I recently read a short article illuminating the usefulness of artificial intelligence (AI). The article suggested that, in the future, AI will be capable of replacing your primary care doctor. It also indicated that a nurse or nurse practitioner working alongside the AI will be able to manage most of the issues that a primary care physician would handle. This was only one industry that the article suggested artificial intelligence could disrupt professional roles.
I had to think about it for a minute. It’s always helpful to look for the truth in an idea before dismissing it. Since I am a physician, my first instinct might be to be defensive and offended. However, the more I thought about it, the more I realized there is an element of truth to this. But I want to be clear that truth is based on a condition. The condition is that we maintain the status quo of primary care health delivery.
The Demise of the Doctor-Patient Relationship.
If we continue the current trajectory of primary care delivery, then I would agree that IBM’s Watson could end up being just as effective as many primary care physicians.
If ultimately, we primarily view people and their health issues through the lens of algorithms, then perhaps AI will be better at processing the algorithms than most physicians. If we continue to prioritize billing, data collection, risk management, and compliance over deep, human engagement, then perhaps Watson will be better at achieving the desired outcomes.
The current status quo of primary care health delivery is dehumanizing to both the physician and the patient. It treats the patient as a problem to be solved and the physician as a technician to be managed. This completely dishonors the fundamental concepts underlying the historical doctor-patient relationship.
How Humane Should Health Delivery Be?
Throughout all of human history, human beings have sought direction from those they view as healers when they’re experiencing various problems. These encounters involved knowing one another, and sensing or feeling one another. All of us have the basic need to be known, felt, and heard. It is fundamental to any therapeutic encounter that the person seeking solutions have these needs met.
We know that when a patient has an experience where they felt listened to and understood, the outcomes from the visit will be better regardless of whether or not the physician can find specific solutions to the problems presented. The encounter has had a positive therapeutic benefit, even if the problem cannot be solved that day. This is fundamental to the practice of medicine, especially primary care medicine.
How Humane is it Really?
The current primary care delivery system does not allow this to take place. Not only is the time for doctor-patient engagement limited based on financial caps imposed by insurance companies, but also the actual agenda of the office visit has been hijacked by risk managers. The physician enters the room with bureaucracy draped all over them. They have to properly document the encounter, even if that documentation is pointless to the actual outcomes. There is risk management and report quality. They have to assign their patients a score in order for money to be properly allocated.
It creates an environment where a physician is more engaged with a computer than they are with the actual patient. A typical medical encounter will last less than 15 minutes, and for much of that time, the medical consultant will be performing data entry duties rather than intently listening to and feeling the presence of the patient.
The current delivery system has created serious obstacles for both the doctor and patient to have this kind of experience. So yes, if this is the best we can do, IBM Watson probably can do better. At least Watson can use an empathetic voice, and perhaps pop up a face on his screen that’s actually looking at you while you punch in your data.
At the same time, we know better. People seeking health are not looking for engagement with artificial intelligence. They’re looking for deep engagement with someone they trust. Someone who knows them, who listens to them, and can offer wise counsel. So if we’re going to just have a system based on sick care, treating symptoms with pharmaceuticals, and watching people with chronic diseases slowly get sicker, then we might as well just let computers take over.
What about a Future with Both Human Intelligence and Artificial Intelligence?
I use technology in my practice and I am very grateful for the research search engines provide when I need up to date information while working with my patients. I believe that AI can help physicians manage the algorithmic side of medicine. However, it cannot search out the deeper influencers of symptoms and conditions people are experiencing. It takes a human to know and understand a human.
If we’re truly after our healthiest selves, and want to experience the best possible lives, then we will have to change the way we experience primary care delivery. We will have to reinvest in the kind of engagement that produces the desired outcomes. And the outcome is for everyone to experience their best health.
Join me! The only way we’ll ever get a different system is if we work together to demand a different system.