Are Decision Support Tools Turning Doctors into Idiots?

A HealthLeaders article by Gienna Shaw notes that some physicians are reluctant to use computerized decision support (CDS) tools because they fear losing the respect of patients and colleagues. There’s some evidence to support this concern:

In one [study], even tech-savvy undergraduate and graduate computer science students preferred physicians who rely on intuition instead of computer aids.

“Patients object when they ask their doctor a question and then she or he immediately types in the question into their laptop and then reads back the answer. It gives patients the feeling that they just paid a $25 copay to have someone Google something for them,” [study author James] Wolf says.

Shaw argues that this is a transient phenomenon in any case because soon everyone will use CDS as payers demand it and the tools get built in to electronic medical records in a way that’s invisible to patients. She’s probably right, but she’s sparked some interesting thoughts.

I prefer physicians who uses sophisticated decision support tools such as SimulConsult, which allows physicians to extend their expert knowledge to make differential diagnoses of rare conditions that even excellent, experienced specialists may see rarely in the course of a career. Doctors are trained to see horses, but there are a lot of zebras out there that are being missed as a result.

Other point of care information tools, such as UpToDate are terrific for keeping current with the latest knowledge. I’m always happy for a doctor to use UpToDate to confirm what he already knows or to find out if there are new developments.

I’ve been favorably disposed toward computerized decision support ever since a summer job at a VA hospital 30 years ago where I programmed an early tool in MUMPS on a DEC PDP 11/34. Yet I can understand where Wolf’s skeptical computer science students are coming from based on my own experience with computerized tools. I’m not a doctor so I can’t relate these directly to medicine, but here are a couple of my own observations for what they’re worth:

I love using my GPS when visiting new places and to find shortcuts. It’s great because it lets me explore new places I would have hesitated to drive to in the past. But excessive reliance on the GPS may have dulled my map reading ability, sense of direction, and ability to learn new routes. I’ll admit that I sometimes end up taking a less optimal route just because the GPS suggests it.
In the olden days doing research required some thought as to the best way to frame the question, what data sources to pursue and the most promising, efficient way to find information. Now the easiest thing to do is usually to type whatever the question is in to Google and see what pops up first. I still know how to go well beyond that but it’s a skill that seems to be eroding.

These tools tend to level the playing field, bring up low performers and reduce costs. The best professionals –in health care or any field– are the ones who can build from the easily available knowledge and add something differentiated on top.

There may be some doctors who really are just typing questions in to Google and reading out the results –although even there they are likely adding value by drawing on their training and experience. The good news is that routine tasks can now be performed by less expensive people or machines. The problems that remain are tougher, which gives ample opportunity for medical experts to earn their keep by applying human judgment that takes into account all that the decision support system can tell them –and then goes beyond.