Hot Take: Medicine is not just about helping patients anymore

[sarcasmrules]

I wanted to get people's opinions on this, especially adcoms. With the advent of AI, more will be developed specifically for medicine and certain specialties. These AIs cannot be developed without a physician on the team. Working with startups that develop these AIs requires full-time commitment, so they would see patients very rarely unless they're a workaholic. This work is just as important as caring for patients because it tackles the shortcomings that still exist in medicine because getting more physicians simply isn't cutting it. Medicine now is also about innovating new ways to tackle existing issues in medicine. I've come across a few AIs specifically developed for healthcare that are doing some real good in mending major issues that have plagued healthcare for decades.

I do attend AI conferences so I may be biased or you could say that gives my opinion more value.

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[bankedsynapse]

This seems to me just a new flavor of the existing roles physicians take at tech companies or in research. I have met physicians whose entire job was working for EHR companies to enhance their product or streamline workflows. Similarly, a PI at a lab I worked for was an MD who no longer saw patients and instead focused on research grants. IMO this is still helping patients, just allows certain providers to flex an alternative skillset later in their career or impart their accumulated knowledge where it could be helpful to their peers down the line.

AI is 'the thing' right now for sure, but at least in this capacity it isn't treading brand new ground IMO.

 

[LizzyM]

Many physicians do a mix of things or swap out one thing for another over time. Many will want to keep a hand in clinical care; maybe clinic one day per week or two months on service each year (ICU /OR/ ED), while having other roles the rest of the time. This can include research, education, and administration.

 

[sarcasmrules]

AI is 'the thing' right now for sure, but at least in this capacity it isn't treading brand new ground IMO.

You should check out Canvas DX and pRXcision. The former allows primary care pediatricians to diagnose autism in a matter of days. Before, they'd need to be on a waitlist that could be longer than a year to see the right specialist to get diagnosed. The latter makes the most effective use of antibiotics to minimize the use of last resort antibiotics and minimize the rise of antimicrobial resistance.

 

[Mr.Smile12]

Read

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Book Review–Doctored: The Disillusionment of an American Physician, by Dr. Sandeep Jauhar - SDN

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You are welcome to write an SDN article based on what you see for very interested prehealth and health professional students/readers.

Writing for SDN - SDN

The Student Doctor Network provides free tools, resources, and advising services to help students become health professionals.

www.studentdoctor.net

 

[sarcasmrules]

Read

25 Best Pieces of Advice from SDN - SDN

The Student Doctor Network provides free tools, resources, and advising services to help students become health professionals.

www.studentdoctor.net

Five Career Questions to Ask Yourself as a Medical Student - SDN

The Student Doctor Network provides free tools, resources, and advising services to help students become health professionals.

www.studentdoctor.net

What Lies Ahead in the Healthcare Industry - SDN

The Student Doctor Network provides free tools, resources, and advising services to help students become health professionals.

www.studentdoctor.net

Book Review–Doctored: The Disillusionment of an American Physician, by Dr. Sandeep Jauhar - SDN

The Student Doctor Network provides free tools, resources, and advising services to help students become health professionals.

www.studentdoctor.net

You are welcome to write an SDN article based on what you see for very interested prehealth and health professional students/readers.

Writing for SDN - SDN

The Student Doctor Network provides free tools, resources, and advising services to help students become health professionals.

www.studentdoctor.net

I just might write an article once I've learned enough. I don't think I have learned enough to offer a comprehensive one yet.

 

[esob]

...allows primary care pediatricians to diagnose autism in a matter of days. Before, they'd need to be on a waitlist that could be longer than a year to see the right specialist to get diagnosed.

The problem isn't in diagnosing autism (or any other behavioral health disorder); it's patient-specific treatment. This is why I get patients all the time in the hospital who feel like they have "failed therapy" after being started on four different medicines (all at homeopathic doses). Don't get me wrong, I think AI will contribute to improving medicine, but at the end of the day, algorithms are guidelines, and there is an intuitive component to the practice of medicine that I have yet to see an AI replicate. Additionally, there is robust evidence that patient rapport, particularly in behavioral health, plays a significant role in response to treatment. Given that there is no one-size-fits-all personality that every patient jives with, we are a long way off from replacing providers with automatons.

 

[Crayola227]

I think the title is misleading. At the end of the day, if what a sworn physician is doing in the healthcare field isn't "helping patients" in some way, then wtf are you [not the literal you, the general "you"] even doing anymore. You've lost the plot. Isn't that why we prosecuted the Nazi physician war criminals and came up with the oath of Geneva? I'm being a bit dramatic here.

I'm not saying you have to see patients, you can do admin, research, tech, whatever. But you're not just wanking off with AI, are you? It's just a new tool for the primary mission.

My advice, change the thread title. I hate edgy ragebait click titles. Medicine will always be helping patients first abd foremost or else it isn't medicine any more.

Try "Hot Take: Medicine isn't just about seeing patients" or "Hot Take: AI can help patients" "Doctor can focus on AI in quest to help patients" any number of ideas. But saying medicine isn't about helping patients is silly imho.

 

[Crayola227]

But also thank you for your contribution and the information you've brought here, that part is wonderful. It's interesting to see some more concrete examples of how AI can benefit patients. These examples were good as well, because they were presented more as an adjunct to a human physician's judgement and not a replacement.

 

[Crayola227]

But also thank you for your contribution and the information you've brought here, that part is wonderful. It's interesting to see some more concrete examples of how AI can benefit patients. These examples were good as well, because they were presented as handling more formulaic aspects of medicine, as an adjunct to a human physician's judgement.

 

[Crayola227]

Having seen the diagnosis of autism by developmental peds experts, I don't think that any algorithm can replace that final judgment of what neurodevelopmental diagnosis is most fitting.

Primary care physicians don't struggle in applying an algorithm for probable autism diagnosis to come to that conclusion. Working diagnoses of autism are used all the time in the meantime.

Autism and related conditions affect social functioning by definition. As such, there is a REASON that it takes months to get into a specialist - because an all day multidisciplinary in depth assessment is needed by folks familiar with all manner of developmental conditions, to tease this apart. It's a social setting. It's not a backlog because people are confused and need an AI algorithm applied for them. There are also other algorithmic and validated tools, such as Autism Detect.

Suspecting autism and related conditions is not difficult. Pinning it down, and not only that, developing an effective and comprehensive treatment plan, moreso. This relies not only on physician experience, but factoring in complex social determinants and relationships that AI cannot. Can a single mom with a very large and violent teen with autism handle outbursts? Is a higher dose of sedating medication appropriate, particularly if is causes weight gain in an already overweight patient? She's the guardian and primary caregiver. Is AI going to take the place of her judgment about what she is willing to do and thinks best?

There are borderline cases and cases with more complexity.

The issues around waiting for a more formal diagnosis is multifold, and part of it is not, primary care physicians are incapable and need AI algorithm help. Some of it has to do with government and health insurance red tape around payment or qualifying for specific treatments. Resources are limited. The idea is to be certain of a certain diagnosis before committing certain resources.

ADHD vs autism vs autism with ADHD are different beasts. Right or wrong, or if it would even help ADHD to apply some treatments for autism such as in classroom support, is not the point. The PCP and AI might make one determination, but in some sense it can be a checkbox to have an expert weigh in. Then again, that's how complex cases with misdiagnosis can creep in, if we treat evals as a checkbox where AI assisting PCPs can replace the developmental peds.

It's actually kind of infuriating to me the suggestion that these issues are for the reason given and that this is where AI would be particularly helpful. I guess I would need to see data that the AI was validated and did better than 1) primary care physicians and 2) developmental peds. I suspect not, and even if so, patients will be best served by developmental peds creating a treatment plan in conjunction with a multidisciplinary team and family.

 

[sarcasmrules]

I think the title is misleading. At the end of the day, if what a sworn physician is doing in the healthcare field isn't "helping patients" in some way, then wtf are you [not the literal you, the general "you"] even doing anymore. You've lost the plot. Isn't that why we prosecuted the Nazi physician war criminals and came up with the oath of Geneva? I'm being a bit dramatic here.

I'm not saying you have to see patients, you can do admin, research, tech, whatever. But you're not just wanking off with AI, are you? It's just a new tool for the primary mission.

My advice, change the thread title. I hate edgy ragebait click titles. Medicine will always be helping patients first abd foremost or else it isn't medicine any more.

Try "Hot Take: Medicine isn't just about seeing patients" or "Hot Take: AI can help patients" "Doctor can focus on AI in quest to help patients" any number of ideas. But saying medicine isn't about helping patients is silly imho.

Fair point. My apologies.

 

[sarcasmrules]

Having seen the diagnosis of autism by developmental peds experts, I don't think that any algorithm can replace that final judgment of what neurodevelopmental diagnosis is most fitting.

It's a diagnostic aid, not to replace doctors. That's what AI is all about. That's why I say "AI will not replace doctors, but doctors who don't use AI will be replaced by those that do."

 

[sarcasmrules]

Having seen the diagnosis of autism by developmental peds experts, I don't think that any algorithm can replace that final judgment of what neurodevelopmental diagnosis is most fitting.

Primary care physicians don't struggle in applying an algorithm for probable autism diagnosis to come to that conclusion. Working diagnoses of autism are used all the time in the meantime.

Autism and related conditions affect social functioning by definition. As such, there is a REASON that it takes months to get into a specialist - because an all day multidisciplinary in depth assessment is needed by folks familiar with all manner of developmental conditions, to tease this apart. It's a social setting. It's not a backlog because people are confused and need an AI algorithm applied for them. There are also other algorithmic and validated tools, such as Autism Detect.

Suspecting autism and related conditions is not difficult. Pinning it down, and not only that, developing an effective and comprehensive treatment plan, moreso. This relies not only on physician experience, but factoring in complex social determinants and relationships that AI cannot. Can a single mom with a very large and violent teen with autism handle outbursts? Is a higher dose of sedating medication appropriate, particularly if is causes weight gain in an already overweight patient? She's the guardian and primary caregiver. Is AI going to take the place of her judgment about what she is willing to do and thinks best?

There are borderline cases and cases with more complexity.

The issues around waiting for a more formal diagnosis is multifold, and part of it is not, primary care physicians are incapable and need AI algorithm help. Some of it has to do with government and health insurance red tape around payment or qualifying for specific treatments. Resources are limited. The idea is to be certain of a certain diagnosis before committing certain resources.

ADHD vs autism vs autism with ADHD are different beasts. Right or wrong, or if it would even help ADHD to apply some treatments for autism such as in classroom support, is not the point. The PCP and AI might make one determination, but in some sense it can be a checkbox to have an expert weigh in. Then again, that's how complex cases with misdiagnosis can creep in, if we treat evals as a checkbox where AI assisting PCPs can replace the developmental peds.

It's actually kind of infuriating to me the suggestion that these issues are for the reason given and that this is where AI would be particularly helpful. I guess I would need to see data that the AI was validated and did better than 1) primary care physicians and 2) developmental peds. I suspect not, and even if so, patients will be best served by developmental peds creating a treatment plan in conjunction with a multidisciplinary team and family.

The company that designed it has pediatricians on the team, so its development should have taken your concerns into account since any pediatrician would know to account for all those things. Don't forget to even get FDA approval, you have to showcase its effectiveness. Yes, Canvas DX is FDA-approved.

Part of the reason it takes months is the lengthy waitlist to see a developmental-behavioral pediatrician, which Canvas DX bypasses and allows PC pediatricians to diagnose at the point-of-care.

So, respectfully, my response to this infuriating comment is don't knock it til you've tried it. I can confidently tell you that you are underestimating the potential of AI's use as an aid in healthcare by a wide margin.

 

[Crayola227]

The company that designed it has pediatricians on the team, so its development should have taken your concerns into account since any pediatrician would know to account for all those things. Don't forget to even get FDA approval, you have to showcase its effectiveness. Yes, Canvas DX is FDA-approved.

Part of the reason it takes months is the lengthy waitlist to see a developmental-behavioral pediatrician, which Canvas DX bypasses and allows PC pediatricians to diagnose at the point-of-care.

So, respectfully, my response to this infuriating comment is don't knock it til you've tried it. I can confidently tell you that you are underestimating the potential of AI's use as an aid in healthcare by a wide margin.

Fair.

Was what I wrote initially. What about my comment is "infuriating"?

Just, people should be aware of the challenges around developmental peds issues, and that while an autism diagnosis can absolutely grease wheels to initiate some interventions while waiting for a complete assessment, there is still a need to wait for these teams and their more comprehensive assessments.

So I don't think Canvas should be a bypass of this, more a stopgap measure until the kid can be seen. Like any test, I would need to see the sensitivity and specificity of the test. Being FDA approved doesn't actually mean something is amazing or takes the place of other standard things.

I think what people miss about these things is that the issue isn't diagnosing straightforward cases, but that there is a great amount of overlap between autism symptoms and a very broad swath of developmental conditions.

I suspect that Canvas is more helpful to lesser experienced primary care peds that are not experts in development and autism. Which is great but doesn't mean it replaces the expert and therefore the wait to see an expert.

Part of my pushback as well, is that are soon as you have a tool like this, people will exactly want to self diagnose or skip the expert and we see a TON of this happening already with autism specifically.

Like I said I haven't looked into studies, methods, and results to assess Canvas. I think it sounds exciting and helpful, and possibly a good adjunct. But physicians tend to be conservative about suggestions to use anything new in place of something old but we know is effective already, even when results are promising. When you experiment this way and are wrong people almost always suffer. And a lot of issues, not the least being user error, often literally cannot be seen until you roll out to the larger population because the n is always greater than anything that can be achieved in a study for FDA approval.

 

[Crayola227]

The company that designed it has pediatricians on the team, so its development should have taken your concerns into account since any pediatrician would know to account for all those things. Don't forget to even get FDA approval, you have to showcase its effectiveness. Yes, Canvas DX is FDA-approved.

Part of the reason it takes months is the lengthy waitlist to see a developmental-behavioral pediatrician, which Canvas DX bypasses and allows PC pediatricians to diagnose at the point-of-care.

So, respectfully, my response to this infuriating comment is don't knock it til you've tried it. I can confidently tell you that you are underestimating the potential of AI's use as an aid in healthcare by a wide margin.

So, respectfully, my response to this infuriating comment, is don't get too excited until you have some direct experience with autism, developmental disorders, pediatrics, and developmental peds?

I was really just trying to provide more education about the challenges in autism diagnosis and management.

I think a lot of doctors get impatient (irony) with bUt WhY dO i HaVe To WaIT to see an expert, which happens all the time. Because they're an expert and more than diagnosis is needed?

 

[sarcasmrules]

Fair.

Was what I wrote initially. What about my comment is "infuriating"?

Just, people should be aware of the challenges around developmental peds issues, and that while an autism diagnosis can absolutely grease wheels to initiate some interventions while waiting for a complete assessment, there is still a need to wait for these teams and their more comprehensive assessments.

So I don't think Canvas should be a bypass of this, more a stopgap measure until the kid can be seen. Like any test, I would need to see the sensitivity and specificity of the test. Being FDA approved doesn't actually mean something is amazing or takes the place of other standard things.

I think what people miss about these things is that the issue isn't diagnosing straightforward cases, but that there is a great amount of overlap between autism symptoms and a very broad swath of developmental conditions.

I suspect that Canvas is more helpful to lesser experienced primary care peds that are not experts in development and autism. Which is great but doesn't mean it replaces the expert and therefore the wait to see an expert.

Part of my pushback as well, is that are soon as you have a tool like this, people will exactly want to self diagnose or skip the expert and we see a TON of this happening already with autism specifically.

Like I said I haven't looked into studies, methods, and results to assess Canvas. I think it sounds exciting and helpful, and possibly a good adjunct. But physicians tend to be conservative about suggestions to use anything new in place of something old but we know is effective already, even when results are promising. When you experiment this way and are wrong people almost always suffer. And a lot of issues, not the least being user error, often literally cannot be seen until you roll out to the larger population because the n is always greater than anything that can be achieved in a study for FDA approval.

You wrote "It's actually kind of infuriating to me the suggestion that these issues are for the reason given and that this is where AI would be particularly helpful." to which I said "don't knock it til you've tried it."