The quest to eliminate diagonostic lapses

FP

The man on stage had his audience of 600 mesmerised. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation. At last he spoke. "Lymphoma with secondary hemophagocytic syndrome," he said. The crowd erupted in applause.

Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice.

The case Dhaliwal was presented, at a medical conference last year, began with information that could have described hundreds of diseases: The patient had intermittent fevers, joint pain, and weight and appetite loss. He was given new information bit by bit—lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopaedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.

Just how special is Dhaliwal's talent? More to the point, what can he do that a computer cannot? The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data. And IBM, on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

In some ways, Dhaliwal's diagnostic method is similar to that of another IBM project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world's best player at the time. Although lacking consciousness and a human's intuition, Deep Blue had millions of moves memorised and could analyse as many each second. Dhaliwal does the diagnostic equivalent, though at human speed.

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