The Real-life Dr. House
For Second Opinion, Consult a Computer?
Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.
Posted by Jill Fallon at December 8, 2012 2:56 PM
To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.
Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?
When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.
Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”
An expert clinical diagnostician like Dr. Dhaliwal might make a decision without being able to explain exactly what is going on in the back of his mind, as his subconscious continuously sifts the wheat from the chaff.
Isabel, the diagnostic program that Dr. Dhaliwal sometimes uses, was created by Jason Maude, a former money manager in London, who named it for his daughter. At age 3, Isabel came down with chickenpox and doctors failed to spot a far more dangerous complication — necrotizing fasciitis, a flesh-eating infection. By the time the disease was identified, Isabel had lost so much flesh that at age 17 she is still having plastic surgery.
He added that Isabel was aimed not so much at the Dr. Dhaliwals of the world, but at more typical physicians.
Dr. David J. Brailer, chief executive of Health Evolution Partners, which invests in health care companies, agreed. “If everyone was a diagnostic genius, we wouldn’t need these decision support tools,” he said.