This holiday weekend I took some time to catch up on my reading and ended up in a place I often end up in. That is the question of how to best configure and offer health care, including care in the area currently termed “mental health.” I put it that way because, as a proponent of integrating mind and body and healing the centuries old Western split between mind and body, I think there really should be no distinction between mental and physical health. Perhaps that is the first point to be made.
One short article from the Atlantic Monthly entitled The Robot Will See You Now by Jonathan Cohn generated pages of notes. This article focuses on IBMs Watson, best known for its success on the TV quiz program “Jeopardy,” which apparently is now focused on the medical information available at the Memorial Sloan-Kettering Cancer Center in New York. Watson is soaking up all the data it can in a project that is designed to produce a computer that can analyze virtually all available medical data, churn it through algorithms, and produce diagnoses and recommendations for further tests and treatment which would be more accurate and reliable than those produced by physicians. The author speaks of this computer as an aid to physicians and also points out that “Wellpoint, the insurance company, has already begun testing Watson as a support tool for nurses who make treatment-approval decisions.” (p. 63) (another problem to be discussed at another time)
In addition, the article discusses changes in the health-care system that will result from this sort of technology:
- Who will practice medicine: “In Silicon Valley and other centers of innovation, investors and engineers talk casually about machines’ taking the place of doctors, serving as diagnosticians and even surgeons – doing the same work with better results, for a lot less money.” One interviewee estimated that robot doctors might replace four out of five human doctors. (p. 64)
- How medicine will be practiced: At some point in the future sensors will be tiny and, of course, the internet is everywhere. So we could have little sensors on, or more likely in, our bodies which report back to medical computers. If blood pressure rises or insulin levels drop or oxygen saturation takes a dip, the computer sends a message (to our smart phone?) and tells us to report to a medical center. The data has arrived before you do and a team of health care workers get to work on you right away. In the author’s words this would happen “…any time you were in danger of becoming unhealthy…” (p. 65)
Wow. Where to begin? There are so many responses to this. My first (others will follow) has to do with how important it is for those of us who think this direction for healthcare is pretty much 180-degrees in the wrong direction to speak out in support of each other and in strong support of maintaining a view that technology like computers, while great tools, cannot provide what people can. I like computers. I am using one now. I have watched my physician go to a computer to find information or verify a finding. A tool such as Watson to sift through data would be a remarkable boon. But that computer cannot provide hope, belief, confidence, connection or support.
I believe there has been an increasing trend in the medical world towards the view that doctors are interchangeable. I realized this when I worked at LA County Hospital (1992-4) and USC’s University Hospital (1997-2001). At USC I was one of two therapists employed by the Department of Family Medicine who saw students on the Health Sciences Campus. Some of the physicians were mystified by our insistence that I see my clients and my colleague see hers. We were not interchangeable. They had apparently accepted that they were. Now the implication is that they (and we) are unimportant and even a hindrance to good medical care (we make mistakes a computer would not). We are trending towards becoming an expendable and expensive nuisance.
It is very true that modern Western medicine has developed some very effective ways of treating some problems. Antibiotics, for example, have saved numerous lives, as have other pharmacological and procedural interventions. Still, many things are difficult to impossible to diagnose, or when properly diagnosed have little in the way of treatment offerings. The question is: how do we best improve this situation?
In a course given at the University of Philosophical Research in Los Angeles, Martin Rossman, MD stated that in his experience the majority of the things brought into a doctors office are not cured by the doctor, but by the body itself. We have, he says, an incredible capacity for healing if we just support the process and get out of the way. This sentiment is echoed by numerous clinicians, among them Victoria Sweet, MD in her recent book God’s Hotel (2012, Riverhead Books).
Many others echo this view, that healing generally comes from within and takes time as well as good food, relaxation, and the caring help of others. All those things Mom talked about. I add to this that, in my view, the body is clearly so intricate and complex that we currently know next to nothing about how it all works and how everything interacts to stay in balance and to thrive. Our methods, refined as we may like to think they are, are really crude and overly powerful. We take one powerful medication to fix an ailment and soon are taking two or three to deal with the unwanted effects of the first one. This happens partly because of the raw power (and toxicity) of the medication and partly because a chemical that acts in one way on a given group of cells will act in completely different ways on other cells and tissues. We can not make the finely tuned delivery that is needed, nor would we know how to aim that delivery if we did.
Further than that, our bodies are not machines. Replacement parts don’t work well, we all know that. And how we respond to help, to rest, to good food and time depends on our connection to other people. Do we trust the doctor? Do we think she is doing the right thing? Do we have the confidence in ourselves to believe that we can get better? Watson probably won’t be a lot of help with those things. The touch, the caring, the empathy doctors provide are important parts of healing and growth. A doctor’s intuition and what is learned from seeing, hearing and sensing a patient’s condition and mood count for a great deal. In addition, a doctor’s ability to generate the belief that we can and will get well can move medical mountains.
Let’s keep Watson handy, but lets not let it take over.
Jonathan Cohn’s article can be found at
thumbnail: http://www.whitehouse.gov/blog/2013/03/20/road-cutting-edge-robots