“We, doctors of the old school, see his place just beside the sick…”

Will artificial intelligence ever replace the doctor why it is impossible to completely standardize the medicine, and what are the pros and cons of self-medication on the Internet, said “Mednovosti” the President of the Scientific society of gastroenterologists of Russia, Professor of the Department of outpatient therapy MSMSU them. A. I. Evdokimova, Leonid Lazebnik.

According to the forecast of the Agency for strategic initiatives already in 2030 will disappear many of the intellectual professions, among them the doctor-the diagnostician. And functions of this specialist will take the device mobile diagnostics and automated expert systems. Good or bad?

– While this is only a forecast, but it is in tune with the developed in the European Union phased concept of health. The first model – the “ice age” (ice age). This is what we are now witnessing: the destruction of health budget, its one-sided development and growth in the commercial segment. This makes it inaccessible for most people, daily quality medical care. And in the end we have a late diagnosis of serious fatal diseases, loss of confidence in the specialty, rapidly increasing the number of investigative cases against doctors. Societal needs are unfulfilled, people want more than their modern national healthcare system. Hence the aggression to our profession, its representatives, and cultivated by media and law enforcement agencies. The consequences of the so-called “modernization of health care”. Expectations exceeded opportunities…

The next step – silicone period (silicon age), in which the emphasis is on e-medicine. The person is still dealing with a real doctor, but direct contact between them is interrupted. The doctor analyzes incoming call centers for patient data and makes recommendations based on the development of professional communities, can remotely communicate with the patient. This scheme is easy to operate are our young doctors who are not trained to communicate with patients, as a person, but a good command of the computer with which to diagnose and prescribe treatment.

But the fact that patients themselves can use the computer, tend to be more informed in their disease than the doctor, and, as a rule, wrongly interpreted received from the network information (who will vouch for its authenticity?). As a result, we again have a late diagnosis of serious diseases, incorrect self-treatment rests with the physician, the blame for disappointed hopes, and then – the Prosecutor’s office or investigative Committee…

And finally, the Golden period (goldage) is the future of European medicine, when doctors will be only in the highly robotic centers, and the rest of the diagnostics will be implemented to remotely medical. According to European estimates, the model will start to work soon, in the 40 years of this Millennium. Intellectual the program analyzes patient data, makes a diagnosis and gives advice where he should go with his serious disease. For example, the patient’s condition with the help of installed in his home sensors studied in the UK, the information is remotely transferred to the analytical center, where the diagnosis and treatment of this disease is best managed in a specialized European center, located in southern Italy.

That is, artificial intelligence, completely replaces the doctor.

– Yes, I agree with academician Vladimir Nikolayevich the other band members, this is the final stage of human existence as a biological species. But while I, as a doctor of the old school, see my place only next to the patient. And the patient is considered as a person with his suffering, with his peculiarities, psychology, and then turn to symptoms and diagnosis. Any tool only needs to confirm the idea of the doctor. In our craft the initial thought: at first I was taught to think, to reflect, and then to appoint examination and treatment. The old medical proverb says: “listen Carefully to the patient, he tells you his diagnosis” (Jonathan Hutchinson). And the art of history taking, was developed by Grigory Antonovich by Saharonim, the entire domestic therapeutic school. But later the truth is: “the Art of diagnosis is the art of balancing probabilities” (sir William Osler). Both examination and treatment should be meaningful.

Modern medicine is an international standards and professional recommendations based on thousands of observations, carefully and very strict statistical analysis. Nevertheless, thinking of the doctor at the bedside carefully collect the anamnesis, and, thinking over the diagnosis and prescribe treatment, balance of probabilities, based on data obtained with the help of modern equipment, be sure to view the international professional recommendations. But each person is different, the similarity of the diseases is deceptive, while the machine can find just one disease, but do not notice the dozens of others that at the same time is this man. In this case, “Art is forever, life is short, experience is dangerous, reasoning is unreliable…” – we encounter this daily.

In addition, the robot can’t empathize with the patient. To strengthen his soul, faith in the recovery, is only capable of experiencing feelings of empathy and compassion doctor. The old medical adage says “Dixietanimamlevati” (lat.) – spoke and eased the soul. After meeting with the doctor the patient will get better, he must believe in me, and I instill in him the belief that he can overcome the disease. Even in the unpromising situation, I must help the patient to believe in themselves and make “pull his hair”. And from then on it will do the job the latest technology and medicines, which must be skillfully exploited. And do not oppose each other, classical and modern approaches to treatment: have a basis, there are add-on. It is necessary to use what is already tried and tested by generations.

Officially like no one opposes. But medical education today, more emphasis on simulation training training. And during the accreditation procedure even use special actors.

– When learning these techniques, the patient is also virtual, but this is dogmatism. Life is much more complicated and rich, to represent a combination of diseases in all their diversity is impossible. No wonder many years ago came to the geriatric clinic, we understand the need to study polymorbidity, i.e., the multiplicity of diseases in one person. To teach future doctors need living examples.

The monstrous defect of the modern approach to medical education is a full otmuchennoj University departments from clinical databases.In the Russian tradition, the Department of clinical has always been a leader in the field, and head of the Department was responsible for medical diagnostic work. But in our modern laws, the teacher can not conduct clinical work and to advise patients. The Department often displaced from hospitals. So now disappear scientific schools that developed from peculiar to them scientific concept, often one of the most advanced in the world, and whose leaders have their own point of view and educate students by example.

But now all the medicine standartisied. And in this light their own point of view and self-concept can be considered as “confusion and vacillation”.

– Of course, there are certain standards, they are important, and no one argues. But standards are applicable for typical situations, and therefore are Advisory in nature. Each disease has its typical symptoms, but not only is there more atypical symptoms, there are different versions of their manifestations. And the doctor should be able to identify and prescribe treatment in accordance with the course of the disease in this particular patient.

The fact that the car is not yet able to replace humans, showed interventions which were carried out with the help of robots, and long-term effects of these interventions.Machines can with pinpoint accuracy to perform certain operations. But only certain. And, it means that the robot should go to a ready-made situation, thought the doctor. And if something went wrong, or the situation is not standard, then it is only hands and head doctor. Another thing is that the training of a physician and further work needs to be of high quality. We have already said a good doctor is a good craftsman (geniuses, for whom the healing art is, after all, not many), and it needs to produce quality products.

Theoretically, Yes. But in practice today in our public hospitals and clinics such flux that it would be naive to expect any special quality. And so, though the machine will help.

– Indeed, it is difficult many you have in the clinic appointment 12 minutes. But this is possible if the patient comes to the doctor prepared.

That is written on paper with a list of complaints, all tests and the alleged diagnosis?

– There are different models. But it is always a major logistical operation.

A good example of this is how does the British model ambulance. First patient arrives in office, architecture representing all the room is divided into sectors, which are sick, and in the middle is a medical center with doctors and nurses. Within an hour and a half while the patient undergoes the appropriate instrumental and laboratory investigation, with him talking to nurses. And when the doctor comes to him, armed with the results of the research, he asks only specific questions on the standards. And then he seems to be missing a few minutes.

I liked the idea of one of the highly respected me the heads of Department to paper the walls of clinics around the doctors ‘ offices by questionnaires.There is a rational link, but of course it should be comfortable for the patient. In particular, each question should be completely understood by the patient and so clearly defined, so he could definitely answer it Yes or no. But it’s all got to be thought out, the doctor must help, and not to establish over his head camera, which will track how many minutes he lost out to drink water.

I think we rather have the camera for the “duration” of a doctor’s time. And patients sitting in the queue on the other side of his door, often resent what he has so long involved with other patients.

– We are shifted to some other plane in the public perception of the physician’s personality. Traditionally (and now it was especially cultivated), the doctor is defined as a social entity which owes its existence to society as a whole and each of us personally. He may not be a disease, a bad mood, he isn’t supposed to be personal time, family. It needs to Shine to others, but don’t have time for combustion without residue. He has no margin for error, lack of knowledge of anything. And what’s the answer? Many believe that the doctor is obliged to save even hopelessly sick person, even a child with severe congenital disorders. You know how many doctors today is in custody or under investigation? View official documents, the numbers are stark and depressing. This has never happened before. Now we are helpless before the aggression of a society.

Segodnyashnego put the doctor in absolute dependence on his so-called wrong actions. I do unwanted side effects of the drugs that are usually impossible to predict. This is the sphere of my scientific interests. But if the medicine I prescribed to the patient, caused in addition to the main and the so-called “spillover” effect that I couldn’t predict, and the patient complained about me to the Prosecutor, I shall bear criminal responsibility. Tell me, please, to save his good name, health, family, I’m going to have these drugs? The same applies to surgeons, it is better not to risk it.

This is now society’s attitude to doctors. “Murderers in white coats” – we have already passed, and not once. But today, were prosecuted not only in order to put the doctor, and to seek in parallel a tremendous amount of damage to health, poor relief and the like. Tell me, it will cause the inflow into the profession for talented young people? And the surgeon will decide on surgical intervention with high risk? I think not. Question: who will get treatment? Well, the powers that be, according to law, in the West. And the rest, are just people?

Let us self-medicate via the Internet. He now took the palm of my grandmother’s recipes “folk medicine.”

– Also an option. A competent person will check the Internet, even with someone to consult and understand what has to help him. Now all serious question arises as to how the doctor to work with a patient who is literate himself. Because people learned in the Internet everything about his disease, and the doctor is just no time for it, although in my experience I must say that a large part of modern medical audience is very literate. Inquisitive a good doctor will always seek opportunities for professional growth, for self-education. Although sometimes hear such denseness…


Necessary to help the patient to understand all this Vale of information. Because the Internet or is it on all occasions, or lying. There any one of us can post anything and pass it off as absolute truth. You can write that the best cure is a well-known poison. And be sure to find someone who’ll drink it. Self-healing also needs to train a doctor, he should tell the patient: “Here is the medicine you need to take then to a certain dose. Side effects such. You must achieve a certain effect.” But to fully help these patients, you need to become more and more literate. And in order that the doctor could educate himself, he needs to create the conditions. As a minimum, to reduce the intensity of his labor to unload.

And then there are the sick, and they are many who have given up on myself. And I don’t want to be treated nor the doctors, nor the Internet.

– Recently I was a tough patient, absolutely running very high intelligence a young man. His life, devoted himself to Bacchus and waved her hand. But we were able to convince him not to retire from life at his age, we must fight, appointed effective drugs from his illness. And the man who was already lying motionless, now gone, had faith in himself, began to fight for themselves. Such patients quite a lot, and that the physician must help them understand that life is a gift from God that is given once, and the most reliable assistant of the man himself. Though perhaps someday, artificial intelligence and teach another car to experience a sense of empathy, but then again arises the necessity of the idea of God, read Sigmund Freud, and everything starts over again…