THE LAST WORD
come to see me, I suddenly am charged with two very
important tasks. First and foremost, I must wade through
the puzzle of the patient’s symptoms and come up with
a hypothesis, a differential diagnosis, and a rational plan
of care. Concurrent to that, now I must allay the patient’s
irrational fears and walk them through the work they have
done with Dr. Google. Most of the time, I look at this part
of the process as an opportunity to educate the patient. I
have often been asked the question “Are you sure we’re
not missing something??” Just as often, I have answered
not with “I’m sure,” but with “We’ll see . . .”
We live in an unprecedented time. The information
superhighway of the Internet is readily accessible to
anyone. My five-year old daughter is better friends with
Dr. Google than I am. When she was younger, I impressed
on her the importance of the books in my office and home
libraries. I would tell her that we could and would look up
the answers to any and all of her questions. Now, as is the
way of 5-year old girls with their fathers, the student has
become the master. She routinely tells me to “Ask Siri” or
“Google it!” Like it or not, this is the state of our healthcare
world. Often, my colleagues will complain about their
physician-patient-Dr. Google interactions, but this is a
fruitless endeavor. Dr. Google is here to stay.
As technology advances, computers are slowly
taking on tasks that have routinely been performed
by physicians. The application of deep learning and
artificial intelligence has led to significant advances in
image interpretation. Dr. Google has significant talents
with image recognition. Already, this type of artificial
intelligence has found foothold in the specialties of
radiology, radiation oncology, pathology, and dermatology.
The massive learning capacity of deep learning algorithms
enables computer systems to handle the large variability
in sizes, shades, textures, and morphology of skin lesions
and detect characteristics well beyond those considered
by humans.
What’s my point? Well, the more we shun the
technology our patients are utilizing, the more out of
touch we become. The world is moving fast. Technology
is moving faster. We need to try and keep up. We need
to consider adapting how we practice. The one major
advantage we have over the machines is that we provide
human contact, a touch, a smile, an empathic response.
When Dr. Google learns this quality of empathy, I may
be out of a job. Or I may find myself working for the
machines they’ve built. My name is Hujefa Vora, and this
is the Last Byte.
A
Dr. Google slows me down. When my patients consult with Dr. Google,
when they bring me these reports, when they go over the top with their
research, they invariably bring a lot of fear into the exam room.
October 2019 I Tarrant County Physician I 27
ll too often, my patients arrive with a
handwritten list of complaints. They set up
an appointment several days in advance.
They consider their symptoms. They write
down the symptoms that they want to
discuss. A patient will consider their
spasms of abdominal pain for days
before succumbing to the urge to
schedule in with me. Understanding the urgency of these
cases, I brought in several nurse practitioners to expand
my capability to see these patients in a timely fashion.
Before my nurse practitioners started working in my office,
an urgent patient might have to wait 48 to 72 hours to be
worked into my schedule. Now, with them, my staff will
tell patients who call for an urgent visit to come right on in.
Even this short wait can trigger a quick consultation with
Dr. Google.
My patients who consult with Dr. Google will often
present this same list of complaints to Dr. Google. They
will then carefully research each one of the conditions
that Dr. Google includes in the differential diagnosis. I
will admit that I have found Dr. Google’s differentials to
be quite encyclopedic. Many of my patients will bring
me printouts of Dr. Google’s assessments. Included with
these assessments, I find in Dr. Google’s reports studies
and patient literature that exhaustively describe treatment
protocols, prognosis, and complications. There is no
dearth of information here. It is almost as if when the
patient is consulting with Dr. Google, they have the world
at their fingertips.
I always appreciate the assistance that all my
consultants and specialists give me. It is hard not to. I
understand that I am just a simple internist. Many of my
patients refer to me as a plainspoken country doctor. I
understand and acknowledge my own limitations. I am
certainly not an unlimited reservoir for all the information
in the world. I don’t know any physicians, for that matter,
that are, except for perhaps Dr. Google.
I’ll be honest with you. Dr. Google slows me down.
When my patients consult with Dr. Google, when they
bring me these reports, when they go over the top with
their research, they invariably bring a lot of fear into the
exam room. I am patient with my patients. I understand
the need to know what is going on with your body. I
understand the need we all have for information. I also
understand, however, that too much information can be
just as dangerous as not enough information. Information
overload stokes the fires of fear. When these patients