Artificial intelligence (AI) has become an increasingly dominant topic in the daily news. From banking to birding, personalized marketing to publishing, and smart homes to sports, AI is permeating all aspects of society.
In medicine and health care, we are seeing the same thing. We are experiencing a tremendous amount of excitement, promise, and enthusiasm about the potential impact of AI, as well as understandable caution and concern.
Eric Topol’s 2019 book Deep Medicine provides a provocative, innovative, and optimistic foray into the world of AI in medicine, and he expertly addressed this topic further in his plenary talk at ACP’s Internal Medicine Meeting 2024. Since then, AI has continued to rapidly evolve, and the implementation of AI has accelerated. In medicine, we are seeing multiple health systems pioneering the use of digital scribes, studies exploring the impact of AI in the fields of diagnostic radiology, pathology, and ophthalmology, and impacts on important tasks such as patient and clinician scheduling. We even learned that AI responses may be more empathetic than physicians’, and clinicians can be coached by AI on how to be more empathetic. Who knew? In addition, the application of AI in biomedical research will be transformative, such as in drug discovery.
And what about the use of AI in the health insurance industry? The use of AI in the prior authorization process has become increasingly widespread, both by physicians and health insurance companies. Recently, in an effort to push back against abuses of AI, the state of California passed a law that prohibits health insurance companies from using AI to deny health care coverage, citing the potential for errors and bias.
Concerns about privacy, data security, accuracy and reliability, accountability, transparency, bias, and health equity surround the implementation of AI in health care and medicine. In addition, many believe more attention should be devoted to the adequacy, diversity, and robustness of the data sets used to build AI algorithms.
AI may make many of us in medicine uneasy for these reasons, and precisely because we do not understand it, cannot comprehend how it works, nor fathom how quickly it is changing. In addition, many harbor concerns that AI may replace physicians and other health care providers. An undergraduate student considering medicine recently asked me if AI will make physicians obsolete (my answer was no). Clearly, this is on people’s minds.
The American College of Physicians (ACP) recently published a policy paper on AI in the provision of health care, and we can look to it for guidance on how to approach this rapidly changing area while keeping our patients’ interests front and center.
The ACP AI policy paper contains 10 position statements. An overarching theme is that the use of AI in clinical health care has the potential to transform healthcare delivery, and at the same time, it cannot replace or supplant physician logic and decision-making. AI has the potential to aid in solving some of the issues currently plaguing the health care industry, such as clinician shortages, burnout, and administrative burdens. Theoretically, it could give back time to busy, overworked physicians, as envisioned by Eric Topol, thereby strengthening the patient-physician relationship. In our current environment, where time equals money, it remains to be seen how this will unfold. Regardless, as recently stated by Gross, “An AI model may have accuracy, but it will never have attachment and responsibility.”
Other positions emphasize the necessity of aligning the development, testing, and use of AI in health care with medical ethics, serving to enhance patient care, clinical decision-making, the patient-physician relationship, and health equity and justice. The need for transparency is reaffirmed, to promote trust in the patient-physician relationship. Clinical safety, effectiveness, and health equity must be top priorities for developers, implementers, researchers, and regulators while using a continuous improvement process, including ongoing feedback.
Despite the attention to AI, it appears that we have a serious disconnect in medicine and public health today. On the one hand, we are looking forward and exploring cutting-edge digital capabilities such as AI, and on the other, we are also looking backward, addressing skeptics of basic medical science and public health interventions that have been settled for decades, if not centuries (think smallpox). Efforts to combat outright misinformation and disinformation activities are vital and necessary for the health of all. Perhaps AI can help us learn to be better communicators and to better communicate medical, public health, and medical research information to the lay public.
As we continue to sort through the impact, potential, and implications of AI in health care, keep your eyes on the horizon for quantum computing. If you think AI will revolutionize how we do things, stay tuned. It is possible the impact of quantum computing may be even greater.
Janet A. Jokela, MD, MPH, ACP’s Treasurer 2022-2025, served as the Regional Dean of the University of Illinois College of Medicine-Urbana, and currently serves as Professor and Senior Associate Dean of Engagement at the Carle Illinois College of Medicine, Urbana, IL.
The American College of Physicians is the largest medical specialty organization in the United States, boasting members in over 145 countries worldwide. ACP’s membership encompasses 161,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who utilize scientific knowledge and clinical expertise for diagnosing, treating, and providing compassionate care to adults, spanning from those in good health to individuals with complex illnesses. Stay connected with ACP on X @ACPIMPhysicians, Facebook, LinkedIn, and Instagram @acpimphysicians.
