Honor above all else

Throughout the hundreds of blog posts I have written, I have often referred to the moral aspect of the practice of medicine. When a police officer runs into a building to save an innocent bystander, risking his own life in return, this requires a special level of dedication. The oath that police officers and firefighters take very much equates to the king’s knights of yesteryear. This is not just about carrying a sword, or a gun or a water hose. This is about a promise to the people in one’s community, that you will be there for them when needed.

I am proud of the oath I took when I became a doctor. I was never dismissive of the importance of what I was doing. Admittedly, this is one of the reasons I became cynical and angry with so many physicians I came to know. Far too many of these “professionals” did not demonstrate the qualities or personality that should go hand in hand with the title of “Dr.”. I am fully aware of the stresses that come with a medical career. I know what it means to miss out on family time. I know that being a physician can be financially difficult, unless you are a plastic surgeon to the scars of the stars. But ultimately, none of that should matter. A physician should always be wary of belittling the honor of the profession.

Far too often lately, I have been talking and writing about the role of physicians in a future laden with silicon. Can a computer ever understand the concept of “honor”? Can a server ever appreciate that the responsibility of practicing medicine carries with it a moral responsibility to the public? Obviously, today’s computers are incapable of such a level of understanding. But one day, a computer will be able to appreciate the gift of life and the responsibility of caring for that life. In the past, I’ve spoken about the day when computers will surpass human beings based on their ability to remember every piece of medical information, ever collected. But perhaps, the true measure of a computer being able to surpass a doctor, is when that computer is capable of expressing a level of humanity that unfortunately is far too often missing in human physicians.

When I was a medical student, I was prepping a patient for surgery. One of my responsibilities was to make sure that the patient was seen by a cardiologist to make sure that he was safe for the surgery. I forgot. I didn’t forget because I was in the process of doing CPR on three patients simultaneously. I forgot because I wasn’t organized and because I hadn’t written it down and I got caught up with stupid other things. My chief resident at the time fixed my mistake. After taking care of the issue, he looked at me and said, “You can’t fix this. You’re lucky that I could, but you missed your chance. At the very least, you should feel the pain.”

The pain he was referring to was a kind of pain that a responsible, honorable person should feel when they have failed at a task that they were entrusted with. Wearing a white coat doesn’t transform a person into a physician. Pardon the imagery, but a person could be standing in their underwear and still very much be a doctor, based on his or her behavior. I failed my patient on that day. And to this day, I feel the pain of that failure, all because of my chief resident who taught me, perhaps, the most important lesson I ever learned.

Perhaps then, this is a measure by which we will know when computers are ready to take on the mantle of “Dr.”. When a computer can “feel” the equivalent of pain over having failed in a task, then and only then will it be possible for a computer to ever understand the significance  of the role of being a physician. Even though the computer will easily learn  all of the medical knowledge that there is, and even though the computer will eventually be able to diagnose patients better than any human, the “feeling” of failure may be what finally qualifies a bunch of computer bits into a doctor’s soul.

The criteria for getting into medical school often has to do with scores on various types of tests. Unfortunately, there is no simple test that can identify those people who are truly respectful of their role as guardian of people’s health.  The joke might be that we will better succeed at creating this trait in computers than finding it in humans.

Any person who cares for the well-being of others has the only real trait that is necessary to be a good doctor. Even 50 years from now, I believe that a human being with this trait will be able to work side-by-side with computers to help humans get healthy and stay healthy. The question being asked again and again is: will there be a need for human doctors when computers can do it all on their own? In my opinion, there can never be such a thing as a lack of a need for a doctor who cares, no matter what that doctor is physically made of.

I want to add a few words about putting the patient first even when the doctor himself is subject to risk. I am presently involved in a situation that requires that I sacrifice a great deal in order to try and stop certain people from their actions. I do not welcome this task, but it must be done. I see the honor of physicians being diminished by these people. I will try my best to restore honor to the title of doctor. I have no idea if I will succeed. But it doesn’t matter.

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.