Prescription By Computer

Properly programmed, the computer can plot the trajectory of a rocket, keep track of a store's inventory, correlate census data and help predict weather more accurately. But can it be trusted to make the kinds of life-and-death decisions that doctors do? The answer may be yes, according to a team of scientists from Massachusetts Institute of Technology and Tufts-New England Medical Center in Boston. The researchers report in the American Journal of Medicine that they have taught a computer to exercise virtually the same clinical judgment that a physician must use in choosing a form of treatment. In the process, they have learned more about how doctors make such decisions.

When the researchers began trying to write a decision-making computer program three years ago, says Dr. William Schwartz, chairman of the department of medicine at Tufts University School of Medicine and spokesman for the group,* they discovered that little was known about how physicians arrived at their complex decisions. "Medical school emphasizes the acquisition of specific factual data," Schwartz says, "but it has paid remarkably little attention to the decision-making process." Thus he and his colleagues are analyzing how a doctor decides on such serious treatment as abdominal surgery.

Look Ahead. A first-stage result of their study is a computer program that duplicates some of the mental processes of a highly skilled physician. Using acute kidney failure as an experimental model, the research group programmed the machine to weigh the risks and benefits of various tests and treatments and to consider such factors as the patient's attitude toward surgery. "We find it is like playing chess," says Schwartz. "Doctors don't make just one isolated move, they have to look ahead at what else is likely to happen."

The Boston group does not have as a goal the replacement of doctors by computers. It hopes, instead, that its findings will refine the teaching of diagnostic and treatment skills to medical students. But the study has also shown that computers could help doctors in their deliberations.

That capacity was demonstrated when the computer was presented with the diagnoses of 33 hypothetical patients with 14 different serious kidney conditions. In all but two cases, the machine recommended the same treatment as did a pair of kidney specialists. In 14 of the 18 cases selected for further testing, the decisions reached by the computer were the same as those of the doctors. In each of the remaining cases, the computer's first choice was regarded by the doctors as a reasonable alternative.

* Drs. Jerome Kassirer and Alvin Essig, both of Tufts, and Professor G. Anthony Gorry of M.I.T.

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