Mary Wakefield

The real reason GPs are grumpy: the robots are coming for them

Google is already undermining medical authority. What will things be like when IBM's Watson is up and diagnosing?

17 January 2015

9:00 AM

17 January 2015

9:00 AM

There’s something wrong with the relationship between patients and their GPs. I’ve spent much of this winter in my local surgery, what with one thing and another, sitting among the stoic and snivelling, drifting between different doctors. They’re pleasant, if perfunctory, but with each visit I became more sure that something fundamental is awry.

The docs seem ill at ease, as if their collective nose is out of joint, and I don’t think it’s overstretching or underfunding that’s the problem. My unprofessional diagnosis is that there’s a change under way in the balance of power between patients and medics; the status of GP as unimpeachable oracle is under threat, he feels the first tremors of what may be a seismic shift, and he doesn’t like it.

For more than half a century, since Christianity first faded from public life, GPs have been our secular high priests. They’re the guardians of birth and death, the purveyors of pills, and we’ve hung on their every word. Now, thanks to the internet and apps testing heart rate, fat and fitness, we’ve all become de facto quacks. At night, by the light of a touchscreen, we scroll through the latest medical guidance, and the doctor no longer seems like a miracle man.

Take my own experience. I’ve always secretly enjoyed a visit to the doctor. I like the rituals, pulse-taking and blood pressure. I like the pebble cool of a stethoscope and the superior sing-song way a GP says: ‘Breathe in … and breathe out.’ I’m a doctor-pleaser, the very model of a deferential patient, except that these days I often know more about my own long-term ailments than the GP, and I sometimes can’t help but mention it (in a tentative and respectful way) when the doc’s out of date. At which point I become the enemy.

The GP turns away, deploys a selective deafness usually used by grandmothers. If he speaks at all, it’s to the effect that my information is both unwelcome and irrelevant. I have offended against the protocols of healthcare, so I sit for the rest of the consultation silent and panicking, now repentant and regretting ever alienating the powers that prescribe.

It reminds me of the dynamic between taxi drivers and passengers, changed now and forever by Google Maps. The Knowledge isn’t exclusive any more — it’s available to all, complete with traffic reports updated in real time. The cabbie is no longer king — even so, he clings to his throne for dear life and it’s a brave passenger who suggests that Google might know best.

But in healthcare, especially primary care, there’s another very particular danger in the doctor/patient relationship. It’s not just that the GP’s bedside manner might evaporate, but that the cure might vanish with it.

It’s a curious fact of our biochemisty that the very trust we place in doctors, that semi-religious deference, contributes to their healing powers. This is true not just of hypochondriacs like me, but of everyone. It’s the mysterious placebo effect and no one, however steely, is immune.

A placebo is the duff sugar-pill that researchers use as a control when testing new drugs. It has no active ingredients, but even so, through faith and expectation, it can have a considerable curative effect. If a patient, given a placebo, is told he’s getting a ‘stimulant’, his pulse rate speeds up, his blood pressure actually increases. If he’s given a large, potent-looking pink pill, or one stamped with a well-known brand, his headache vanishes quicker.

What’s true of pills is true of doctors too. Patients treated by medics dolled up in white coats with badges saying ‘senior surgeon’ recover better than those treated by GPs in jeans. Faith matters in medicine; our expectation of getting better plays a crucial role in recovery, which is why it might be quite a serious matter if we lose our unquestioning admiration for GPs. Their pills would lose their mojo, patients would languish for want of believing they’d get better. What a weird revenge it would be for doctors if the effect of our disenchantment in them was that we suffered more.

But as with taxis, so with medical matters. When humans prove fallible, machines step up to fill their shoes. Are you prepared for your first consultation with Doctor Droid? Because he’s out there preparing for you. Do you remember Watson, the IBM computer who beat contestants on the American quiz show Jeopardy? Quiz shows weren’t his ultimate ambition, it turns out. He’s currently retraining as a GP, reading and absorbing thousands of medical papers. His handlers say he’s becoming better at diagnosing patients every day; and I have to say I’m not entirely hostile to the idea.

Just think: Dr Watson would know all the new guidance, every cure and caution, from the second it was published on the line. He’d cross-check data in a nano-trice and never descend into a huff. Normal doctors are susceptible to something called anchoring bias — a human’s tendency to rely too heavily on a single piece of information. A physician hears two of three symptoms, decides on a diagnosis consistent with those, then rejects any evidence that might contradict the diagnosis. A related problem comes when he lights upon the right diagnosis but stops there, without realising that other conditions may be present too. Dr Droid wouldn’t let you down like that. But what of the placebo effect? Without the authority of a human, would it still have its crucial curative effect?

Who knows, perhaps the placebo effect will work double-time with a droid. If the internet’s his oyster, why shouldn’t a patient’s confidence soar? I see no reason that Dr Droid shouldn’t be programmed with the voice and manner of an old-school GP. My Dr Droid would have the pleasantly superior drawl of a prelapsarian medic, the high priest’s confidence without his need for obeisance. It could be the best of both worlds.

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Show comments
  • John Smith

    Yes, the internet is the discerning person’s friend
    That is why the establishment hates it and wants to control it

    • balance_and_reason

      silly comment

      • John Smith


        • balance_and_reason

          The internet has revolutionised commerce, education, communications, business practice, employment, research, academia, and government; largely for the better, sometimes exceptionally so. There are some draw backs and negatives obviously but the positive ‘s massively outweigh the negatives.
          To suggest some dark power hungry establishment is against all this just because it can’t control it is standard GCSE protest march fodder. Nonsense.

          • John Smith

            So why is Cameron in the USA keen to have access to our & companies encrypted data?

            Why did Erdogan in Turkey shutdown the social media to suit his agenda

            The media hates social media because many people get news from it far faster than the more traditional routes. They can also get a viewpont other than the Beeb’s

          • balance_and_reason

            Well, unless you are a moron, you know exactly why Cameron is asking for access to encryption keys on the internet or communications transmissions. Erdogan, or the chinese politburo and possibly North Korea are not a fair equivalent of the UK, or European establishment.
            I agree that it delivers other news than solely from the BBC and don’t have a problem with that.

  • Eels

    I like it when my patients are well informed. It helps me learn and empowers them. We have know for a while that this is going to happen and more and more our job will be to facilitate choice rather that inform. I have no problem with that. At all.
    We are grumpy, not because we are poorly paid, we are not. And not because we are going to be taken over by robots. ( that actually would be fun) We are grumpy because we are working in an age of ever increasing demand, expectations, social disconnect, profound unhappiness and the imposition from Gvt of the worst of private sector economics and at the same time command and control economics.

    We are busy because people are older and have more problems that they expect to be dealt with.

    If I had a robot that could help me spend more time doing my job as I would like it to be done then Hooray..

    • balance_and_reason

      I think 3 million extra little souls recently arrived might be something to do with the crush.

      • thomasaikenhead

        More like ten million as the population in the UK has grown from 50 million to 60 million plus due to mass immigration and a resultant higher birth rate?

        • balance_and_reason

          I wonder what percentage of new births are delivered by migrants who have arrived in the last 20 years….

    • Dodgy Geezer

      At last, a sensible comment!

      A computer is a tool, like any other. And in a world with more sophisticated computers than we have at the moment, humans will still have a place – usually doing the more interesting work of deciding the higher-level strategy of our professions and callings rather than the mundane administration.

      With doctors there may be an opportunity to return to the older patient relationship of confidant and adviser rather than processor of illness reports…

    • Tom M

      Does having a robot mean that we wouldn’t need to run the gauntlet of the receptionists in the practice?

      • Eels

        Yes, but be careful what you wish for. The robo-receptionist, made by Omnicom, for instance, is programmed to “neutralise” the worried well…

    • davidofkent

      It’s quite odd really. Our GP surgery was almost empty this mid-morning and on the previous couple of times I popped in to leave prescription requests. However, if you telephone for an appointment you will always be told that the next one is from one week to two weeks away. So where are the doctors? I suspect that they prefer to work part-time at the expense of seeing patients. The GP element of our NHS is the BIG problem.

  • mpwoodhead

    GPs are unique in having to deal with uncertainty. Is that a virus or meningococcal disease? Often it’s a gut feeling based on continuity of care – that’s why they’re called family doctors. Dr Android can’t handle that – sends everyone off to hospital, system collapses.

    • whiteafrican13

      Erm… how are “GPs are unique in having to deal with uncertainty”?! Everyone from a lawyer to a croupier to a forex trader deals with huge uncertainty on a day to day basis…

      If you mean that Watson can’t assess a collection of facts and work out what known diseases or causes would best explain those facts, I think you’ll find it can. The entire point of the Jeopardy test was to see how good it was at assimilating facts and identifying an answer based on probabilities – and it did so better than most humans. Like the article says, the robots are coming.

      • mpwoodhead

        As gatekeepers, GPs deal with more uncertainty than other health professionals, whether that be specialists in their narrow streams, or nurses on triage lines who follow protocols. A sick person isn’t just a flow diagram with a correct diagnosis at the bottom of the page. They have backgrounds, histories, families and often messy lives, all of which need to be taken into account when making a diagnosis and settling on a treatment. I’d like to see a robot decide how to deal with a women whose diabetes is out of control because of her alcohol use, who has mental health problems for which she is already taking several different medicines as well as a whole range of family problems which distract her from her diabetes management. Does the Dr Robot also come with a Kleenex dispenser and a special shoulder to cry on?

  • Chris Hobson

    A future AI can read trillions of pages of medical literature and eventually perform medical experiments on virtual bodies. By the way it is coming for everyones job noone is safe.

  • rtj1211

    Like all these things, the computer will only be as valuable as its ability to weigh the relative importance of data sources.

    • Nicholas Erskine

      You could say the same about humans.

      • Dodgy Geezer

        Exactly. A human brain IS a computer.

        The only issue is whether we can write suitably sophisticated code to match or exceed what the brain does. One day we will.

    • St Ignatius

      Actually, recent advances in machine learning make it possible for a consumer laptop to far outstrip the humans ability to make inferences from large datasets. Humans use intuition because they can’t do computation.

    • balance_and_reason

      Humans weigh up , at the moment. Computers sift, sort and present data much better than we can….

  • Abtalyon

    A young girl presents to her G.P’s office having vomited twice in the previous twelve hours. She has no other complaints and physical examination is normal. Despite this, her G.P. felt that further investigation was required and arranged her admission to hospital, where she was re-examined and tests carried out over the next 24 hours. On the point of being sent home, she vomited for the third time and complained of vague discomfort in her abdomen. At operation, a swollen inflamed appendix, about to perforate, was removed.

    Let the new wonder computer program be fed the information contained in the first sentence. I am sure all readers would be interested to know if it can match the decisions of mere mortal doctors.

    • Dodgy Geezer

      …Let the new wonder computer program be fed the information contained in the first sentence….

      I can’t see why it would have any difficulty.

      Expert systems of this type operate in a great deal more complex way that by simple comparison, but in this case (assuming your example is a true one) we have prior case information indicating that repeated vomiting may be an indication of appendicitis, so that will be considered as a possibility.

      If the machine (or the doctor) is presented with a completely unknown or confused set of symptoms, I would expect the doctor (or machine) to refer the patient to hospital for further tests. As happened in this case. The parallels are exact.

      • Abtalyon

        The example is an actual case. Contrary to your expectations, most G.P’s might well have sent her home with the proviso that she call if further symptoms occurred. Even the hospital consultant was ready to discharge her home and only relented when she vomited once more. Moreover, if there were definite signs of appendicitis, can a computer elicit them? I doubt it. Even more problematic is the decision to operate when physical signs are far from clear-cut.

        The whole concept of self-diagnosis using computer programs rests on the patient feeding in relevant and accurate information. Every working doctor knows that obtaining coherent data from patients , even intelligent ones, is a difficult task. Many patients cannot tell one what medicines they may be taking or recall the actual dates of relevant medical events, operations and the like.

        It is not enough to include “possibilities” when what is required, sometimes urgently, is a definite diagnosis. Current software used by physicians still requires a high degree of knowledge and experience in assessing the results and taking appropriate action. I do not think that the average patient is yet in a position to assume this role.

    • Tom M

      A long time ago my brother fell over in the playpark. He was diagnosed with a broken arm. The hospital managed to “set” and plaster the wrong arm. Let’s present a similar case to the new wonder programme and see what happens.

  • Ambientereal

    The patient has something that the doc will never have because he is inside of his body and “feels” the illness. A good educated patient with some curiosity and an internet access can sometimes do a lot. On top of it every patient is “different” and illnesses use to be recurrent, so we have a valuable experience or our past illnesses and their already felt symptoms, something that the physician don´t. Summarizing, either the medical science progresses a lot, or the patient will soon solve most of his health problems alone.

  • Iain Paton

    I wouldn’t necessarily agree with this view.

    On the occasions I’ve been to the doctor’s surgery or elsewhere, as a patient or as a parent of a patient, medics have been very happy to discuss ailments or conditions intelligently as well as various treatment options, rather than simply handing down a diagnosis or description from on high. The more people who stay at home with paracetamol with flu, who elevate and immobilise a sprain, who go to the chemist and apply a remedy at home, who check their symptoms on Google and write a quick note before going to the surgery, the better for the overloaded NHS.

  • Hildegarde

    I’ve read this column twice and I am still unsure what it is trying to say. I don’t even know why I’m commenting on it, except to say that if the writer really has spent most of this Winter in the Doctor’s surgery, then may she is too ill to write coherently.

  • Perseus Slade

    In the end, there is nothing a computer can`t to better than a human.
    All expert jobs will disappear.
    And when proper robots are made, all manual jobs will go too.

    It will be necessary to completely re-arrange society.

  • anon

    Recent experience of a major medical happening in my family is that 1. the machines are very much already with us, doing the quants, producing probabilities, which direct precautionary treatment. 2. It’s just probabilities, nobody actually knows what’s going to happen, it’s the interaction between your body (which on some level is sui generis) and events that decides what happens.
    The patient has a role because s/he knows his/her body, broadly knows the health history of parents, grandparents, siblings etc.
    The doctor has an important role where he/she has had a long relationship with you and so with you has observed how your body works, perhaps has observed how the bodies of your relatives work, can help you make any decisions.
    The system is weakened inter alia by the removal of dedicated family GPs (who have the personal knowledge) in favour of GP teams.

  • Goparaju Venkata Ramesh

    Superb admixture of Wit, Satire, Idiom and Irony. Loved reading it 🙂

  • Smith Alice

    1TopSpy allows you to easily monitor the GPS location of your children or employees. A GPS tracker, you’ll be able to ensure your child isn’t wandering around after school when he or she should be home or at a friend’s or that your teen is driving safely and in an agreed-upon area. You should try it:D

  • Robert McKensie

    I got shouted at for mentioning i looked up the effects of treatments on the internet. The GP said all that all the information on the intenet about health was rubbish, i am looking for another GP.