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Dec. 6, 2012

TOPIC: Industry, Medical, Patients & Members, Research

Can IBM Watson Replace Dr. Dhaliwal? Probably Not!

Posted by E. Michael D. (Mike) Scott

Everyone in the rare disease community who watched IBM’s “Watson” computer perform on “Jeopardy” early this year probably started to wonder about the potential of “Watson-like” systems to assist doctors in accelerating the accurate diagnosis of rare and unusual medical disorders — one of the first and most critical steps in assuring quality of care.

An article by Katie Hafner in Monday’s New York Times got me thinking about this issue all over again. This article may be of interest to many in the rare disease community.

Ms. Hafner’s article compares the way one of America’s truly expert diagnosticians — Dr. Gurpreet Dhaliwal, an associate professor of clinical medicine at the University of California, San Francisco — goes about the process of assessing the likelihood of particular clinical conditions in specific patients based on all of the available data and compares it to the way that computer programs can support and facilitate that process. She asks three key questions:

  • Just how special is Dr. Dhaliwal’s talent?
  • What can he do that a computer cannot?
  • Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?

In truth, of course, we really can’t answer any of these questions yet. As one reads through the article, it becomes clear that multiple factors are involved:

  • What Rudyard Kipling described (in one of the Just So Stories) as the “satiable curiosity” that Dr. Dhaliwal exhibits about the details of each patient’s condition and the way that those details truly correspond to characteristics associated with very different clinical conditions
  • The ability of a person (or a computer) to absorb, remember, and synthesize information
  • The “gut sense” that an expert diagnostician learns to rely on about what just feels feels right or wrong in a particular case

The application of computers to facilitate the accurate diagnosis and treatment of individual patients has a history going back to the late 1960s and early 1970s. By the 1980s, a still-evolving program called DXplain was being used at Massachusetts General Hospital to offer physicians a ranked list of possible clinical diagnoses based on a definable set of symptoms and laboratory data. And, according to Hafner, Dr. Dhaliwal himself says that he sometimes uses a diagnostic checklist program called Isabel, “just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.”

The bottom line is probably that no computer will ever be able to replace a really skilled diagnostician … but a “Watson-like” computer system may make it an awful lot easier for less skilled diagnosticians to make the right diagnosis sooner and with a greater degree of accuracy.

Anyway … Ms. Hafner’s article is certainly worth reading … and if you are a patient with an undiagnosed condition who lives in the San Francisco area, you could do worse than see if you could get an appointment to see Dr. Dhaliwal, although my bet would be that his phone is going to be ringing non-stop for the next few weeks!

4 Responses to “Can IBM Watson Replace Dr. Dhaliwal? Probably Not!”

  1. You mention “the potential of ‘Watson-like’ systems to assist doctors in accelerating the accurate diagnosis of rare and unusual medical disorders.” You also say that such a “‘Watson-like’ computer system will make it easier for the less skilled diagnostician to make the right diagnosis sooner” and more accurately.

    These are euphemisms for reducing the economic and emotional costs of “delay-in-diagnosis” which is a problem vulnerable to computer-assisted analysis.

  2. Jason Maude says:

    I am the founder of the Isabel system that Dr Dhaliwal uses as a 2nd check.

    Too much time is spent worrying whether computers will replace doctors and not enough trying to get doctors to use the computer systems that have been shown to work like Isabel. Computers will never replace doctors and we never designed Isabel with that in mind. We know that humans are good at designing tools that make them much better at what they were doing before. Doctors will be even better diagnosticians if they use Isabel.

    This is particularly so with rare diseases where early recognition is that much harder. Isabel covers 6,000 diseases, many more than any doctor can hold in their memory and recall appropriately during a 15 minute consultation.

    Your readers will be interested to know that we have recently released a free, patient version of Isabel which can be accessed at http://symptomchecker.isabelhealthcare.com

    This is a very powerful symptom checker which will enable them to get involved in the research of their diagnosis and work on a collaborative differential diagnosis.

  3. Hi Mr. Maude. Thanks for the link to the patient-oriented symptom checker. This may indeed be very helpful for some patients.

  4. Wow that was odd. I just wrote an extremely long comment but after I clicked submit my comment didn’t appear. Grrrr… well I’m not writing all that over again.

    Anyway, just wanted to say superb blog!

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