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.
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They came from different places and with different ideas, which still resonate today
- Early British settlement of the American colonies came in four distinct waves, from different places.
- Puritans, Cavaliers, Quakers and Borderers had their own ideas of what America should be.
- Some of the cultural fault lines in today's America can be traced back to those differences.
Four 'folkways'<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0MDY2NC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzOTAzNzk0OX0.YfBxVdS46dX1eUZhGA_4remlW4YYMIxlZ65wjQ2pyMs/img.jpg?width=980" id="d2108" class="rm-shortcode" data-rm-shortcode-id="2efd697c8c1a31a446da2d4f34168094" data-rm-shortcode-name="rebelmouse-image" alt="\u200bQuaker pioneer William Penn (center) treating with the Delaware Indians for the purchase of what was to become Pennsylvania." />
Quaker pioneer William Penn (center) treating with the Delaware Indians for the purchase of what was to become Pennsylvania.
Image: frieze by Constantino Brumidi (1865) in the Rotunda of the US Capitol; via Architect of the Capitol - public domain.<p>How many Americans are of British descent? It's a surprisingly difficult question to answer. Is that because, in an age of hyphenated identities, the founding one still is the default? Or has that identity become so amalgamated that it is now irrelevant? Perhaps the correct answer is: a bit of both. </p><p><span></span>In the 1980 Census, 61.3 million Americans (32%) self-reported British ancestry; most claimed English descent (26%), followed by Scottish (4%), and tiny amounts of Welsh (<1%) and Northern Irish. In the 2010 Census, that figure had dropped to 37.6 million (14%), with just 8% reporting English heritage, 3% Scottish and 2% Scotch-Irish. </p><p>The precipitous drop in self-reported British antecedents corresponds in part with the rise of those who identify as (unhyphenated) 'American', up from 12.4 million (5%) in the 1990 Census to 20.2 million in 2000 (7%) – the largest growth of any ethnic group in the 1990s.</p><p>However, back around the year 1700, about 80% of the population of what was to become the United States were of English (or Welsh) descent, with about 11% of African origin, and the rest being Dutch (4%), Scottish (3%) and other European. The imprint of the British on early American society was overwhelming, diverse and long-lasting: the regional and cultural differences between the settler groups created distinct regional and cultural identities in America.</p><p>That's the argument made by David Fischer, a history professor who in 1989 published a 900-page treatise on early migration to North America called <em><a href="https://global.oup.com/ushe/product/albions-seed-9780195069051" target="_blank">Albion's Seed</a></em>. He identified four British 'folkways' that came over to the other side of the Atlantic in the 17th and 18th centuries (<em>see map</em>), each with their own ideas about the liberty they wanted to find there.<br></p>
From exodus to flight<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0MDY2NS9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY0NDg1MzczOX0.-LwTLCpuIub9QhTVWL9vhnd8Jlz9j8aRyt9bePqQPuo/img.png?width=980" id="65f97" class="rm-shortcode" data-rm-shortcode-id="4457df0ca7f66fe87026322bad771da6" data-rm-shortcode-name="rebelmouse-image" alt="\u200bMap showing the origin and destination of four British 'folkways' that influenced American society." />
Map showing the origin and destination of four British 'folkways' that influenced American society.
Image: Geni.com<p><strong></strong><strong>1. The Exodus (1629-41)</strong></p><ul> <li>About 21,000 Puritans, migrating from East Anglia to New England.</li><li>These religious fundamentalists believed in 'ordered liberty': everybody had the right to live by their own rules, and the duty to live according to God's law.</li><li>The Puritans were a major influence on the culture of the Northeastern US, especially in terms of business and education.</li></ul><p>These religious fundamentalists are the ones who came over on the Mayflower and gave America Thanksgiving and the self-image of being a 'City on a Hill'. Puritan society was gloomy and repressive: 'exceeding the bounds of moderation' was a punishable offense, and even just 'wasting time' got you into trouble.</p>The other side of the coin: life was very well-ordered. There was little income inequality and crime rates were low. Not only was charity towards poor the rule, being uncharitable was, yes, a punishable offense. Domestic abuse was punished severely. Women had a relatively high degree of equality. And government operated via town assemblies in which all could have a say.<br><br><strong>2. Cavaliers and their Servants (1642-75)</strong><ul><li>Some 45,000 Cavaliers drawn from English nobility and their indentured servants, migrating from the South of England to Virginia and the Lowland South.</li><li>These aristocrats believed in 'hegemonic liberty': dominion over self, and others. In other words: keeping slaves was okay, but domination by others was not.</li><li>The Cavaliers were the foundation of plantation culture in the South. </li></ul><p>The Cavaliers came from the losing side of the Civil War in England, which was now led by the Puritan-inspired Oliver Cromwell. Royalist, Anglican and aristocratic, they brought along with them their indentured servants – more than 75% of the total migration – hoping to recreate in Virginia and environs the socially stratified agrarian society they had left behind.</p><p><span></span>When their servants began dying en masse, they started importing African slaves, laying the groundwork for the race-based slavery system that underpinned the economy of the South until the end of the Civil War.</p><strong>3. The Friends' Migration (1675-1725)</strong><ul><li><strong></strong>Around 23,000 Quakers, migrating from Northern England to the Delaware Valley in Pennsylvania, and later to the Midwest.</li><li>These religious liberals believed in 'reciprocal liberty': granting others the freedoms they wanted for themselves, including the right to vote, to own, to be free, to worship and to a fair trial.</li><li>Quakers had an important impact on the industrial culture of the Mid-Atlantic and Midwestern regions of the US.</li></ul><span></span>Halfway between the fun-hating Puritans and the pleb-hating Cavaliers, the Quakers seem modern and likeable. Believing everybody intrinsically good, they practiced tolerance, pacifism, gender equality and racial harmony. They opposed slavery, the death penalty, and cruelty to animals and children.<p>Quakers replaced a wide range of social acknowledgements according to rank (bows, nods, grovels) by a single, neutral equivalent: the handshake. Quakerism was perhaps one of the first Christian denominations to become indistinguishable from liberal, secular modernity. On the other hand, they were more prudish even than the Puritans. Doctors had a hard time treating Quakers because they described everything from their necks to their waists as their 'stomachs', and everything below as their 'ankles'. </p><p><strong>4. The Flight from Northern Britain (1717-75)</strong></p><ul><li>Some 250,000 'Borderers', migrating from the Anglo-Scottish borderlands and Ulster to the Backcountry of Appalachia.</li><li>These individualists believed in 'natural liberty': freedom to do as one pleases, without interference from society or government.</li><li>Borderers contributed to the rural culture of America's South and the ranch culture of its West. </li></ul><p><span></span>Inhabiting the border regions between Scotland and England, and between protestant settlers and catholic natives in Ireland, the Borderers were used to violence and lawlessness, and to lives that were nasty, brutish and short. </p>It is no coincidence that they ended up in Appalachia, at that time itself a violent border region. It was the kind of world they knew. Borderers were wary of government, prone to violent family feuds and not bothered by traditional morality. By one estimate, in the year 1767, 94% of all 'backcountry' brides were pregnant on their wedding day.<p><span></span>These Borderers were not much beloved by other settler groups in America. One Pennsylvanian writer called them "the scum of two nations". But the Borderers also contributed vigorously to the success of both the American Revolution and America's westward expansion. </p>
'Blue' vs. 'Red'?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0MDczNy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MzE5MTc4NH0.EtbfEc9BlGG8R4VlyHr2W7kQ0LzvRdAHRRRlsEI01Pg/img.jpg?width=980" id="ce2a3" class="rm-shortcode" data-rm-shortcode-id="ba2cd744238f9a08ce63e85be2860528" data-rm-shortcode-name="rebelmouse-image" alt="Representative Preston Brooks (SC) caning Senator Charles Sumner (MA) on the Senate floor. The attack, on 22 May 1856, symbolised the breakdown of civil discourse between North and South, prefiguring the Civil War." />
Representative Preston Brooks (SC) caning Senator Charles Sumner (MA) on the Senate floor. The attack, on 22 May 1856, symbolised the breakdown of civil discourse between North and South, prefiguring the Civil War.
Image: lithograph by John L. Magee (1856); public domain.<p>It's tempting, and perhaps not entirely unjustified, to see in these four strains of British 'folkways' the antecedents of some of America's current cultural divides. One might for example see Puritans and Quakers as constituting elements of the 'blue' tribe, while Borderers and Cavaliers could be considered the ancestors of the 'red' tribe.</p><p><span></span>But thinking of America as a "death match between Puritan-Quaker culture and Cavalier-Borderer culture", as one commentator put it, is perhaps a bit too easy. There may be plenty of overlap within either pair, there is also much to distinguish each from the other. And then there are other and subsequent migrations contributing to and complicating the picture.</p><p>Nevertheless, a bit of cultural archeology can be illuminating, if only to see where the bodies are buried.<br></p><p><strong><br></strong></p><p><strong>Strange Maps #1049</strong></p><p><em>Got a strange map? Let me know at </em><a href="mailto:firstname.lastname@example.org">email@example.com</a><em>.</em></p>
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