"Robot Doctor" Offers Online Diagnostic Advice for Patients

Nicholas Genes, MD, PhD


September 28, 2006

Dr. Aleksandr Kavokin earned degrees in medicine and immunology in Russia, then completed a surgery internship in the United States before heading off to work at a pharmaceutical company. So what in the world made him want to develop an artificial doctor program?

With a lifelong interest in artificial intelligence, Dr. Kavokin, along with several mathematicians and cyberneticists, developed and launched "Doctor Robot". The Web site provides an online questionnaire for patients to fill out, and it uses their answers to link their symptoms with diagnoses. The program is functional but still evolving, with about 200 questions now in the database. Ultimately, he hopes to offer more than 8000 queries that will be correlated with diseases.

In addition, the site provides a collection of common medical problems that are described in layman's terms, a forum where Dr. Kavokin answers readers' health questions, and a section with medical quizzes for practitioners. And, as regular readers of this column might have guessed, Dr. Kavokin also publishes a Weblog, called RDoctor Medical, which highlights health news and other Web sites that catch his eye.

I had the chance to correspond with Dr. Kavokin recently about his online activities and his thoughts on medical computing.

Dr. Aleksandr Kavokin hosts Grand Rounds
October 3, 2006

Dr. Genes: Most doctor-bloggers go to great pains to hide their identity, or they put disclaimers on their sites that say nothing they write is intended as advice. You are taking a bold step in actually putting your name out there with each post and piece of medical advice you dispense on the forums. Are you worried that someone will misinterpret your advice? Or take it, and have a poor outcome?

Dr. Kavokin: Well, mostly I worry that I could give wrong advice and a person could be hurt, since it is true that diagnoses cannot be made over the Internet or the phone. I worry less that I can be sued, since I also put disclaimers that patients should see their doctor. Yet, yeah, the possibility of a lawsuit is always there. However, I do not think it is right when a doctor first thinks about lawsuits and money issues, then about patients. People ask medical questions; they want to know opinions. I give them.

In medical school in Russia, I was trained as a doctor, not as a money-making machine. Times are changing; Russia is changing as well. Yet my opinion is that a doctor should still be a doctor, not a rabbit to be afraid to say anything.

My belief is that 80% to 90% of diagnoses can be made by solely getting the thorough medical history and doing physicals. I am missing the physicals part over the Internet, and there is no way I can give correct diagnoses or really give perfect advice on complex cases all the time. So, I do not really give definite advice. I rather give my opinion about what it can be from my point of view and based on my knowledge. I do not rely on my memory only; I recheck every advice I give with available medical literature to be sure that I do not miss something.

Dr. Genes: Some have argued that any remote diagnosis tool is suboptimal and inherently flawed; there is more to being a doctor than matching keyword symptoms to complaints. You seem to acknowledge as much by frequently advising readers to see their doctor. So is there much benefit to these kinds of programs?

Dr. Kavokin: People who argue that diagnosing with computer tools is suboptimal often have their own interest invested in the idea that they are unique and nobody and nothing can replace them. Still, the progress is ongoing, despite their resistance.

Obviously, it is much better to read an EKG on your own and charge 150 bucks for reading it instead of a computer program doing it for free. No doubt most cardiologists will say any EKG-reading program is junk. However, human decisions are also not always perfect, nor is evidence-based medicine. Today they advise hormone replacement therapy, tomorrow they blame it; yesterday they advised thalidomide for pregnant women, then got crippled children.

I do not believe that at the present point a computer program can really replace a human doctor. Right now, the programs that exist (including ours, called Symptomat) just give a direction, not a definite answer. Still, the diagnostics programs could be a help. The medical knowledge has become so vast and complicated that no one human can remember everything. Computers are designed exactly for that -- to sift through huge databases and match known questions and answers.

Half a century ago, nobody believed a machine could play chess or pass a Turing test. They do it now -- pass Turing tests and beat world champions. Again, modern computers do not work the way a human brain works. Chess programs do not really think. They just try billions of combinations. And a chess game is really simple compared with a medical problem. Yet, chess computers win. And it does not matter that the way is different. They win. So it is very possible that for some problems in medicine, computers may perform better than humans.

Dr. Genes: On that note, are you in fact a licensed physician in the United States?

Dr. Kavokin: I am not a licensed physician in the United States. I did several years of medical research in cardiology at Yale, and I had a year of internship in general surgery in Philadelphia. I have a PhD in allergy and immunology from Russian State Medical University. Right now I work in a pharmaceutical company performing clinical trials. It is an American company, but many of the studies are done in Eastern Europe and Russia. So, rather than being a specialist in a narrow area, I have some general medical knowledge.

Dr. Genes: With such a broad education, how did you settle on computer diagnostics and blogging?

Dr. Kavokin: I am blogging because I have some knowledge and I want to share it. Actually, in the beginning I was afraid to give medical advice over the Internet - too many worries, from being wrong to being sued. Still, my concern is that patients visiting doctors in the United States do not always get what they want. I have been there [as a patient] myself -- the amount of paperwork was mind boggling. On the other hand, I see that there is really little that can be changed. So the blogging is the way to communicate with the patients -- not just one but with everybody who suffers from similar problems.

About my background -- I was born in Kazakhstan, studied in med school in Moscow, Russia. The school is good -- one of the top 3 in Russia. I was always interested in medical research, wanted to find a cure for every disease. After a year in med school, I was drafted into the army. I served 2 years as a sergeant in the area near Chernobyl. I finished med school, did a PhD for 3 years, came to the United States to do cancer research in South Carolina as a postdoc, then came to Yale for cardiology research also as a postdoc, and did an internship in surgery. I came back to Russia to do some clinical trials. That's about it.

My interests are numerous. For example, I was interested in the problem of rejuvenation, and in many other medical and nonmedical problems. I also used to work with electronic devices as a hobby and even had formal training in electronics in high school. Other interests include sports -- playing water polo in high school and at Yale.

The remote diagnosis was always interesting to me. There were some really simple diagnostics programs in the 1980s when I first saw them. With the development of the Internet, many more people can use them.

Dr. Genes: Who else works for your site?

Dr. Kavokin: The site was done with the help of my brother, Oleg Kavokin, MD. He got a diploma of physician-cyberneticist -- it is sort of a rare profession. There are only 2 universities that have a limited number of spots. It is sort of a medical doctor who is also trained in cybernetics to research and combine the opportunities in medical informatics. He did multiple online projects and is very experienced in programming. My father, Alex Kavokin, PhD, also helps. He is a professor of mathematics and software engineering.

Dr. Genes: A family affair, then. On Tuesday, October 3, Dr. Aleksandr Kavokin plays host to the wider family of medical blogs when RDoctor Medical hosts Grand Rounds. Grand Rounds is the collection of the best in recent medical blogging, appearing at a different site each week. Thousands of readers from around the world visit the site to learn more about medicine from the perspective of doctors, students, nurses, and more. Check it out, and experience the human side to online medicine (the link to Grand Rounds goes live on October 3, 2006, when the new edition appears).


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