https://www.ncbi.nlm.nih.gov/pubmed/29648509
Time to regenerate: the doctor in the age of artificial intelligence.
Author information
- 1
- 1 Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK.
- 2
- 2 Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, University of Birmingham, Birmingham B15 2TT, UK.
- 3
- 3 Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
- 4
- 4 NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK.
- PMID:
- 29648509
- DOI:
- 10.1177/0141076818762648
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The doctor as the human—artificial intelligence interface in diagnosis
Effective communication of a serious diagnosis requires considerate assessment of a patient’s hopes, fears and expectations. Much of this is non-verbal. A skilful physician ‘reads between the lines’. These channels of communication are instinctual and they influence the doctor’s consulting behaviour on a minute-by-minute basis, often without them realising. The most sophisticated dimensions of this human-tohuman interaction happen at an innate level and cannot be replicated by an algorithm.
Triaging the doctor to the high-risk patient
The role of the doctor in the emergency room is likely to be as team-leader, knowledge-handler and communicator. The coordination of the rapidly evolving estimates of diagnostic certainty, recommended treatment pathways, and, where possible, discussion of potential benefit and risk with patient and relatives is going to be key. These roles do not need to be restricted to a doctor, but they do require a human.
Directing the doctor to the complex, the nuanced and the ‘doesn’t fit’
Alternatively, it may be the patient’s needs, rather than their condition, that is complex. Healthcare decisions for a patient with learning difficulties, dementia, addiction or significant social deprivation are likely to require more human support than for other patients.
The doctor as patient educator and advisor
Humans are, however, notoriously poor at comprehending probability and evaluating risk, and especially so when it pertains to their own health or the health of a loved one. Therefore, for most patients, one of the most important roles for the doctor will be to understand risk and communicate this to the patient, whether around diagnostic certainty, the safety of an intervention or the efficacy of a treatment. The doctor will also need to be able to explain the way artificial intelligence has ‘formulated’ a treatment plan
It is worth noting that this does not require a detailed knowledge of machine learning techniques. Just as doctors use other investigations such as a magnetic resonance imaging scan without a detailed knowledge of its mechanics, so it should be possible to communicate the value of arti- ficial intelligence in informing clinical decisions without deep computational knowledge.
The doctor as patient advocate
We need to move from a ‘black-box’ to a ‘glass-box’ mentality. In this debate, the key contribution of the doctor will be their understanding of the two overlapping domains – the experience of patients in the ‘real world’ and their specialist knowledge of both the potential and risks of medicine.
The doctor at the end of life
In contrast, a human physician recognises that some human decisions are not simply a matter of survival-based logic. Despite the similarity of Asimov’s law to Hippocratic concepts, humans have a more nuanced understanding of beneficence and non-maleficence which incorporates not just length of life but also quality of life.
One patient with a terminal disease may choose palliation; another will opt for further chemotherapy.
201804 time to regenerate _ the doctor in the age of AI.pdf
