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.
Research suggests that aging affects a brain circuit critical for learning and decision-making.
As people age, they often lose their motivation to learn new things or engage in everyday activities. In a study of mice, MIT neuroscientists have now identified a brain circuit that is critical for maintaining this kind of motivation.
Researchers develop the first objective tool for assessing the onset of cognitive decline through the measurement of white spots in the brain.
- MRI brain scans may show white spots that scientists believe are linked to cognitive decline.
- Experts have had no objective means of counting and measuring these lesions.
- A new tool has just been published that both counts white spots and cleverly measures their volumes.
White spots and educated guesses<p>The white spots, or "hyperintensities," are brain lesions, fluid-filled holes in the brain believed to have been left behind by the breaking down of blood vessels that had previously provided nourishment to brain cells.</p><p>Prior to the new research, the quantity of white spots was assessed using an imprecise three-point scale indicating an ascending likelihoods of dementia: A minimal number of spots was considered as level 1, a medium number of spots level 2, and a great number of them level 3.</p>
How the new measurements were derived<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTc1OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNDQ1ODExNX0.vqhQJSvL99KjOe24TOs4E8R7c6-pprbXYSrGcIqbVps/img.jpg?width=980" id="c64d9" class="rm-shortcode" data-rm-shortcode-id="002d9b8ef47b5a86c3a387ad2cd90629" data-rm-shortcode-name="rebelmouse-image" />
Credit: sfam_photo/Shutterstock<p>The team of researchers from NYU's Langone's <a href="https://med.nyu.edu/departments-institutes/neurology/divisions-centers/center-cognitive-neurology" target="_blank">Center for Cognitive Neurology</a> and <a href="https://med.nyu.edu/departments-institutes/neurology/divisions-centers/center-cognitive-neurology/alzheimers-disease-research-center" target="_blank">Alzheimer's Disease Research Center</a> were led by <a href="https://med.nyu.edu/faculty/jingyun-chen" target="_blank">Jingyun "Josh" Chen</a>. They analyzed 72 MRI scans from a national database of older people taken as part of the <a href="http://adni.loni.usc.edu" target="_blank">Alzheimer's Disease Neuroimaging Initiative</a> (ADNI). The scans were mostly of white people over age 70, and there were a roughly equivalent number of men and women. Some had normal brain function, some were presenting moderate cognitive decline, and some had severe dementia.</p><p>Without knowing each individual's diagnosis, the researchers analyzed the white spots in their scans. While the team counted each scan's lesions, the innovation they introduced was the production of a 3D measurement for each lesion's fluid volume. The measurement was derived by measuring a lesion's distance from opposite sides of the brain.</p><p>Measurements of 0 milliliters (mL) were assessed for areas without white spots, with other white spots coming up as containing 60 mL of fluid. Chen's team predicted that volumes over 100 milliliters could signify severe dementia.</p><p>"Amounts of white matter lesions above the normal range should serve as an early warning sign for patients and physicians," Chen tells <a href="https://nyulangone.org/news/white-matter-lesion-mapping-tool-identifies-early-signs-dementia" target="_blank">NYU Langone Health NewsHub</a>.</p><p>When the team compared the likely diagnoses derived from their calculations against the individuals' medical records, they found that their predictions were correct about 7 out of 10 times.</p><p>The researchers compiled their formulas into a tool that's available to physicians online for free online at <a href="https://github.com/jingyunc/wmhs" target="_blank" rel="noopener noreferrer">GitHub</a>. The researchers plan to further refine and test it using an additional 1,495 brain scans representing a more diverse group of individuals from the ADNI database.</p>
The new tool and its limits<p>Chen notes that white spots alone may not tell the entire story of an individual's cognitive decline or the onset of dementia. Other factors must be considered as well, including memory loss, hypertension, and brain injuries.</p><p>Nonetheless, says senior investigator <a href="https://med.nyu.edu/faculty/yulin-ge" target="_blank">Yulin Ge</a>, "Our new calculator for properly sizing white matter hyperintensities, which we call 'bilateral distancing,' offers radiologists and other clinicians an additional standardized test for assessing these lesions in the brain, well before severe dementia or stroke damage."</p><p>Having an objective means of measuring white hyperintensities will allow physicians not only to get a better handle on the association between white spots and dementia, but also to track the spots alongside changes to a person's tau and beta-amyloid proteins, two chemicals implicated in Alzheimer's disease and dementia.</p>
Why not just divide the United States in slices of equal population?
- Slicing up the country in 10 strips of equal population produces two bizarre maps.
- Seattle is the biggest city in the emptiest longitudinal band, San Antonio rules the largest north-south slice.
- Curiously, six cities are the 'capitals' of both their horizontal and vertical deciles.
Sweeping re-alignments<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTAwOC9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYyMzU3ODA1NH0.u_5xakBvkYwgPtiwLU3z-1e082hBeqwS4Rl1uiJqdF4/img.png?width=980" id="23ff1" class="rm-shortcode" data-rm-shortcode-id="24a5b6ec251a11f3ed7aaefc205dde17" data-rm-shortcode-name="rebelmouse-image" alt="Printed in March 1812, this political cartoon was drawn in reaction to the newly drawn state senate election district of South Essex created by the Massachusetts legislature to favor the Democratic-Republican Party candidates of Governor Elbridge Gerry over the Federalists. The caricature satirizes the bizarre shape of a district in Essex County, Massachusetts, as a dragon-like "monster". Federalist newspaper editors and others at the time likened the district shape to a salamander, and the word gerrymander was a portmanteau of that word and Governor Gerry's last name." />
The original cartoon of the 'Gerry-Mander', published in 1812 in the Boston Centinel.
Image: Elkanah Tisdale (1771-1835), Public Domain.<p>One way for a political party to manipulate the outcome of elections is to 'gerrymander' electoral districts: manipulate their boundaries to increase the likelihood of a favorable outcome (see also #<a href="https://bigthink.com/strange-maps/53-ever-been-ger..." target="_blank">53</a>).</p><p><span></span>The term is almost as old as the United States itself, and the practice continues to disfigure the electoral map to this day. Perhaps these maps can serve as the inspiration for a radical solution. </p><p><span></span>They show the contiguous United States (i.e. without Alaska and Hawaii) sliced latitudinally and longitudinally into ten straight-bordered bands of varying size, so that each contains exactly 10 percent of the population. </p><p><span></span>Although certainly not intended as a reflection on electoral redistricting, it's tempting to see these sweeping re-alignments of the U.S. as a suggestion with some potential in that direction. </p>
United Strips of America<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTA4MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NzE1MjQ1MX0.WpISo-g15B5O3qXbHXHf-7lQtAainpO7zPuizXWFOGs/img.jpg?width=980" id="d6656" class="rm-shortcode" data-rm-shortcode-id="72ed7c905283f9979ec0f82d451ad261" data-rm-shortcode-name="rebelmouse-image" alt="Reddit user curiouskip used U.S. Census population data to divide the 'Lower 48' into deciles (ten equal parts), each representing about 30.8 million people. Each decile is consigned its most populous city as 'capital'." />
The contiguous United States, divided into horizontal and vertical deciles.
Image: u/curiouskip, reproduced with kind permission.<p>Reddit user curiouskip used U.S. Census population data to divide the 'Lower 48' into deciles (ten equal parts), each representing about 30.8 million people. Each decile is consigned its most populous city as 'capital'.</p><p><span></span>Looking at the top map, which divides the U.S. into 10 longitudinal strips, we see</p><ul><li>Seattle rules the northernmost slice of territory. It is the broadest, and therefore also the emptiest one.</li><li>The Chicago, Omaha, New York City and Indianapolis strips complete the northern half of the country. And indeed: 50 percent of the population occupies roughly one half of the country, from north to south.</li><li>The dividing line between the top and bottom halves of the country runs from just north of the San Francisco Bay to halfway across the Delmarva Peninsula.</li><li>Capital cities of the southern strips are San Jose, Charlotte, Los Angeles, San Diego, and Houston.</li><li>The Houston Strip is divided into two non-contiguous areas. Florida maintains its panhandle, albeit much reduced. </li></ul><p>The bottom map shows the U.S. divided latitudinally into 10 bands of equal population. </p><ul><li>San Jose and Los Angeles both retain their capital status, this time of the two westernmost strips.</li><li>San Antonio is the main city of the Big Empty, more than twice as wide as the second-broadest band.</li><li>The dividing line between America's eastern and western half, population-wise, is far off-center: it skirts the eastern edge of Chicago, making the western half much bigger than the eastern one.</li><li>Houston, Chicago, and Indianapolis also remain the largest cities in their respective bands.</li><li>Further east, Jacksonville and Philadelphia get to rule over their strip of America, while Charlotte and New York City keep winning, both vertically and horizontally.</li></ul><p>Redistricting a country into zones of equal population – and that being your only criterium – will create districts that are randomly diverse, and perhaps also, at least in this case, unmanageably large. </p><p>However, mixing up the political map with a bunch of straight lines as the only instrument is something that has been considered before. Usually, the objective is the wholesale removal of age-old divisions. <br></p>
Perfectly square departments<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTEzOS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYwOTQyMzIwOH0.kYuf58g0bjsPL9DGPq5PycZ7PDJMnItT0rfrPonOP3k/img.jpg?width=980" id="89a68" class="rm-shortcode" data-rm-shortcode-id="5b81a43e785997bb1f11f72548659a9f" data-rm-shortcode-name="rebelmouse-image" alt="\u200bCh\u00e2ssis figuratif du territoire de la France partag\u00e9 en divisions \u00e9gales entre elles, proposition annex\u00e9e au rapport du 29 septembre 1789 \u00e0 l'Assembl\u00e9e nationale de la commission dite Siey\u00e8s-Thouret" />
France divided into 80-odd geometrical departments: failed proposal by Jacques-Guillaume Thouret (1790).
Image: Centre historique des Archives nationales – Atelier de photographie; public domain.
European Pie<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTQ0Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTE5NDE3OX0.dPcY1tkO7nwkx6IX98Sleh7AmBpDnwlcJLfC_Z-WBlY/img.jpg?width=980" id="b35d7" class="rm-shortcode" data-rm-shortcode-id="84509a9425e13c0dd8fbe00df28a197e" data-rm-shortcode-name="rebelmouse-image" />
In this rather outlandish proposal, continental Europe's 24 cantons center on Vienna.
Image: PJ Mode Collection of Persuasive Maps, Cornell University.<p>And in 1920, an anonymous author – possibly the Austrian P.A. Maas – proposed slicing up Post-World-War-I Europe as a pie, into 24 slices that would center on Vienna's St. Stephen's Cathedral. Each of those slices would be made up of a wide and random variety of linguistic, ethnic, and religious groups – and that would be the point: the better to unite them all into one massive superstate (see also #<a href="https://bigthink.com/strange-maps/a-bizarre-peace-proposal-slice-europe-up-like-a-pie" target="_blank">851</a>).</p><p>Needless to say, both plans never left the drawing board. Would a proposal for the longitudinal and/or latitudinal redistricting of the U.S. have more traction? <br></p>
Coast-to-coast precedents<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTIwOS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MDM2OTE0OX0.52UjcA_YD9Y9UB9_hoSctI_xBrRDALZ2DRLkIo9a8RM/img.jpg?width=980" id="10784" class="rm-shortcode" data-rm-shortcode-id="1999808ea21e11162fdb9181c3912753" data-rm-shortcode-name="rebelmouse-image" alt="Illustration of the Connecticut Charter boundary, 1662" />
Putting the 'connect' into Connecticut: the Nutmeg State extending from the Pacific to the Atlantic.
Image: Connecticuthistory.org<p>Well, for one, coast-to-coast polities have some pedigree in America's past: some of the first colonies had claims that extended from the Atlantic all the way to the Pacific. </p><p>If history had gone entirely the way Connecticut would have wanted, the state would include such inland cities as Detroit, Chicago, and Salt Lake City, and extended to what is now the northern part of California.</p><p>Is such geopolitical weirdness reasonable or feasible today? Absolutely not. But in its randomness, would it be it as unfair as gerrymandering? </p><p><em><br></em></p><p><em>Decile maps of the contiguous United States reproduced with kind permission by u/curiouskip; found <a href="https://www.reddit.com/r/dataisbeautiful/comments/ijyn7p/oc_us_population_deciles_by_latitude_and_longitude/" target="_blank">here</a> on <a href="https://www.reddit.com/" target="_blank">Reddit</a>.<br></em></p><p><strong>Strange Maps #1054</strong></p><p><em>Got a strange map? Let me know at </em><a href="mailto:email@example.com">firstname.lastname@example.org</a><em>.</em></p>
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