Does your doctor really need to be alive?

For those people who are concerned and perhaps even frightened by the potential of technology, I suggest that they not view the following page. This page is actually a summary of some of the imagined future technologies as depicted in a TV show called “Black Mirror”. The author  of the article does an excellent job of summarizing the various advancements that are described and displayed in the TV show. The disturbing part is that all of the elements seen in this show will, as the author argues, likely be a part of our real day to day life experience, sooner than we all are ready for.

There were a couple of references in this article where  I was not even sure  if the author was speaking about real life technology or about an episode in the show. Just the following excerpt already speaks volumes about the potential, positive and negative, of soon to be widespread technology. The author notes that “a company called LifeNaut (slogan: “eternalize”) is handling the “mindfiles” that give <a robot> her personality”. One can see a real life demonstration of this technology by viewing the following video. And the answer is yes, if you are asking me whether I felt a tingle in my spine as I watch this video.

This brings me to the following question that actually has been asked countless times in the science-fiction world, but also in the real world of science [which seem to cross over more and more every day]. How does one measure consciousness and self-awareness? I can define self-awareness. I can tell anyone I meet that I am self-aware and describe what that means to me. The person I’m speaking to can do the same. At the end of this exchange,  both I and the person I’m speaking to conclude that we are both self-aware and therefore unique from, at least, present day computer technology.

What if I was interacting with a robot that “knew” how to simulate the actions and interactions of a person who is self-aware? To use the highly scientific definition in physics, “if it walks like a duck and quacks like a duck, then it’s a duck”. We measure the reality of the person we are interacting with based on a whole set of cues, many of which are subconscious [even including something as basic as the smell that another human would have]. It is interesting to note that in the first “Terminator” movie, the Terminator robot was described as having bad breath. In other words, the simulation of a human was accurate down to something that we rarely think of [until it literally hits us in the face].

This long introduction brings me to a very simple question about the future of healthcare. Doctors today speak at great length about the doctor-patient relationship. While doctors often state that they do not have sufficient time to humanly interact with the patient [versus just professionally interacting], these doctors still argue that the doctor-patient relationship is both holy and ultimately the discerning factor between human physicians and computerized healthcare.

But with all due respect to human physicians, they are assuming that technologists will never succeed in creating  a simulation of human behavior. This simulation would not be self-aware. It could demonstrate emotion and empathy, but only as a programmed response to the actions of another individual. Assuming that this human simulation  wore a white coat and stethoscope around its neck, it is most likely that human patients could not tell that it was in fact a simulation.

There is presently a technology that is being used in many locations around the world, that allows a doctor to remotely do rounds and interact with and even examine patients in a hospital. The “head” of this device is a computer screen that displays the upper body of the physician. The examination itself is performed via specialized hardware that allows the physician to remotely hear the patient’s lungs and heart and to see and speak to the patient. This is for all intents and purposes a robot. It might not look like the Robby the Robot from “Lost in Space”, but it is just as much an advanced piece of engineering.

The day will come when the “doctor” displayed on the screen of this device, is a simulated physician. The graphics will be of such high quality that the human patients will totally believe that they are speaking to a human. The artificial intelligence that guides this simulated physician will be sufficiently capable to carry on a full conversation and deal with any of the medical issues that arise. Admittedly, if you pulled this device aside and tried to have a philosophical discussion with the simulated physician, you might quickly discern that this is not human. But that doesn’t matter. As far as the patient’s know, they have just spent 15 to 20 minutes with a very polite, empathetic and helpful physician. In fact, there will be patients who say that the experience was so pleasant that it reminded them of physicians of old, who used to make house calls and actually care about the human part of the patient.

A great deal is being written about how computers will assist human physicians in caring for patients. There is this lingering assumption that humans will always be required in order to “humanize” the care that patients are receiving. But I am confident that simulations of human behavior will deliver the equivalent experience to patients. In fact, the computer version of the physician will be able to sense and detect a whole range of psychological signs that are also of medical concern. For example, the simulated physician will detect and analyze the tone of the patient’s voice and thereby quantify the mood of the patient. While a human physician could easily miss the subtle signs of early depression, the soulless simulation could not only detect a depressed state but even carry on a supportive conversation to lift the patient’s mood.

I guess the ultimate test of these physician simulations will be when psychiatric care can be delivered by a computer. When a robot can express the appropriate emotions and empathy in order to help a patient work through a psychologically difficult episode, it will be very hard to argue that humans have an advantage, simply because they are self-aware.

Although it might sound strange to say this, but the scenario I have described above would be ideal. There’s nothing wrong with computers simulating human behavior. But if a computer ever truly becomes self-aware, then we may very well face one version of all of the doomsday scenarios described in countless science fiction novels. As long as computers only simulate awareness and humanity, humans will be safe. In fact, most humans if not all of us, will quickly forget that our caretaker or neighbor or nurse or grocer are in fact simulations. There will definitely come a time when humans who passed away will be simulated and continue to interact with those loved ones still left behind. As pathological as this might sound, it will soon enough become a cultural norm. I leave it to the reader to decide what this ultimately means.

In many descriptions of future robotic-based dystopias, humans on the whole are better off than many people today. For some, this will be acceptable. For others, they will try to bring down the entire system that runs these simulated humans or simulans (if you allow me to coin a term). Only time will tell how all of this will play out. I admit that I am curious to see where all of this goes. At the same time, a part of me is happy that I am old enough that I will not have to live in such a society for very long.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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