We went to see the patient and I watched with self-satisfaction as he asked the same questions I had. When did the pain start? Where is it? I waited for him to tell her it was likely IBS. But he didn’t. He paused and looked at her face after his last question, and for the first time I noticed she wasn’t making eye contact. She was looking at the ground. “We’ve known each other for a long time,” he told her gently, “and you seem worried. Can you share what you’re thinking?”
For the next 15 minutes I watched as they talked about how she was processing her sister’s diagnosis, her fears about the future, what it all meant for her future colon cancer screening, and why at this point we were most concerned about IBS.
My supervising physician and I talked about it. “You learn how to look,” he said. “When you care, you get a feel for it.”
That lesson has stayed at the forefront for me as I’ve watched artificial intelligence sweep through medicine and enter the clinical environment of our internal medicine residency program at the Johns Hopkins Hospital. AI scribes. Chatbots that tell you a differential diagnosis if you put in a patient’s symptoms. Electronic medical record tools that will summarize a patient’s hospital course for you. But they can’t feel.
But they’re wrong that physicians will become obsolete as AI becomes better at processing information. As I learned in medical school, truly caring for a patient begins before the first question is asked and the first test is ordered. It begins with looking. Noticing a second of hesitation before a patient responds. Seeing the pits in a nailbed. Hearing a change in heart sounds between visits. It begins when you commit to focusing entirely on the person in front of you, and to creating a relationship—that’s how you get a feel for it.
Great physicians define the input. They decide which symptoms matter, observe what wasn’t said, and understand what information deserves the most attention. They are curious about the patient in front of them, and that curiosity drives them to dig deeper, discover information an algorithm couldn’t, and direct the flow of information—not just receive it.
Could AI in the coming decades replace these doctors? Probably. If the input is just data, the output would probably be the same. But the patients’ experience will be the one I would have given my patient with abdominal pain: incomplete and ineffective.
Healthcare workers need to inform how medical AI is developed and deployed, so it doesn’t propagate checkbox medicine and promote the creation of AI-equivalent physicians who can follow protocols but have no feel for medicine.
It also means we need to focus on recruiting people to medicine who have the “soft skills” and attributes that have defined great physicians for centuries: a focus on serving others, forming connections, building trust, and empathizing.
AI will become better at recognizing disease. Whether medicine becomes better at recognizing patients depends on whether physicians still learn to look—and learn to feel.
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