Friday, August 3, 2018

COMPUTERS AND MEDICINE

      Recently I came to know about the old IBM building new IBM computer for medical diagnosis. The thought process of making a diagnosis is like computer . The history is like data fed in to computer and so is the physical examination and then the computer will make some 'Differential Diagnosis 'or the various possibilities , based on the data fed . The possibilities in Differential Diagnosis are listed in order of probability. So the number one would be most likely and the last one on the list would be least likely. So the precess is similar when we do not use computer and use the Human Brain as the computer.. We do not us the computer in day to day medical life and we do not need one and  it may be time consuming and may be even confusing . I was told that the new IBM computer is more accurate than the best of best clinicians . My issue with this process is the problem of the Data that is fed . The computer gives the diagnosis based on information that is given to the computer. The human brain is same . If we as physicians do not put in or get accurate information , the diagnosis can not be accurate. This brings to my my today's story.

      I was called in on a consult for this patient who was 38 years old . He was diagnosed to have pneumonia by hospital doctor . When I saw him , his mother was bedside . He was a nonsmoker and did  not consume alcohol He was working in a office and had no dust exposure. He was sick for almost 6 or 8 months . He had gone to walk in clinic and was told to have bronchitis . He was given antibiotics and sent home . he continued to have problem and so he went to see family doctor . He was given cough syrup and some more antibiotics . The chest x- ray was ordered . He continued to feel poorly and now was short of breath . He went back to family doctor and was given an inhaler. He was told to do CT scan . His copay was too high and he did  not do it . The shortness of breath got worse and so he came to ER and was admitted . In ER the CT scan is done and he was told to have pneumonia. I saw the patient . He had some congestion on the back side of the lungs. He was on oxygen . When I saw the CT scan I was more concerned . The CT scan had extensive congestion ,in both lungs . It was not like typical pneumonia . So I was not sure  as to the cause . He did not have much fever .
    I ordered the blood oxygen and when it came back with low oxygen , I decided to transfer him to ICU. He was also anemic and he told me that he knew that and was told to take iron . ( I was not sure why a young male would get iron deficiency anemia  ) I ordered number of tests and antibiotics . I also called the infection disease consultant . They ordered more and ordered HIV or blood test for AIDS . So I talked to them . While taking history , I had asked him as to the sexual history as the thought of AIDS causing the anemia and the chronic sickness and atypical pneumonia had crossed my mind . He had told me that he did not use any drugs and he had not had any sexual exposure in last 20 years . So I was shocked when the test for the AIDS came positive .Thai solved all the mystery. The anemia and the chronic sickness, and the atypical pneumonia etc were all related to HIV .

      So the Brain computer of mine did not get the data of some risk factors was not 'entered ' . But the Infectious Disease doctor , did not pay any attention to that information and just went with 'instinct' . The instinct was correct !