Electronic Providers: The Push-Button Physician
In 1960, the scientist and illustrator Athelstan Spilhaus depicted a graphic future of digital medicine for his regular Sunday comic strip “Our New Age.” Soon, Spilhaus claimed, patients would be able to hook themselves up to computers, push buttons to answer questions about their symptoms, have their key vital functions measured by sensors, and send that information to a central processing unit. In the blink of an eye, “a diagnostic computer will receive the telemetered information, and after checking by physicians . . . will automatically prescribe a course of action while you wait!” If this vision of mainframe medicine was meant to provide a utopian future for patients as consumers of healthcare in a digitally mediated world, it evoked a dystopian future for the profession of medicine. On one level, these computers served as metaphors for the encroaching mechanisms of healthcare bureaucracy, embodying longstanding fears of “socialized medicine” in which doctors would themselves become cogs in a larger machine instead of independent private practitioners. But on a more visceral level, they also threatened to displace doctors from the locus of their greatest area of expertise—the rational practice of diagnosis and therapy—and relegate them to the role of technicians. This talk traces the rise of algorithmic approaches to diagnosis and care in medical decision-making in postwar years, as early attempts at AI first modeled their decision processes after expert physicians (an origin of the “expert-systems” model of AI) and then became models for physicians to learn to think against as well as with, as they imagined utopian and dystopian futures of data-driven medicine.
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