Artificial Intelligence in Medicine – Part 6: Impact of AI on the Doctor-Patient Relationship

“Physicians are valued for being brilliant diagnosticians and they now have more information and tools and technology at their disposal than ever before; yet patients don’t feel cared for, and doctors don’t feel like they can care for patients enough.”^[i]

Abraham Verghese, MD is hardly a household name, but among many doctors he is something of a hero. As Professor for the Theory and Practice of Medicine at Stanford University Medical School, he holds an influential position with his medical students. His consistent message about the importance of person-to-person connectedness between doctor and patient gradually gained wider traction.

In 2011 he was invited to speak at TED Global^[ii] in Edinburgh, Scotland that September. Suddenly, he had a huge internet audience. His talk, “A Doctor’s Touch,” has now had over a million views. He describes how doctors are on the brink of losing the personal touch. He worries that technology is turning doctors into high-paid clerical workers, to everyone’s detriment.

Integrating computer intelligence into personal medicine

As an example of the unwitting negative impact of computer intelligence into Verghese bemoans the growing proportion of a doctor’s time that is devoted to electronic health records (EHR). This is fact, not fiction. In 2016, the Annals of Internal Medicine published results of an interesting study in which 57 U.S. physicians in outpatient care (family medicine, internal medicine, cardiology and orthopedics) were observed for 430 hours, while 21 of them also turned in after-hours diaries. What portion of a doctor’s time goes where? The study found that during the day:

• 27% spent on direct clinical face time with patients
• 49.2% on EHR and desk work

During an actual examination,

• 52.9% on direct clinical face time
• 37% on EHR and desk work

For those who kept after-hours diaries, 1-2 hours of work at night, mostly on EHR tasks.^[iii]

There is, of course, a tremendous upside to EHR in terms of amassing uniformly encoded patient data. When Artificial Intelligence (AI) is applied to such potentially enormous databases, the benefits can include greatly reduced diagnostic errors, fewer medication errors, and a foundation for research into disease and treatment demographics, among many others.

However, what seems to be the impact of EHR time vampire on practice of medicine is a trend toward doctors losing the qualities that are often just as healing as their knowledge of diagnosis, prescriptions and procedures. They are the intangible qualities that no computer intelligence can provide: listening, eye contact, empathy, caring, and intuition. Not only does the loss of meaning in a doctor’s work lead to physician cynicism and burnout, it leaves patients feeling neglected at a deep level.

Verghese puts it eloquently:

…the leading E.H.R.s were never built with any understanding of the rituals of care or the user experience of physicians or nurses. A clinician will make roughly 4,000 keyboard clicks during a busy 10-hour emergency-room shift. In the process, our daily progress notes have become bloated cut-and-paste monsters that are inaccurate and hard to wade through.

…The living, breathing source of the data and images we juggle, meanwhile, is in the bed and left wondering: Where is everyone? What are they doing? Hello! It’s my body, you know!^[iv]

Actually, Verghese is optimistic about the possibilities, provided that AI and machine-learning algorithms are carefully vetted to avoid unintended consequences, and that the raw data is good and meticulously entered. He and many other experts recognize that not only does AI have the potential to liberate a doctor’s time in order to be more personally available and energized for each patient; it can also be harnessed to improve a doctor’s ability to communicate with patients by providing teaching and self-evaluative “bedside manner” tools.^[v] Both instances are win-wins for doctor and patient alike.

This is a rosy peek at how AI might affect the doctor-patient relationship. Of course, regardless of a computer report on an imaging study, in the end a doctor must use his/her professional diagnostic and treatment judgement. It is my belief that a healthy partnership between doctor and AI will develop, and if the doctor’s time can truly be freed up to attend to each patient using those intangible qualities, the patient will get the best a doctor can offer, and healing will be facilitated in an optimum way.

Watch for Part 7 of this series that focuses particularly on AI in my own specialty, radiology. Meanwhile,
If you’d like to spend 18 minutes listening to Dr. Verghese’s inspiring TED talk, click here.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Inserro, A. “Restoring the Doctor-Patient Relationship with Artificial Intelligence.” AJMC Focus Blog. Mar. 28, 2019.
[ii] TED stands for Technology, Entertainment and Design. The TED organization posts 18 minute talks online for free distribution under the slogan “ideas worth spreading”. TED was conceived by Richard Saul Wurman in February 1984 as a conference; it has been held annually since 1990.
[iii] Sinsky C, Colligan L, Li L, Prgomet M et al. Allocation of Physician Time in Ambulatory Practice: A time and Motion Study in 4 Specialties. Ann Intern Med. 2016 Dec 6;165(11):753-760.
[iv] Verghese, A. “How Tech can Turn Doctors into Clerical Workers.” The New York Times Health Magazine, May 16, 2018. https://www.nytimes.com/interactive/2018/05/16/magazine/health-issue-what-we-lose-with-data-driven-medicine.html
[v] Rowe, J. “What AI Could Do for Doctor-Patient Relationships.” AI Powered Healthcare, Aug. 29, 2019.