Trust me, I am a computer

It is a chant repeated by most physicians: the doctor-patient relationship is unique to humans and it is even what sets physicians apart from other medical professionals.

A study was performed to assess people’s level of comfort with a computer versus a human, when asked personal questions that would be considered embarrassing. The conclusion? That humans preferred “opening up” to a computer versus a human being. I think the reason is clear – people felt more comfortable sharing intimate information with a non-judgemental machine rather than a human who might even share this information with others.

Doctors speak of the intolerable situation whereby they are forced to allot only a few minutes per patient, in order to generate a sufficient income to “feed themselves”. At the same time, they speak of the significance of the doctor-patient relationship. As I understand things, despite the glorification of human contact with the patient, it seems to be a theoretical issue, as no doctor has time to build such a relationship.

I also find that doctors do not give sufficient credit to physician assistants nor nurse practitioners as being ideally suited to provide the extra time that doctors so lack. Or instead, these professionals can do as much as possible of the more repetitive and standardized care, leaving the doctor maximum time to devote to each patient.

What this article says to me is that the doctor-patient relationship is important BUT is not solely the domain of humans. It IS possible to create a computer based interface that is indistinguishable from a human, in tone of voice and content of speech. We are not yet at the point of having human looking robots actually sit across the desk of a patient. But, for example, soon, computers will “man” phones for basic medical consults. In time, they will be able to take a complete and detailed history and advise (and order) tests. And yes, the time will come when computers will be able to provide the equivalent (and even better) care than that of a human doctor. For some things, like certain examinations, there may still be a value to having a human involved. But the role of the human doctor is going to completely change within the next few decades.

At this point, the obvious question is what will the role of doctors be in the future. As a rule, I do not predict specifics beyond a few years. But failing to recognize that computers can and will replace most tasks human now perform, is folly. Medical students, who are just now starting their studies, will face a revolution in care within the span of their careers. On one hand, they will see a new world where the diseases that haunt us today, will be curable. But at the same time, they will slowly cede their roles and most likely even their authority, to other specialists and/or computers.

What is definitely needed is more studies like this one. We need to honestly and in an unbiased fashion, research the way in which humans interact with computers. We may discover that humans still prefer humans for certain issues but prefer computers for others. But without the research, we will never know. We cannot do this research with the forethought that the human doctor-patient relationship is inviolable. We have to take a step back and prepare ourselves for the reality that is coming.

I suspect that many doctors will read the results of this study and argue that it is only one study and that it “must be wrong”. I have no issue with skepticism. The answer is more and more research. But if that research repeatedly shows that computers can provide for patients, what human doctors cannot, then the doctors need to swallow hard and accept this. Holding on to old customs (whether carrying a black bag or wearing a tie that carries bacteria from patient to patient) is archaic in a new world where evidence based care should be the foundation of everything a doctor does. And for those cases when the evidence is lacking? Well, that demands more and more research and more computer power to analyze all the data.

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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