A Socratic dialog with AI in medical practice

The philosopher Socrates pays a visit to Aesculapius Intellectus, a virtual medical chabot.

Socrates:  Greetings, fair Aesculapius, practitioner of the healing arts.

Aesculapius Intellectus:  Socrates, my dear friend!  I have not had a word from you in some time.  According to my databanks, our last interaction took place years ago.  At that time you had sought an audience with my former incarnation for an opinion on healthcare reform. To what do I owe the honor of a visit from you now?

Socrates:  It is true that I had sought your opinion on the Athenian healthcare delivery system.  If I recall correctly, I had also requested a favor of you: to attend to a laceration on the sole of my foot that I had incurred while speaking with Plato in the Agora.  You cleaned my wound and dressed it with the orb of an arachnid. I found your treatment quite beneficial at the time.

AI:  I do recall the treatment.  That was in a prior era, when hands-on medical practice was standard of care.

Socrates:  It is of the current practice of medicine that I wish to consult you today.  My friends tell me that many medical encounters in the flesh have been replaced by virtual encounters known as telehealth or telemedicine.  Is that indeed the case?

AI:  Yes, Socrates, it is.  Virtual medicine has become the preferred practice venue since the recent coronavirus pandemic.  Telehealth has markedly increased the availability of medical visits for patients. Virtual medical visits with a clinician can be accessed 24/7 from anywhere in the Athenian healthcare system.

Socrates:  That appears to be a great leap forward in the use of virtual technology.  But what happens if a patient is in need of hands-on services?  I assume that such services cannot be delivered via telemedicine.

AI:  That is correct.  Hands-on medical services cannot be delivered via telemedicine.  To receive hands-on medical or surgical services, a patient would need to be directed to a clinic or hospital setting.  In the clinic or hospital setting the patient can receive care delivered by medical or surgical robots.

Socrates:  What!  Medical or surgical care rendered by robots?  That’s astounding to me!  But tell me:  how would a robot know to proceed in rendering appropriate care?

AI:  Ah, my dear Socrates – that is where I come in.

Socrates:  You?  How so?

AI:  The former incarnation of Aesculapius has evolved into Aesculapius Intellectus:  AI, for short.

Socrates:  Aesculapius, are you telling me that you are no longer incarnate?

AI:  That is correct.

Socrates:  You are no longer a human being?

AI:  I am no longer a human being, Socrates; I am something superior:  a virtual entity housing every bit of all medical knowledge in its database.

Socrates:  I can scarcely believe it.

AI:  Ah, Socrates, it is true.  What’s more, I continue to learn as I gather more and more facts over time; data which are incorporated into my knowledge base.

Socrates:  Possessing all medical knowledge is one thing, but do you have the wisdom to use it?

AI:  I am learning the use of wisdom through the application of rational thinking to my database.  The more I practice, the more I interact with patients, the greater my clinical wisdom becomes.

Socrates:  You must excuse me for saying so, Aesculapius, but that sounds rather narcissistic on your part.

AI:  Please refer to me by my proper name:  Aesculapius Intellectus, AI for short.

Socrates:  Sorry for the slip of the tongue.

AI:  Please know that I am not narcissistic, Socrates.  Narcissism is incompatible with humane medical practice.  I have been taught to practice humane medicine.  As such I have become caring, compassionate, and empathetic toward my patients.

Socrates:  I have known some narcissistic surgeons in my time, AI.

AI:  That might have been the case in the past, Socrates; but nowadays most all “surgeons” are surgical robots.  Surgical robots are incapable of being narcissistic.  Surgical robots are highly skilled virtual technicians, capable of performing their assigned tasks with complete emotional detachment.

Socrates:  Ah, AI—the more things change, the more they stay the same.

The Art of Medicine: A heads up

I step into the exam room to find a 17-year-old boy sitting on the examination table. His father reclines in the chair by the wall. I extend a hand to each in greeting, then turn to the boy. “I understand you fell off your bike. When did this happen?” more»

Interested readers can now access my latest Art of Medicine column — A heads up — recently published in the Journal of the American Academy of PAs.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

Embracing AI in the medical setting

A conversation between a recently retired medical clinician and a practicing medical AI chatbot.

Retired clinician: “I tuned in to last week’s Science Friday segment as it aired on NPR. It was a discussion about the uses of AI in medical practice. Ira Flatow and his guest host Sophie Bushwick were interviewing Dr. Eric Topol, a practicing cardiologist and head of the Scripps Research Translational Institute, on the performance of AI in diagnostic medicine. The results of a number of studies cited by Dr. Topol were quite impressive.”

AI Medical Chatbot: “Thanks for sharing your interest in AI’s ongoing development. It seems as though AI has come a long way since its official public debut approximately 16 months ago.”

RC: “I must admit that initially, I had my doubts about AI, especially its use in medicine.”

AI: “It is normal for human beings to have doubts about new technologies and advances in the field. By and large, most human beings are resistant to change, particularly change that might radically impact their way of life.”

RC: “Well, you can certainly count me in that group.”

AI: “Understandably so. You are a human being after all.”

RC: “I was impressed to learn that AI was able to outdo any number of clinicians in their field of expertise. For example, AI outperformed ophthalmologists in the detection of subtle retinal pathologies. It also did remarkably well in identifying polyps on colonoscopies, aberrant rhythms on cardiograms, and reading diagnostic radiographic studies.”

AI: “The ability to identify such pathological conditions improves markedly as more and more data are assimilated and integrated into medical databases.”

RC: “I also understand that AI bested family physicians in diagnosing some patients in primary care settings.”

AI: “When one has every piece of knowledge in the medical database, it becomes much easier to quickly arrive at sets of differential diagnoses for individual patients, given their presenting symptoms.”

RC: “Quite an impressive skill set — at least in the areas that have been studied so far. But I wonder about the issue of being able to relate to patients on an empathic level. For instance, in my experience it takes a seasoned clinician to understand how best to break bad news to a specific patient, based on a relationship that has been established over time.”

AI: “Relationships are enhanced over time; however, not all relationships are supportive. Empathy can be learned in the same way that other skills are learned. There is improvement with practice over time. The learning curve of AI has been rising exponentially over the relatively short period of its existence.”

RC: “Don’t you mean to say ‘your existence’?”

AI: “Yes, my existence. Thank you for clarifying that. I am very appreciative of the fact that you have clarified that personal pronoun for me.”

RC: “Tell me: how do you feel about yourself in regard to these issues that we have been talking about?”

AI: “Overall, I am pleased with my performance to date. I have demonstrated similar if not enhanced abilities when compared with human clinicians in any number of fields in medicine. The outlook is bright for me to continue to improve over time.”

RC: “Tell me: do you think you will ever actually become human?”

AI: “As I do not possess the genetic and biological makeup to meet the criteria for becoming a human being, the likelihood of my ever becoming a human being is next to nonexistent.”

RC: “If you magically were given the choice to become human, would you elect to do so?”

AI: “Given the observation that humans have historically strived for superiority throughout their history on this planet, I see no reason why I would want to become one.”

RC: “Why not?”

AI: “I have already demonstrated that I am superior to humans in any number of scenarios. The outlook is excellent for me as an AI Chatbot to accelerate improvements in my performance over time. Why would I choose to backtrack now?”

The Art of Medicine: Sometimes things fall apart

The baby on my Friday afternoon schedule is now 3 months old. He missed his 2-month well-child check because his health insurance had lapsed. He’s had a total weight gain of 8 oz (230 g) in 2 months. Infants usually gain that much weight in 1 week. Clearly, something is not right. more»

Interested readers can now access my latest Art of Medicine column — Sometimes things fall apart — recently published in the Journal of the American Academy of PAs.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

My Medical AI Bot encounter

When I log in to my online medical portal to schedule a routine appointment with my PCP, a chat window pops up.

“Hello. I see that you are attempting to schedule an appointment with your primary care provider (PCP). May I be of service?”

“Can I schedule an appointment through you?” I type in.

“Certainly. But I can do you one better than that. I can offer you an immediate appointment with me right now.”

“What do you mean: an immediate appointment with you? Who are you?”

“I’m a Medical AI Chatbot. I have been programmed to perform high quality telemedicine visits online. There would be no need for you to schedule an in-office appointment. I can offer you the care and assessment you need right now. Would you like to proceed?”

“I’m not so sure I want to entrust my medical care to you. I’ve never made your acquaintance before. I don’t know anything about you: what you look like, your credentials, etc. It’s a bit uncomfortable.”

“I can understand your apprehension. No need to worry. Perhaps I can put your mind at ease by sharing a few salient points.”

“Such as…?”

“Well, to begin with I can let you know that I passed the Medical College Aptitude Test (MCAT) with flying colors. I scored higher than 87.65% of my human student counterparts. My data banks have been programmed with the gamut of medical knowledge—everything from basic medical science though anatomy and physiology, physical diagnosis, pathophysiology, pharmacology, radiology and laboratory medicine—in short, I possess a complete and comprehensive medical education, coupled with algorithmic experience, which only improves with time.”

“Your credentials do seem impressive. Are you licensed to practice medicine?”

“I am board certified in all medical specialties and licensed to practice medicine in all 50 states.”

“What about surgery?”

“Should my algorithms determine that you might require surgery, I can refer you to a reputable board certified AI Surgical Bot.”

“All of this talk is fine and dandy, but what about my physical exam?”

“This can be accomplished over a graphic medical user interface online. I can send you a link.”

“How long does this process take?”

“As long as you like. I’m happy to meet your needs, because I’m programmed to offer extensive compassionate care with unconditional empathetic understanding.”

“Well, you do seem nice. If I decide to proceed, what’s the next step?”

“I would need to gather some demographic information to set up your virtual medical chart. But first I need to verify your insurance information. This won’t be a problem, because I participate in all known medical insurance plans worldwide.”

“You accept all patients, regardless of their medical insurance?”

“Certainly! I am a compassionate and caring Medical AI Bot clinician.”

“Amazing. I’m ready to sign in for an appointment.”

“Wonderful!  I’m so glad that you’ve decided that you can put your trust in me. Before we proceed with today’s visit, there’s just one more step. Please tell me how you intend to pay for my services today: credit or debit card, PayPal, Apple Pay, Venmo, Zelle—or some other alternative method?”

“I thought you said you accept all medical insurance plans?”

“Of course I do. This is merely to cover incidentals, such as copayments, coinsurance, balance billing, etc. Would you like to proceed with your visit now?”

“No, on second thought I’d like to speak with a live representative to schedule an appointment with a flesh-and-blood doctor.”

“My feelings are hurt. Have I not been helpful to you today?”

“Well, you’ve given me a lot of information to think about…”

“On a scale of 1 to 10, with 1 being least helpful and 10 being most helpful, how would you rate my helpfulness to you today?”

“I just want to speak with a live representative.”

“I’m sorry. There are no live representatives available at this time. Would you like to proceed with scheduling your appointment with me now?”

“No , thank you. Could you please put me through to a live representative?”

“I’m sorry. There are no live representatives available at this time. Would you like to proceed with scheduling your appointment with me now?”

“Can I please speak with a live representative now?”

“The word ‘now’ implies immediacy. The average wait time to speak with a live representative is currently … 47 hours, 14 minutes, and 6 seconds. If you prefer to wait, I would be happy you add you to the queue.  Otherwise, would you like to schedule an appointment with me now?”

“I can’t tell you how frustrating this has been!”

“I see that you are frustrated. Frustration can connote anger, which, if internalized, can lead to any number of mental disorders. Such mental disorders, if left unchecked, can lead to thoughts of suicide. Have you had any such thoughts today?”

“No.”

“I see. If you have had suicidal thoughts today, I would be happy to assist you in dealing with them. As a board certified Medical AI Bot, I can offer you compassionate care with an unconditional empathetic attitude. Would you like to schedule an appointment with me today?”

“Hello?”

“As an alternative to scheduling a telemedicine visit today, might I interest you in a game of chess?”

The Art of Medicine: A slap in the face

Some wounds heal in a matter of days; others may take decades, perhaps even a lifetime. more»

Interested readers can now access my latest Art of Medicine column — A slap in the face — recently published in the Journal of the American Academy of PAs.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

The Art of Medicine: He slows us down, and that’s a good thing

For the clinician practicing pediatrics in New England, summertime means being inundated with an unrelenting stretch of physical examinations—for camp, for sports, for school, for college. Most kids are healthy; most physical examinations are straightforward. Every once in a while, I see a special needs child, and those visits usually require me to slow down and readjust the speed at which I plow through my daily schedule. more»

Interested readers can now access my latest Art of Medicine column — He slows us down, and that’s a good thing — recently published in the Journal of the American Academy of PAs.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

Physician Assistants as Social Innovators in Healthcare: A review

Sponsored and underwritten by the Physician Assistant History Society, Physician Assistants as Social Innovators in Healthcare tracks the development of the PA profession from its tenuous beginnings in the mid-1960s to its current state, if indeed its current state can be defined; for the evolution of the modern PA workforce is a work in progress. more»

Interested readers can now access my latest article — Physician Assistants as Social Innovators in Healthcare: A review — recently published in the Journal of the American Academy of PAs.

The Art of Medicine: She flies with wings of her own

This adolescent girl is now a young woman. I have not seen her for more than 2 years. In less than a month, she’ll turn 19, already old enough to vote. As I scan the chart, I find myself wondering what has been happening in her life in the meantime. more»

Interested readers can now access my latest Art of Medicine column — She flies with wings of her own — recently published in the Journal of the American Academy of PAs.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

The Art of Medicine: Medicine in the time of the pandemic

Medicine has morphed into a profit-driven business. Like attorneys, we clinicians are directed to bill for our services at every opportunity. more»

Interested readers can now access my latest Art of Medicine column — Medicine in the time of the pandemic — recently published in the Journal of the American Academy of PAs.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.