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Technological approaches to diagnosing dementia and a reflection on the role of human doctor

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The COVID-19 pandemic has brutally disrupted medical student teaching. However, throughout this period, maybe somewhat concerningly, I have found myself learning more than I may have done otherwise.

After our studies were postponed in March, I signed up to volunteer as a Doctors’ Assistant in The Royal Derby Hospital in April and May of 2020. It was probably the most valuable medical school experience I have had to date. During this time, I was able to learn alongside work, about a huge number of conditions which passed through my short-stay ward.

I have had an interest in Neurology since early on in my medical training and fortunately due to the huge variety of conditions in my ward, Neurology registrars were in abundance. I befriended one such doctor, who invited me to attend the NUH Neurology weekly academic meetings.

Due to the constraints of social distancing, these meetings had migrated to a virtual platform. Every Thursday morning, I would go up to the reg’s office and listen intently to the variety of esteemed academics who were invited to speak over Microsoft Teams.

One such talk which really caught my attention was given by consultant neurologist, Dr Daniel Blackburn from Sheffield University, an expert in Dementia and an active researcher at the Sheffield Institute for Translational Neuroscience. Technological difficulties meant the PowerPoint presentation wasn’t visible, but this was substituted by an extremely detailed and engaging discussion over Dr Blackburn’s research.

I was surprised to find out that a large proportion of GP and specialist memory clinic time is spent differentiating patients with functional memory disorders (FMD) and those with neurodegenerative dementia (ND). The quick MMSE is a screening tool often used by GPs for patients presenting with memory issues, but studies have shown that it has limited value in the detection of mild cognitive impairment in dementia. The MOCA is often used in specialist clinics and is a much more sensitive tool. However, it is time-consuming (can take up to 30 minutes to complete) and its low specificity means that further assessment is still required before a diagnosis can be made. In summary, the inadequacy of these tests means that some patients are referred unnecessarily, and some patients who do have dementia slip through the net.

Dr Blackburn’s team are working on a novel approach to use speech recognition technology as a screening tool to reduce unnecessary referrals and missed diagnoses. The program they are developing requires patients to spend around half an hour answering questions aloud in front of a PC. The AI software analyses the intonation and word content of the patient’s responses and matches this to its extensive bank of data from previous patients – some of whom had dementia, some of whom didn’t. It all sounded extremely promising until Dr Blackburn mentioned that at the moment the software only correctly picks out 40% of the patient’s word content. He went on to explain that this was not a huge problem as the majority of the test’s diagnostic value comes in the analysis of the patient’s intonation. Dr Blackburn clarified that studies have shown that speech intonation is one of the first changes seen in mild cognitive impairment. I was impressed that in recent trials, the program was able to accurately differentiate between FNDs which do not require further investigation and NDs which most certainly do.

After the meeting I reflected extensively on what I had heard. On the one hand I was extremely impressed and excited that the two realms of technological development and of medicine are merging. After all, it is technology like this which has the potential to reduce physician workload and improve patient outcomes.

On the other, I was slightly apprehensive; is this just the first step towards the de-humanisation of medicine? How long will it be until the job of a doctor is made redundant?

After a number of conversations with different physicians and some further reflection, I concluded that the role of the physician is more than just that of just diagnosis and management. It is of care and compassion towards the humans who come to us at their most vulnerable.

This point really hit me when one of the patients on my ward, I will call him Ted, started to deteriorate, and it became clear that he would not survive. I first met him on a lightning speed ward round when we popped in for just a few moments to discuss his sepsis, pneumonia, kidney and heart failure. As we were about to leave Ted begged me to stay and hold his hand; he was unimaginably lonely and scared of what awaited him. Due to restrictions as a result of COVID-19, Ted’s family were not allowed to visit him in hospital and to make matters worse, his hearing problems meant he was unable to have proper conversations with his family over the phone. My role became one of reassuring and comforting both him and his family as well as spending time listening to his worries and giving him the human contact that he really needed. It became clear to me at that moment that people will always need people to care for them. No machine could take that job.

Of course, doctors will increasingly work in tandem with technology to improve diagnostic accuracy and patient outcomes; however, I hope that they will never be eliminated completely.

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