Doctor-Patient Relationship in Tech-enabled Healthcare

Written by - Dr K. Ganapathy, Distinguished Visiting Professor at IIT Kanpur, & Distinguishedd Professor at The Tamil Nadu Dr MGR Medical University.

1968 : I entered Medical School 56 years ago. Trained in the 20th century, in the BC era my generation would today be considered to belong to the Neanderthal Age.

I injected air into the brain and dyed directly into the Carotid Artery to see if there was any displacement of ventricles or blood vessels in the brain – a surrogate marker for a possible “Space Occupying Lesion”. Tuberculoma and Cysticercosis (growths due to TB and parasites) were as common as benign and malignant brain tumors. Getting the patient’s consent for surgery was a one-sided conversation.

No questions were asked. Such was the faith and trust reposed in the surgeon. The role of the patient and the family in the decision-making process was minimal. We could not share our responsibility with anyone.

I was Amicus curiae and the Devil's Advocate rolled into one. We entered the brains of our patients even before the surgery, trying to understand what he/she and their families would want, and took a surrogate decision on their behalf, in their interests.

2024: Tomorrow the Digital Health we will be practicing will be 5P (Predictive, Personalized, Precision, Participatory, and Preventive) medicine with AI as a major component. As 80% of the 41 Zetabytes (410 trillion GB) of digital information currently available is unstructured AI will detect patterns and trends, which our gray matter is unable to decipher.

Powerful AI techniques are unlocking clinically relevant information, hidden in massive amounts of data. Wanting to be future-ready and ahead of the curve, are we turning a Nelson’s eye and forgetting our past?

After all, it is NI (Natural, Native) Intelligence that led to the birth of AI. In a world where algorithms make diagnoses, wearables track vital signs, and robots are remotely controlled, to perform surgical procedures, will clinicians of the last century become an endangered species?

Technology today is working overtime to guarantee patient safety and quality improvement. There is already a marked shift in using technology to promote good health. In the next two decades the necessity to diagnose and treat established diseases will significantly reduce. There will be no chapter on “Complications”.

Genomics, radiomics, and specialties hardly existing today will replace many disciplines. The increasing use of a Digital Twin of a patient will enable accurate assessment and a preliminary “ in silico” trial.

We need to remind ourselves that technology is a means to an end, not an end by itself. Proactive measures need to be taken to ensure that increasing the use of technology does not lead to depersonalization and dehumanization.

Sir William Osler’s observations 150 years ago “ --- the good physician treats the disease, the great physician treats the patient who has the disease”

“-----Patients don’t care how much you know until they know how much you care”

“---Listen, listen, listen he is telling you the diagnosis” is even more relevant today. The world has turned upside down. Very soon a clinician who does not use AI in his/ her armamentarium would appear to have come from another planet!

Terms such as “ trust” and TLC (Tender Loving Care) espoused by my teachers, may soon disappear. Once new technologies roll over you, if you are not part of the steamroller, you are part of the road. The writing is on the wall!

The ultimate disruption will be when what today is termed AI will become ANI, not perhaps in my lifetime but certainly in the lifetime of my children.

The A in AI after all stands for Augmenting, Amplifying, Accelerating, Assisting, and Analyzing in an Ambient milieu.

A smart empathetic clinician using ANI will become smarter. A mediocre clinician using ANI will not necessarily become smarter. The Hippocratic Oath may have to be replaced with a Robocratic Oath.

After all “To err is ChatGPT, to forgive is human !!”

[Disclaimer: This is an authored article, DHN is not liable for the claims made in the same.]