levels of quality and reliability, of course, but this is not an insurmountable problem —  statistical algorithms are quite good at separating signal from noise.

When I went to Dr. Watson as a patient, I’d contribute my own data: the contents of my personal health record, any recent test results, and a description of my symptoms. Current speech recognition and natural language processing technologies are so good that I could give this description over the phone.

Dr. Watson would then go to work. It would approach the problem (“What condition(s) does Andy have?”) from many directions at once, turning loose an army of algorithms. Each of them would examine the data I’d supplied, compare it to previous cases and patterns detectable in the accumulated body of medical knowledge, and reach a diagnosis. To oversimplify a bit, the supercomputer would give my case to a host of non-identical virtual diagnosticians, each of which would return with its answer about what was wrong with me. The real-world equivalent of this would be to give my case to hundreds of differently-trained and -oriented doctors, then collect all their answers.

If a large majority of these answers were consistent — if most of the doctors thought I had the same condition — I’d have pretty high confidence in this consensus diagnosis. In just the same way, if most of Dr. Watson’s algorithms converge to the same answer, the computer has high confidence that it knows what’s wrong with me. As those of us who watched the Jeopardy! competition learned, when Watson was confident it was usually also correct.

I can also easily imagine Dr. Watson asking for more information: “Andy, have you traveled abroad in the past month? If so, where?” “Go get a blood test, please, and have the lab upload the results.” “Let’s do an MRI. I’ve scheduled you for one tomorrow”

Once it has all the additional information it thinks it needs, Dr. Watson can arrive at a diagnosis almost instantaneously. And it’s worth stressing the strengths of this diagnosis:

  • It’s based on all available medical knowledge. Human doctors can’t possibly hold this much information in their heads, or keep up it as it changes over time. Dr. Watson knows it all and never overlooks or forgets anything.
  • It’s accurate. If Dr. Watson is as good at medical questions as the current Watson is at game show questions, it will be an excellent diagnostician indeed.
  • It’s consistent. Given the same inputs, Dr. Watson will always output the same diagnosis. Inconsistency is a surprisingly large and common flaw among human medical professionals, even experienced ones. And Dr. Watson is always available and never annoyed, sick, nervous, hungover, upset, in the middle of a divorce, sleep-deprived, and so on.
  • It has very low marginal cost. It’ll be very expensive to build and train Dr. Watson, but once it’s up and running the cost of doing one more diagnosis with it is essentially zero, unless it orders tests.
  • It can be offered anywhere in the world. If a person has access to a computer or mobile phone, Dr. Watson is on call for them.

What’s more, Dr. Watson knows what it knows, and what it doesn’t know. If a case has it stumped — if it doesn’t have high confidence in its own diagnosis — it can call in the humans to take over. No pride or ego will get in the way of its doing so.

We find ourselves now at a truly amazing point in time. All the elements needed to build Dr. Watson are in place and pretty thoroughly tested. It’ll be a great challenge to turn Watson the world’s best Jeopardy! player into Dr. Watson the expert diagnostician, but geeks both medical and digital love a challenge. I predict they’ll succeed with this one.

If they do, wouldn’t you rather get diagnosed by Dr. Watson instead of a human physician? I’m not using this question as a rhetorical device; I’m asking it in all seriousness. In his op-ed, Verghese frets a good bit about the digitization of health care delivery, but I’m eager for technology to improve this inefficient, error-filled, and pre-industrial industry. I am blown away by the skill, knowledge, and dedication of just about all the health care workers I’ve come in contact with, but the adjectives in the previous sentence are all accurate.

If and when Dr. Watson gets as good at diagnosis as Watson is at Jeopardy! I want it as my primary care physician (even though I’m thrilled with my current PCP). I think I’ll get better medical care as a result.

Do you agree? If not, why not? Leave a comment, please, and let us know. I’ll discuss responses in my next post here.