Are Doctors Destroyed by their Frankensteins?

March 23, 2016

Frankenstein's monster, more commonly called Frankenstein after its creator, Victor Frankenstein, in Mary Shelley’s 1818 novel - Frankenstein or The Modern Prometheus. In Shelly’s story Victor builds a creature in his lab through a method consisting of chemistry and alchemy. This 2.4-m high hideously ugly monster is shunned by human society which leads him to seek revenge against his creator. In the process, Frankenstein kills his creator’s brother, best friend and, finally, Victor’s father and Victor himself dies, drowning in icy waters, while searching for the monster in the Arctic Circle. Frankenstein has lived on through theatre shows, films and TV series.

A similar story is being re-enacted in the medical field where the robotic innovations invented to fine-tune diagnosis and treatment of patients, like Frankenstein, are progressively destroying and making doctors redundant and helpless watchers from the sidelines. But, to appreciate this, a bit of background on traditional doctoring is in order.

There are good reasons to become a doctor which is one of the most sought after professions today for there is good money to make in it. Even centuries ago there was good reason, as Francis Quarles, Finnish poet (1592-1644) had said: “Physicians, of all men, are most happy: Whatever good success they have, the world proclaimeth and whatever faults they commit, the earth covereth”.

Doctors making mega bucks is widely discussed. But, now comes the question of doctors passing the buck – to medical robots or Artificial Intelligence (AI). Until the early decades of the last century, the main diagnostic tool available to the doctor was his stethoscope. I have personally seen an old consulting doctor in Bombay knocking at the joints of the patients ( including my father) with a light wooden hammer. He also looked at the outstretched tongue, probed the nose and the ears with a torch and pressed the stomach and other parts below the rib cage. And he asked questions about the lifestyle of the patient and the health and longevity of the patient’s parents and siblings. And there was a blood pressure checking instrument.

Then came blood, stool and urine tests, ultrasound, all sorts of “scopies” and scans. The availability and use of these tools, in ever-sophisticated avatars, is expanding by the day – often to the despair of patients who seem to think that these expensive tests are prescribed casually for academic and speculative reasons. Major decisions, based on these tests, are taken by consulting doctors to whom the family physician refers the “cases” at a certain critical point (And there is hushed talk about some family doctors getting “reference” kickbacks). He is supposed to give the final, authoritative decision such as going in for surgical operation.

The table of the US President in the Oval Office of White House has a placard reading: “The buck stops here”. In other words, the President is assuming responsibility for whatever is done in his name. Ideally and logically, every medical consultant should hang such a placard in his office. This is especially true in this age when he can cross-check his diagnosis and prognosis with the best consultants in the world through teleconferencing.

Yet, instead of this happening, some doctors are likely to turn to the roulette wheel (which decides the fortune or disaster of gamblers in casinos) to decide on the best course of action in a given situation. Researchers from the University of California have developed a tool which, they hope, will help ease the burden of making difficult treatment decisions. It is a roulette wheel that allows patients to visualise the probable outcomes associated with different treatment options for different diseases. The roulette wheel can be adapted to represent any current clinical question and is based on “best current evidence”, according to its developers, Dr Jerome R Hoffman and his colleagues.

For illustration purposes, Hoffman describes how a healthy 65 years old man might use the roulette wheel to decide whether or not to be screened for prostate cancer with a standard PSA blood test. By spinning the roulette wheel the man sees that his chances of developing symptoms of prostate cancer in his lifetime are very small, regardless whether he has a PSA test or not. But he also learns that if he undergoes PSA test and cancer is found, treating the cancer results in a 50% reduction in the chances of dying from prostate cancer. The roulette wheel also shows him that he has 58% chance of developing erectile dysfunction or incontinence because of treatment of prostate cancer. According to Hoffman, gone are the days when doctors dispensed advice and recommendation without involving the patient. Shared decision making is now largely how decisions are taken. He is hopeful that the roulette wheel will help the patients, in consultation with their doctor, to make difficult treatment decisions.

If you closely analyse the above you will see that what is presented is a joint decision or consensus arrived at with the patient. This is a disguised procedure to disown responsibility of the doctor and put the blame for any misadventure on the patient. This, in other words, is passing the buck.

That brings us to the issue of robots or AI overtaking the functions of doctors implied in the title of this article, There is a vast body of current and ongoing literature on the subject tolling the bell against the doctors with doomsday predictions for them. However, I would rather present the sobering and balanced views of Professor Richard Lilford, University of Warwick’s Chairman of Public Health, in an article titled “Do Robots Feature in Future of Medicine?” by Jessica Powell and published in The Telegraph (London - 15-10-15). The central point of the article, based on Prof. Lilford’s interview, is: Could Technology Further Assist, or Take-over, from Doctors?

Picture the General Practitioner (GP) surgery of the future: a robot doctor has replaced its human predecessor, using a super-computer brain to calculate drug doses in seconds with no risk of fatigue-induced errors (by doctors). What with the advance of AI technologies, this might not seem such a far-fetched concept. But, Prof. Lilford, is convinced this won’t happen. To think otherwise, he suspects, is to grossly underestimate the complex skills of doctors.

“I’m a sceptic on artificial intelligence,” he says. “I don’t think computers will ever supplant the doctor’s diagnosis. I think things will change – a computer might suggest a diagnosis. If a patient has just come back from India at a time of year when dengue fever is rife, for example, then a computer might b able to prompt the clinician a second opinion; but the doctor will still make the final call.” What’s more, whereas a computer is brilliant when dealing in certainties, Prof. Lilford notes: “You’ve [often] got to act in medicine before you’ve got any certainty and that sort of thing the doctor will have to do.” Human intuition, then, shouldn’t be underrated.

Above and beyond this, Prof Lilford believes the fact that a doctor is a comforting, supportive human presence is crucial when you’re ill. “That’s one of the strongest beliefs I have about medical practice,” he says. “It’s lethal to think that you can separate the psychological care from the physical care. They are part and parcel of the same thing,” he argues. “I mean, you could programme a computer to say, ‘I’m sorry’ but... Just how far this would fall short of genuine human compassion is self-evident.”

While Prof Lilford might not be convinced that computers are about to do doctors out of a job, he does believe there’s a lot of change in store over the next 50 years. “History is littered with people who said that there were no more discoveries to be made,” he notes. “There was a very famous president of The Royal College of Surgeons who, in 1924 I believe, said surgery had reached its apotheosis. That was before transplant surgery, before bypass surgery, before keyhole surgery, before neurosurgery. So given that history, a person would be foolish to say that there won’t be more discoveries.”

The future of medicine is as exciting as ever, especially when you look back at the huge advances we’ve continued to make in recent years. Computers are now playing a part in prescribing in some hospitals – issuing warnings about drug doses or combinations calculated to be unsafe for a patient – which Prof Lilford thinks is a great thing in terms of protecting against ‘human fallibility’. And the explosion of the Internet into people’s homes, of course, has allowed the public to be more informed about their health, which he describes as “almost unambiguously a good thing”. Far from stalling then, science and technology has meant we’re reaching new and often unexpected frontiers in health care all the time.”

This is the global picture. When we come to India, with the corporatisation of hospitals, doctors, well-paid themselves, are supposed to be the pillars of profit-centres of the hospitals by prescribing sophisticated tests, needed or not, so the hospitals can recover their investments (and make profit) in expensive diagnostic and operation equipment. This is also extended to the high-cost ICUs.

But, these modern corporate doctors will have no worry about collecting their bills from dying patients, as John Gray, English poet (1688-1732) had said:

“Is there no hope?” the sick man said,
The silent doctor shook his head,
And took his leave with signs of sorrow,
Despairing of his fee tomorrow.

This is about mainstream medical practice. Then there is medical transcription business which is heavily outsourced to India by the West. Doctors and bad handwriting historically go well together, as noted by Mathew Prior, English poet (1664- 1721):

You tell the doctor, that you are ill
And what does he, but write a bill,
Of which you need not read one letter,
The worst the scrawl, the dose the better.
For if you knew what you take,
Though you may recover, he must break.

Indian doctors are no different when it comes to bad handwriting. As the Tulu saying goes: “Anne Barethina Annene Vodod” (What elder brother has written only he can read). Yet, our chemists are mind readers. They decipher the scrawl, lately aided by Mobile references to the doctor. Meanwhile Indian Medical Council has decreed that prescriptions should be written in capital letters. Mercifully some modern doctors give computer print-outs.

Let us end this sombre discussion on a lighter note. Before medical transcriptions became big business, computers were also used for translations. In irreligious Russia, a computer was asked to translate the Biblical passage:”The spirit is willing indeed but the flesh is weak”. The translation:”The wine is good but the meat is stale”!


Veteran journalist and author, John B Monteiro now concentrates on Editorial Consultancy, having recently edited the autobiography of a senior advocate, history and souvenir to mark the centenary of Catholic Association of South Kanara and currently working on the history/souvenir to mark the platinum jubilee of Kanara Chamber of Commerce & Industry.



By John B Monteiro
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Comment on this article

  • doctors are acting irresponsible with the patient as well as with their family members, Mangalore

    Mon, Mar 28 2016

    After the growth of unmeasured population and diseases and so many colleges bring out so called doctors either their parents are doctors or in family somebody is a doctor or you get good dowry money like. The days are over were the doctors were referred as Godly person who does a great job .Now a days everything has changed the moment you go to the doctors who are specialized with degrees,ask immediately to several test and scans which are irrelevant to the patient suffering. It has become now a business and everything is linked to swindle the patient bare naked. If the doctor does not join this chain will become useless.Even the pharma companies are controlling doctors and there is no hope at all things will change. Everything can happen on papers and advertisement.God alone can save from the mercy of such doctors and hospitals.

  • Subrahmanya, Muscat/Mangalore

    Sun, Mar 27 2016

    Does medical education system need rellok? in this modern computer era..
    Wastage of young/energetic age till 30 to complete a PG..About 90% useless subjects which they can read..anytime..
    Some new system 5 or 6 years combined specialization course is requirement of the day..
    Really policy makers should start new look at education system..

  • Neville Fernandez, Mangalore/Antigua

    Fri, Mar 25 2016

    On the side of the physicians, MBBS used to be of 5.5 years duration, and MD of three years duration. The quantum of knowledge is growing by leaps and bound every year, but the time available to assimilate all all this knowledge has remained static. So are we going to double the time taken to qualify as a physician, OR

    1. Leverage our access to information technology to train our physicians on how to manage available information, how to discriminate between good and not so good sources of information, and how to information.

    2. Leverage newer technologies like all the scopies and scanning you have written so eloquently about, to have faster treatment turnaround time, better patient outcomes, and more timely and accurate diagnoses?

    Points to ponder.....

  • Neville Fernandez, Mangalore/Antigua

    Fri, Mar 25 2016

    "This is a disguised procedure to disown responsibility of the doctor and put the blame for any misadventure on the patient".

    The concept of patient autonomy was not known to me at least, when I studied to become a physician. If a parent was diagnosed with cancer, family hid the diagnosis from them, lied to them, and decided what treatment was best. The patient had little say, if any at all. I understand parents taking responsibility for children, but not people imposing their decisions on family who are adults capable of making their own choices. We live in the information age, even if people do not have an internet connection at home, they have one on their mobile phones, and believe me, they have Googled all their symptoms and possible treatments before they get to the doctor. So the question is, does providing the patient with information on all available options for screening or treatment empower the patient and further patient autonomy, or does it cripple the patient with the burden of choice? At some point the patient will ask the physician for assistance with the decision, and that's where we step in.

  • Neville Fernandez, Mangalore/Antigua

    Fri, Mar 25 2016

    "This is especially true in this age when he can cross-check his diagnosis and prognosis with the best consultants in the world through teleconferencing".

    What you say is true, but who is going to pay for teleconferencing? Note that it is not the technology cost, which has gone dow to a great extent, that is the hindrance, but the cost of conferencing with another physician in real time, who is on a different time zone and is making available his/her time for consultation. They'll have their costs too. A consultation typically costs USD 200 to 300 in the West, so who's going to pay for it? If we pass this on to the patient that will be deemed unacceptable. If we pass this on to insurance then premiums will go up.

    Finally, physicians will be accused of seeking second opinions to inflate healthcare costs and split the fees with the foreign consultant.

  • Mangalurian, Mangaluru

    Fri, Mar 25 2016

    Great write-up Mr Monteiro.

    The banking industry saw a few ripples when the computers were introduced and later on when ATMs started being set up to automate the cash vending. No doubt the medical world is slowly moving in a similar direction.

    The medical industry though thrives on the innate fear in humans about their physical health. The industry at times creates panic when a few people suffer from some virus in a distant land. Who wants to take a chance?

    With such fears, people will, at least for the next few years, still approach the doctors for some credible advice.

    It is quite possible that soon we will see some tiny gadget at home that will connect the body to some website which will instantly spit out all the current and the future ailments for the person, as well as a list of medications to order at the click of a mouse.

    Such convenience in diagnosis as well the purchase of medications will certainly bring a great deal of relief to the aam aadmi, but could also contribute to the demise of pharmacies and clinics as we know them. Medical personnel will still be needed to deal with the emergencies and the toothaches.

  • Donald Roche, Mangalore

    Thu, Mar 24 2016

    If the doctor who no longer know what causes the pain in head, heart or stomach without scan, ECG.,biopsy or x-rays chances of getting single patient a day. A road to medical knowledge is through the pathological lab.and not through an apothecary's shop. People pay the doctor for his trouble, for his kindness they still remain in his debt.
    It is true we can read a doctor's bill but we can't read his prescription.
    Yes we find all equipment even AI (artificial intelligence) but equipment lack in the modern hospital is somebody to meet the patient at the entrance with handshake or AI (Air India) welcome.

  • Dr.Fernandes H.R, Mangalore/Dubai

    Thu, Mar 24 2016

    Well researched on Present advancement of Medical Practice and its benefits & pitfalls, where in Human touch/feelings, giving confidence and Hope, is missing & relying of AI and robotics are are taking the prime place. Of course doctors make money(which they have spent on admission PLUS 5years of Hard work) and sometimes listen to taunt"just MBBS",so further their studies(post graduation) & Indian psyche-to educate their children in Medical field. Kudos Mr.J.B Monteiro for excellent write up of advancement of Modern Medical Practice.

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