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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.
Apparently the Catholic Church is a small business.
- Churches and ministries received up to $10 billion in federal assistance during the first round of stimulus.
- The Catholic Church exploited a loophole to be considered a "small business" and received up to $3.5 billion in forgivable loans.
- With stimulus measures ending last week, up to 40 million Americans are in danger of losing their homes.
People wait for Pope Francis to give a short speech followed by the Angelus from the window of his apartment over St. Peter's Square on September 02, 2018 in Vatican City, Vatican.
Photo by Spencer Platt/Getty Images<p>Catholic institutions in America employ over <a href="https://www.washingtonpost.com/news/wonk/wp/2013/03/13/the-new-pope-will-be-one-of-americas-biggest-employers/" target="_blank">one million people</a>, over <a href="https://www.statista.com/statistics/234488/number-of-amazon-employees/#:~:text=This%20statistic%20represents%20the%20combined,-%20and%20part-time%20employees." target="_blank">200,000 more</a> workers than on Amazon's payroll. Quite a small business.</p><p>The Catholic Church wasn't the only non-taxpaying entity to receive a boon. A campus ministry subsidiary of the Presbyterian Church of America <a href="https://ministrywatch.com/churches-and-religious-non-profits-received-6-10-billion-in-covid-relief-funds/" target="_blank">received between $5-$10 million</a>. Another $5 million went to Willow Creek Community Church, a megachurch whose longtime pastor was <a href="https://ministrywatch.com/a-ministrywatch-analysis-what-happened-at-willow-creek/" target="_blank">accused of sexual misconduct</a> in 2018. </p><p>The First Baptist Church of Dallas <a href="https://www.reuters.com/article/us-health-coronavirus-ppp-religious/televangelists-megachurches-tied-to-trump-approved-for-millions-in-pandemic-aid-idUSKBN2480CB" target="_blank">received up to $5 million</a>. The church's leader, Robert Jeffress, <a href="https://www.dallasobserver.com/news/top-10-things-first-baptist-dallas-pastor-robert-jeffress-thinks-8326587" target="_blank">believes</a> abortion caused 9/11, gay sex can make you explode, and pedophilia and homosexuality are inherently related. Jeffress also sits on Trump's evangelical advisory board. </p><p>Churches and ministries receiving at least $2 million include ministry group, Jews for Jesus (<a href="https://www.ecfa.org/MemberProfile.aspx?ID=6322" target="_blank">total assets</a>: $39,596,245); evangelical book and music publisher, David C Cook (<a href="https://www.ecfa.org/memberprofile.aspx?id=7737" target="_blank">total assets</a>: $87,871,425); Mariners Church, an Irvine-based megachurch (<a href="https://www.ecfa.org/ComparativeFinancialData.aspx?ID=23142&Type=Member" target="_blank">total assets</a>: $107,026,283); The Summit Church, a North Carolina-based Southern Baptist church (<a href="https://www.ecfa.org/MemberProfile.aspx?ID=44905" target="_blank">total assets</a>: $60,694,442); and Orlando-based Ligonier Ministries (<a href="https://www.ecfa.org/MemberProfile.aspx?ID=5396" target="_blank">total assets</a>: $46,203,410).</p><p>Another <a href="https://ministrywatch.com/ministries-and-churches-receiving-more-than-1-m-in-paycheck-protection-program-funds/" target="_blank">400 ministries received at least $1 million</a> in forgivable loans under the CARES Act. </p><p>To reiterate, up to 40 million Americans may lose their home this year. </p><p>While churches already save <a href="https://bigthink.com/21st-century-spirituality/how-to-make-71-billion-a-year-tax-the-churches" target="_self">$71 billion</a> in tax relief every year, both Republican and Democratic proposals allow religious organizations to participate in the next round of stimulus funding. </p><p>Blessed are the meek, unless you have a lobbyist. Then you're just blessed. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
The mluitfaceted cerebellum is large — it's just tightly folded.
- A powerful MRI combined with modeling software results in a totally new view of the human cerebellum.
- The so-called 'little brain' is nearly 80% the size of the cerebral correct when it's unfolded.
- This part of the brain is associated with a lot of things, and a new virtual map is suitably chaotic and complex.
Just under our brain's cortex and close to our brain stem sits the cerebellum, also known as the "little brain." It's an organ many animals have, and we're still learning what it does in humans. It's long been thought to be involved in sensory input and motor control, but recent studies suggests it also plays a role in a lot of other things, including emotion, thought, and pain. After all, about half of the brain's neurons reside there. But it's so small. But it's not, according to a new study from San Diego State University (SDSU) published in PNAS (Proceedings of the National Academy of Sciences).
A neural crêpe
A new imaging study led by psychology professor and cognitive neuroscientist Martin Sereno of the SDSU MRI Imaging Center reveals that the cerebellum is actually an intricately folded organ that has a surface area equal in size to 78% of the cerebral cortex. Sereno, a pioneer in MRI brain imaging, collaborated with other experts from the U.K., Canada, and the Netherlands.
So what does it look like? Unfolded, the cerebellum is reminiscent of a crêpe, according to Sereno, about four inches wide and three feet long.
The team didn't physically unfold a cerebellum in their research. Instead, they worked with brain scans from a 9.4 Tesla MRI machine, and virtually unfolded and mapped the organ. Custom software was developed for the project, based on the open-source FreeSurfer app developed by Sereno and others. Their model allowed the scientists to unpack the virtual cerebellum down to each individual fold, or "folia."
Study's cross-sections of a folded cerebellum
Image source: Sereno, et al.
A complicated map
Sereno tells SDSU NewsCenter, "Until now we only had crude models of what it looked like. We now have a complete map or surface representation of the cerebellum, much like cities, counties, and states."
That map is a bit surprising, too, in that regions associated with different functions are scattered across the organ in peculiar ways, unlike the cortex where it's all pretty orderly. "You get a little chunk of the lip, next to a chunk of the shoulder or face, like jumbled puzzle pieces," says Sereno. This may have to do with the fact that when the cerebellum is folded, its elements line up differently than they do when the organ is unfolded.
It seems the folded structure of the cerebellum is a configuration that facilitates access to information coming from places all over the body. Sereno says, "Now that we have the first high resolution base map of the human cerebellum, there are many possibilities for researchers to start filling in what is certain to be a complex quilt of inputs, from many different parts of the cerebral cortex in more detail than ever before."
This makes sense if the cerebellum is involved in highly complex, advanced cognitive functions, such as handling language or performing abstract reasoning as scientists suspect. "When you think of the cognition required to write a scientific paper or explain a concept," says Sereno, "you have to pull in information from many different sources. And that's just how the cerebellum is set up."
Bigger and bigger
The study also suggests that the large size of their virtual human cerebellum is likely to be related to the sheer number of tasks with which the organ is involved in the complex human brain. The macaque cerebellum that the team analyzed, for example, amounts to just 30% the size of the animal's cortex.
"The fact that [the cerebellum] has such a large surface area speaks to the evolution of distinctively human behaviors and cognition," says Sereno. "It has expanded so much that the folding patterns are very complex."
As the study says, "Rather than coordinating sensory signals to execute expert physical movements, parts of the cerebellum may have been extended in humans to help coordinate fictive 'conceptual movements,' such as rapidly mentally rearranging a movement plan — or, in the fullness of time, perhaps even a mathematical equation.
Sereno concludes, "The 'little brain' is quite the jack of all trades. Mapping the cerebellum will be an interesting new frontier for the next decade."
What happens if we consider welfare programs as investments?
- A recently published study suggests that some welfare programs more than pay for themselves.
- It is one of the first major reviews of welfare programs to measure so many by a single metric.
- The findings will likely inform future welfare reform and encourage debate on how to grade success.
Welfare as an investment<p>The <a href="https://scholar.harvard.edu/files/hendren/files/welfare_vnber.pdf" target="_blank">study</a>, carried out by Nathaniel Hendren and Ben Sprung-Keyser of Harvard University, reviews 133 welfare programs through a single lens. The authors measured these programs' "Marginal Value of Public Funds" (MVPF), which is defined as the ratio of the recipients' willingness to pay for a program over its cost.</p><p>A program with an MVPF of one provides precisely as much in net benefits as it costs to deliver those benefits. For an illustration, imagine a program that hands someone a dollar. If getting that dollar doesn't alter their behavior, then the MVPF of that program is one. If it discourages them from working, then the program's cost goes up, as the program causes government tax revenues to fall in addition to costing money upfront. The MVPF goes below one in this case. <br> <br> Lastly, it is possible that getting the dollar causes the recipient to further their education and get a job that pays more taxes in the future, lowering the cost of the program in the long run and raising the MVPF. The value ratio can even hit infinity when a program fully "pays for itself."</p><p> While these are only a few examples, many others exist, and they do work to show you that a high MVPF means that a program "pays for itself," a value of one indicates a program "breaks even," and a value below one shows a program costs more money than the direct cost of the benefits would suggest.</p> After determining the programs' costs using existing literature and the willingness to pay through statistical analysis, 133 programs focusing on social insurance, education and job training, tax and cash transfers, and in-kind transfers were analyzed. The results show that some programs turn a "profit" for the government, mainly when they are focused on children:
This figure shows the MVPF for a variety of polices alongside the typical age of the beneficiaries. Clearly, programs targeted at children have a higher payoff.
Nathaniel Hendren and Ben Sprung-Keyser<p>Programs like child health services and K-12 education spending have infinite MVPF values. The authors argue this is because the programs allow children to live healthier, more productive lives and earn more money, which enables them to pay more taxes later. Programs like the preschool initiatives examined don't manage to do this as well and have a lower "profit" rate despite having decent MVPF ratios.</p><p>On the other hand, things like tuition deductions for older adults don't make back the money they cost. This is likely for several reasons, not the least of which is that there is less time for the benefactor to pay the government back in taxes. Disability insurance was likewise "unprofitable," as those collecting it have a reduced need to work and pay less back in taxes. </p>
What are the implications of all this?<div class="rm-shortcode" data-media_id="ceXv4XLv" data-player_id="FvQKszTI" data-rm-shortcode-id="3b407f5aa043eeb84f2b7ff82f97dc35"> <div id="botr_ceXv4XLv_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/ceXv4XLv-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/ceXv4XLv-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/ceXv4XLv-FvQKszTI.js"></script> </div> <p>Firstly, it shows that direct investments in children in a variety of areas generate very high MVPFs. Likewise, the above chart shows that a large number of the programs considered pay for themselves, particularly ones that "invest in human capital" by promoting education, health, or similar things. While programs that focus on adults tend to have lower MVPF values, this isn't a hard and fast rule.</p><p>It also shows us that very many programs don't "pay for themselves" or even go below an MVPF of one. However, this study and its authors do not suggest that we abolish programs like disability payments just because they don't turn a profit.</p><p>Different motivations exist behind various programs, and just because something doesn't pay for itself isn't a definitive reason to abolish it. The returns on investment for a welfare program are diverse and often challenging to reckon in terms of money gained or lost. The point of this study was merely to provide a comprehensive review of a wide range of programs from a single perspective, one of dollars and cents. </p><p>The authors suggest that this study can be used as a starting point for further analysis of other programs not necessarily related to welfare. </p><p>It can be difficult to measure the success or failure of a government program with how many metrics you have to choose from and how many different stakeholders there are fighting for their metric to be used. This study provides us a comprehensive look through one possible lens at how some of our largest welfare programs are doing. </p><p>As America debates whether we should expand or contract our welfare state, the findings of this study offer an essential insight into how much we spend and how much we gain from these programs. </p>
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