STAT recently published an article on a new aspect of managed medical care.
They found that
That’s ... kind of scary.
Dr. Allan M. Block
Certainly, computers aren’t bad things. In 2023 America you can’t practice medicine without them. They aren’t malicious. They can analyze a lot of data faster than we can (for the record, the average memory capacity of a human brain is 1 petabyte, so we’re still ahead of the average desktop in that regard).
Computers, though, are pretty uniform. I’m a Mac person, and I can go into any Apple store and buy one. Right off the shelf I know how to work it, how it will run a given program, and can predict how it will handle different commands and such. They’re pretty much the same.
People are not quite as easy. Anatomically and chemically we’re similar, but that’s not the same. There are immune, genetic, and multiple other factors that put a lot of variables into the equation. Part of our training is knowing that and taking it into account when making treatment plans.
Algorithms, and artificial intelligence, can only do so much of that. If they were right all the time sports betting wouldn’t exist. But it does, because sports depends on the participants, who are people (or horses), and they’re not exactly alike ... for that matter how they’ll perform varies from day to day for the same individual.
But medical care isn’t a sport (even though hospital call can seem like a marathon). The data we give computers to use is generally based on averages – a rehab stay of 16.6 days for an 85-year-old woman with a broken shoulder (per the above article). But they don’t realize that averages are actually a collection of data on a bell-shaped curve. An insurance company will be only too happy when one person completes their rehabilitation in 11.6 days, and then feel it’s unreasonable when another takes 21.6.
That said, many of the companies involved say the final decisions are made by humans and that the algorithms are just guidelines.
Maybe so, but the STAT article suggests they’re putting too much credence in what the computer says, and not the specific circumstances of the individual involved.
That ain’t good, at least not for the patients.
Medicine, for better or worse, is a business. In an ideal world it probably wouldn’t be, but we don’t live in one.
But it’s unlike any other business out there, and shouldn’t be run like one. A car repair shop knows what parts to order and generally how long repairs will take. Once they’re done the car should be ready to roll out of the shop.
People aren’t like that.
I understand the need to prevent abuse and overbilling for unnecessary days and services. Medicine, unfortunately, has plenty of opportunities for the dishonest to take advantage of.
It’s a thin line, but, at least today, turning treatment decisions over to algorithms and computers is a bad idea for the people we’re supposed to be caring for.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.