Taking "Stock" of Our Health.

• Author: Singleton, Marilyn M.
• Position: MEDICINE & HEALTH

SOME PUNDITS blamed algorithmic trading for the stock market's recent wild ride. Algo-trading relies on computers programmed to follow defined instructions for placing trades. For example, the computer buys 25 shares of stock when its 50-day moving average goes above the 200-day moving average--period. Algo-trading was popularized as a systematic approach that removes much of the human element from the transaction.

Advanced medical algorithms are becoming the next best thing. Their intended purpose is to improve and standardize decisions made in the delivery of medical care, enabling multiple levels of health care practitioners to use the same "thought" process.

A medical algorithm can be a list of risk factors for various conditions, such as heart disease, or a simple calculation such as BMI (body mass index) utilizing height and weight to determine ideal numbers. Many algorithms are flowcharts with a binary decision tree: if BMI is greater than 25, do this; if not, do that. Newer algorithms based on machine learning, a form of artificial intelligence that simulates how humans learn, can analyze and diagnose radiology images or pathology slides or predict the actual risk of developing certain conditions.

Some of these advances are extraordinary and likely will add to our medical armamentarium, but they do not exist in a vacuum. Concomitant with the flow chart revolution, patients complain that when barely a nanosecond has passed since the physician's first "hello," they are handed a DNR form.

Yes, it is a good thing for a physician to know about a patient's desires at what could be the end of his or her life, but it is unsettling when the 35-year-old "provider" cheerfully encourages a patient to fill out the form, crowing that she signed her DNR form. The patient is thinking, "You'll feel a lot different about it at 65 than you do now."

However, in today's health care delivery factories, when illness strikes, "your" doctor may be a previously unknown-to-you hospitalist whose sole knowledge about you comes from lab tests, x-rays, findings on a physical exam, and a form you signed 10 years ago. Your family relationships, religious views, and the like are not his or her purview. When death actually is walking down your street, you want to know and trust those in charge of your life.

In a recent case, a toddler was declared brain dead by one hospital, but...