[ad_1]
When Kim Hilliard shows up at the diabetes clinic at the University of New Orleans Medical Center, she's not there just for an eye exam. The human contacts that accompany it help him navigate his complex health condition.
In addition to diabetes, the 56-year-old has hypertension. She also underwent back surgery and a bariatric operation to help her control her weight.
Hilliard is also at risk for blindness, which can result from a disease called diabetic retinopathy. So, this February, his vision will be evaluated by a new practitioner: software.
Such automation begins to infiltrate medical care. Depending on how it is deployed, this could help reduce medical errors and potentially the cost of care. It could also create a gap between health care providers and people with more modest means.
"My fear is that we end up with what I called an" apartheid of health care, "says Sonoo Thadaney-Israni, of the Stanford University School of Medicine. "If we create algorithmic care and" kiosks "in one way or another, with a focus on efficiency and throughput, the people who will eventually access and who will use them will be those who will not already have privileges of any kind. "
We are far from this dystopian world for the moment, but are we going in this direction? This possibility is what concerns it.
Hilliard's experience at the clinic underscores the importance of human contact. She is here every year for an eye exam to look for signs of blindness that may occur in people with diabetes.
"I had complete diabetes when I was 40," she says. It's a challenge for her to stay abreast of all her health issues. "I'm going to so many doctor's appointments that I'm tired!" she says.
The software for identifying early signs of diabetic retinopathy, called IDxDR, can do this work without the intervention of an expert, but the qualified medical staff of this clinic is playing, for the moment at least, still an active role .
After Hilliard finishes the exam, Nurse Practitioner Chevelle Parker shows her pictures of her eye.
"If we zoom in here, we can see some small fat deposits here, okay?" Parker says. Hilliard leans over and studies the image of his retina. "It can come from the food you eat," says Parker. "Think of some of the fatty foods you eat – sausages, bacon."
Hilliard says she stopped eating these foods last fall after her gastric bypass.
"Well, when you eat them, the deposits settle on your eyes," says Parker. "That's why we're talking to you about your diet.And now that you know you can not have one, that's the reason, OK?"
Parker continues to strengthen dietary recommendations for diabetes. Hilliard should have breakfast less than an hour after waking up, and she should be sure to eat protein instead of carbs at the end of the day.
Hilliard gratefully accepts the advice as well as a referral to an ophthalmologist, who will need to take a closer look at the signs of eye damage.
"I'm doing what I can to not go blind," says Hilliard. "So, whatever they tell me to do, that's what I do, at least I try."
Hilliard's experience cruelly reminds us that health care is more than just a transaction. In the United States, six in ten adults have chronic disease and four in ten have two or more, according to the Center for Disease Control and Prevention.
It's the real world in which computer algorithms are starting to take off in medicine.
"I think it's been too long since we assume that any new technology is good, the more it's worth," says Abraham Verghese, a doctor who works in partnership with Thadaney at a Stanford center that focuses on the human aspects of medical care .
"New is not always better," he says as we sit all three in their office.
Medical care, like many of our society, creates haves and have-nots, says Thadaney. "We need to make sure that technology does not further exacerbate equity and inclusion issues."
"Just to advance this thought," says Verghese, "the artificial intelligence algorithms we already know are causing inequities in bail, inequities in real estate" as well as in the maintenance of order. Unconscious racism and other prejudices mingle without the developers even being aware of it. "This same type of algorithmic approach can easily infect the medicine and probably does," says Verghese.
These technologies are driven by companies interested in making a profit, which does not necessarily lead to better care. In fact, the savings promised by these technologies could result from reducing the time spent face to face by a doctor or nurse.
"One thing I think has not changed since ancient times, is that when you are seriously ill, you feel bad," says Verghese. "And among all the other things you need, you also want someone to take care of you – not just a member of your family, but a person with the scientific knowledge to also express his or her care. . "
Thadaney says that a member of his household recently brought this item home. He had been injured in a bicycle accident. The treatment involved a complex crossing in two hospitals and a rehabilitation center. Thadaney was able to plead his case. "I was able to call doctors friends," she says. "I was able to appeal to the management of these organizations and ask for something different."
This intervention alone gave her family a benefit, but she said that what really helped her was a visit to Verghese. The doctor "did not tell him anything different from what he already knew," she said, but he comforted and reassured, "and I think it accelerated his recovery."
Verghese said that he was recently reading Walt Whitman's stories about the time he was taking to look after the wounded in medical tents on the mall in Washington DC.
"He did what these young men needed the most," says Verghese. "They were so far away from home, they needed someone to read them, to hold their hand, to write letters to them and to take care of every task." And that was the The most basic kind of care, nothing has changed, you know, we're still the same people. "
Verghese hopes that technology, such as artificial intelligence, can improve medical care, but only if it is not done to the detriment of human contact. AI can potentially allow clinicians to spend more time with their patients, depending on how they are deployed. In principle, the AI could also help the most difficult tasks.
"We do not need another image recognition. [system], "he says. They are all very good and very tidy. "
But where technology can do the most good is to help sort the clues collected during medical treatment. "Medicine is a mess," he says. "Help us."
Some of the simple improvements that AI can bring have their place, says Thadaney. "Yes, the patient wants you to ensure the efficiency of your system to avoid 19 bills with the same stupidity."
But patients also want to get better. To achieve this, doctors and nurses can not simply be machine assistants. Her mantra to the young doctors she advises is: "At the end of the day, be there – it matters a lot."
In March, Stanford inaugurated a new institute dedicated to the human dimensions of artificial intelligence. "We want to make sure there are ways to create and disseminate best practices," says Dr. Russ Altman, professor of bioengineering and genetics at Stanford and associate director of the new institute. "It is unfair and unrealistic to expect technologists to be experts in the field."
He shares the concerns of Verghese and Thadaney that machines could degrade the human relationship at the heart of medicine.
"Medicine is a combination of art and science," which will be complemented by artificial intelligence, says Altman. "But the act of getting your hands on a patient, showing that you really care about what's there, what's their problem [and] Assuring them that you will accompany them on an odyssey – it could take a while, "he says. It is very difficult to imagine being replaced by a computer. "
You can contact NPR Scientific Correspondent Richard Harris at [email protected].
[ad_2]
Source link