A doctor’s touch

A recent online edition of The Journal of the American Medical Association features an essay by two doctors titled “The iPatient Meets the iDoctor.”  The authors acknowledge the time-saving benefits of AI, such as its ability to assimilate and consolidate clinical documentation, imaging, and laboratory results. They also tell us that AI gives less-trained health workers "the diagnostic performance of the most experienced physicians.” In fact, AI already matches or exceeds physician performance on standardized knowledge multiple-choice examinations. This advantage is particularly useful in under-resourced areas where patients may receive “expert-level care where none previously existed.”

But they mourn the accompanying losses, which include the “hollowing out of longitudinal patient-physician relationships,” as seen in the loss of primary care doctors and increased use of emergency departments, telehealth, and urgent care clinics.  Such short-term relationships are likely to overlook subtle changes in a patient’s health, such as a change in gait.  

Most important, perhaps, is the loss of physical touch. The ritual of the physical examination, the authors maintain, “…localizes the patient’s complaint on their body (and not on a laboratory printout, an inbox message, a biopsy report, or a radiologic finding) …When we care for patients without physical touch, we distance ourselves from their embodied identity and in time from our own.”

The authors, both MDs, are David Rosenthal and novelist Abraham Vergese, author of A Covenant of Water and Cutting for Stone. I recommend the latter. I’m sure it’s semi-autobiographical.

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