The Conversation

Responses and reverberations


In March, Jonathan Cohn examined whether doctors will become obsolete as technology revolutionizes—and increasingly automates—health care.

Sherlock Holmes, the master of observation, had an intellectual catalyst in the comparatively prosaic and empathetic Dr. Watson. Physicians, at their best, are observers, drawing clues from a patient’s history, physical exam, and lab results. With the ever-expanding tome of medical knowledge driving further subspecialization, there are, invariably, knowledge gaps. Fortunately, as demonstrated by Jonathan Cohn’s article, computers can help fill these gaps and free physicians to actually treat the patient (which has, in many patients’ eyes, become an afterthought to their overworked, robotic doctors). It’s time physicians embrace their own Watson. Sir Arthur Conan Doyle, himself a doctor, would surely agree.

Marshall Dines, M.D., M.B.A.
Los Angeles, Calif.

Automation is the key disruptive innovation needed to improve care and lower medical costs? Really? Although automation can often guide smarter clinical decisions and steer dollars more efficiently through the maze of insanely complex reimbursement rules, it isn’t likely to be the solution to our health-care woes—not least because human interaction and compassion are essential to effective healing, and cannot be automated.

Robots, however, may be the only ones willing to deliver care in the future, because doctors are opting out. Data show that disaffection among physicians is at an all-time high: in one 2012 study, nearly half of 5,000 surveyed physicians said they hoped to be out of medicine within five years; nine out of 10 said they would not recommend entering the profession. Their reasons? Uncertainty and dysfunction in the system, not fear of automation. From many physicians’ perspectives, medicine is no longer a profession but a commodity; its central purpose is not improving the health of patients but maintaining the health of the system. Today’s doctors and patients often do not develop meaningful, trusting relationships but merely conduct transactions (“billable events”).

Rather than replacing physicians, perhaps a more helpful aim for automation would be to untangle the current information-and-payment mess, to allow doctors to deliver care more effectively and efficiently. One hopes that our resource-rich country, which has arguably the world’s best medical training and capacity for innovation, can regain its footing and refocus to serve the needs and best interests of patients.

Frank M. Reed, M.D.
Missoula, Mont.

The increasing use of computer-based medicine (CBM) is rarely driven by providers. A considerable impetus is political diktat, thanks to bountiful donations from rich Silicon Valley enterprises to political campaigns. The introduction of CBM on a broad scale may well result in better clinical outcomes, but only at a significant financial cost. Robots will broaden the differential-diagnoses list available to clinicians and thus, given the current and seemingly uncontrollable medical-malpractice environment, compel further diagnostic testing, with the concomitant costs and risks of false positives. False or misinterpreted lab testing will then spawn more and often dangerous, not to mention costly, diagnostic testing.

Barry Kisloff, M.D.
Pittsburgh, Pa.

I see The Atlantic has taken its monthly trip into medical cuckoo-land. Yes, of course, computers can do anything, including hit home runs and sink basketball shots, and can do these things better than people can do them. However, the idea is a long way from reality. When I was a young man in my fellowship 35 years ago, one of the other fellows in the program decided to drop out—he felt that computers would soon make doctors redundant. So this idea has been around awhile. The problem is not only that programming computers to practice medicine is very difficult; it is also that doctors spend little time just pondering diagnostic possibilities. Most of their time is spent on data entry and patient assessment.

The real potential addressed in this article has nothing to do with computers. Cohn proposes that cost savings can be realized by using less-well-trained personnel than doctors. Well, we can do that right now. In fact, the way Europeans get by so cheaply is by giving their doctors no more training than an American nurse-practitioner receives. Just start calling nurse-practitioners doctors and forget the computers.

People who believe that a computer will not miss diagnoses fail to understand how much serendipity is involved in hitting upon the right diagnosis in the first place.

Diodotus comment

Why Obama Really Matters

In March’s “The Emancipation of Barack Obama,” Ta-Nehisi Coates posited that the president’s reelection matters even more than his election because it repudiates the history of violence and legal maneuvering designed to strip blacks of privileges. A reader offers another reason.

For a long time, many people—myself included—worried that if Obama was voted out of office, the Democratic Party would not nominate another black person for the foreseeable future. That’s one reason many of us wanted Obama to win reelection, beyond the political and policy implications that are important in their own right. The election of Barack Obama was a milestone in the history of race relations in this country, but his reelection was probably necessary for the message to fully sink in. And in a way, it was ideal that his victory wasn’t some foregone landslide—the fact that it surprised so many people has probably helped serve as a wake-up call.

Kylopod comment

education and economics

In March’s Chartist dispatch, Nicole Allan and Derek Thompson studied “The Myth of the Student-Loan Crisis.”

The authors try to justify the 150 percent increase in college costs since 1995 and the 300 percent jump in college-loan debt since 2003 with a variety of misleading graphs and statistics.

First of all, comparing the return on a college degree to the return on stocks or on gold is not valid. You can invest money in the stock market or gold and let the investment do the rest. With college, you have to invest money and put in years of work, while at the same time giving up other pursuits that may have economic returns, such as starting a business. And after college, the return on your investment will, to a large extent, depend on the ongoing effort that you put in throughout your career.

The authors correctly point out that a college education, as well as a high-school education, can be very important to an individual’s success. So I am thankful that our local K–12 schools have kept their costs in line with inflation and do not use the importance of their work to justify a similar 150 percent increase in costs and 300 percent increase in local debt. Because in the long run, managing costs is essential to making education accessible and sustainable for future generations of students.

Brian Schneider
Menomonee Falls, Wis.

“The Myth of the Student-Loan Crisis” presented an infographic on college debt that was long on graphics and short on info. Yet even where the authors are committed to denying there is a crisis, the data poke through the happy-talk narrative.

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