Deep empathy: How AI can strengthen doctor-patient connections
Some experts may worry that AI will depersonalize health care, but others see its potential to deepen relationships.
- Today's rate of innovation and change has made it difficult for patients and physicians to effectively integrate technology into medical best practices.
- Experts agree that physicians need more time in their day to build bonds with patients.
- Dr. Eric Topol believes that artificial intelligence may help restore that time, creating what he calls "deep medicine."
Today's rate of technological change is as unprecedented as it is unpredictable. This speed of innovation has created medical marvels that improve and save lives. Other technologies, however, have proven more difficult for physicians and patients alike to integrate successfully into health care practices.
"Exhibit A is the electronic health record (EHR), which has made the blood of countless physicians boil with frustration," writes Michael Dowling, president and CEO of Northwell Health, in his book Health Care Reboot. Created to store, track and share patient records, "[t]he EHR can be a cruel taskmaster, demanding a doctor's attention during a patient visit and requiring numerous clicks to enter even basic data."
Physicians spend an average of six hours per workday logging clinical data into the EHR—and face-time with patients suffers. The average doctor-patient consultation clocks in at 18 minutes, and a fair amount of that time goes to logging information.
Like it or not, technology is part of the patient experience. One study found that barriers to widespread adoption of electronic personal health records will likely include computer anxiety and concerns for security and privacy.
For better or worse, technology is affecting the doctor-patient relationship. According to Eric Topol, executive vice president of Scripps Research, the most beneficial change can come if we properly navigate artificial intelligence.
Will AI replace doctors?
With AI taking on the routine work, doctors will have more time to be actively involved with patients and referring physicians.
Photo: Tom Werner/Getty Images
That may sound counterintuitive. Technology like EHRs have affected doctor-patient interactions, and when we speak of AI entering a job market, it's with premonitions of the robopocalypse. Consider America's roughly 2 million truckers, who may lose their jobs to self-driving vehicles.
Yet blue-collar jobs are not the only ones subject to AI takeover. Some jobs that require the most advanced education are more likely to become obsolete, according to entrepreneur Andrew Yang. "Doctors, lawyers, accountants, wealth advisers, traders, journalists, and even artists and psychologists who perform routine activities will be threatened by automation technologies," he writes in The War on Normal People.
Day-to-day workplace routines will determine whether AI can perform a job, because the technology can perform routine tasks faster and more accurately than people, without needing a break.
To pick one example from medical practice, radiologists spend much of their time analyzing patient films. It takes years of education to develop that skill. Even then, certain diagnoses can be tricky and human deficiencies, such as confirmation bias and inattentional blindness, can lead to mistakes.
Deep learning could streamline the process of analyzing medical images. One day, AI may be able to read more medical images more quickly and compare them to a catalog exponentially larger than anyone could memorize. It may also detect anomalies too fine for detection by the human eye. And you only have to develop an AI once, as opposed to the extensive costs of training and maintaining human radiologists.
AI is unlikely to eliminate the need for radiologists, but rather it may enable radiologists to be more actively involved with patients and referring physicians as part of the care team. We're years away from AI becoming commonplace in radiology departments. However, the principles are sound and the technology is already under development. Some day, when AI can manage standalone diagnosis for routine cases, radiologists will be free to focus on the most challenging cases.
AI will free up radiologists' time to work on the most challenging cases. Here, neuroradiologists in Paris operate on a patient affected with an arteriovenous deformation.
Photo GERARD JULIEN/AFP/Getty Images
Deep learning, deeper empathy
In Deep Medicine, Topol suggests that well-implemented AI can free physicians from repetitive tasks, providing more face time to meet, inform, reassure and follow up with patients. It can also minimize burnout and improve health care quality. Topol cites one study from the National Bureau of Economic Research that found for every extra minute a home visit lasts, risk of readmission was reduced by 8 percent.
The same gains may be possible with EHRs. Integrated AI can make it easier to log entries, consolidate records, and draw data from external sources such as a patient's smartwatch or mobile device.
"Human performance is unlikely to change materially over time. But machines will progressively outperform humans for various narrow tasks," Topol writes. "To take humans to the next level, we need to up our humanist qualities, that which will always differentiate us from machines." He calls deep learning's potential to support medical empathy and outcomes "deep empathy."
A humane pairing
Busywork and routine labor so severely cut into physician schedules that Danielle Ofri, an associate professor of medicine at New York University School of Medicine, has suggested imposing fines on hospitals that detract too much from patient face-time.
As the National Bureau of Economic Research survey suggests, health care is a field where literally every minute counts.
"Most importantly ... when people are sick, they need empathy," Topol told Big Think in an interview. "They need the person who is their doctor to be with them, to understand what they're going through, because being in pain and being sick is the loneliest thing in the world. And if you don't have a doctor that is empathic, that is the worst-case scenario. We've got to get that back."
But Topol indicates a caveat: Implementing AI in health care just as an efficiency tool would counteract potential gains in doctor-patient relationships.
Michael Dowling agrees. As he told Big Think in an interview: "A lot of publicity has been given to a lot of these [big tech] players. But the core of the care being delivered to people who are very sick is still being done at hospitals and doctors' and ambulatory sites."
And that core must be building a humane — and, indeed, human — doctor-patient relationship.
A new study finds that some people just want privacy
- Despite its reputation as a tool for criminals, only a small percentage of Tor users were actually going to the dark web.
- The rate was higher in free countries and lower in countries with censored internet access.
- The findings are controversial, and are limited by their methodology to be general assumptions.
What do half of those words mean?<p> For those who don't spend all of their time on the internet, a few of these terms might be new to you. We'll go over them first before we continue. If you do know all of these terms, you can skip ahead to the next section.<br> <br> <em>Surface Web:</em> The regular internet that you can find with a search engine. You're on it right now; unless my work is shared in places I don't know about. <br> <br> <em>Deep Web</em>: The part of the internet not indexed by search engines. This includes things like your email inbox; you can't get there from a search engine but have to enter a password to find it from another page. You've probably visited the deep web today too. </p><p><em>Dark Web</em>: A subsection of the deep web that requires special software to access. While not everything there is bad, there are social media sites, email services, hidden forums, and even puzzle games down there; this is also where you would find the places for illegal markets and other, extremely nefarious, things.</p><p> <em>Tor:</em> A kind of software that allows users to browse the internet in near-total anonymity. It does this by encrypting connection data and scrambling the route a computer takes to connect to a site, thus making it difficult, but not impossible, to find who is using a particular website. The potential value of this to criminals should be evident to you. <br> <br> While it often gets bad press for how it can be used for illicit purposes, it should be said it was created and used by the United States government for often banal purposes. The leaders of the Tor Project often remind the public that "normal people" use Tor for everyday internet activities as well.</p><p> As a personal example, I once used it to get around the Great Firewall of China when I wanted to get to the regular, uncensored internet.</p>
Back to the study<p> The study observed the final destination of a random selection of Tor users and determining if they went to surface websites or more hidden areas of the internet after connecting to the Tor network. This was done by monitoring the data from entry points in the Tor network, which would allow an observer to find out that somebody is going to a particular place, but not who.</p><p> Those going to surface websites were assumed just to be using Tor for anonymity and security, while those going into the dark web were presumed to be more likely to be using it for less legal reasons. <br> </p><p> Despite the popular conception of Tor as a tool for criminals looking to cover their tracks, only 6.7 percent of these users went to sites defined as the dark web, which were themselves not necessarily devoted to illegal <a href="https://www.sciencealert.com/only-a-small-fraction-of-the-dark-web-is-being-used-for-hidden-activity-study-finds" target="_blank" rel="noopener noreferrer">activity</a>. </p><p> The results were further broken down by country, which revealed another layer of information. The authors noted that in countries deemed "not free" by Freedom House, the rate of possible malicious use goes down to 4.8. In countries considered free, the percentage nearly doubles to 7.8 percent.</p>
What does this mean for the internet?<iframe width="730" height="430" src="https://www.youtube.com/embed/MBh7K5ooF2s" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> The dark web might be a little lighter than previously suggested. While it is true that there is some horrible stuff down there, this study suggests the people getting to it using the Tor network are overwhelmingly using it for legal, and perhaps even banal, purposes. This interpretation is additionally supported by the difference in usage across countries judged free and not free. In those countries with censorship, where a variety of tools must be used to get to sites like Facebook or Wikipedia, the percentage of users going towards locations on the dark web was smaller.</p><p>The authors conclude:</p><p style="margin-left: 20px;"><br> "The Tor anonymity network can be used for both licit and illicit purposes. Our results provide a clear, if probabilistic, estimation of the extent to which users of Tor engage in either form of activity. Generally, users of Tor in politically "free" countries are significantly more likely to be using the network in likely illicit ways."</p><p> Additionally, they mention that the Tor network's infrastructure is predominately in free countries, which then see higher rates of its use to reach places that could advance illegal activities. This find may be of interest to policymakers who may wish to balance the promotion of autonomy and the freedom of information with the goal of preventing crime.</p>
What’s the catch?<iframe width="730" height="430" src="https://www.youtube.com/embed/2UNUMgM9Gwo" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> It has been suggested that the internet is the first thing humanity ever created that we don't fully understand. If that is true, it should surprise nobody that there are objections to the methods used to study it. <br> <br> The executive director of the Tor Project, Isabela Bagueros, explained their objection to the study's methodology and assumptions to <a href="https://arstechnica.com/gadgets/2020/11/does-tor-provide-more-benefit-or-harm-new-paper-says-it-depends/" target="_blank" rel="noopener noreferrer">Ars Technica</a>:</p><p style="margin-left: 20px;"> "The authors of this research paper have chosen to categorize all .onion sites and all traffic to these sites as "illicit" and all traffic on the "Clear Web" as 'licit.'</p><p style="margin-left: 20px;">This assumption is flawed. Many popular websites, tools, and services use onion services to offer privacy and censorship-circumvention benefits to their users. For example, Facebook offers an onion service. Global news organizations, including The New York Times, BBC, Deutsche Welle, Mada Masr, and Buzzfeed, offer onion services.</p><p style="margin-left: 20px;">Whistleblowing platforms, filesharing tools, messaging apps, VPNs, browsers, email services, and free software projects also use onion services to offer privacy protections to their users, including Riseup, OnionShare, SecureDrop, GlobaLeaks, ProtonMail, Debian, Mullvad VPN, Ricochet Refresh, Briar, and Qubes OS…...</p><p style="margin-left: 20px;">Writing off traffic to these widely-used sites and services as "illicit" is a generalization that demonizes people and organizations who choose technology that allows them to protect their privacy and circumvent censorship. In a world of increasing surveillance capitalism and internet censorship, online privacy is necessary for many of us to exercise our human rights to freely access information, share our ideas, and communicate with one another. Incorrectly identifying all onion service traffic as "illicit" harms the fight to protect encryption and benefits the powers that be that are trying to weaken or entirely outlaw strong privacy technology."<br> </p><p>The critique here is justified; there are legitimate websites hidden behind layers of security which were deemed "illicit" by this study's methods. Many people are just trying to protect their anonymity when using them. However, the study's authors based their assumption on previous studies that demonstrate that these hidden sites are used for illegal activities at a higher rate than other parts of the <a href="https://www.cigionline.org/sites/default/files/no20_0.pdf" target="_blank" rel="noopener noreferrer">internet</a>.</p><p>Until a more rigorous and ethically ambiguous method of determining exactly what people using the network are doing on these dark websites is utilized, the findings of studies like this will be general and based on broad assumptions. </p><p>Despite all of this, we can take a few things from this study: most people using Tor to explore the internet aren't using it for evil, those using it in places with limited freedom of information are even less likely to use it for such purposes, and external factors can have significant impacts on how people use a tool such as the internet. <br></p>
Mice will even run on a wheel in nature. Pheromones help inspire that behavior.
- University of California, Riverside researchers discovered a link between scent and fitness motivation in mice.
- The vomeronasal organ is activated by the smell of pheromones, influencing sexual behavior and cardiovascular activity.
- While there's no proof the same connection exists in humans, at least one elite athlete believes a link exists.
How do we smell? - Rose Eveleth<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="a8578bde67fc5b4a70746c49ca3a19cc"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/snJnO6OpjCs?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Many animals utilize olfaction to navigate their terrain. Comparatively, humans have a pretty weak sense of smell. For this study, the researchers looked at the vomeronasal organ (VNO), a feature of a number of amphibians and mammals, and its influence on volunteer wheel running (VMR) in mice.</p><p style="margin-left: 20px;">"Although the role of the vomeronasal chemosensory receptors in VWR activity remains to be determined, the current results suggest that these vomeronasal chemosensory receptors are important quantitative trait loci for voluntary exercise in mice. We propose that olfaction may play an important role in motivation for voluntary exercise in mammals."</p><p>The team chose fanatical runners that are more intrinsically motivated to get on the wheel than their peers. (The lab that produced this study even has a <a href="https://sites.google.com/ucr.edu/hrmice/home" target="_blank">High Runner Mice website</a>.) Apparently, these mice have strong vomeronasal sensory receptor neurons, which pick up the scent of pheromones (among others) as a form of motivation. </p><p>A link between these neurons and sexual behavior already exists; this study appears to expand the olfactory sense to another physical activity. The chemosensory signals received by VNO activation sets off a chain reaction in their nervous system. Just like humans can't help but dance to a good beat, mice crave the rush of running when the right scent hits them. </p>
Could this apply to humans as well?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDg1ODk4NS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyNTY4MzM0N30.N-53oWoMUAPMNa9_ZxeMx6YKFRLhD-k7RzUIK8Bvl2U/img.jpg?width=1245&coordinates=0%2C208%2C0%2C208&height=700" id="f048a" class="rm-shortcode" data-rm-shortcode-id="db26fd2092faab325198afcaf2dc018b" data-rm-shortcode-name="rebelmouse-image" />
Credit: BillionPhotos.com / Adobe Stock<p>Christopher Bergland thinks so. The elite athlete knows all about treadmills. He holds the <a href="http://www.recordholders.org/en/list/treadmill-bergland.html" target="_blank">world record for the longest treadmill run</a> over a 24-hour period. In a recent column, he claims that <a href="https://www.psychologytoday.com/us/blog/the-athletes-way/202011/need-motivation-exercise-olfaction-is-primal-motivator" target="_blank">scents have been motivating him to exercise</a> for decades.</p><p style="margin-left: 20px;">"Even as a middle-aged person with a middle-of-the-road libido, smells from my adolescence—such as classic Coppertone sunscreen mixed with a spritz of vintage Polo Green cologne—still give me a "Vroom!" feeling that gets my juices going. The same smells that I used to run five back-to-back marathons through Death Valley in near 130º heat and to break a Guinness World Record by running 153.76 miles on a treadmill decades ago, still motivate me to go for daily jogs at a 'conversational pace.'"</p><p>He still uses smells to inspire his workout regimen. In his 2007 book, "The Athlete's Way," Bergland discusses aromatherapy as a performance enhancement and motivational tool. This makes sense: we might have devolved in our olfactory senses a bit, but smells still heavily influence our world. Flavor, for example, is <a href="https://www.scientificamerican.com/article/experts-how-does-sight-smell-affect-taste/" target="_blank">just as much about smell as taste</a>. </p><p style="margin-left: 20px;">"Acquiring information related to scent through the back of the mouth is called retronasal olfaction—via the nostrils it is called orthonasal olfaction. Both methods influence flavor; aromas such as vanilla, for example, can cause something perceived as sweet to taste sweeter. Once an odor is experienced along with a flavor, the two become associated; thus, smell influences taste and taste influences smell."</p><p>We're certainly motivated to eat thanks to the scent of our favorite foods. The idea that smell would get us out of bed and onto a bike is not far-fetched, whether we realize it or not. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His new book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank" rel="noopener noreferrer">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>
Researchers dramatically improve the accuracy of a number that connects fundamental forces.
- A team of physicists carried out experiments to determine the precise value of the fine-structure constant.
- This pure number describes the strength of the electromagnetic forces between elementary particles.
- The scientists improved the accuracy of this measurement by 2.5 times.
The process for measuring the fine-structure constant involved a beam of light from a laser that caused an atom to recoil. The red and blue colors indicate the light wave's peaks and troughs, respectively.
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