Professor Hans van Leeuwen is the dean of the Medical Faculty (Erasmus MC) and one of the early contributors to Challenge Accepted. Van Leeuwen has always been interested in connecting people who are doing completely different things. ‘When I heard about the initiative, my first reaction was: yes, this is how we’re going to collect expertise,’ he says in a video. We spoke to Van Leeuwen at his office on the fourteenth floor of Erasmus MC – with a beautiful view of the city of Rotterdam – about the challenges his discipline is facing nowadays and how to go about solving these.
What has the Initiative Smarter Choices for Better Health yielded so far?
‘I’m working together with the deans of Erasmus School of History, Culture and Communication (ESHCC) and Erasmus School of Social and Behavioural Sciences (ESSB) to see if we can develop something that pushes at the boundaries of our expertise.’
Like what?
‘For example: we are currently looking at the human side of the medical digitalization and technologization. We need to work together with scientists with a more sociologic and historic view in order to meet the challenges faced in the field. Maybe this will be the fourth initiative, next to the three that are formulated already. The role of technology is getting bigger. Walk into a random room at Erasmus MC and you will find machines, machines, machines. This will only increase in the near future. Think, for example, of artificial intelligence: will the doctor be replaced by a machine?’
Will it?
‘It’s very likely this will happen. The progress is going at a very fast pace. We already use a surgical robot. It looks like an extended arm of the surgeon, but it will probably develop in a way that will mean that the surgeon won’t have to be in the operation room at all. Now he still needs to operate the machine, but what if the machine can do the operation by itself, and even more precisely than a human can? The questions we are facing are not whether these type of develpments will happen, because they will. A computer can process a lot more terabytes of information than a human being. A time will come where the computer will diagnose better than the doctor.
But: how will we humans cope with this development? How will the patients react, will they trust the machine enough? And how will the doctors react if machines take over their business? We need to change the medical curriculum, because in ten years a doctor will need other competences than today.’
And what does history and social science add to this development?
‘There is a very human side to this progress. We cannot get there with our ‘beta perspective’ alone. For example: doctors who are now in their forties have to work for another 25 years. They will face a whole new work field. How will they cope with all these new applications? Will they accept that a computer is going to take over their diagnoses? And how can we make sure patients a will listen to a machine telling them they have appendicitis? There is a very human side on all these developments. We can use the knowledge of medical ethics, but the other faculties have an expertise like sociology, history and communication we can use well.’
'A time will come where the computer will diagnose better than the doctor. But: how will we humans cope with this development?'
Professor Hans van Leeuwen, dean of the Medical Faculty (Erasmus MC) and one of the early contributors to Challenge Accepted
Your prediction of the future is a bit scary. Will the doctor really be replaced by a machine?
‘The question is: why would you trust a human being more than a computer? We already know that, for example, the computer is more accurate when it comes to brain scans than we are. If we let the computer evaluate the brain scan it makes less mistakes than a human being would. This also applies to other diagnostics. A Google computer could teach itself the Japanese GO game in only six hours, and could beat the world’s best GO player. So a computer can also be self-taught. We are thinking for example of adding computer programming to the medical curriculum. We need future doctors to be able to work with and trust the computer. You see, the challenges we are facing are not minor ones.’
Will humans eventually become superfluous?
‘No, I don’t think so, only our role will change. Humans will have to evaluate and curate the knowledge and technology available. At Erasmus MC we’ll have to make sure we have all the data available. In collaboration with other faculties we will need to bring together different perspectives and forms of expertise, stop working on our own islands.’
'I hope this shows that we need to work together, across disciplines.'
Professor Hans van Leeuwen, dean of the Medical Faculty (Erasmus MC) and one of the early contributors to Challenge Accepted
Is working on the man/machine case your biggest task these days?
‘As dean I think it’s an important subject to consider. Right now we are working in collaboration with students from TU Delft on the project: ‘Spreekkamer 2030’. How will the doctor’s office look like in 12-years’ time?’
My doctor’s office looks actually exactly the same as when I was a kid, 30 years ago.
‘Yes, it will probably stay like this for a while. But eventually it will change. Interesting research has been done in Great Britain on conversation analyses. When patients said ‘yes’ of ‘yeah’ as positive responses to a offered diet-program, scientists observed they weren’t in fact planning on following the instructions and needed more information. If they would use other words than ‘yes’, they were more willing to follow the given advices. With this kind of information, we can program a computer better to analyze a conversation.’
Don’t you believe that the human doctor has something called ‘intuition’ or a ‘sense’, which a computer doesn’t?
‘Maybe, I’m not sure. Maybe we can teach the computer to also take emotions into account, or lies, or body language and other non-verbal forms of communication. The sky is the limit. As long as this helps in making more people healthy, helps to diagnose better and more accurately, why would we reject the idea? We can profit from these digital progresses in the case of individual patient care. Maybe we will always need the human component, I don’t know. But first and foremost we must make sure that people (patients as well as doctors) don’t get scared of all of this. I hope this shows that we need to work together, across disciplines. We need scientists from different fields with different frameworks and different views on the same subjects. If these worlds can understand each other, then we can be truly innovative.’
- More information
Challenge Accepted is a joint campaign from the Erasmus University Rotterdam and Erasmus Trustfonds, that calls on all scientists, students and alumni to contribute to advancing three ambitions that help shape the future.
Erasmus University Rotterdam aims both to inform more effective health policies as well as help people make better lifestyle decisions. Academics from a wide range of disciplines are joining forces to make healthcare fairer, smarter and keep it affordable.
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