This morning I opened the BBC website and found this article GPs turn to AI to help with patient workload - BBC News
Obviously a hot topic this week as the PM talked about how AI is going to help the UK and the NHS and what not... Will not get into the political aspect of this as this is not Twitter, but I do want to share my thoughts as a young cancer patient.
I was a healthy and fit 30 year old who rang the GP after having a couple of episodes of low grade fevers (3-4 days with ~37.3-37.6 C) in a 3 week period. I was given amoxicilin for a week but the fevers returned again 2 weeks later, and that time I was given amox again but for 10 days. It had to be an infection, my LDH and reactive protein C were very high but apart from that there was no other symptoms. The routine was to wake up at 7.29, try to book appointment in the app -> no luck... put an alarm again for 7:59, start calling the GP landline... press number 1 asap because you knew by memory what the instructions were -> join a queue and after 10-15-20 mins talk to a triage assistant to explain what you had -> get a telephone appointment -> super quick and rushed call with a different GP every time (some GPs worked monday to wednesday, others thursday and Friday, the beauty of working NHS and private... devastating for patient continuity but good for business). In a period of 5 months I had about 9 telephone appointments, 4 blood tests with phlebotomist, urine test, chest Xray, zero face to face contact with a nurse or a doctor.
My symptoms of fever and sweat did not tick all the necessary boxes. I had sweats after taking the paracetamol but these were not 'drenching', I was tired during the fever periods but I wasn't fatigued all the time, I didn't lose weight, and I didn't find any lumps or swollen nodes. So apart from an infection the doctors did not consider the possibility of this being something else. Again, despite having done multiple blood tests and urine and blood cultures, the main hypothesis was an infection of some sort.
One day I was sent to A&E with a GP note to do a scan, but they didn't think it was needed and went on to do urine and blood tests but nothing else. Was I pissed off with the doctors? Yes, very. Would a database or some sort of AI help doctors to see what different illnesses I could have, based on a national data set? I guess so. Getting the right diagnosis can be a lottery, depending on your postcode, the experience of your GP, their willingness to think outside the box, their willingness to talk to other colleagues to get to the bottom of the issue... So yeah, maybe the AI approach would help.
However, for those doctors who are already not thinking outside the box, who are not the most 'active' ones, could this be a tool to just become complacent and diagnose whatever the software suggests? Would they just go with the most possible option and ignore the one with the lowest probabilities? Maybe. When I was having the fevers I am sure no-one thought I could have lymphoma because (once I saw a doctor F2F!) I didn't have enlarged lymph nodes, I was young but not as young as teenagers/early 20s who get lymphoma, and I wasn't ticking those boxes. So I was a low probability one. But my nodes were on my groin, so outside the obvious groin/armpit area. My fevers were around 38 at max, not 39-40... So it wasn't as obvious.
We don't even share information across different trusts but we think AI is the solution, what data will AI used? During my diagnosis time I moved and when I went to A&E to my local hospital they didn't even have my history of blood test results in the system. I had to show them on my phone. Would AI help here? No, because the data was not available and the assumptions would just be wrong!!
Reading the article I see how there is one GP using a free software to transcribe the appointment talks to text. A free one! So I am guessing not NHS approved, not official, not validated, not tested, and who knows how it complies with data privacy/protection. One has to be a bit critical of this way of working, if the app is not approved how does a GP guarantee that my data is not going to end up in someone else's hand. Who would be liable in case of a data breach? What happens if your next employer gets some info from an AI recruitment tool and finds out about your medical history?
To conclude, I am for an AI tool which is developed with the NHS and works in a closed system, with information which is fed and taken from and by the NHS trusts, and that uses cases and data to help doctors make informed decisions. Something that points the nurses and doctors towards diagnosis which they haven't seen before or which are consider rare, so they can think about these. But I am also worried that relying on AI to resolve the real issues of the system can be a bit of a disaster. Data privacy and protection has to go before anything else. And we still need critical thinking from our doctors and we need them to be involved in research, in being up to date with new treatments and diagnostics tools, etc. AI can't make up for the Gov not providing enough resources and headcount. If my doctor had more time and didn't rush through a patient every 3-4 minutes, maybe I would have been diagnosed earlier? Maybe yes, maybe not. If the database/AI were available to analyze tests and symptoms and compare it with a national database where other people had the same and ended up diagnosed with lymphoma... Would the diagnosis had been quicker? Yes I guess so.
Anyway, just my thoughts. Most people I know who have or have had cancer have faced a misdiagnosis at some point. Tech is needed to help reduce human errors and help with 'out the box thinking', but time and resources I think are the main driver for a better system.
