Is this what we want for our patients and the future of medicine? Sacrificing compassion and reassurance of the human experience for the sake of efficiency? Or, do we want a blend of both to deliver the best healthcare we can. Artificial intelligence is the ability of machines to perform tasks that normally require human intelligence such as reasoning, learning, decision making and problem solving. AI uses computer software to simulate human cognition that drives machine learning algorithms that can teach the machine how to perform a specific task and provide accurate results by identifying patterns. It does so by developing its own algorithms from massive amounts of downloaded data. We see this in Google, Siri, Alexa, IBM Watson, directional maps and more which have permeated our daily lives such that we are absolutely in need and are dependent on them. Already, the use of AI has affected the labor force. One survey reported that 75% of the companies questioned said they expect AI technology to eliminate up to 26 million jobs over the next five years. The medical community is no different and jobs have been lost and more will or be modified in many sectors. The use of AI is also moving from hospital administrative tasks to actual clinical decision making. AI is being used in pathology, radiology, cardiology, gastroenterology, and primary care. Algorithms for diagnosis and treatment of various disease entities and emergencies are already being used and more are being formulated and tested. Amazon, last fall, launched a virtual clinic in 50 states staffed by “licensed providers.” Licensed by whom and where? The recent Covid pandemic helped accelerate AI development. Globally, AI in the healthcare market accounted for $14 billion dollars in 2020, but it is projected to reach $119.8 billion dollars by the year 2027. wAI is a wonderfully exciting complex innovation that will no doubt help but will also change the landscape of the practice of medicine to come. But, not without serious concerns about its ability to overtake and stifle the human art of medicine. The president of the artificial intelligence society stated that the medical community and society will have difficulty moving through this “transitional phase” where machines will be doing better and more efficiently than humans. There is that word again, efficient. The FDA and the AMA are taking steps to develop a model for evaluating, standardizing, and regulating the use of AI but it is still in its early days and essentially AI is unregulated. Big tech is already fighting some minor regulations. There are some phenomenal assets that AI can bring as an adjunct to the practice of medicine.
AI can provide real time data for a quicker diagnosis and decision making allowing for earlier and more personalized therapies. AI can streamline tasks such as scheduling, coding, reviewing insurance claims and even generating care paths/ By maximizing productivity and cutting healthcare costs, it can reduce the estimated $750 billion that is wasted annually. It can help monitor patient progress and alert patients and providers if a condition worsens. Recently a woman was awakened in the middle of the night by her smartwatch alerting her that she had gone into atrial fibrillation and her risk for stroke. AI can advance medical research by analyzing massive amounts of data to discover new insights patterns and correlations from large and complex datasets that would be otherwise difficult for humans to process. With limited or nonexistent healthcare access in impoverished communities exacerbated by the shortage of health care professionals, AI can improve health care by enhancing remote access to these areas. It is estimated by the year 2035, there will be a global deficit of 12.9 million skilled healthcare workers in the workforce. Although I’ve touched on a few of the phenomenal things that artificial intelligence can do to enhance the practice of medicine, there are concerns about the implementation of artificial intelligence in the healthcare arena. It comes with significant risks to the delivery of medical care, the patient doctor human relationship and the future educational experience and training of doctors and other medical allied professionals. There are major ethical concerns with the development and use of AI in health care. AI can make decisions that can have significant impacts on human lives, health, and well-being. Interestingly a recent poll showed that 67% of patients do not trust AI as being a total driving force in their healthcare. The information from portable healthcare monitoring devices is not subject to privacy laws and is used in AI databases. The data from smartphones and watches about our lifestyles, eating habits, exercise and everything we do can go directly to our insurance companies which could be used to adjust future coverage and premiums. Conglomerates like Google and Microsoft are already partnering with large healthcare providers to download massive amounts of medical data to enhance machine learning of artificial intelligence. With these partnerships between large private equities and large healthcare delivery systems one would think that there should be a moral responsibility to share these algorithms with smaller institutions, however this may not be the case in the future. With the influx of massive
amounts of private equity money, will we see a point where all major healthcare systems will be owned and operated on a for profit model and cause healthcare costs to rise? Will the new healthcare delivery team be the hospital CEO, the chief digital officer and the AI computer? Cybersecurity is paramount. With increasing amounts of patient data being stored and transmitted electronically, healthcare providers are facing growing security risks. Cyber-attacks can compromise patient data, disrupt scheduling healthcare services and potentially interrupt the delivery of healthcare altogether. A recent survey showed that in 2020 security breaches had jumped 42%. Investments in cybersecurity is expected to reach $24.1 billion by the year 2026. AI is not infallible and can be prone to mistakes or fail to perform as expected. Data shows that AI error rates are almost equal to the human error rate in medicine at present. However, when used as an adjunct to diagnose, human accuracy improves dramatically. Bias issues are another concern. Unless they are corrected, the data introduced into its algorithms may prejudice the decisions made by AI. A major discussion occurring right now is where will the impact fall for accountability and responsibility? Who is liable for the outcomes and consequences of AI’s decisions or actions. Who is responsible for the oversight and regulation and who is entitled to the benefits and risks of AI in healthcare. International medical groups are calling for the establishment of oversight of how algorithms behave in real world scenarios. It is imperative that we ensure that doctors oversee the development of the health algorithms and their implementation. These are some of the questions that need to be addressed before increasing dependence on AI in healthcare. Also, what effect will it have on the autonomy of caregivers to independently decide on treatments for their patients? The stakes are very high if things go wrong with our development and legislation of this phenomenal revolutionary new technology. To quote Dr. Deepak Chopra, “The basic nature of being is to react to unpredictability and the infinite possibilities, whereas artificial intelligence reacts on previous predictability and draws conclusions from that. Humans have the power of awareness which a computer cannot and will never develop nor possess.”
This freight train silently coming down the track at full speed cannot be left unchecked. There needs to be significant in-depth studies on its impact on the practice of medicine, the delivery of healthcare, training of future doctors as well as the present and future health care labor force. We will, as before, continue this coming year to stay focused on immediate issues that affect the practice of medicine and health care in Louisiana, however the main focus of my year will be to explore AI’s impact on our practice of medicine. To create an awareness and bring it to the forefront of discussion with doctors and legislators to recognize the obvious need for standardization and regulation before full implementation. We need to avoid the chaos we have already seen in the unregulated development of electronic medical records. I will do my best to help our society form policies and guidelines to help enhance our physician’s ability to practice better and more accurate medicine. But clinicians need to understand that these tools are to augment clinical decision making and should not be used to replace it. Yes, the landscape of medicine is changing and will continue to do so for more generations of physicians to come. Let’s not abdicate our responsibility of training the next generation of doctors to artificial intelligence. We must encourage our future doctors to continue to practice the human aspect of the Art of Medicine and to teach it for generations to come. Anyone or anything can learn the science of medicine, but it takes a human to teach how to live our oath to give compassion, empathy and your whole life and essence to another person for their well-being and healing. A computer cannot and will not ever learn how to do this. The handshake, encouragement, the touch and sometimes just your presence are all as necessary for healing as being correct with the diagnosis and treatment. As Carl Jung said.” Medicine cures diseases, doctors cure patients”. We cannot let the quest for efficiency and accuracy in medicine overshadow the human art of medicine. I will continue to advocate for the physicians of Louisiana. I hope to help us balance the delivery of efficient, accurate medicine with the extraordinarily valuable art of medicine. To quote Hypocrites “Where the art of medicine is loved there is also a love of humanity.” I wish to thank my lovely wife Shelia and my family for years of unwavering love and support and thank you for your confidence entrusting me with the responsibilities and duties of President of the Louisiana State medical society.
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