octors are an insecure bunch these days. We work under the threat of being replaced by machines smarter than us. Vinod Khosla, a Silicon Valley venture capitalist, says that the medical profession is approaching extinction and predicts that the majority of our work will eventually be outsourced to algorithms and other artificial tools of clinical reasoning.
He’s partly right. But I think my profession is headed to evolution, not extinction.
Much of what we once did with our eyes, hands, and ears has been replaced by machines. In my corner of the United States, a child who comes to an emergency department with abdominal pain is likely to have a CT scan before ever being examined by a physician. The stethoscope, the very tool that shaped and defined the bedside examination, began to be phased out as a way to examine the heart sometime at the end of the last century. Other more sensitive diagnostic modalities have dulled our capacity to understand and depend upon what we see and hear.
As the medically mundane is being replaced by machines, we are entering a post-human era of medicine. In “The Innovator’s Prescription,” Clayton Christensen and Jason Hwang describe the landscape of medicine as evolving from one of intuitive guesswork and pattern recognition to one of precise, targeted medicine — care well-suited, it seems, for automation and artificial intelligence.
This view of post-human medicine may seem repulsive to those who see medicine as uniquely human. Some of that view is grounded in arrogance — surely nothing could ever do what we do as well as us. But as medicine confronts its limitations, modern providers are faced with a paradox: We want the precision and specificity of the machine yet we want to believe that we can still do it all with our hands and eyes and ears.
We probably can’t. So we need to start redefining what the human doctor of the 21st century will do.
Cleaning away work that is ‘no longer human’
This redefinition is an important exercise for practicing physicians. It’s even more important for how we train the next generation. What will a doctor need to know or be able to do 20 years from now?
Medicine is changing faster than those charged with training doctors can keep up. Medical educators in the early 1990s wouldn’t have been able to foresee that medical imaging would replace the physical exam. The democratization of information brought by the internet and the unrestricted access to information by patients would have been considered heresy at the time. Our ability to predict the future course of medicine and the role of the physician in it is predictably poor.
Yet there are certainties from which we can draw. Knowledge, for example, has expanded well beyond the scope of what any one human can assimilate. So it’s likely that the next generation of doctors, instead of committing to memory what they need to know, will access what they need to know.
It’s possible that the destiny of my profession will come down to the answer to this question: What can a human do that a machine can’t? What makes 3 cubic feet of muscle, bone, and nerves wrapped in a white coat so special? To answer this is to define the shape and identity of the 21st-century physician.
In a brilliant stroke of irony, I suspect that it may be Khosla’s clinical machines that help us solve our professional dilemma. In his book, “The Most Human Human,” Brian Christian suggests that only through machines will we be able to understand what it is to be human. He describes the rise of artificial intelligence as a type of maggot therapy: It consumes only those portions of the physician’s work that are no longer human, restoring us to health.
A primitive analogy, to be sure, for a modern dilemma. But it’s an apt description.
Better put: If a machine can do it, then it was never really human to begin with.
Perhaps the future will hold a role for physicians somewhere among the technologies that diagnose and target therapy. As the human body becomes digitized and quantified, there will be an emerging role in shaping individual human information as knowledge and wisdom. There will be an essential role for humans as docents that put the deluge of data and diagnostics into a broader human context.
Doctors need to embrace the machine
As medicine undergoes perhaps its most extreme transformation, physicians should be optimistic about the opportunity for redefinition. In the discussion about doctors and machines, there’s an assumption of inevitability that could be referred to as technological determinism. According to this theory, a society’s technology determines its social structure and cultural values. Simply put, we follow the lead that technology appears to provide.
Physicians begrudgingly accept the technology they’re given and assume that the process is part of some master plan. Electronic health records may serve as an example. Few doctors find the early iterations of these records to be helpful in patient care, but see their imposition as an inevitable consequence of progress — a rising tide that can’t be pushed back.
But instead of seeing ourselves as victims of the machine, we need to see ourselves as active participants in not only shaping the future but defining our role before we arrive. Physicians have agency.
In their new book, “Machine, Platform, Crowd: Harnessing Our Digital Future,” MIT economists Andrew McAfee and Erik Brynjolfsson capture the emerging roles of humans with their question, “So we should ask not ‘What will technology do to us?’ but rather ‘What do we want to do with technology?’ More than ever before, what matters is thinking deeply about what we want. Having more power and more choices means that our values are more important than ever.”
All of this starts with the recognition that physicians face a very different future. No matter what machines can and can’t do, the progression of technology calls upon us to undertake a critical rethinking of what we are doing now.
Bryan Vartabedian, M.D., is an assistant professor of pediatrics at Baylor College of Medicine and an attending physician at Texas Children’s Hospital, both in Houston. He blogs about medicine, technology, and culture at 33 charts.