I can remember the good old days when my doctors would actually look at me during a medical visit, or recognize that we were in the same room during the exam. Now, they spend our time together glancing at the clock or focusing entirely on their Epic systems keyboard. I am old enough to recall the days when there was time during a medical checkup to chat about stuff in general, about politics or books that we had just read, or why the U.S. medical system was going down the crapper. Ah, the good old days for sure.
Now, just getting a freaking appointment is a struggle. I’m not totally sure what has gone wrong, though I always have a hypothesis or two on every topic. The thing is, I live in Madison Wisconsin. This is a regional medical center where doctors love to live and practice, and where the prestiguous University of Wisconsin Hospital is located. Drive around the west side of my city and you stumble across a medical building on every other block (sometimes every block). I’m not talking about an individual doctor’s office like you would see in Florida but a whole building filled with highly trained medical professionals who presumably could be devoted to my medical well-being. Okay, too often they are dedicated to narrow part of my health or to singular afflictions … the G.I. system or my left ear or my aching butt. Nevertheless, they seem to be everywhere.
Despite being in this medical care heaven, just try to see a real physician. I dare you … just try. I used to be able to see my internist promptly and without issue. I recall getting my periodic colonoscopy scheduled in a couple of weeks (back in the old days). Hah, my internist ordered my most recent one back in November. His association used to have a general surgeon in house, and it seemed easy to get the procedure done in a very reasonable time.
Now, however, I am referred to a specialist in another one of these ubiquitous clinics. I was told not to even call the clinic for at least two weeks to permit time for my request to get into their system. When I did call, the first opening was some five months out. I asked the gal who had the pleasure of seeing my backside (admittedly my best side) why the long wait. She mumbled something about Covid causing delays and then a lower age threshold for initiating screenings. Possibly, but still. I can remember when Republicans asserted we surely did not want socialized medicine in the U.S. like they have in Canada because of the delays in getting service. Duh, we have a for profit system (in part) and the wait times to be treated are excruciatingly long. I’ve never, ever heard a foreigner (no Canadian for sure) say they wanted to move here for our health care system
One more example! In every visit my dermatologist usually finds another spot or two that needs excavation to remove a cancerous growth of some sort. I spent too much tiime in my debauched youth out in the sun and not enough time studying in the library. Fortunately, none have been Melanoma but they often require the Moh’s protocol (developed at Wisconsin) which can be a lengthy procedure but which ensures that all the cancer will be removed.
Again, I usually could get that operation scheduled within a very reasonable amount of time. How things have changed, it has been several months since my latest spot was identified on my facial cheek and another Moh’s procedure deemed necessary. I’ll be lucky if my cheek doesn’t fall off before they get to me. I like my dermatologist and we usually can chat about literature during the lengthy Moh’s procedure. But I’m a bit concerned that I now have enough time between diagnosis and treatment to write another one of my 500 plus page books.
The other day, I saw my new ear specialist. My former ear doc was one of the best in the State. I was bumped to him by another surgeon since he was one of two in the state who could handle a delicate operation that involved removing a deeply embedded tumor in my left ear without damaging the surrounding facial nerves or slicing through an artery. It was a 5.5 hour operation and I was grateful for his expertise. But he, like several of my other docs, has retired recently. Most are bailing out early these days and I’m beginning to wonder if they are trying to escape me personally. Only my neighbor, a rather reknowned infectious disease doc, has continued to work into his 80s.
So, I have a new ear doc since there is some suspicion that the tumor may be coming back. He breezes in (with medical residents and students in tow), putzes in my ear for a bit, mentions something about an MRI in a year and is gone. I hardly had time to start an argument with him about our insane health care financing system though, when I raised the issue, he did not score points with me when he blamed bad lifestyle decisions by patients for the comparatively higher health costs in the U.S. While that is undoubtedly a contributing cause, our systems failures cannot be ignored.
He obliquely did mention the Epic system though. he noted that, when he was training at Duke medical school, they introduced the Epic system. He made the point that the number of patients being seen dropped by one-third but the program remained revenue neutral (no loss of income). Before I could push him on whether that was good or bad from his persepctive, he was gone. But that did not sound good to me.
I should say that he personally is not to blame for treating me as a cog on the assembly line. In most professions, everything is driven by the bottom line these days. Medical facilities are now profit centers and nothing must slow up the assembly line. The clock is ticking when the doc enters the door and, in my ear doc’s defense, he does strike me as competent. Still, it is discomforting that you hesitate to ask a question knowing that will make your medical professional uneasy. After all, any delay will put him behind in the daily grind of assembly line medicine.
Fear not, though. There may be an answer on the horizon. I just read about recent research illuminating the wonders of AI technology. A study by researchers at the University of California-San Diego comparing responses to 200 medical questions from an artificial intelligence program (ChatGPT) as compared to highly trained human medical personnel. The responses were then subject to a blind assessment by a panel of medical professionals. So, how did the machine do compared to real doctors?
The machine generated responses were three to four times more reliable and accurate than those from human docs. The machine was less likely to make things up if it didn’t know the answer.
Shockingly, the machine were judged to be seven times more empathetic as their human counterparts.
Hmmm, one would think that humans would evidence a more human touch in patient-physician interactions. In fact, a full 60 percent of people surveyed still want to be treated by a human and not a machine irrespective of such outcomes. Your friendly (or not so friendly) doc is not likely to be replaced soon. Still, at first blush, it is shocking that machines are more sensitive and compassionate than our fellow humans. Okay, not so shocking. I’ve always felt that humans were way over rated.
On further thought, perhaps that is not so surprising. First, the machines are only mimicking what we think of as human reactions and can be trained to be better at it. Humans vary considerably along atributes such as empathy. In the future, who knows what the capabilities of machines might be. Perhaps they will evolve to feel real emotions.
It is more than that, though. With medicine increasingly driven by the bottom line, humans are not permitted to be human any longer. Docs are being reduced to assembly-line personnel … robots that look human but have institutionally been stripped of all their humanity. And like the specialization that Henry Ford introduced in Detroit a century ago, physicians have been forced into increasingly narrow specializations so that productivity can be maintained as the sick flow along the assembly line. Routinization, after all, is the key to efficience which drives up profits. When I met the woman who did my colonoscopy, I wondered if that was all she did. If that had been my job in life, I would have considered suicide within a year.
In addition, most medical interactions are reduced to gathering and inputing information into automated systems. Increasingly, communications with patients are done remotely through venues such as MyChart from Epic systems. Some docs aready complain that half their day is spent on the computer, not dealing one-on-one with patients. Routinized practice dominated by on-line automated systems requirements have become the norm. Would replacing the human factor be much of a change? Would we even notice the transition?
Will artificial doctors, especially when doing diagnostic and triage functions, be a bad thing? I cannot say. However, we cannot take much comfort in the salient trends evident in contemporary medicine, at least in the States. Experienced doctors are retiring early. They are burnt out and/or despairing in the face of mountains of paperwork, assembly line patient interactions, and corporate bottom lines. The young recruits to medicine might well be driven more by the money to be made than any sense of professional purpose. If that is the case, perhaps the machines cannot replace human doctors soon enough. After all, they don’t get tired or dissillusioned or cranky or distracted by the thought that they are late for their tee time at the club. [Note: My opthamologist, whom I thought highly of, did have a rather low single digit golf handicap which made me somewhat suspicious :-)).
On the other hand, what would prevent the next generation of AI medical healers from realizing that those pathetic human they are helping are hardly worth the effort. Why keep these talentless humans alive? How convenient for the machines if they have taken, or been given, control over the future health of the species as they realize just how useless we are. That is just a thought.
I can’t end another discussion on AI without sharing a poem one of them generated recently. It is on the topic of America’s pasttime … baseball.
“In Summer’s embrace,
Bats crack, balls soar through the air,
Baseball’s timeless grace.”
Next time I am tempted to write a book, I’ll just ask a machine to do it for me. As I keep saying, I’m so glad I’m old.