As a writer, my genuine concern is whether reading is dying out, not if I will be replaced by someone more facile with AI. For the last several centuries, reading has been ascendant, but now that is changing.
“Oral culture, in contrast, tends to be more fluid, harder to evaluate and verify, more prone to rumor, and it has fewer gatekeepers. Those features have their advantages … We also just love talking, and listening, as those modes of communication reach back into human history much further than reading and writing do. Speech is part of how we bond with each other. Still, if any gross generalization can be made, it is that oral culture makes objectivity and analytic thought harder to establish and maintain.”
From the Free Press, Goodbye to the Age of the Book
War has always been a laboratory for innovation. The mustard gas of WWI resulted in the first cancer chemotherapies; the rapid airlift of our wounded in Viet Nam resulted in today’s Level I trauma centers.
“Arguably, [WWI] was the first war where science and technology were mobilized as part of the war effort,” says Jeff Schramm, a Missouri University of Science and Technology historian of technology. “Labs and people all over, at universities and in the industries, were working on stuff for the war. That was unprecedented.”
From Nautil.us, The 6 Most Surprising, Important Inventions From World War I
In an attempt to surmount the increasing barrier created by electronic records and their screens between physicians and patients, the software titans that delivered the faulty software have provided a software answer – the increasingly ubiquitous scribe furiously taking down notes of the physician-patient encounter. Of course, with all things software, human scribes are rapidly being replaced by, wait for it, AI. In describing one AI summarized encounter, the author writes,
“The summary was surprisingly fluid and accurate. But it did not capture the catch in Pamela’s voice when she mentioned the stairs, the flicker of fear when she implied that she now avoided them and avoided going out, the unspoken connection to Pamela’s traumatic relation to her own mother’s death that the doctor never elicited.”
In addition to losing the unsaid, AI, as with all computers, can do things much faster than a mere human.
“In this trajectory we can see the evolution of what Michel Foucault described in The Birth of the Clinic as the ‘medical gaze' – the separation and isolation of the diseased body from the lived experience of the person and their social environment. Where the 19th-century gaze fragmented the patient into lesions and signs visible to the clinician, and the late 20th-century evidence-based gaze translated patients into odds ratios and treatment protocols, the 21st-century algorithmic gaze dissolves both patient and doctor alike into never-ending streams of automated data. AI views both suffering and care as computational problems.”
From the Guardian, What we lose when we surrender care to algorithms
While there are many reasons for the opioid crisis, I believe there is a consensus that an initiating factor was the decision to treat “pain as the fifth vital sign” in medicine, along with temperature, blood pressure, heart and respiratory rates. So when I saw a headline arguing for “lifestyle” as a vital sign, I cringed. The opening phrases did little to alleviate my concern,
“Considering that lifestyle factors are a significant driver of chronic diseases, it is time to treat these behaviors within the clinical workflow with the same importance as vital signs, medications, and lab results.”
While that is true, what follows, written by the President of the American College of Lifestyle Medicine (ACLM), is a litany of ways to incorporate more questionnaires into the electronic medical record and then disseminate this new, presumably helpful information to all practitioners. For physicians, already burdened, AI, the new sorcerer’s apprentice, would distill the information and provide guidance we could share with our patients.
“a short clinical assessment designed by the American College of Lifestyle Medicine captures readiness, willingness, and confidence to make lifestyle changes, as well as behaviors that are aligned with the six pillars of lifestyle medicine: optimal nutrition, physical activity, sleep, stress management, connectedness, and avoidance of risky substances.”
But from a medical viewpoint, optimal nutrition, risky substances, and connectedness seem to be more, to capture the latest dietary push, more sizzle than meat. One can only hope that this new vital sign works out better than the last. You can read more about the ACLM by my colleague Katie Suleta on our website. In the meantime, from Medscape, It’s Time to Treat Lifestyle Like a Vital Sign in EHRs
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
