A 7 year old kid walks into my clinic accompanied by his parents. He doesn’t speak to me and is probably terrified of doctors.
Even before anyone has spoken anything to me I see what the problem they’ve come to me for. His right eye is more prominent than the left. A few hundred calculations are going on in my head and I arrive at a set of differential diagnoses. I’ve got to narrow down the list of diagnoses by patient history and clinical examination.
The mother seems distressed while she’s narrating the history. I have to wean the information that I want from the random set of sentences in no particular order that she’s putting out at me. She gets more upset as she progresses with the story of her child finally requiring the father to clarify a few of my doubts about the history.
I examine the child armed with my list of possible diagnoses, his age and the history. I can quickly diagnose the problem as I palpate an orbital (eye socket) mass just behind the eyeball. The little boy is scared stiff at what I’m doing and tries to protest feebly with whimpering. I manage to wrestle with the kid and get done with the examination with minimal difficulties. I believe the diagnosis is a dermoid cyst — a congenital benign tumour which is easy to manage. The CT scan and the radiologist will later confirm my diagnosis.
I tell the parents about the diagnosis and that it will have to be confirmed with a CT scan and also to know the extent. I tell them that this will require surgery and go through the salient features of the surgery, the pros and cons, risks and complications, etc. I sense that both are getting horrified by the minute, so I now choose to focus on the good parts- like the prognosis of this tumour is excellent!, etc. The mother finally blurts out, “But he is just a child! How can he have surgery. He’s so small!” and she starts crying. I stop and give her a tissue while I try to reassure her. She grabs at my hand and holds it tight asking “Is this serious, doctor?” I say “Not at all. This is one of the less difficult things I encounter in my job”. I really meant it!
I now look at the father and wonder what’s going on his mind since he’s hardly said anything since he’s come into the clinic. Maybe he’s considering taking a second opinion or maybe I’m already the fourth doctor who is saying the same thing. Or he’s thinking how much it will cost him and whether his company’s medical insurance will cover the surgery for this congenital tumour? Or he’s just as stressed as his wife but doesn’t know how to show it.
I speak a little more going over the essentials, ordering the imaging and blood investigations while answering any questions the father has. This whole encounter has lasted 20 mins with lots of patients waiting for me after this. I need to switch off and turn my complete attention to my next patient.
This is a straightforward surgery. I’ve done this lots of times- remove a dermoid cyst from an Orbit. The child is under anaesthesia and I’m pondering the best approach with the minimal scars. I choose the eyelid crease incision where the resulting scar is hidden under the eyelid crease. It will be like no surgery ever happened once the incision wound heals. I dissect out the tissues-skin, muscle and bone to expose the tumour. I have to be careful and meticulous as a ruptured dermoid cyst is a messy affair. Just then a vessel bursts at the corner of the wound and is bleeding profusely. I try various methods but it just doesn’t stop. I finally manage to stop the bleeding by ligating the artery supplying that part. Weird anatomy this kid has I think to myself-one more to my experience book. The tumour still needed to be removed. I work carefully around the capsule of the tumour being very careful not to let it tear. After what seemed like an eternity, I get the tumour out with it’s capsule still intact. A surge of satisfaction runs through my whole body- it is like I’ve been injected with opioids. This burst of endorphins would only be understood by a surgeon who has had many ruptured dermoid cysts. The surgery lasted a little over an hour.
I close up the wound meticulously in layers and wait for the Anaesthesist to reverse the anaesthesia. I meet the parents on my way out. I reassure them that all went according to plan even though there was slightly more bleeding than I expected. They seemed relieved that it was all over. I get home but this boy is not far from my mind while I’m internally celebrating a surgery gone well. Though everythings seems alright, I do worry till I have seen the child the next day.
The Follow Up
Next week, that 7 year old terrified boy comes running into the clinic with a ball in hand and his parents in tow. He doesn’t seem to be intimidated by me now and we had a tough time to make him sit for the examination. The tumour was gone and the swelling in it’s stead had almost completely disappeared. His mother fussed about every little thing that happened to her kid since the surgery. I cut her short and asked a few leading questions which was answered by the father when he saw that the mother wasn’t interested in giving me the answers I wanted and would rather tell what she wanted to tell me. I then reassured both of them, answered as many questions as I could and called the boy for review after one month while I did a lap of victory in my mind- small battles, big victories. This whole consultation lasted about 15 mins.
If any robot with artificial intelligence can automate the above process in the same amount of time, I would gladly give up my job without batting an eyelid. This example mind you was a very simple case with a very excellent prognosis. This get messy when it is not so.
Fortunately for me and my other doctor friends- much to the chagrin of the naysayers, AI is nowhere close to replicating human empathy and at making those 50–50 judgement calls without depending on any data points. How to zone in on the correct information points from a random rambling of a parent? How to sense the sense of dread in a patient or among his near and dear ones? How to convince them to go ahead with surgery while also educating them about what the surgery entails-success, chances of failure, complications and risks. How to make them see the cost benefit ratio of a treatment while allowing for reasonable requests by them to depart from the regular protocol? How to make the ethical calls that doctors need to make everyday. How to know anatomy of the body but to make peace with the fact that each surgery is different and that surgery can never be made an assembly line job to be automated. How to do the hand-holding of the patient when something goes off-script and the patient is distressed. How do you empathize and console the patient when the prognosis is bad? The actual surgical procedures in contrast seems like the easiest part of my job.
True, today’s AI tech is already doing incredible work. Some medical fields like dermatology, radiology, pathology may be threatened in the near future. Even complex fields like internal medicine and medical oncology is getting lot of inputs from AIs.
Of course I need to emphasise that I’m not arguing that never in the future will AI robots replace the jobs doctors do. I’m just saying the AI robots will be complementary to human doctors and won’t be a zero-sum game for a long time to come. AIs will help us reduce our mistakes, decrease our workload, make us work more sane hours and in turn manage our work-life balance- but at least in the foreseeable future they aren’t going to replace us. Maybe it will lead to lot of us doing less mundane, repetitive jobs and with doctors doing much higher intellectual level work.
Not just doctors. Any field which involves human interactions and personal trust cannot get by without the human touch. Before physicians and surgeons are taken over by AI , many professions like law, accountancy, engineering and teaching will take the boot first.
The shift, if at all it happens is going to be a very slow one. If in the event of AI finally taking over the medical profession, there will be enough time for doctors to adapt to the new paradigm.
Doctors will find other things to do or probably take on a less stressful job!