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Expert systems and computer-controlled decision making in medicine

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Abstract

The search for “usable” expert systems is leading somemedical researchers to question the appropriate role of these programs. Most current systems assume a limited role for the human user, delegating situated “decision-control” to the machine. As expert systems are only able to replace a narrow range of human intellectual functions, this leaves the programs unable to cope with the “constructivist” nature of human knowledge-use. In returning practical control to the human doctor, some researchers are abandoning focusedproblem-solving in favour of supportiveproblem-analysis. Using ONCOCIN and QMR as examples, this article contrasts these approaches and suggests that the latter avoids many of the difficulties currently facing medical expert systems.

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References

  • Bischoff, M. B., Shortliffe, E. H., Carlisle Scott, A., Carlson, R. W. and Jacobs, C. D. (1983). Integration of a computer-based consultant into a clinical setting.Proceedings of the 7th Annual Symposium on Computer Applications in Medical Care, pp. 149–152.

  • Bramer, M. A. (1982). A survey and critical review of expert systems research. In D. Michie (ed.)Introductory Readings in Expert Systems. Gordon & Breach, New York.

    Google Scholar 

  • Buchanan, B. G. (1982). New research on expert systems. In J. Hayes, D. Michie and Y-H. Pao (eds)Machine Intelligence Vol. 10. Ellis Horwood, Chichester.

    Google Scholar 

  • Buchanan, B. G. and Shortliffe, E. H. (1984).Rule-Based Expert Systems: The MYCIN Experiments. Addison-Wesley, Reading, Mass.

    Google Scholar 

  • Clancey, W. J. (1979). Tutoring rules for guiding a case method dialogue.International Journal of Man-Machine Studies, 11, 25–49.

    Google Scholar 

  • Collins, H. M. (1990 Forthcoming).Artificial Experts: Social Knowledge and Intelligent Machines. MIT Press, Cambridge Mass.

    Google Scholar 

  • Collins, H. M. (1985).Changing Order. Sage, London.

    Google Scholar 

  • Collins, H. M. (1986). Expert Systems and the science of knowledge. In W. Bijker, T. Hughes and T. Pinch (eds)The Social Construction of Technological Systems. MIT Press, Cambridge, Mass.

    Google Scholar 

  • Feigenbaum, E. A. (1986) Autoknowledge: from file servers to knowledge servers. In Salamon, Blum and Jorgensen (eds)Medinfo 86. North-Holland, Elsevier Science Publishers.

  • Fieschi, M. and Joubert, M. (1986). Some reflections on the evaluation of expert systems in medicine.Methods of Information in Medicine, 25, 15–21.

    Google Scholar 

  • Hunter, J. R. W. (1986).Artificial Intelligence in Medicine: A Tutorial Survey. University of Sussex: AIMG-8.

  • Janik, A. (1988). Tacit knowledge, working life and scientific method, In B. Göranzon and I. Josefson (eds)Knowledge, Skill and Artificial Intelligence. Springer-Verlag, London.

    Google Scholar 

  • Langlotz, C. P. and Shortliffe, E. H. (1983). Adapting a consultation system to critique user plans.International Journal of Man-Machine Studies, 19, 479–496.

    Google Scholar 

  • Latour, B. and Woolgar, S. (1979).Laboratory Life: The Social Construction of Scientific Facts. Sage, London.

    Google Scholar 

  • Long, W. J., Naimi, S., Criscitiello, M. G. and Kurzrok, S. (1988).Reasoning about therapy from a physiological model.Biomedical Measures for Information Control, 2 (1):40–45.

    Google Scholar 

  • Martins, G. R. (1984). The overselling of expert systems.Datamation, Nov, 76–80.

  • McCarthy, J. (1982). Some expert systems need common sense.Human Machine Interface.

  • McDermott, J. (1984). To think for themselves, computers must first learn some common sense.Electronic Design, October, 83–84.

  • Miller, P. L. (1983). Critiquing anesthetic management: the ATTENDING computer system.Anesthesiology, 58, 362–369.

    Google Scholar 

  • Miller, R. A. (1984). INTERNIST-1/CADUCEUS: problems facing expert consultant programs.Methods of Information in Medicine, 18, 137–165.

    Google Scholar 

  • Miller, R. A., Pople, H. E. and Myers, J. D. (1982). INTERNIST-1, an experimental computer-based diagnostic consultant for general internal medicine.The New England Journal of Medicine, August, 468–476.

  • Miller, R. A., Schaffner, K. F. and Meisel, J. D. (1985). Ethical and legal issues related to the use of computer programs in clinical medicine.Annals of Internal Medicine, 102, 529–536.

    Google Scholar 

  • Miller, R. A., McNeil, M. A., Challinor, S. M., Masarie, F. E. and Myers, J. D. (1986). The INTERNIST-1/QUICK MEDICAL REFERENCE Project—status report,The Western Journal of Medicine, December, 816–822.

  • Ostberg, O. (1988). Applying expert systems technology: division of labour and division of knowledge. In B. Göranzon and I. Josefson (eds)Knowledge, Skill and Artificial Intelligence. Springer-Verlag, London.

    Google Scholar 

  • Rector, A. (1984). Knowledge-based systems in medicine: a review. In J. Fox (ed.)Expert Systems: State of the Art Report. Pergamon Infotech, Maidenhead.

    Google Scholar 

  • Rennels, G. D. and Shortliffe, E. H. (1987). Advanced computing for medicine.Scientific American, October, 154–161.

  • Schwartz, W. B., Patil, R. S. and Szolovits, P. (1987). Artificial intelligence in medicine: where do we stand?The New England Journal of Medicine, 316, 11, 685–687.

    Google Scholar 

  • Sheil, B. (1985). Programming the uncertain with exploratory systems.Computer Design, March, 133–139.

  • Shortliffe, E. H. (1986). Medical expert systems: knowledge tools for physicians.The Western Journal of Medicine, December, 830–839.

  • Shortliffe, E. H., Scott, A. C., Bischoff, M. B., Campbell, A. B., Van Melle, W. and Jacobs, C. D. (1981). ONCOCIN: An expert system for oncology protocol management.Proceedings of the 7th International Joint Conference on A.I., 876–881.

  • Speller, G. J. and Brandon, J. A. (1986) Ethical dilemmas constraining the use of expert systems.Behaviour and Information Technology, Vol. 5, 2: 141–143.

    Google Scholar 

  • Suchman, L. (1987).Plans and Situated Actions. Cambridge University Press.

  • Szolovits, P. (1982).Artificial Intelligence in Medicine. Westview Press, Boulder, Colo.

    Google Scholar 

  • Van De Reit, R. P. (1987). Problems with expert systems.Future Generation Computer Systems, Vol. 3: 12.

    Google Scholar 

  • Warner, H. R., Olmsted, C. M. and Rutherford, B. D. (1972). HELP: a program for medical decision making.Computers and Biomedical Research, Vol. 5, 65–74.

    Google Scholar 

  • Winograd, T. and Flores, F. (1986).Understanding Computers and Cognition. Ablex Publishing, New Jersey.

    Google Scholar 

  • Yu, V. L. (1983). Conceptual obstacles in computerized medical diagnosis.The Journal of Medicine and Philosophy, 8, 67–76.

    Google Scholar 

  • Yu, V. L., Buchanan, B. G., Shortliffe, E. H., Wraith, S. M., Davis, R. Scott, A. C. and Cohen, S. N. (1979a). Evaluating the performance of a computer-based consultant.Computer Programs in Biomedicine, 9, 95–102.

    Google Scholar 

  • Yu, V. L., Fagan, L. M., Wraith, S. M., Clancey, W. J., Scott, A. C., Hannigan, J., Blum, R. L., Buchanan, B. G. and Cohen, S. N. (1979b). Antimicrobal selection by a computer.Journal of the American Medical Association, 242, 12, 1279–1282.

    Google Scholar 

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Authors and Affiliations

  1. Science Studies Centre, School of Humanities and Social Sciences, University of Bath, Claverton Down, BA2 7AY, Bath

    Barrie Lipscombe

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  1. Barrie Lipscombe
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After hearing for several decades that computers will soon be able to assist with difficult diagnoses, the practicing physician may well wonder why the the revolution has not occurred. Scepticism at this point is understandable. Few, if any, programs currently have active roles as consultants to physicians (Schwartz, Patil and Szolovits, 1987, p. 685)

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Lipscombe, B. Expert systems and computer-controlled decision making in medicine. AI & Soc 3, 184–197 (1989). https://doi.org/10.1007/BF01891429

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