Restoring the Doctor–Patient Relationship With Artificial Intelligence

Physicians are valued for being brilliant diagnosticians and they now have more information and tools and technology at their disposal than ever before; yet patients don’t feel cared for, and doctors don’t feel like they can care for patients enough.

According to the latest book from Eric Topol, MD, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, the promise of artificial intelligence in healthcare is that it can give time and space back so that so that physicians are valued for their empathy and compassion. In turn, what he calls “shallow medicine”—the practice of medicine that stems from inadequate examinations, unnecessary tests and procedures, missed or misinterpreted findings, which then leads to waste and medical error—will be replaced by “deep medicine,” which enables caring physicians to deliver precise, individualized prevention and treatment.

Topol spoke about his book recently at the Pepperdine Graziadio Business School’s 5th annual Future of Healthcare Symposium.

“We are flooded with data,” said Topol, a cardiologist. “The things that we do in healthcare, like medical images at exceptionally high resolution, and genome sequencing, and sensors that can get continuous output, are driving this data flood.”

This could all be a good thing if the data could be dealt with, said Topol, the director and founder of the Scripps Translational Research Institute. However, there are pitfalls.

“We have over 12 million serious diagnostic errors in this country each year,” he said, adding that the figure is probably underestimated. “That, obviously, is dreadful.”

In addition, patients generally report their experience of visiting a doctor is not a positive one. For their part, doctors don’t have time for deep, reflective thinking about a patient’s condition

“What we practice today is fast and shallow, laden with mistakes and waste,” he said.

But now, by computationally analyzing deep phenotyping—understanding all the different layers of what makes up a human being, as well as geonomics and the immunome—physicians can have a much more complete understanding of patients as well as the time to treat them.

Topol recalled a previous review article of his called “Individualized Medicine: from Prewomb to Tomb,” and said a mentor told him he “blew it” on the title; had he had called it "From Lust to Dust," it would have received much more attention.

“Every part is starting to take hold in geonomics,” he said, from genomic scanning of sick newborns, to cancer, to identifying possible antibiotic resistance if one is sick with sepsis. “Why would you wait days for a blood test?” he asked rhetorically, when knowing the right antibiotic to use could be had within hours.

He also noted that “all common conditions are getting a polygenetic risk score,” with heart disease the most common one.

In addition, there are sensors to track almost every condition, such as the Apple Watch; Apple recently announced results of its atrial fibrillation study.

“This is good for people, potentially, who have significant risk, or have symptoms,” Topol said. “It may not be so good if used widely in all people who have an Apple Watch.”

His favorite device, he said, is a small, portable ultrasound device that connects to his phone and displays results on an app. With it, he diagnosed his own kidney stones, although when he went to his doctor, the physician “looked at me like I was an alien” and sent him for a $3000 CAT scan, which showed the same results.

The real possibilities of artificial intelligence, he said, is that it can penetrate through many layers of information to understand patterns, make diagnoses with greater accuracy, and give “the gift of time” back to doctors.

In a chapter called "Deep Liabilities" in his book, he refers to the possible negative effects. They include privacy issues, which have not been resolved in the United States, as opposed to Europe; human bias corrupting inputs; and the current inequities in US healthcare and society. All of this, if not resolved, could make things worse instead of better, he said.

But he emphasized that the status quo had to change, given that US healthcare spending is the highest in the world, yet has poor outcomes, and the deep disatisfaction held by both patients and physicians with American healthcare.

"We need to restore this relationship that has eroded so dreadfully over the last few decades," Topol said. "We need to get more humane."