Doctor vs Machine in Medicine

Sometimes the Ego of man may amaze even the machine. Often we have seen, Doctors denying the investigation reports and test reports challenging the Machine with their Clinical acumen. Is it fair to challenge the machine? Is this Doctor vs Machine a right thing? Can machine be right everytime? Let us debate on the topic.

In the Round, a patient was examined and found to have murmur. The consultant finds it to be systolic murmur in the mitral area, matching with Mitral regurgitation. Echo is ordered. The next day the report reveals it as Mitral Stenosis instead. Consultant is unconvinced with the report ” Report must be wrong, it does not match the clinical finding, get a second echo opinion”. For students it was a huge thing. Their consultant has challenged the machine and the doctor operating it. An interesting match, whose result seems to be more interesting.

But for the other student, he is unconvinced with the challenge. How can one challenge the objectively assessed thing over his clinical skill, was that just an ego ? Couldn’t the cardiologist even differentiate the systolic and diastolic murmur, didn’t he even see the flow in doppler?

The next Echo reveals Mitral Stenosis.

Another scenario is where the consultant is in the round. Everything matches the cirrhosis with Portal hypertension, but the USG shows normal liver and spleen, normal caliber of Portal veins. The consultant is unconvinced and repeats the test and next day, the nodular architecture of liver with increased portal vein caliber is detected.

Once the Serum Bilirubin measurement had wrong callibrations and showed high bilirubin in the patient, a way too higher than clinically seen 25mg/dl in case of Viral Hepatitis. Repeat was sent to another centre and reported it as 5mg/dl.

These are three scenario where the machine is challenged by the doctor, with victory on either site each time. So question is how appropriate is this challenge.

The Debate –

Doctor says-

Who knows about the patient better

Who examines the patient

I have an experience of 30 years on this

Machines are Better but cannot be depended upon all time.

The man  behind machine may not be good enough.

Calibration and sampling may be wrong.

 

Machine says-

Why do you challenge the objective assessment?

Can you see the Cells and Organs?

How many time have you made mistake in your assessment?

Why the ego of clinical acumen?

 

The Verdict-

Whatever the report may be, it is always advised to clinically correlate it with the patients condition. If the echo shows ejection fraction of 25% in a patient who is running around without a problem, it is right if doctors say the report must be wrong. Even though the machine may not be wrong , there are steps and people behind the test who may be wrong. CBC , Bilirubin, RDT, RBS, ABG everything can be wrong, the decision on whether the reports are valid or not correlating it with the patients condition is Doctors.

However, doctors should not make unnecessary challenges , demanding that their clinical skill is better in dubious cases should be limited. Challenging an ECHO done is a good cardiologist sound too much of Ego. Cause what you see is always better than what you hear.

Dr D. Sharma, MBBS.

Email- dibsharma@gmail.com

If you have a different opinion on this or an experience, please share with us in comment section.