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Nurul Ahad, Medical Director at Practice Plus GroupA s science surges ahead, many question whether the artistry of medicine is a forgotten practice. This is an exciting time, redefining the limits of human dexterity. The speed of scientific advancement, with the faster introduction of medical innovation, continues to challenge posing questions around the role of clinicians.
The potential of AI to revolutionise medicine appears vast, with two obvious potential advantages to human performance. Firstly, AI can learn and process big data more efficiently than clinicians. It can digest, extract, and aid clinicians in making informed decisions. Moreover, AI can perform predefined tasks with a higher degree of precision, without the limitations of fatigue orcompromised performance. Some forecast it is replacing 80% of what doctors do.
The current pandemic has focused minds on how to deliver healthcare with reduced face-to-face interactions. A new reality is possible where a patient can complete a full pathway with almost no face-to-face interaction: virtual clinics with algorithms aiding diagnosis for robotic-assisted surgery and rehabilitation in a virtual physiotherapist clinic. 3Dmotion-capture technology, a game-like interface with an avatar, can progress through exercises and education both pre-and post-procedure.
"The art of medicine comes with experience and an inherent belief that good is being done. Like two sides of a coin, they must co-exist"
Patient progress can be monitored with live feeds; surgery can be planned using 3D images or printed models; large amounts of data collated and used to design patient-specific prosthesis, reducing surplus equipment in the theatre. We have already moved awayfrom computer-assisted prosthesis placement to robotassisted cuts, and are only a step away to full robotic surgery. Medical records, treatment plan designs, imagebased diagnosis - connected healthcare systems are also areas to benefit from AI. Then what role, if any, does the clinician hold?
I believe AI should co-exist, freeing-up surgeons, to practise the art of medicine. I know orthopaedic practice is data driven, and we continue to create algorithms to assist in decisionmaking, theatre utilisation, surgery, and aftercare. I embrace it with trepidation and enthusiasm in equal measures.
The art of medicine comes with experience and an inherent belief that good is being done. Like two sides of a coin, they must co-exist. Yet both require the ability to trust and the complexity of personality, behaviour, and belief.
Trust implies placing something of value in another, and in medicine, when vulnerable. Trust properly understood involves human thoughts, motives, and actions and lies beyond technical and mechanical characteristics.
Patients place their health in doctors’ voluntary responsibility and discretion. AI does not have a voluntary agency or motives or character. Can we, therefore, embrace trust in AI? Does trust extend to absolving doctors of blame in times of errors? As we underwrite human error in our consent, should machine error deserve a mention?
Computer vision can now screen early cancer better than humans. It continues to improve in identifying fractures in orthopaedics. As AI makes ground, who remains accountable? If a tumour is missed, does the blame lay in the direction of the software’s owner or designer? As machine learning is an integral part of artificial intelligence, what laws or processes decide the direction of self-learning?
This uncertainty makes us resistant to embrace AI at the same pace as change we can see, feel, and evaluate. As AI becomes an integral part of care, do we expect the same trust of the unknown to be shared by patients?
Despite better accuracy, safety, and speed, resistance to medical AI by patients, in my view, is based on our own belief that we are unique. Inflexible, standardised care does not take this into account. The inherent belief of uniqueness is a complex human emotion and one that cannot be explained by data process. Understanding this element of care delivery will allow us to find the balance between both sides of the coin.
Personalised care, despite its flaws and inaccuracy, remains the patient’s preference if it equates to treatment as an individual. The power of individuality and the empowerment of taking patients through their unique journey is most evident in our recent drive to perform day case arthroplasty.
Experience shows that despite the science of evidence-based medicine, nothing is a stronger factor in achieving success of early discharge than the patient’s belief and trust in the process. If I can term the artistry of medicine in one word, it would be empowerment. Let the clinicians question the how and the why.
Our relationship with medical AI will evolve. As results show better, faster, and safer practice, our confidence in systems that digest data, assess risk, and act independently may not be understood but may reach a balance of trust as they have with the likes of MRI scans, the internet, or Google maps.
We pledged: “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.” Innovations are giving us time to focus on the forgotten artistry of medicine, allowing us to focus on what really matters -treating the patient with a disease, and not the disease in a patient.
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