Item — HN Reader

One way to think about AI's potential impact is less about replacing what physicians do well currently, and more about doing things they can't do at all.

Take ECGs -- it's true that in a hospital, an automated ECG interpretation doesn't buy you much. But what about about the patient with a paroxysmal heart rhythm that doesn't show up when they're at the doctor's office?

I was at a patient conference recently, and people were describing the first time they felt atrial fibrillation (a common abnormal heart rhythm). Many times, by the time they got to the doctor, they were back in sinus rhythm and thus the ECG showed no abnormality. Some were told they were just feeling "anxious" or "going through menopause." It often took months of persistence just to get a diagnosis.

Now, if have cheap sensors + AI analyzing the patient's whole heart history before they walk in the door, you can do a lot of good for real people.

1 comments

To address your example directly - we already have holter monitors that would show a case of atrial fibrillation quite easily. They aren't terribly expensive, at least for something that has to have FDA approval, and they are frequently used. Heck, you don't even need "AI," in the sense of neural networks/machine learning/some other buzzword. Current systems will review a strip collected over several days and flag any abnormal rhythms.

The problem comes with determining who to put on a monitor. In the case of the patients you described, it's actually quite likely that the doctors seeing these patients considered the possibility of afib. The symptoms, though, can be very vague, and they are seen nearly every day in the doctor's office. It's simply too expensive to put every patient on a holter monitor - the doc's office has to be paid to maintain the monitors (which people abuse at home), the nurses have to be paid to teach patients how to correctly wear them, the monitor company has to be paid for whatever absurdly expensive and proprietary review software they supply, and the prescribing doctor (oftentimes the prescribing cardiologist) has to be paid to review and confirm the machine's interpretation.

All of this for a transient rhythm which any second year medical student would easily recognize if presented the EKG from across the room.

The sad reality is that the patients you described were experiencing the system as it is "designed" (I use the term loosely) to work. The fact that someone is persistently seeking help for their problem dramatically raises the probability that something is truly wrong, and doctors actually recognize this and take it into account. This is one of the reasons it's considered best practice to establish a long term relationship with one doctor who knows you well, but it's harder and harder to do with insurance companies only reimbursing for 15 minute visits.