I’ll Tell You Where to Insert Your AI!

I am a family doctor in an underserved community in northern Maine. My soonest available appointment is in three weeks. I see half as many patients per day as I did twenty years ago, before computerized records.

Northern Maine has one otolaryngologist, one cardiologist, two podiatrists, no endocrinologist, no gastroenterologist, no rheumatologist, no dermatologist, no plastic surgeon, no neurologist except for one visiting Houlton from Boston sometimes. We have rotating visiting specialist services by vascular surgery, nephrology and neurosurgery. One of my friends has been waiting three years for a dentist appointment.

Needless to say, primary care doctors here have to manage a greater variety of conditions that in more urban areas are more easily referred out to specialists and subspecialists, who elsewhere even have to advertise and compete for patients.

I am quite frankly disappointed and angry that people who say they can make computers more clever are putting their effort into creating the “next level” of medical software - AI powered decision making.

We don’t even have efficient chart entry programs. I mean, how can any one imagine that a computer could make a correct or rapid diagnosis if there isn’t an efficient way to enter patient histories and physical exams? Most of my colleagues in American medicine use boilerplate prepopulated chart entries that sadly lack nuance and detail. How could another doctor reading that - or, worse, a diagnostic computer program - get any sense of what’s going on?

In my opinion, the computer industry has skipped over the fact that in our “industry” (don’t you love that notion?), we are asking highly trained clinicians to be data entry clerks? More and more doctors now have scribes, an extra person in the room to enter information and data into the EMR.

How would it be if we had computers listening to the conversation (history taking) and the doctor’s explanation to the patient, such as “your neck is soft without enlargement of thyroid or lymph nodes” and entering it all automatically, unobtrusively into the electronic medical record?

And how would it be if I just had to tell the patient what test I wanted to order and then have the AI powered computer program place the order for me, without me clicking or dragging a mouse around, and without typing a single keystroke?

If our computers worked like that, we could see more patients, we would have more time to think or check the latest literature on topics we have to tackle because of the lack of specialists. And fewer of us would retire prematurely or commit suicide because of burnout.

Five months ago, on A Country Doctor Writes, I posted “Make it So”.

https://acountrydoctorwrites.blog/2022/09/18/make-it-so/