[addcommitpush]

If they had absolute perfect performance at zero cost, you would not need a radiologist.

The current "workflow" is primary care physician (or specialist) -> radiology tech that actually does the measurement thing -> radiologist for interpretation/diagnosis -> primary care physician (or specialist) for treatment.

If you have perfect diagnosis, it could be primary care physician (or specialist) -> radiology tech -> ML model for interpretation -> primary care physician (or specialist.

[MengerSponge]

If we're talking utopian visions, we can do better than dreaming of transforming unstructured data into actionable business insights. Let's talk about what is meaningfully possible: Who assumes legal liability? The ML vendor?

PCPs don't have the training and aren't paid enough for that exposure.

[bilbo0s]

Nope.

To understand why, you would really need to take a good read of the average PCP's malpractice policy.

The policy for a specialist would be even more strict.

You would need to change insurance policies before your workflow was even possible from a liability perspective.

Basically, the insurer wants, "a throat to choke", so to speak. Handing up a model to them isn't going to cut it anymore than handing up Hitachi's awesome new whiz-bang proton therapy machine would. They want their pound of flesh.

[philwelch]

Let’s suppose I go to the doctor and get tested for HIV. There isn’t a specialist staring at my blood through a microscope looking for HIV viruses, they put my blood in a machine and the machine tells them, positive or negative. There is a false positive rate and a false negative rate for the test. There’s no fundamental reason you couldn’t put a CT scan into a machine the same way.

[matheusmoreira]

Pretty much everything has false positives and false negatives. Everything can be reduced to this.

Human radiologists have them. They can miss things: false negative. They can misdiagnose things: false positive.

Interviews have them. A person can do well, be hired and turn out to be bad employee: false positive. A person who would have been a good employee can do badly due to situational factors and not get hired: false negative.

The justice system has them. An innocent person can be judged guilty: false positive. A guilty person can be judged innocent: false negative.

All policy decisions are about balancing out the false negatives against the false positives.

Medical practice is generally obsessed with stamping out false negatives: sucks to be you if you're the doctor who straight up missed something. False positives are avoided as much as possible by defensive wording that avoids outright affirming things. You never say the patient has the disease, you merely suggest that this finding could mean that the patient has the disease.

Hiring is expensive and firing even more so depending on jurisdiction, so corporations want to minimize false positives as much as humanly possible. If they ever hire anyone, they want to be sure it's absolutely the right person for them. They don't really care that they might miss out on good people.

There are all sorts of political groups trying to tip the balance of justice in favor of false negatives or false positivies. Some would rather see guilty go free than watch a single innocent be punished by mistake. Others don't care about innocents at all. I could cite some but it'd no doubt lead to controversy.

[addcommitpush]

In that scenario, the "throat to choke" would be the primary care physician. We won't think of it as an "ML radiologist", just as getting some kind of physical test done and bringing it to the doctor for interpretation.

If you're getting a blood test, the pipeline might be primary care physician -> lab with a nurse to draw blood and machines to measure blood stuff -> primary care physician to interpret the test results. There is no blood-test-ologist (hematologist?) step, unlike radiology.

Anyway, "there's going to be radiologists around for insurance reasons only but they don't bring anything else to patient care" is a very different proposition from "there's going to be radiologists around for insurance reasons _and_ because the job is mostly talking to patients and fellow clinicians".

[bigfudge]

Doesnt this become the developer? Or perhaps a specialist insurer who develops expertise and experience to indemnify them?

[bilbo0s]

Oh that could indeed happen in that hypothetical timeline. But in that timeline the developer would be paying the malpractice premium.

And it would be the developer's throat that gets choked when something goes awry.

I'm betting developers will want to take on neither the cost of insurance, nor the increased risk of liability.

[tnel77]

They didn’t say there wouldn’t need to be change related to insurance. They obviously mean that, change included, a perfect model would move to their described workflow (or something similar).

HackerNews is often too quick to reply with a “well actually” that they miss the overall point.