will computer partially replace primary care physicians?

[Fullmetal_Biochemist]

Hi all, just wonder from the medical student's point of view, is it possible for computer (artificial intelligence) to partially replace the role of primary care physicians? For example, one family doctor could supervise a dozen of nurses whom operate computers for diagnosis, giving treatment for simple cases (cold, contraceptive medications, ...), deal with insurance companies, and give out referrals?

[Med0123]

no

10char

[seeking1]

Having done a masters in this field, I can say resoundingly "no, anytime soon, we will likely have to wait many lifetimes before we get close".

[rmorelan]

Hi all, just wonder from the medical student's point of view, is it possible for computer (artificial intelligence) to partially replace the role of primary care physicians? For example, one family doctor could supervise a dozen of nurses whom operate computers for diagnosis, giving treatment for simple cases (cold, contraceptive medications, ...), deal with insurance companies, and give out referrals?

 

as a side note - family medicine is likely one of the most complex specialties from a machine to assist in - there is a huge broad knowledge base with a big social component to the problems to solve. When AI develops, and it will, it would be more likely to be applied in other fields first - radiology, cardiology, robotic surgery etc have parts that are more likely to be automated sooner. We already have developments in those areas actually. well my thoughts anyway - the more objective a specialty is the more likely a computer could assist.

[A-Stark]

When we have AI capable of taking histories and performing examinations, we human physicians may have something to worry about. That is a long, long time from coming to pass, though, assuming it ever does.

 

To take an example from cardiology, most ECG machines provide automatic interpretations that appear at the top of strip. These are, however, frequently wrong, and sometimes very wrong, and are absolutely no substitute for the trained, experienced eye (and mind).

 

Of course, our brains have evolved over millions of years to be able to interpret and adapt multidimensional stimuli (not just time and space, but smell, taste, and the infinite variety of sound). The idea that an AI will equal that in the not-too-distant future is fanciful. The trick comes in that humans often fail as well (not that machines are ever infallible), so the role for computers/"AI" may be for assisting in quality control and consistency.

 

In the meantime, we have UpToDate.

[farmin]

Can't replace their role.

1.Too many ambiguities in this field

2.Even if computers are capable of all the functions of a physician you still need someone to take on liability, that is the ultimate role of the physician. A firm would never accept liability on that kind of level. If physicians don't agree to take on that liability, the software would never be developed.

[future_doc]

We have NPs & PAs.

[rmorelan]

We have NPs & PAs.

 

Yeah well that is the point - do you need a doctor to do a physical exam? That is not really a skill that requires profound intelligence (interpreting the exam may). Can an electronic stethoscope when placed on the standardized positions interrept the sounds? Quite possibly? On the lungs - again quite possibly. In ICU it was the nursing staff that did all the physical examinations as it was one to one patients. Just because some parts of the doctoring job require high intelligence/education doesn't mean they all absolutely do.

 

The problem is always replacing everything part of the job (very hard) but that isn't how it starts.It starts by machines getting better and better at doing parts of it (like reading EKGs - getting better all the time, ha quite often a lot better than some doctors). Can machines do mammogram screening? They already assist doing that. Can machines auto-order drugs to keep people electrotyles, heparin, insulin in range (we are already build devices to do just that). The list goes on and on actually. There is big race to add protocols for various things in the hospital - ACS protocol say in the emerg for cardiology. That is basically a glorified flowchart which is exactly the specs someone would ask for when building a program.

 

When parts of the job get easier collectively it puts back pressure on the system to need fewer and fewer of X around because they have that support. Knock off screening images and you need fewer radiologists for instance - leaving only the tougher problems in that field behind (and arguably upping the stress in that job as nothing left is easy ie no down time).

 

so you aren't going to see FM version 1.0 coming out any time soon But you will see increasing software - some of which is way to primitive to call AI - showing up more and more.

[Fullmetal_Biochemist]

how about other healthcare professionals taking over or extending their roles into the realm of family medicine? is it possible?

[future_doc]

Being a computer programmer and physician, one day you may be on the front line of creating Radiology v. 1.0 & upgrades to make medicine more efficient and cost effective, saving phyisian's their valuable time.

[hexonu]

We already have this to a certain extent, its called a standing order often initiated by triage nurses.

 

There are definitely parts of medicine that can be made more efficient through the use technology, but because we deal with human lives the physician role will never go away as a computer can not take liability.

[rmorelan]

We already have this to a certain extent, its called a standing order often initiated by triage nurses.

 

There are definitely parts of medicine that can be made more efficient through the use technology, but because we deal with human lives the physician role will never go away as a computer can not take liability.

 

No but the owner of that system can. We transfer liability through technology all the time actually - we just aren't used to thinking that way openly.

 

Eventually you reach the point where you become more liable if you don't use technology - it depends on the standard of care.

 

This all isn't about the role of physicians going away - it is about over time reducing the amount of tasks a physician needs to do (which in turn drops the number of doctors needed). Not going to happen quickly to say the least but this is the entire point of technology - eventually it replaces tasks.

 

as a side note:

Imagine would would happen if we really did manage to create something like say Data from startrek - a faster, smarter, learning machine with perfect memory that could be replicated over and over again without that pesky childhood aspect. Oh and they don't sleep or ever get tired or even actually age or really die with backups so they are immortal it has been said in this changing world that the function of any species ultimately is to evolve its successor or die out trying. We may be the first species to use our evolved tools to actually build our successor.

[futureGP]

how about other healthcare professionals taking over or extending their roles into the realm of family medicine? is it possible?

 

Taking over is probably not going to happen, although there are NP-led clinics out there, it is not very common and the purpose is a bit different. Extending of roles into family medicine is definitely possible and happening currently. PAs and NPs work alongside family physicians sort of like residents, taking history/physical and reporting back to the MD etc. whether or not they get to direct treatment/prescribe probably depends on how comfortable the MD feels about their skills etc.

 

what's more interesting is you actually have more PA/NPs working in hospitals in specialty clinics where they also work as a physician extender, taking history/physicals etc. and many of the physicians i shadowed actually appreciate the work they do because for most of the time they're so overwhelmed with consults that the extra help is always good.

[hexonu]

Taking over is probably not going to happen, although there are NP-led clinics out there, it is not very common and the purpose is a bit different. Extending of roles into family medicine is definitely possible and happening currently. PAs and NPs work alongside family physicians sort of like residents, taking history/physical and reporting back to the MD etc. whether or not they get to direct treatment/prescribe probably depends on how comfortable the MD feels about their skills etc.

 

what's more interesting is you actually have more PA/NPs working in hospitals in specialty clinics where they also work as a physician extender, taking history/physicals etc. and many of the physicians i shadowed actually appreciate the work they do because for most of the time they're so overwhelmed with consults that the extra help is always good.

 

I think you're a bit confused with the NP role. We function similar to a resident, but we don't report back to any physician unless it's for a consult. Also, it's not the responsibility of the doctor to judge our competencies, we act based on our own scope of practice. For example, if I've never intubated a patient or had the skill checked off it would not be within my scope of practice. We practice under own individual licences and we are not an extension of the physician like PAs are. We can prescribe based on our diagnoses, with the exception of controlled substances.

[futureGP]

I think you're a bit confused with the NP role. We function similar to a resident, but we don't report back to any physician unless it's for a consult. Also, it's not the responsibility of the doctor to judge our competencies, we act based on our own scope of practice. For example, if I've never intubated a patient or had the skill checked off it would not be within my scope of practice. We practice under own individual licences and we are not an extension of the physician like PAs are. We can prescribe based on our diagnoses, with the exception of controlled substances.

 

ideally that is how the regulatory body sets NPs out to be.

 

I guess it really depends on where you work, but if you look at the roles NPs play in hospitals in specialty clinics, this is exactly how it is (mostly because although you may have the rights to all the things you described above, the hospitals are not so willing to give NPs the rights so many do function like residents). NPs in primary care may be different.

 

this might change however

[medigeek]

I think you're a bit confused with the NP role. We function similar to a resident, but we don't report back to any physician unless it's for a consult. Also, it's not the responsibility of the doctor to judge our competencies, we act based on our own scope of practice. For example, if I've never intubated a patient or had the skill checked off it would not be within my scope of practice. We practice under own individual licences and we are not an extension of the physician like PAs are. We can prescribe based on our diagnoses, with the exception of controlled substances.

 

NPs can manage the most basic things which do not require extensive education. Simple as that. You're a nurse, not a doctor.

 

Also, if computers replaced physicians, I'm pretty sure a vast majority of jobs would be gone well before then and the unemployment rate would have skyrocketed.

There's many things which can be replaced, but the public isn't very open nor accepting of sorts of changes which will compromise their peace of mind.

[NLengr]

For my specialty, I have worked with an NP inside the community hospital. I'm q surgical resident. Essentially, he worked as a resident. He reviewed consults from ER, people from clinic, patients who werent going according to plan on the floor post op etc. with the staff.

 

Now whether that was the local protocol or whether it was a legal thing, I don't know. Also it wasn't primary care so maybe that also changes things.

[Coco13]

as a side note - family medicine is likely one of the most complex specialties from a machine to assist in - there is a huge broad knowledge base with a big social component to the problems to solve. When AI develops, and it will, it would be more likely to be applied in other fields first - radiology, cardiology, robotic surgery etc have parts that are more likely to be automated sooner. We already have developments in those areas actually. well my thoughts anyway - the more objective a specialty is the more likely a computer could assist.

 

Agreed, family medicine is quite complex and uses the art of medicine more than most other specialties.

[rmorelan]

For my specialty, I have worked with an NP inside the community hospital. I'm q surgical resident. Essentially, he worked as a resident. He reviewed consults from ER, people from clinic, patients who werent going according to plan on the floor post op etc. with the staff.

 

Now whether that was the local protocol or whether it was a legal thing, I don't know. Also it wasn't primary care so maybe that also changes things.

 

Yeah when I have worked with them I have found that the ones with experience often are acting quite similar to a senior resident. In whatever their area is they are extremely educated. Experience counts for a very great deal in the end. I mean that is really a lot of what medicine is - two years of preclerkship theory is really nothing - non specific theory and often review from UG. It is the following years, and years with hands on and reading around things that counts. Anyone can do that really.

[Mighty Molar]

I got a sick last year; before visiting the physician's office, I searched WebMD, Google, and UpToDate just to have a rough ideas about my illness; surprisingly, the diagnosis was identical

 

now, obviously, WebMD is very primitive and could never replace a real MD, but it was just an old web-app. I could imagine, in the near future, a well-designed AI / program to do a much better job. A trained NP or PA will do the physical exam, interact with the patient, and then enter all the parameters into the PC Complicated medical problem will later be referred to MD

 

Just ~10 years ago, I still used the black and white screen Nokia cell phone; and my current I-phone 4s would sound like a science-fiction items at that time. Wonder how thing will change in the next decade

 

just my thought

[seeking1]

ITT: discussions about the advent of health informatics.

[medigeek]

I got a sick last year; before visiting the physician's office, I searched WebMD, Google, and UpToDate just to have a rough ideas about my illness; surprisingly, the diagnosis was identical

 

now, obviously, WebMD is very primitive and could never replace a real MD, but it was just an old web-app. I could imagine, in the near future, a well-designed AI / program to do a much better job. A trained NP or PA will do the physical exam, interact with the patient, and then enter all the parameters into the PC Complicated medical problem will later be referred to MD

 

Just ~10 years ago, I still used the black and white screen Nokia cell phone; and my current I-phone 4s would sound like a science-fiction items at that time. Wonder how thing will change in the next decade

 

just my thought

 

Pharmacists were supposed to be replaced by machines like 4 years ago, their job market remains unaffected by technology (in a negative sense).

 

Also, how do you distinguish yourself from having a certain illness where the odds are 70% while the other is 65%? How do you pick up on rare symptoms? Who's going to take liability for these decisions? A 90k'year NP?

 

By the time GPs are replaced largely, then so will have the majority of the work force. Not exactly ideal for the economy.

 

Personally because of the unknown, surgery is definitely the 'safest" specialty. No one is going to let artificial intelligence operate on them.

[rmorelan]

 

Personally because of the unknown, surgery is definitely the 'safest" specialty. No one is going to let artificial intelligence operate on them.

 

ha don't count on that - some newer autotracking suturing systems are coming online now that make somethings more accurate. We have real time image tracking and robotic surgery. A lot of the tools you would need are already there. I think surgery is actually one of the ones that would be more likely to be replaced over some of the other fields (of course not tomorrow though).

 

The point is no one would be replaced in the near future - only that their jobs would have parts taken over etc, etc eventually leading to more and more automation.

 

As for the economy - as a thought exercise I have to say where do you think all the tech is leading to? What is the end point of technology as it were. I always think that is an interesting question.

[Mighty Molar]

Have you guys read the news about auto-driving cars currently developed by Google Inc? Not to mention many cars in Montreal already have auto parking option. Who know what we will have in 10 years (of course, not tomorrow)

[rmorelan]

Have you guys read the news about auto-driving cars currently developed by Google Inc? Not to mention many cars in Montreal already have auto parking option. Who know what we will have in 10 years (of course, not tomorrow)

 

I am looking forward to those - I don't find driving particularly enjoyable - imagine taking a long trip by car when you can actually sleep or study etc. Ha!