DOCTORS' LOUNGE
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MY SCREEN DID NOT SAVE ME AUTHOR Mary Barry, MD
I
about fell out of my chair while reading a
recent opinion piece in the New England
Journal of Medicine (NEJM) of May 16.
David Asch, MD, Sean Nicholson, PhD,
and Marc L. Berger, MD, together wrote
“Toward Facilitated Self-Service in Health
Care” (Vol. 380:20), in which they describe
the physician-patient encounter as “health
care’s choke point.” highly educated people have to, ugh, touch the patient.) And who
would design and own and profit from all these regulating bodies?
And who would pay for all of that? I suspect the unsuspecting
patient would, in the end.
The problem, they say, is that by insisting that doctors be involved
in the care of patients, “we shackle ourselves to a system in which
increased patient needs must be met with more doctors.” They point
out that McDonald’s overcame this with a fast food production line,
and TurboTax overcame the need to use a tax accountant. “Until
we invent the TurboTax of health care, we won’t achieve the kind
of productivity gains needed for transformative change in quality,
access or cost.” Our goals are simple: caring for our patients the best we can. We
do this because excellent medical care demands that we understand
and respect the person needing it, at that moment, and for that
one person. We do this for ourselves and our consciences. We do
this because we hate human suffering. So, what’s in it for the Bot?
They propose that “Bots” deliver first-line care via artificial
intelligence algorithms for common primary care ailments such as
hypertension, hyperlipidemia, anticoagulation and diabetes. Bots
would determine the necessary “care” and deliver it online. These
Bots would be backed up by a physician extender, supervised ulti-
mately by a physician, albeit hundreds of miles away. They would
abolish state-based regulation of licensing medical professionals.
“Once health care is untethered from in-person contact, efficiencies
would be generated by interstate commerce.” They would abandon
“legacy payment systems based on how and where care is delivered.”
But, of course, they would then insist on “expanding the regulatory
expertise, processes and capacity for ensuring that self-service ap-
proaches to health care meet the safety and effectiveness standards
we expect from drugs, devices, clinicians and organizations.” This
would require a huge financial investment. (The investors, of course,
expect to reap billions from their robots – think of the savings if no
One of their goals for these Bots is thus “productivity gains.”
Doctors and their APRNs and PAs in the corporate/EMR medical
model run endlessly on their laptop wheels, spending days and nights
thinking and talking and examining and deciding, and typing and
typing and typing and typing and typing.
It’s a thing that is motiveless, emotionless and remorseless. It is
nothingness, a cyber-void made of numbers. Its existence makes
some people very rich, profit being always the motive behind human
endeavors that enrich the few and ruin the rest. It would have to
be an enormous profit, to withstand the medicolegal bills that will
mount as people suffer the disastrous results of machines making
medical decisions. Medical care without benefit of human touch,
intuition, engagement, compassion and judgment is not care. It’s a
fraud and a crime to impersonate a doctor.
Does the Bot realize the patient is demented, or making things
up? Can the Bot tell the patient is holding back tears? Can the Bot
see how they look septic? How’s that Bot going to hear a gallop? Will
the Bot understand that the patient believes not one thing the Bot
types? Can the Bot smell cigarettes? Can the Bot admit you because
your lips are blue, because you have a thousand-yard stare, because
you are fainting on your feet? No, no, forever no. Without talking
to, examining and studying the patient, there is no possible way to
care for him. Humans are required just to repair the machines: so
(continued on page 36)
JULY 2019
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