The evolving art of Medicine in an era of Artificial Intelligence

A folklore; There was a civilization so advanced that God was concerned. He sent Gabriel to see if this particular civilization should continue to exist or should be wiped out of existence. Gabriel descended from the heavens and found a boy nearing manhood in a small village. He asked “Where is Gabriel?”. The boy started doing some calculations and once the calculations were complete he drew a circle around him and Gabriel. And said “Gabriel exists in this circle; either it is me or you.” The civilization was desecrated by God.

The moral of the story as taught in the philosophy class was the importance of self-identity. God was not mad at computational excellence but rather blind faith in computation. The circle represents the confidence interval and the boy represents a generation that is being brought up in a culture of computation supremacy to a level of religious belief. His answer that it is either me or you signifies that he does even have confidence in self-identity in the presence of computational odds. This is considered the original sin in some philosophical constructs: “a loss of self-identity.” 

Futuristic representation of artificial intelligence in pop culture is not far from this folklore today; and might just be the future. The expansion of artificial intelligence algorithms at a rapid rate and with now stacks deployed to handle diverse situations.1 The near universal availability of usable, applicable data and its exponential growth.2 Recent breakthroughs in quantum computing to achieve supremacy.3 It is not the question of “if”, it is the question of “when”. This truly is a universal challenge in all walks of life. However, it applies especially in medicine as the whole field is defined by empathy at its core; “the healing touch”.

“The practice of medicine is an art, based on science,” 4 and therefore evolves with the evolution of science itself. The very development of evidence-based medicine (EBM) from the 1980s proposed a challenge to clinical freedom and re-integration of science in the art of medicine.5 The clinical practice was challenged to integrate population-based evidence-based medicine (EBM) to be applied to individual patients. The very promise was from the evolution of EBM based on population level statistics to eventually evolve into personalized medicine using precision. We now live at the dawn of precision medicine enhanced by artificial intelligence. 6

We have a tendency to overestimate the impact of innovation in the short term and underestimate it in the long run.7 The naysayers in the field of medicine want to chalk up the disruption due to AI, to just hype. However, the writing is on the wall and potential benefits clearly outweigh the risk. The issue is transition period, the transition to EBM was clearly problematic for practicing physicians of the time and required significant re-education and change in clinical practice. A similar evolution in practice will be required with AI playing an increasing role in healthcare. This change would be more laborious and challenging then anticipated.  

Transformational cultural change due to digitization of healthcare 8 has already resulted in increased burnout and decreased physician autonomy resulting in decreasing empathy.9 With the advent of AI in healthcare the perceived loss of clinical freedom would likely result in more burnout, as these innovations are seen as a direct threat to provider autonomy and clinical decision making. Medicine is not an exception as many industries face similar challenges and will require significant vocational retraining in the age of AI.10 This perception is clearly not the intent nor the reality. These technologies are designed to supplement and augment the provider rather than intended to replace them. “Will AI ever replace physicians? No—but physicians who use AI will replace physicians who don’t.”

This transformative change will come with its challenges and limitations.11 This very change not only will defy our practice habits but in some cases our very identity and will be deeply humbling.12 To preserve our self-identity as healers to the person in front of us and not an algorithm deciding the fate of life. This change also demands increased organization of physicians and revival of physician polity.13 To make sure resources are allocated equitably14 for physician education15 along with the deployment of these breakthrough technologies. Also, clear guidelines are established to affirm proper medico-legal liability.16 We as physicians need to protect our autonomy and self-identity in the era of mass adoption and simultaneously realise and educate ourselves of the great potential of AI in healthcare for our patients. 

References:

1. “How Fast Is Artificial Intelligence Growing? Look At The Key ….” 19 Dec. 2018, https://www.forbes.com/sites/joemckendrick/2018/12/19/how-fast-is-artificial-intelligence-growing-look-at-the-key-bellwethers/. Accessed 21 Nov. 2019.

2. “The Exponential Growth of Data – insideBIGDATA.” 16 Feb. 2017, https://insidebigdata.com/2017/02/16/the-exponential-growth-of-data/. Accessed 21 Nov. 2019.

3. “Quantum Supremacy Using a Programmable … – Google AI Blog.” 23 Oct. 2019, http://ai.googleblog.com/2019/10/quantum-supremacy-using-programmable.html. Accessed 21 Nov. 2019. 

4. “The essence of the art of medicine | The Medical Journal of ….” 21 Aug. 2006, https://www.mja.com.au/journal/2006/185/4/essence-art-medicine. Accessed 21 Nov. 2019.

5. “False dichotomies: EBM, clinical freedom, and the art of ….” https://mh.bmj.com/content/31/1/23. Accessed 21 Nov. 2019.

6. “How Artifical Intelligence Is Advancing Precision Medicine.” 18 Oct. 2019, https://www.forbes.com/sites/nicolemartin1/2019/10/18/how-artifical-intelligence-is-advancing-precision-medicine/. Accessed 21 Nov. 2019.

7. “Amara’s Law | Matt Ridley – The Rational Optimist.” 12 Nov. 2017, http://www.rationaloptimist.com/blog/amaras-law/. Accessed 21 Nov. 2019.

8. “Digital health is a cultural transformation of traditional … – NCBI.” https://www.ncbi.nlm.nih.gov/pubmed/29184890. Accessed 21 Nov. 2019.

9. “Effect of Organization-Directed Workplace Interventions on ….” 26 Sep. 2019, https://www.sciencedirect.com/science/article/pii/S2542454819300876. Accessed 21 Nov. 2019.

10. “Automation Will Make Lifelong Learning a Necessary Part of ….” 24 May. 2018, https://hbr.org/2018/05/automation-will-make-lifelong-learning-a-necessary-part-of-work. Accessed 21 Nov. 2019.

11. “Adopting AI in Health Care Will Be Slow and Difficult.” 18 Oct. 2019, https://hbr.org/2019/10/adopting-ai-in-health-care-will-be-slow-and-difficult. Accessed 21 Nov. 2019.

12. “Advancing algorithmic care – Penn Today – University of ….” 11 Nov. 2019, https://penntoday.upenn.edu/news/advancing-algorithmic-care. Accessed 21 Nov. 2019.

13. “Why Doctors Should Organize | The New Yorker.” 5 Aug. 2019, https://www.newyorker.com/culture/annals-of-inquiry/why-doctors-should-organize. Accessed 21 Nov. 2019.

14. “Opinion | The Business of Health Care Depends on Exploiting ….” 9 Jun. 2019, https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html. Accessed 21 Nov. 2019.

15. “How to Read Articles That Use Machine Learning – JAMA ….” 12 Nov. 2019, https://jamanetwork.com/journals/jama/fullarticle/2754798. Accessed 21 Nov. 2019.

16. “Potential Liability for Physicians Using Artificial Intelligence ….” 4 Oct. 2019, https://jamanetwork.com/journals/jama/fullarticle/2752750. Accessed 21 Nov. 2019