Category Archives: But seriously guys

Man vs. machine: Who will win the title of Dr. Right?

I’ve got doctors on the brain recently, probably because I’ll be seeing a new one next week. I get excited about a new doctor almost the way some people anticipate a first date. Will I like her? Will she “get” me? Will she at least be better than the last loser? Might she—dare I dream she could be the One? The doctor I’ll want to commit to forever, in sickness and in health?

I am hoping this new doc will work out. But lately I’ve wondered if I’ve been looking for care in all the wrong places. What if the doctor for me isn’t like those others I’ve known? What if my Dr. Right isn’t even human? That’s right—I’m talking about Watson.

watsonjeopardyAccording to an article in the Atlantic, a future in which computers process symptoms, test, diagnose, prescribe, and even perform surgery is no idle daydream. Picture this: you walk into your doctor’s office and he/she sits in front of you with a laptop or tablet, typing in your symptoms (or recording them via voice recognition technology), and then you both wait as the system crunches the data and spits out a list of potential diagnoses and tests to be ordered. Or, maybe, the symptom-listing step is bypassed entirely, because you’ve already been walking around with sensors in your clothing or on your smartphone that have been feeding information about your bodily processes directly into the system, leaving you to fill in only the less quantifiable information—the psychological stuff, perhaps, if they haven’t found a way to quantify it yet. The doctor, in this scenario, wouldn’t be much more than an accessory to the work of the computer.

Personally, I’m intrigued. I’d love to know that my symptoms were being recorded in a database longer lasting than my memory or a doctor’s poorly executed scrawl on a clipboard (it’s mind-boggling to me how backwards and unsystematic our current electronic medical records are). I also appreciate the idea of my symptoms being systematically investigated for patterns, without ignorance or biases clouding the picture. Research is moving too quickly and medical practices are too overbooked for doctors to be able to keep up with the volume of new knowledge or prioritize it appropriately. A computer, properly “trained,” perhaps could.

The Atlantic article references a TechCrunch article from 2012, in which writer Vinod Khosla writes compellingly about “Dr. Algorithm” eventually replacing 80 percent of physicians, with the remaining 20 percent continuing to make themselves redundant by helping the computers improve at diagnosing illness. The Atlantic article characterizes doctors’ response to this prediction as “skepticism, derision, and anger.”

I’m sympathetic. Since I work in book publishing, you might say that I’m living in a glass house when it comes to throwing technological stones. After all, people love to claim that publishing houses are on their way out. Why work with a publisher when you can use CreateSpace? Who needs a publicist when there’s Twitter? Why bother with an editor when you can just turn on spell check?

From my perspective in the publishing industry, I see the oversimplifications implicit in these questions. I know that editors do more than check spelling, and I don’t think that what they do do—isolate and clarify ideas, improve upon the readability, accuracy, and quality of writing, and push authors to consider cuts or additions that would not occur to them, given their proximity to the material—will be made redundant anytime soon. Beyond that, anyone who self-publishes must face the difficulties of designing a beautiful cover and interior, working out the intricacies of metadata and ebook distribution through multiple channels and formats, and finding the time for the kind of promotion that allows a book to sell more than a hundred copies or so. People in publishing have developed expertise in these things and do them on a daily basis. It’s hard to say exactly which traditional publishing professions will still be in play ten or fifty years from now and how the industry as a whole will look, but I do feel safe predicting that it won’t be dead yet.

Similarly, I think it would be oversimplifying to ask, “Who needs doctors when we have WebMD?” WebMD is a fantastic tool, and more sophisticated systems like Watson offer even wilder possibilities. Still, as the Atlantic goes on to note, doctors “do more than process data. They attend at patients’ bedsides and counsel families. They grasp nuance and learn to master uncertainty. For their part, the innovators at IBM make a point of presenting Watson as a tool that can help health-care professionals, rather than replace them.”

Doctors—those mystical good ones, anyway—provide something a computer cannot: connection on a human level. A real, warm hand to hold in trying times, a shoulder to lean on, a compassionate face, a soothing tone. Will we see doctors become, essentially, medical counselors? Will, perhaps, the top 20 percent go on diagnosing alongside the computers, while the rest simply provide the “human” care they’re currently too busy to give?

I must admit, I scoffed a bit at this idea. My mind went to a recent NYT Well blog post about “failing” medical students, which discusses a certain student who couldn’t handle the pressure of working with patients but “did extremely well on all her tests,” so her professor found it difficult to fail her. The prof claimed there were “no multiple choice exams when it comes to things like clinical intuition, communication skills and bedside manner.” Many commenters on this post pointed out that medical schools prioritize the memorization of data for standardized tests over the teaching of those “soft skills” that the Atlantic article suggests may be doctors’ most critical contribution in the future.

On a personal note, I’ve had terrible doctors when it comes to soft skills. They were uninterested in communicating with me, they were too harried for empathy, and as for providing a shoulder to lean on, they may as well have worn barbed-wire epaulettes. Their “hard” skills weren’t stellar, either—they couldn’t seem to cobble my symptoms together into a diagnosis, and they all had their own pet distractions: one harped on fiber, one was big into prescriptions, and one always managed to turn the conversation back toward ear wax. I’ve never felt confident in my doctors’ ability to help me, and in the end, like many people, I had to ask to be tested for celiac disease (and then ask—beg, really—for my test results, too). Would these doctors improve if they had more time to relax and speak with their patients, or would they just become even more useless? I don’t know for sure, but faced with docs like mine, I’m ready for the robot revolution.

But I do have one friend in med school who talks a lot about her doctor-to-patient training as though it’s the part of school that interests her most: the part in which students role-play difficult conversations about health or meet real patients to learn about their medical history. My friend is smart, too, and if she retains her interest in interacting with patients and doesn’t get burnt out by school, she just might be the face of the future of medical care. If the doctor I’m about to meet is anything like this friend, I’ll feel like I’m in good hands—though that doesn’t mean I’ll stop doodling Watson’s name in the margins of my notebook anytime soon.

How do you feel about the idea of robots taking over the stethoscope? Heady daydream, or science-fiction nightmare?

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The Week of the Nutter Butter

It was heartening to learn yesterday that not every doctor’s office gives out crackers after a celiac endoscopy. (There were also some less heartening doctor stories, but that’s pretty much par for the course—this is going to be another one, fair warning.) But the conversation raised another question for me: If you (or your kids) have been tested for celiac disease, did you eat gluten while you were waiting to hear the biopsy results?

Snide remarks about Keebler’s aside, I must admit—I did. While I waited for my results, I chowed on garlic naan; I slurped cookie dough pudding from Sunshine Happy Something-or-Other Bakery in Chinatown; I went to a dear friend’s apartment for dinner, where he served up mushroom-barley soup. (“It’s gluten-free!” he said. “Besides the barley?” I said. “…Oh,” he said.)

But, mostly, it was the week of the Nutter Butter.

I ate Nutter Butters almost every night of the week after my endoscopy before my diagnosis was confirmed (nine days, actually, not that I was counting). I’d get to the end of the day thinking, “Maybe I won’t do that again today,” and then I’d buy a pack anyway. The guy at the corner store came to recognize me and probably wonders where I’ve been lately. If I’d been more honest with myself at the start of that week, I could’ve bought one family-size package and done the whole thing much more cost-effectively. This may be pushing the limits of strange eating behaviors to which it’s okay to admit on the Internet, but on several of those nights I opened up the cookie sandwiches and spread them with jam. (Great with strawberry, and surprisingly good with fig.)

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I ate those things like I’d never be able to again—which, of course, I was correctly assuming would be the case. (Oh, sure, Pamela’s has a peanut butter cookie, and there are knockoff recipes all over the web, but if it’s not in the shape of a peanut and mass-produced it doesn’t count.) Do I even like Nutter Butters that much? I don’t know. It was a compulsion.

By Monday, going in to week two, I was ready to quit. I just needed to know I had celiac, wanted my doctor to get it over with and tell me to lay off the Nutter Butters. But Monday his receptionists put me off all day, so on Monday night I enjoyed my daily fix. This is the last time, I thought.

Tuesday morning, I called again, and hung up dejected at the response that my results still weren’t in. I spent the day playing phone tag with the two receptionists who took turns feeding me conflicting stories: “We’re waiting for a fax from the lab”; “We’re waiting for the doctor to get in and review the results”; “Oh, actually the lab still hasn’t sent them”; and, finally, “I have your results, and everything’s fine! You don’t have any bacteria in your stomach!” (Yeah.)

By that point, being told “Actually, everything’s fine” was not an option. What about my 97 (or 95, or 98, or 90, depending on what source you check) percent chance of having celiac disease based on my serology results? What about all the psyching up I’d been doing for the past few weeks? What about all those stupid Nutter Butters? I’d been eating them as a final hurrah! A farewell! And what the heck did bacteria have to do with anything?

I let myself get more and more frantic on the phone, thinking that would eventually get me my (real) results—which it did, when I strong-armed the receptionist into faxing me the results, found that they did indicate villous atrophy, and called back to demand another number at which to reach the doctor, who had by then left for the day (because I had “called too late”).

Even though I’d been sick for two and a half years and for much of that time accepted I’d just always be sick, suddenly the thought of spending even one more evening eating peanut butter sandwich cookies opened up a vast black maw above me. (An exaggeration? Fine, it was cloudy with a chance of Nutter Butters.) And whether I got my results that day or not, couldn’t I have just gone home and not eaten Nutter Butters? Couldn’t I have gone gluten-free at any time I wanted? Did I really need that harried 30-second phone call with my doctor to know, “You’re positive. Try to avoid wheat, rye, barley”?

Yeah, for whatever reason, I did. I needed certainty; I needed a real turning point; I needed closure. I’m pretty sure that without that lame conversation with my doctor, I would’ve gone home, bought my mediocre sandwich cookies, and steamrolled a few last villi. Then spent all of Wednesday trying not to let the same thing happen again. Funny how habits work, isn’t it?

Since receiving my diagnosis, I’m proud to say I haven’t (knowingly) eaten a single speck of gluten. And after a bit of a slump, the past few days I’ve even felt my cooking mojo stirring again. I’m looking forward to putting the finishing touches on my kitchen setup, feeling better, and eating well for life. Though it’s probably going to be a while before I try out a Nutter Butter imitation.

Tell me some of your food memories (fond or otherwise, -free or otherwise) in the comments! Do you miss Nutter Butters and or Oreos?

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