Will Healthcare Internet of Things(HIoT) dehumanize healthcare?

Good afternoon everybody. As a neurosurgeon, trained in the BC era before computers and before Christ are one and the same. I am extremely concerned whether the increasing use of artificial intelligence in health care will dehumanize health care as a whole. Healthcare is something very personal. It is very hard to feel that your experience was excellent. When those treating you, don’t introduce themselves or make eye contact, or say what they are doing to you and why conversely when these simple things are addressed the experience rapidly improves, the good news is that excellence in health care is neither hard nor expensive, but the bad news is that despite that in some places even these apparently simple things are not common.

Today, it’s a Venn diagram if you want to call it, people, processes and technology Let us see what is actually happening . James Mayo several decades ago mentioned very clearly that patients don’t care how much you know. They don’t care about artificial intelligence, until they know how much you care for them. The aim of excellence is to produce disease and prolong life that trial of medicine is to eliminate the need for a physician. It doesn’t matter if cut if care is cutting it and technologically advanced If it doesn’t take into account the patient’s goals whatever your do may not really be worth doing.

Now let’s see what is the future of personalized medicine, personalized medicine has already started we are now talking of genomics we are talking of customizing antibiotics to suit exactly what you need. As Steve Job once said, Job said you can see the Apple here are solutions which may not really have been a problem. Just because technology helps us to solve a problem does not mean it was a problem in the first place. At last lecture about five decades ago said when he introduced the Gamma Knife which at that time was the world’s most technologically advanced instrument, he said. I quote, a fool with the tool is still a fool.

At the end of the day my dear friends is a man behind the machine that comes not the machine itself. When you have a hammer, everything around you looks like a nail and it was an expensive hammer even more so. I am worried that artificial intelligence may be a story of a technology in search of an application rather than being a technology should not be an end in itself. It should merely be a tool to achieve an end. You can see here several publications, which talk about advances in predictive preventive and personalized medicine. Mind matters. Working with emotional intelligence is as important as is working with big data and analytics.

Many of us are refused to accept the fact published literature in JAMA and other sources that the third commonest cause of death in the United States of America is iatrogenic. It is we members of the healthcare system who produce the equivalent of two jumbo jets crashing every day. This is what is happening in hospitals. If this occurs in the U.S. you can imagine how it is in other countries in the world, because of the U.S. fantastic ability to analyze data, they are able to document this. There are stories, hundreds of stories about knee replacements causing problems strengthening causing problems and so on. There are many publication. What happens when doctors don’t listen?

Don’t let your doctor kill you and so on and so forth. Of course, artificial intelligence is helping us tremendously to identify the causes of preventable death which occurs in hospitals. But let us not for a moment forget that in artificial intelligence alone is not enough. It depends on how you used. This was a photograph which I took six years ago and the world has changed since then. It’s rather difficult to find out even for me where this two week old baby is assisted by all the technology in the world. imagine the new intensive care units are going to be in a few hours from now. Sir William Osler said a century ago, listen, listen, listen. He’s telling you the diagnosis.

To him, each patient was a universe of one. Building patient report, confidence and trust, this was what we were taught in the 20th century. Of course, a friend of mine very recently said, when I talked about the importance of empathy and sympathy he said, doctor we will be having artificial empathy and artificial sympathy. I don’t know whether this is going to happen in my lifetime.

In the 20th century particularly in developing countries, it was assumed that the doctor knows best Today in 2018, the patient is primarily involved in decision making in weighing the various options available I foresee that in the next few years I will be a member of an endangered species and perhaps will be a small component in the entire decision making process of the empowered patient. This is the future, this is what is going to happen. We were all taught that communication is the basis of good health care. Communication is a skill not an inborn trait and this is the key to a good doctor-patient relationship. I wonder how important communication will be in the era of digital health care.

Most doctors interrupt patients every 18 seconds when they are conversing and again it has been shown that 54% of patient concerns and 45% of patient complaints are not properly addressed Will AI address all these language of course is a barrier and I am talking I am NOT talking of Taiwanese I am NOT talking of India I am NOT talking of English I am talking of a language which the patient speaks that doctor however the super specialist he may be must get into the mind of the patient and understand what exactly the patient was and of course inexperience and Prejudice adds to the complexity of communication.

Today we have embarked on the e-patient movement engaged e-patients are changing what’s possible in healthcare. The e stands for electronic equipped enabled empowered expert English and even etc etc. This is the patient of today Dr. Google and professor Facebook, the social media are giving us intense competition. Digital clinicians need to work together with the e-patient. Societies like society for participate medicine have already started. I am worried that the era of the mpathizing doctor may be totally absent in a few years for now. Communication, communication, communication. This is the essence in addition to clinical judgment and wisdom The lower part of the slide shows an example of a patient whom I had seen who had done an MRI 2008.

10 years later, the MRI is absolutely the same hearing is preserved. Though my special area of interest is Neurological Surgery, I withheld the temptation of treating him at all. Ladies and gentlemen, not treating is as important or more important than treating. Just because you know how to treat does not mean you need to treat. One should be a clinician par excellence it is not machine language it is important. It is not random forest which is important but you need to be a clinician path excellence. Never, ever discount the history of the observations of a patient family. Long-term goal was a short-term goal for your patient and their family Patient’s survival at what cost Yes, I can treat the patient.

I can introduce 21st century technology but is this what the patient wants? We need to get into the mind of the patient and understand what he wants Reduce the giant problem into individual constituents and try to address each one of these individual constituents. The ideal doctor is a master craftsman, a superb technician skilled in knowing more and more about less and less. He is a specialist among specialists. Constantly innovating, he has to unlearn; he has to relearn. If you don’t emotionally change, you will be history. And finally, new skills must be acquired. W hat got you there does not keep you there. You become a member of the Jurassic Park very quickly.

I insist that every one of us today not learn but more important be unlearned. We relearn. This is what is important. Be ready to do a mid-course correction, respond to what the patient wants. Do not react Do the job you hate the most. This is the most difficult thing and remember we are what we repeatedly do . The doctor has to be a scientist. Measure measure measure Evidence-based medicine you need proof . The days of randomized clinical trials to be replaced by big data analytics prediction of the future. Update update update This is what is required continually assess what is working and what is not.

I cannot resist the temptation of giving you two examples from my own neurological practice of the last four decades to show what I consider clinical judgment and wisdom. primum non nocerum Do not make the patient worse. Here is a young lady whom I saw 20 years ago and made a diagnosis of a cavernous sinus meningioma and aggressive neurosurgeon would certainly have operated on her but I thought that reversing her eurological deficit keeping her healthy is more important. I have been following her and to my absolute satisfaction a few months ago when I repeated the MRI the findings had not changed at all over a period of two decades. Non-intervention is as important as using all the technology in the world.

Get another instance of a giant arteriovenous malformation occupying one-third of the cerebral Hemisphere Again aggressive micro vascular surgeons may have suggested surgery followed byradio surgery and so on. What did I do? In 1999 I delivered stereotactic radiosurgery in multiple sessions a major part of the AVM was still left behind. But I was under the impression that I don’t care how the MRI looks. It’s how the patient looks at is important to me and again 18 years later when I repeated the investigations . the AVM was still present I’m sure they’re younger neurosurgeons today would be laughing at me but I am delighted because the patient is neurologically absolutely fine.

So this, ladies and gentlemen, is where clinical judgment and wisdom comes and not at all sure where the artificial intelligence will take into account what the patient wants.