AI Will Be an Elixir for Both the Art & Science of Medicine

Medicine has always been described as both an art and a science from the early days of Hippocrates' discussion of the technai, a Greek term for “art” or skilled trades. Digital medicine could and should strive to create a better symbiosis of art and science, unifying them to maintain and improve the status of medicine as a revered profession…with more meaningful relationships and services that are adapted to a digital age. We can’t expect to go back to the good old days. In the words of one of my wise mentors, friend and colleague, Jesse Tannenbaum, “the good old days, weren’t!”

The traditional healer, the image of the venerable doctor with their black medical bag, had limited medical tools and limited medicines to offer their patients. Even with little to offer, they were able to create relationships and bonds with their patients. They were very connected to their community. What they lacked in science, effective medication, or technology, they made up for with empathy, kindness, time, and tangible personal relationship with patients and their families. These relationships provide more than an idealistic vision of the days of yore, they enable physicians to fine tune communication, treatments, and care for their patients. This relationship allows the patient to lead the physician to the right decisions and the right care. They are partners in a dance…

This is the idealistic vision of what medicine was and what medicine can be. What if this was all a lie? What if all along, doctors have been overworked, embroiled in a passionate pursuit of their profession, and subtly disconnected from their patients and burned out? Did Hippocrates have it wrong when he wrote De arte? Let’s pause for a moment. Is this really true? Is it hyperbole? Human behavior has been fairly constant throughout generations, and people typically don’t change. People are human. Doctors are human. Then and today, we have likely had our moments where we are overwhelmed and disconnected, paternalistic, arrogant, indecisive, biased in our decision making, indifferent to evidence, unaware of the outcomes of our actions, engaged in conflict of interest, and severely lacking in context about our patients. Is medicine really any better or worse today? That can be a subject of great debate.

Today’s physicians are overworked, burned out, inundated with crushing amounts of information, drowning under the weight of EMR’s tying us to computer screens. How do we cure disease? How can we get improved outcomes? We are seeing more patients. We are drowning in data. We are using more evidence based practices in real time. The concepts of quality and safety in healthcare, resilience, acknowledgement of our biases, realization of the need for recognizing inequities in care are emerging now.

Now as always, there have been deficiencies in healthcare and bright spots that demonstrated the adaptability and resilience of our workforce. There is perhaps no better example than the COVID-19 pandemic. During a dire time, healthcare has not necessarily thrived, but it has endured, innovated and evolved.

Telemedicine and asynchronous virtual care have found their stride, at a time when inequities in society and healthcare and our more complete understanding of the impact of social determinants of health have become more readily apparent. Patient reported data is hanging over physicians heads…is it the patient-doctor relationship’s salvation or simply the Sword of Democles poised to finish off the exhausted American physician. Technology has helped us through this crisis, but will we become better? Will we thrive and emerge from the ashes to become a newer, more advanced medical system? Will we learn to take advantage of the strengths of artificial intelligence while simultaneously learning that the bias we build into artificial intelligence could damage us all? We will still realize that the relationship between clinicians and patients is the most sacred process that technology can support, but never quite replace.

There are a myriad of bright, shining examples of artificial intelligence in medicine! Virtual reality, analytics, clinical research, telemedicine, imaging, robotics, patient tracking technology, natural language processing, and other applications will guide us to make better choices and design better healthcare products. I am pleased to announce that I will be introducing a series of blog articles that will review the National Academy of Medicine’s extensive policy statement, Artificial Intelligence in Healthcare (Matheny, et al. 2019. Artificial Intelligence in Health Care: The Hope, the Hype, the Promise, the Peril. NAM Special Publication. Washington, DC: National Academy of Medicine) This piece gives us an extensive and detailed description of our current progress and gives us hope for future directions. The next installment will detail some of the key discussion points and provide opportunity for broad application of best practices and unique avenues for creative development. Along the way the challenge for physicians, innovators, engineers, investors, and futurists is to consider how we can advance the art of medicine by enhancing relationships between care teams and those people suffering with disease while improving outcomes. The first challenge in the discussion: AI should be described as Augmented Intelligence, not Artificial Intelligence, in the healthcare space. More to come…