An algorithm doesn't raise its hand and pledge the Hippocratic oath. Clinicians do. We are the ones who pledge the oath. That means we're responsible for the algorithm as well.
What should the doctor do? Hypothetical Helen is not a real patient, but her scenario is based on very real technology that's currently in use at Stanford Hospital. CHAKRABARTI: If you're a computer scientist, the tool is a highly complex algorithm that scours a patient's electronic health record and calculates that person's chance of dying within a specified period of time. If you're in hospital administration, it's the advance care planning, or ACP model. For the rest of us, and for Helen, it's a death predictor.
DR. LIN [Tape]: But what do we do with that data? And so one potential use case for this is to really improve our rates of advance care planning conversations. Along with a diagnostic ultrasound of her urinary system, history of bladder disease and the difficulties she had breathing following a previous surgery, along with the number of days she spent in the hospital this time, all that together puts the 40-year-old mom of three at very high risk of dying in the next year, according to the model. It also surprises her doctor.
The guide suggests that doctors ask for a patient's permission to have the conversation, to talk about uncertainties, and frame them as wishes. Such as, Helen, I wish we were not in this situation, but I am worried that your time may be as short as one year. It also suggests asking patients, Does their family know about their priorities and wishes?
CHAKRABARTI: Finally, as a once and future patient myself, my mind wanders back to that searingly human moment, in hypothetical Helen's case. The moment when the doctor first sees that alert, when she looks at Helen lying in bed, still hooked up to medical monitors, wanting to go home. WILSON: And I think it would be important for me to know some of the baked in equity issues. For example, in algorithms that, you know, I want to be clear about the kind of coding and how the algorithm arrived at that decision. So that's an unqualified yes for me.
Source: Healthcare Press (healthcarepress.net)
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