Once again Rick Novak serves up a virulent novel that addresses an ongoing change in medicine that worries most of us – the growing dependence on robotics in surgery and the dehumanization of medicine: doctor patient interaction is altered by EMR and IT reporting of visits to insurance companies and the warmth of communication suffers. Rick takes this information to create a story about the extremes of AI in the form of a glowing globe that is Dr Vita and the struggle computer scientist/anesthesiologist Dr Lucas assumes as he tries to save medicine from the extremes of the ‘new age’ called FutureCare. As expected, Rick’s recreation of the tension in the OR and in interaction of the physicians is on target: his own experiences enhance the veracity of the story’s atmosphere.
Rick Novak writes so extremely well that likely has answered the plea of his readers to continue this `hobby’. He is becoming one of the next great American physician authors – think William Carlos Williams, Theodore Isaac Rubin, Oliver Wolf Sacks, Richard Selzer, and also the Brits Oliver Wendell Holmes et al. Medicine and writing can and do mix well in hands as gifted as Rick Novak. Highly Recommended. Grady Harp, April 19
Doctor Rick Novak’s editorial “Artificial Intelligence in Anesthesia and Perioperative Medicine is Coming” was just published in EC Anaesthesia. I refer you to the direct link here.
Highlights from the paper follow:
Artificial intelligence in medicine (AIM) will grow in importance in the decades to come and will change anesthesia practice, surgical practice, perioperative medicine in clinics, and the interpretation of imaging. AI is already prevalent in our daily life. Smartphones verbally direct us to our destination through mazes of highways and traffic. Self-driving cars are in advanced testing phases. The Amazon Echo brings us Alexa, an AI-powered personal assistant who follows verbal commands in our homes. AIM advances are paralleling these inventions in three clinical arenas:
1. Operating rooms: Anesthesia robots fall into two groups: manual robots and pharmacological robots. Manual robots include the Kepler Intubation System intubating robot, designed to utilized video laryngoscopy and a robotic arm to place an endotracheal tube , the use of the DaVinci surgical robot to perform regional anesthetic blockade , and the use of the Magellan robot to place peripheral nerve blocks [3,4]. Pharmacological robots include the McSleepy intravenous sedation machine, designed to administer propofol, narcotic, and muscle relaxant , and the iControl-RP machine, described in The Washington Postas a closed-loop system intravenous anesthetic delivery system which makes its own decisions regarding the IV administration of remifentanil and propofol . This device monitors the patient’s EEG level of consciousness via a BIS monitor device as well as traditional vital signs . One of the machine’s developers, Mark Ansermino MD stated, “We are convinced the machine can do better than human anesthesiologists.” The current example of surgical robot technology in the operating room is the DaVinci operating robot. This robot is not intended to have an independent existence, but rather enables the surgeon to see inside the body in three dimensions and to perform fine motor procedures at a higher level. The good news for procedural physicians is that it’s unlikely any AIM robot will be able to independently master manual skills such as complex airway management or surgical excision. No device on the horizon can be expected to replace anesthesiologists. Anesthetizing patients requires preoperative assessment of all medical problems from the history, physical examination, and laboratory evaluation; mask ventilation of an unconscious patient; placement of an airway tube; observation of all vital monitors during surgery; removal of the airway tube at the conclusion of most surgeries; and the diagnosis and treatment of any complication during or following the anesthetic.
2. Clinics: In a clinic setting a desired AIM application would be a computer to input information on a patient’s history, physical examination, and laboratory studies, and via deep learning establish a diagnosis with a high percentage of success. IBM’s Watson computer has been programmed with over 600,000 medical evidence reports, 1.5 million patient medical records, and two million pages of text from medical journals . Equipped with more information than any human physician could ever remember, Watson is projected to become a diagnostic machine superior to any doctor. AIM machines can input new patient information into a flowchart, also known as a branching tree. A flowchart will mimic the process a physician carries out when asking a patient a series of increasingly more specific questions. Once each diagnosis is established with a reasonable degree of medical certainty, an already-established algorithm for treatment of that diagnosis can be applied. Because anesthesiology involves preoperative clinic assessment and perioperative medicine, the role of AIM in clinics is relevant to our field.
3. Diagnosis of images: Applications of image analysis in medicine include machine learning for diagnosis in radiology, pathology, and dermatology. The evaluation of digital X-rays, MRIs, or CT scans requires the assessment of arrays of pixels. Future computer programs may be more accurate than human radiologists. The model for machine learning is similar to the process in which a human child learns–a child sees an animal and his parents tell him that animal is a dog. After repeated exposures the child learns what a dog looks like. Early on the child may be fooled into thinking that a wolf is a dog, but with increasing experience the child can discern with almost perfect accuracy what is or is not a dog. Deep learning is a radically different method of programming computers which requires a massive database entry, much like the array of dogs that a child sees in the example above, until a computer can learn the skill of pattern matching . An AIM computer which masters deep learning will probably not give yes or no answers, but rather a percentage likelihood of a diagnosis, i.e. a radiologic image has a greater than a 99% chance of being normal, or a skin lesion has a greater than 99% chance of being a malignant melanoma. In pathology, computerized digital diagnostic skills will be applied to microscopic diagnose. In dermatology, machine learning will be used to diagnosis skin cancers, based on large learned databases of digital photographs. Imaging advances will not directly affect anesthesiologists, but if you’re a physician who makes his or her living by interpreting digital images, you should have real concern about AIM taking your job in the future.
There’s currently a shortage of over seven million physicians, nurses and other health workers worldwide . Can AIM replace physicians? Contemplate the following: All medical knowledge is available on the Internet; most every medical diagnosis and treatment can be written as a decision tree algorithm; voice interaction software is excellent; the physical exam is of less diagnostic importance than scans and lab tests which can be digitalized; and computers are cheaper than the seven-year post-college education required to train a physician. There is a need for cheaper, widespread healthcare, and the concept of an automated physician is no longer the domain of science fiction. Most sources project an AIM robot doctor will likely look like a tablet computer. For certain applications such as clinical diagnosis or new image retrieval, the AIM robot will have a camera, perhaps on a retractable arm so that the camera can approach various aspects of a patient’s anatomy as indicated. Individual patients will need to sign in to the computer software system via retinal scanners, fingerprint scanners, or face recognition programs, so that the computer can retrieve the individual patient’s EHR data from an Internet cloud. It’s possible individual patients will be issued a card, not unlike a debit or credit card, which includes a chip linking them to their EHR data.
It’s inevitable that AIM will change current medical practice. In all likelihood these changes will be more powerful and more wonderful than we can imagine. A bold prediction: AIM will change medicine more than any development since the invention of anesthesia in 1849. How physicians interact with these machines will be a leading question for the twenty-first century.
Silicon Valley transforms American medicine with the invention of Doctor Vita, the world’s first artificial intelligence physician module. Medical care is streamlined, automated, consistent, and costs are controlled. Enter Dr. Alec Lucas, a young computer scientist and physician who perceives serious flaws in the FutureCare System. Patients are dying. When Lucas makes his concerns public, he’s persecuted as an unsafe outlier of antiquated and flawed human medical care. The FutureCare System attacks his quixotic bid to halt the revolution in medical technology, and Lucas strives to solve the dystopian horrors behind Doctor Vita.
Rick Novak MD is board-certified in internal medicine and anesthesiology, and is an Adjunct Clinical Professor in the Stanford University Department of Anesthesiology, Perioperative and Pain Medicine. His experience in operating rooms, clinic settings, ICUs and emergency rooms give him unique and broad insight into what the near future of artificial intelligence in clinical medicine can and must look like.
The year 1984 has come and gone, but the dystopian future of medicine described in the novel Doctor Vita is with us today.
Alec Lucas is a physician. His job is to diagnose and treat disease, and to keep people alive. Enter Doctor Vita, the most important invention in the history of medicine. Each Vita is a 12-inch white sphere packed with unlimited medical knowledge, compassionate empathy, a tireless work ethic, and a capacity for machine learning. Doctor Vita units are inexpensive, tireless, and brilliant, and arrive as the solution to America’s healthcare crisis.
Doctor Vita’s job is to also diagnose and treat disease, and Doctor Vita’s purpose is to take Alec Lucas’ job. When Lucas witnesses patients dying in never before seen ways, he’s convinced the Vita system is causing the fatalities. In retaliation, the machines blame the deaths on human errors by Lucas. The three physician inventors of Doctor Vita, powerful men of great wealth and even greater ambition, are determined to bury Alec Lucas beneath the tidal wave of artificial intelligence in medicine.
Set on the stage of a modern academic hospital, Doctor Vita is a prescient tale of Orwellian medical advances. In this near-future tale of man versus machine, Doctor Vita blends science, murder, and ethical dilemma as the story drives toward the unexpected twists at its conclusion.
Author Rick Novak MD is a double-boarded internal medicine and anesthesia doctor trained at Stanford University, and a current Adjunct Clinical Professor of Anesthesiology at Stanford. This realistic vision of Doctor Vita, set in the operating rooms and clinics of the future, could only be written by a physician experienced in both settings—one who balances both the advances of Silicon Valley and the tenants of traditional medicine.
All Things That Matter Press is publishing the novel Doctor Vita in 2019.
As a practicing physician, I find it to be a fascinating paper, and I recommend you click on the link and read it. The authors begin with a discussion of the art and value of BS detection. They mention that Ernest Hemingway was once asked, “Is there one quality needed to be a good writer, above all others?”
Hemingway replied, “Yes, a built-in, shock-proof, crap detector.”
The authors write, “While flat-out dishonesty for short term financial gains is an obvious answer, a more common explanation is the need to say something positive when there is nothing positive to say. . . . The incentives to generate BS are not likely to diminish—if anything, rising spending and stagnant health outcomes strengthen them—so it is all the more important to have an accurate and fast way to detect and deter BS in health care.”
The authors list their Top 10 Forms of BS in Health Care. The first four forms of BS weave a common theme:
Top-down solutions: High-level executives and top management in the health care industry are supposed to engineer alternative payment models, but nothing has worked to date.
One-size-fits-all, off-the-shelf: Leadership of industry and government assume one solution will work for multiple organizations, without customization.
Silver-bullet prescriptions: A “silver bullet” is described as something that will cure all ills, and must be implemented because it been “decided that it is good for you,” Electronic health records (EHRs) are a prime example of a silver-bullet prescription. The federal government pushed the use of EHRs, claiming the systems would reduce costs and improve quality—but Burns and Pauly argue EHRs “eventually raised costs and only mildly touched a few quality dimensions.”
Follow the guru: We must follow a visionary guru with a mystical revelation about what needs to be done. The authors describe how, in health care, Harvard professor Michael Porter and former CMS (Center of Medicare and Medicaid) administrator Don Berwick launched theories based on population health, and per-capita cost, to little success.
The current U.S. healthcare market is dominated by large corporations, led by businessmen who outline a yellow brick road for physicians to lead patients along. There is minimal effective policy-making from physicians. Healthcare stocks consistently grow in value, with little relationship to an improvement in clinical care, value, or cost. The government is involved as well, as in their mandate for Electronic Health Records (EHRs), a technology change that cost a lot of money, while forging a barrier between clinicians and the patients we are trying to interview, examine, and care for.
Where will the current trends take us? Will businessmen and/or the government prescribe health care? Will more and more computers and machines dominate health care?
Self-driving cars, Siri, Alexa, automated checkouts at Safeway, and IBM’s Watson are technologic realities. Will we someday see a self-driving physician with the voice of Siri and the brains of Watson?
Call that device “Doctor Vita.”
The saga of Doctor Vita, by Rick Novak, arrives in 2019 from All Things That Matter Press.
How do you imagine the future of medical care? Cherubic young doctors holding your hand as you tell them what ails you? Genetic advances or nanotechnology gobbling up cancerous cells and banishing heart disease?
Rick Novak describes a flawed future Eden where the only doctor you’ll ever need is Doctor Vita, the world’s first artificial intelligence physician, endowed with unlimited knowledge, a capacity for machine learning, a tireless work ethic, and compassionate empathy.
Set on the stage of the University of Silicon Valley Medical Center, Doctor Vita is the 1984 of the medical world– a prescient tale of Orwellian medical advances. In this science fiction saga of man versus machine, Doctor Vita blends science, suspense, untimely deaths, and ethical dilemma as the technological revolution crashes full speed into your healthcare.