Medicine is not that compartmentalized.
In my experience in anesthesia, it is the broad exposure that gives you a better understanding of your patients and their potential pitfalls. It is the little nagging voice in your head when you read a complex pre op eval. If we were just tube jockeys, it wouldn't matter.
The goal
is to turn us into tube jockeys for the lion's share of care. The article is more than a decade old.
http://www.newyorker.com/archive/1998/03/30/1998_03_30_074_TNY_LIBRY_000015236
This is the free excerpt:
MEDICAL DISPATCH about whether the medical community should rely on computers to perform certain medical diagnoses. Two years ago, Dr. Hans Ohlin, the 50-year-old chief of coronary care at the University of Lund Hospital, in Sweden, participated in an electrocardiogram (EKG) study led by Lars Edenbrandt, Ohlin's colleague and an expert in artificial intelligence. The EKG, which is used to detect signs of a heart attack, is one of the most common diagnostic tests, performed more than 50 million times a year in the U.S. alone. The purpose of the Swedish study was to deduce whether a computer could outperform an experienced human specialist in successfully diagnosing heart attacks among patients using their EKG results. Edenbrandt fed his computer over 10,000 EKGs until the machine grew expert at reading them. Then he approached Dr. Ohlin, one of the top cardiologists in Sweden, and asked him to make diagnoses on 2,240 EKGs from the hospital files. When the results were published this past fall, they showed that machine had beaten man by 20%. In Western medicine, machine-like precision among physicians is prized above all; the keys to perfection, it seems, are routinization and repetition. Consider hernia repair. In most hospitals, hernia operations take about 90 minutes and cost more than $4,000; in 10-15% of the cases, the operation fails and the hernia returns. At the Shouldice Hospital, a small medical center outside Toronto, however, hernia operations take 30-45 minutes, the recurrence rate is 1%, and the cost is around $2,000. The secret of the clinic's success is that the 12 surgeons at Shouldice perform hernia operations and nothing else; each surgeon repairs between 600-800 hernias a year--more than most general surgeons do in a lifetime. All the repetition apparently changes the way they think: the surgeons become accustomed to dealing with nonstandard situations in an automatic mode. If the Swedish EKG study argues that there are situations in which machines should replace physicians, the Shouldice example suggests that physicians should be trained to act more like machines. The writer describes observing Dr. Richard Sang, of the Shouldice Hospital, as he performed a hernia operation. Sang performed each step in the operation without pause, and the entire procedure took just half and hour. The doctors at Shouldice seem to deliver hernia repairs the way Intel makes chips. Although the medical establishment has begun to recognize that some form of automation can produce the best results in medical treatment, it has been reluctant to apply the same insight to the area of medical diagnosis. The radical implication of the Swedish study is that the individualized, intuitive approach that lies at the center of modern medicine is flawed, and it may cause more mistakes than it prevents. There's ample support for this theory in studies done outside medicine. Cognitive psychologists--like Paul Meehl, in his classic 1954 treatise, "Clinical Versus Statistical Prediction"--have shown repeatedly that a blind algorithmic approach usually trumps human judgement in making predictions and diagnoses. The superiority of computer algorithms may attributed to the fact that humans are inconsistent: we are easily influenced by recent experience, distractions, and outside suggestions; and we are also less skilled at considering multiple factors. It is probably inevitable that in the next few years physicians will begin letting computers take over diagnostic decisions. One network, PAPNET, is already gaining mainstream use in the screening of digitized Pap smears for cancer. Other hospitals are also taking a lesson from the success of Shouldice and creating superspecialized treatment centers. Mechanized medicine may seem horrifying to many people, but a medical community where computers perform many of the diagnoses may free doctors up to do what only they can do--talk to and care for their patients--thus, ironically, creating a more compassionate medical environment.
