With Compassion Toward None, With Technology for All?

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Chandrakanth Are, MBBS, MBA, FRCS, FACS

Chandrakanth Are, MBBS, MBA, FRCS, FACS

Dr. Are is Jerald L & Carolynn J. Varner Professor of Surgical Oncology & Global Health; Associate Dean for Graduate Medical Education (DIO); and Vice Chair of Education Department of Surgery, University of Nebraska Medical Center, Omaha.

Imagine health care in the not too distant future… 

JOHN IS GOING about his usual Saturday at home, when his health-care–enabled smart watch alerts him to a sudden rise in his heart rate. As he is wondering about the reason, he feels a sharp pain in his left lower quadrant. The tachycardia crosses the previously set threshold on his health-care– enabled smart phone, which then automatically triggers an alarm that ushers an autopiloted car into his driveway. As he gets into the car, the autopilot connects to his smartphone, and based on the data accumulated, it automatically drives him to the nearest appropriate automated self-care health booth, designed to focus on abdominal ailments. 

Once there, John seats himself in the booth, which is equipped with all types of radiologic imaging capabilities as well as blood and urine sample–testing equipment offering immediate results. In addition, there is a remote, artificial intelligence (AI)-enabled robot physician that can interact with John to obtain a history and determine what tests and treatment are needed. A protocol-enabled history triggers appropriate lab work and imaging, which leads to a provisional diagnosis of diverticulitis. 

“Medicine is the one field where human interaction is indispensable.”
— Chandrakanth Are, MBBS, MBA, FRCS, FACS

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The AI-enabled robot physician determines the severity of the condition and prescribes antibiotics and other required medications. It then relays the signal to John’s phone, which stores it in his permanent, hack-proof health-care portfolio. In addition, it calls for the autopiloted car to get John back home. All of this done is without having to wait anywhere and without a single human interaction. 

What a seamless health-care episode, and what is there not to like about this technocentric but human-bereft health-care delivery model? 

Innovations in the Pipeline 

WE MAY WELL have the technology to do exactly what is described in this scenario in the near future. We currently have numerous health-care–related technologies that many feel are nimble predecessors to these innovations, which may soon begin rolling down the pipeline. A few major technology companies are working away in secret labs—with names like “1492”— to creatively disrupt our health-care systems. 

At a practical level, we already have technology that can read radiologic scans with greater than 95% accuracy. Laboratory work can be done by transcutaneous contact with immediate results, which can help decision-making in real time. Anesthesia for some procedures can be provided by machines operating independently. 

For the younger generation that may never have experienced illness of any kind and prefers texting to talking, this could be nirvana, and many institutions would be delighted with this health-care delivery model. Hospitals might foresee great benefits by eliminating human personnel and the associated fallibility. Insurance companies and other entities will realize the benefits of error-minimized care that can reduce costs and translate to profits. 

“The field of medicine, dealing with humans and their ailments, has long been and will continue to be anchored to the human touch.”
— Chandrakanth Are, MBBS, MBA, FRCS, FACS

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The information technology industry is already eager for these advances, with some Fortune 500 companies dipping their toes in the ocean of health care. Imagine how they will transform health-care delivery once they jump in completely. And lest we forget, to the world of unethical hackers (as opposed to ethical hackers, who do exist), this could be a land of paradise, full of opportunities for nefarious activities. 

The Human Touch 

IT IS QUITE possible that health-care delivery will be transformed by technology in ways unimaginable to the unprepared (or even the adequately prepared) mind. It is quite likely there will be innumerable benefits to this technology-based transformation of health care. But before we surrender ourselves 

completely to the inevitable incursions of technology into health care at speeds greater than 2,000 megabits per second, we may want to press pause for a moment. 

Technology has already had a significant beneficial impact on health care. We are able to treat diseases that until recently were universally fatal. We are able to determine causes and find cures for old and new diseases alike. As a result, the human life span has progressively increased over the past century. But having an obsessive reliance on technology at the expense of human interactions for everything in health care can also be troublesome. Technology should be used, but within its limits, and always combined with compassion—which can only come from human interaction or involvement. 

Medicine is the one field where human interaction is indispensable. Even in today’s most sophisticated hospitals, most patients want to interact with a person. They want to share their sorrows and crave a human response to their ailments. A human in illness derives succor from another human, and there is no substitute for that sort of empathy. A human can see, hear, and feel the pain that a sick patient is going through, which no robot will be able to do regardless of its AI enhancements. The warmth of the physical touch of a fellow human being can do wonders for a sick patient. The field of medicine, dealing with humans and their ailments, has long been and will continue to be anchored to the human touch. 

“I sincerely hope we can … provide ‘compassion for all and technology for all’ at this seminal time for health-care delivery in our nation.”
— Chandrakanth Are, MBBS, MBA, FRCS, FACS

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Knowing the Limits of Technology 

AS WE MOVE forward, let us utilize technology but within its limits. There is no better illustration of that proviso than Charles Lindbergh’s first successful transatlantic flight. There were other pilots who had more sophisticated planes with more complex and advanced technology than Lindbergh’s plane. These other pilots packed their planes with as much of the latest technology as possible, which seemed good in thought, but it made their planes much heavier. In fact, pilots of some of these more advanced planes had also packed wine and sandwiches to pop open once they reached the other side of the Atlantic. In contrast, Lindbergh used only the technology that was needed, but also relied on his significant human skills. This smart but spartan use of technology kept his plane lighter in weight but heavier in capability and instincts. His much lighter plane combined with his sharp human instincts made history. 

In 1865, an eloquent man uttered these immortal words at a seminal time in our nation’s history: “With malice toward none, with charity for all….” Let us not practice medicine in an environment of “compassion for none and technology for all.” Instead, I sincerely hope we can transform that principled phrase and provide “compassion for all and technology for all” at this seminal time for health-care delivery in our nation. ■

DISCLOSURE: Dr. Are reported no conflicts of interest. 




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