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Computers? Say no



‘Algorithms evolve, push us aside, render us obsolete’ is a phrase exclaimed in a song called ‘Algorithm’ by Muse.

And it’s true. Algorithms now seem to dominate medical practice, decision making and guidance in both primary and secondary care: e-consultation prior to getting a GP appointment; 111 assessment prior to going to A&E; use by the general public of numerous ‘symptom sorters’ and other supposedly helpful diagnostic apps; Dr Google himself; and many more.

If we are honest, most of the decisions that we make as GPs are by that mysterious quality that is known as ‘intuition’. This of course develops with knowledge and experience.

Can algorithms pick up unconscious cues and signals from patients?

Most experienced GPs have learned to trust intuition, and that if you don’t listen to it, it is likely to be ignored at your peril; we all are likely to have a story where it has either saved us or a patient that we have seen.

Do algorithms have the understanding, instinct and values that provide the foundation of most of our decision-making as GPs? Can algorithms pick up unconscious cues and signals from patients, and process the often conflicting expectations and practicalities that is needed in complex decision-making? The answer is, of course, no.

More often than not, the symptom sorter apps get the answer completely wrong, and paradoxically actually creates work for GPs, who then have to disentangle the mis-information and stress and anxiety that the patient presents before you.

How often have we heard about incidences such as ambulances called out for colds and hayfever; shin splints being mis-diagnosed as Charcot joints, and someone with central chest pains being told that they may be having a ‘sickle cell crisis’?

In the end, this is a question of our humanity and the mystery that is human consciousness. It is absolutely fundamental to good decision-making: the question ‘why are we conscious?’ is still regarded as one of the greatest mysteries of the universe, along with the workings of the human brain , which is in turn the most complicated object in the known universe.

Why trust computer algorithms, when we have the twin miracles of human consciousness and the human brain to make our decisions with? It’s time to ditch the algorithms.

Dr David Mummery is a GP in west London and academic clinical research fellow at Imperial College London