Computing science will probably exert its major effects by augmenting and, in some cases, largely replacing the intellectual functions of the physician.
WB Schwartz, 19701
In 1970, nephrologist and early researcher into artificial intelligence (AI) in healthcare, Dr WB Schwartz wrote a special article for the New England Journal of Medicine titled “Medicine and the Computer. The Promise and Problems of Change.”1
Schwartz outlined the rapid advances in AI and the imminent social costs associated with these. He asserted that physicians would resent the loss of decision-making autonomy to the battery of computers that would manage everything from the delivery of anesthesia to physical patient care.1
Nearly fifty years on, many themes from that article still resonate today – privacy concerns regarding electronic patient records, the use of AI as a decision support tool 1-3 – and some are largely redundant. But the most important of the issues predicted by Schwartz, and just as relevant today as they were five decades ago, are a redefinition of, or refocusing on, the role of the physician and the relationship with the patient, and the need for our medical curriculum to change to meet the demands of the new technology.1
Schwartz had concerns about the willingness of physicians to accept some of the necessary changes.1
“It might be argued, of course, that the opportunity to deal more extensively with the emotional aspects of disease will compensate the physician for his diagnostic and therapeutic skills, but it is far from clear that most physicians are equipped by either temperament or training to accept change of this kind gracefully.”1
Using AI to increase healthspan
Arguably, AI is now here or imminent.4 The AMA Journal of Ethics recently published an entire issue dedicated to the ethical dimensions of AI in healthcare.
Dr Joseph Kvedar presented an optimistic view of the current status of AI in healthcare at the Innovations in Global Health Professions Education (IGHPE) annual meeting in Kuala Lumpur in 2018, outlining how imaging technologies are making improvements in diagnostics.5
IGHPE has featured many other innovators in its meetings and podcasts who have spoken about developments in specific areas, ranging from electronic patient records to student learning.6 One such innovator is Dr Daniel Kraft who also spoke at IGHPE 2018 on the impact that technology, inclulding AI, is having on patient care and how it is growing exponentially.7 The pervasiveness of technology today could not be missed in his presentation: he presented “virtually” in Kuala Lumpur via robot from his office in the USA.
In a recent blog post for Innovations in Global Health Professions Education, Dr Kvedar argued that the introduction of AI will allow us to focus on the human elements of healthcare and increase the healthspan: “Healthcare professionals need to look for opportunities to outsource routine tasks to machines, not be afraid to do so, and appreciate the value of caring and human connection, judgment and attention to quality.”8
The arrival of AI and implications for health professions education
Schwartz rightly noted that medical education would need to change to encompass AI and its associated developments, although he was thinking more of the technological skills required.1 More recently, the Dean of Weill Cornell Medicine-Qatar and co-Editor-In-Chief of IGHPE, Dr Javaid Sheikh, spoke about the important role education has to play in preparing the health professionals of today and the future for these technologies.9
Wartman and Combs argued that the medical education curriculum needs a reboot to enable students to develop the skills to deal with data and communicate effectively to patients in a data-driven healthcare environment.10 Medical students also agree that AI should be included in their training.11
We can shape the change
Schwartz’s article revealed an overly optimistic view of the pace of development of AI in healthcare.1 However, he did have the foresight to recognize two of the most important changes needed to ensure AI is a development for the better: the changing focus of the healthcare provider from the technical to the human elements of medicine, and the need for education to support health professionals in delivering this new world.
While the seismic shifts in the delivery of healthcare he predicted have not (yet) materialized, it appears they are coming. Thoughtful reflection on how the practice and education of healthcare changes to maximise the benefits of AI will, as Kvedar said, help us focus instead on using technology to improve the health of society.8
1. Schwartz WB. Medicine and the Computer. N Engl J Med. 1970 Dec 3;283(23):1257–64.
2. Williams H, Spencer K, Sanders C, Lund D, Whitley EA, Kaye J, et al. Dynamic consent: a possible solution to improve patient confidence and trust in how electronic patient records are used in medical research. JMIR Med Inf [Internet]. 2015 Jan [cited 2019 Mar 5]; 13;3(1):e3 [7 p.]. Available from: https://medinform.jmir.org/2015/1/e3/ doi: 10.2196/medinform.3525
3. Noorbakhsh-Sabet N, Zand R, Zhang Y, Abedi V. Artificial intelligence transforms the future of health care. Am J Med [Internet]. 2019 Jan 31 [cited 2019 Mar 5]; [epub ahead of print]. doi: 10.1016/j.amjmed.2019.01.017
4. Saria S, Butte A, Sheikh A. Better medicine through machine learning: what’s real, and what’s artificial? PLOS Med [Internet]. 2019 Dec 31 [cited 2019 Mar 5];15(12):e1002721 [5 p.]. Available from: https://blogs.plos.org/speakingofmedicine/2018/11/28/better-medicine-through-machine-learning-whats-real-and-whats-artificial/ doi: 10.1371/journal.pmed.1002721
5. Kvedar K. AI: enabling human interaction in an era of digital med. 2018 [cited 2019 Mar 5]. Available from: https://www.youtube.com/watch?v=i8Ekl2srl20&index=6&list=PL3GN-K8Q8HF8fXzsbxRXN3zwReZQZJTlM
6. Innovations in Global Health Professions Education [Internet]. Doha, Qatar: Innovations in Global Health Professions Education. 2015- [cited 2019 Mar 4]. Available from: https://www.innohealthed.com/
7. Kraft D. The future of health and medicine: where can technology take us? [Internet]. 2018 [cited 2019 Mar 4]. Available from: https://www.youtube.com/watch?v=zUKmo85h8Pw&feature=youtu.be
8. Kvedar J. Making the 21st Century the century of the healthspan. 2019 Feb 26 [cited 2019 Mar 5]. In: Innovations in Global Health Professions Education. Innovators blog [Internet]. Doha, Qatar: Innovations in Global Health Professions Education. 2015- [about 2 screens]. Available from: https://www.innohealthed.com/2019/02/26/making-the-21st-century-the-century-of-the-healthspan/
9. Sheikh JI. IGHPE Kuala Lumpur 2018: Opening remarks [Internet]. 2018 [cited 2019 Mar 5]. Available from: https://www.youtube.com/watch?v=oCSKLJcKMvs&list=PL3GN-K8Q8HF8fXzsbxRXN3zwReZQZJTlM&index=2
10. Wartman SA, Combs CD. Medical education must move from the information age to the age of artificial intelligence. Acad Med. 2018 Aug;93(8):1107–9. doi: 10.1097/ACM.0000000000002044
11. Pinto dos Santos D, Giese D, Brodehl S, Chon SH, Staab W, Kleinert R, et al. Medical students’ attitude towards artificial intelligence: a multicentre survey. Eur Radiol. 2018 Jul 6; [epub ahead of print]. doi: 10.1007/s00330-018-5601-1