Physician visits hardly changed from the time Hippocrates practiced medicine in the 5th Century BC through the end of the 20th Century. An examination by a physician involved the patient conversing with a physician. Doctors were the primary source of medical knowledge. Beginning around the 18th Century, medical books for laymen began to appear, such as “Every man his own doctor,” (ca. 1727), Domestic medicine; or, The family physician, (ca. 1772). Druggists and apothecaries collaborated closely with doctors but also sold concoctions directly to patients. The dubious nature of apothecary concoctions are why the FDA was created along with the Pure Food and Drug Act of 1906.
The dawn of the 20th Century brought greater regulation, both good and bad. The Flexner Report (1910), “Medical Education in the United States and Canada,” led to the closure of more than half of (mostly substandard) medical schools. Particularly hard hit were those schools training minorities and people of color. Physician training was standardized and substantially increased. In the process, an already respectable profession became an elite profession. The Food, Drug, and Cosmetic Act of 1938, created two distinct classes of drugs (prescription drugs, and over the counter drugs). The law was enhanced by the Durham-Humphrey Amendment of 1951. Thus, over the years physicians became not just the care providers, but also the gatekeepers to the U.S. health care system.
In the 1990s the Internet made medical information widely available to the masses. At its core, the doctor-patient relationship is an information exchange. As doctors became harder to see due to their scarcity, patients turned to sources online. Patients could learn more about diseases and conditions online than their physicians would ever have time to discuss with them. However, patients still had to see a doctor to receive care or access medications.
Artificial intelligence (AI) chatbots can answer questions and is approaching many physicians’ capabilities. The New York Times reports that many physicians feel threatened by AI.
A.I. programs are becoming “existentially threatening,” for doctors, Dr. Chen said. “They threaten your identity and your purpose.”
Dr. Harlan Krumholz, a cardiologist at Yale and adviser to OpenEvidence, an A.I. program for doctors, agrees.
“A.I.’s reasoning and ability to make diagnoses is already outpacing what physicians can do,” said Dr. Krumholz, who is also a co-founder of two start-ups using A.I. to interpret medical scans and digital data.
AI is causing some doctors to rethink what it means to be a physician. What is their purpose in the age of chatbots that can spit out accurate answers to medical questions 24 hours a day and do not take vacations. Will AI boost the productivity of doctors the way tractors boost the productivity of farmers? Or will it put skilled knowledge workers out of a job like the assembly line did to cobblers and tailors? AI can document and transcribe office visits. It can triage and steer less severe patients to mid-level practitioners, freeing doctors to treat more serious cases. AI can read X-rays, but what is physicians’ niche? Most physicians believe they still have a part to play, but it will be different than what they are used to.
“Medicine is going to change,” Dr. Pandolfino said. “You can’t fight it.”
But physicians still have important roles to play.
“Internal medicine is a people-facing specialty,” Dr. Linder said. “You get to know patients over time. You know their values. You know their families.”
Dr. Joshua Steinberg, a primary care physician at SUNY Upstate Medical University in Binghamton, N.Y., agreed.
“Even if an A.I. has read all the medical literature, I will still be the expert on my patients,” Dr. Steinberg said.
“I think our doctoring role may look a little different, but I will still be sitting on a little rolling stool, talking to the patient,” he said.
That begs the question: is Dr. Steinberg correct and is that what patients want? For centuries, the gold standard has always been a physician sitting in front of patients, conversing one-on-one. But what if patients no longer want to schedule office visits weeks in advance, drive across town, and wait in a crowded waiting room for a 10-to-15-minute face-to-face visit with a human doctor. What if the alternative is swinging by CVS without an appointment and chatting with a robot that has full access to your medical record regardless of which CVS (or Walgreens) you stopped at. Seconds later perhaps the robot approves medications for a nominal fee. More from New York Times:
“The real concern isn’t A.I. itself,” said Dr. Leo Anthony Celi, the clinical research director of M.I.T.’s laboratory of computational physiology. “It’s that A.I. is being deployed to optimize a profoundly broken system rather than to reimagine it.”
“Today’s patients,” Dr. Celi said, “may not realize how badly the current system is failing them.”
There are numerous telemedicine firms online, where you never meet your doctor face-to-face. You do not even talk to him on the phone. You fill out a questionnaire, and medications arrive in the mail. Perhaps in the future the role for physicians will be to oversee integrated AI care systems with patients mostly treated using AI. Or perhaps the training of physicians should change to fill roles we cannot yet fathom. Patients may do not want an AI empowered status quo. AI should boost access to care, not be bottlenecked by the same outdated constraints.
Read more at NYT: A.I. Is Making Doctors Answer a Question: What Are They Really Good For?