Published on 8 June 2023

Future Medicine: Where No Man Has Gone Before

Professor Joseph Sung
Dean, Lee Kong Chian School of Medicine

There is a paper published in the April issue of JAMA which is quite disturbing: that patients prefer AI Chatbot than physicians talking to them. Ayers et al reported in their article entitled “Comparing Physicians and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum”, that chatbot responses were rated as significantly higher quality than physician responses in generating quality and empathetic responses to patients. Patients are choosing Robo-doc rather than the human-doc. That is alarming. 

I then asked ChatGPT-4, “Would doctors be replaced by AI?” The answer was profoundly diplomatic: “At this moment, it is unlikely that AI will totally replace doctors… Medicine is a rather complex discipline, caring for patient requires knowledge as well as empathy… However, AI can learn to use words in its communication with patient that “show” empathy.” In other words, if we cannot find a way to work with AI, we can be replaced by AI.  

Technology has advanced exponentially and even unexpectedly. Some experts are warning that we are already in a ‘danger zone’ as we are losing control of AI. Existing AI algorithms and the addition of Large Language Model can sew ideas in our mind and change people’s behaviour. Sequential and interactive algorithms can change our beliefs and our values, permeating quietly through our consciousness. Before AI gains consciousness, we are starting to lose our self-consciousness. If responsible use of AI can already lead us to mistakes with detrimental effects, where would irresponsible use of AI lead us to?  “AI can pose the risk of extinction as great as a pandemic or nuclear war,” said a group of AI experts. The threat is so imminent that Elon Musk (CEO of Tesla), Sam Altman (CEO of Open AI and creator of ChatGPT), Demis Hassabis (CEO of Google-DeepMind) and Eric Horvitz (Chief Scientific Officer of Microsoft), among others, have had to issue an open letter calling for a pause of  6 months in GPT development in order to avoid an existential risk to humanity. The pessimists may be wrong, that AI will bring the end of the World, but the optimists may be too naïve to think that AI can only be benefiting mankind to live a better life. 

In the medical field, I can see that the practice of Medicine will be quite different 5 – 10 years from now. On the bright side, a lot of mundane work such as recording clinical findings and notes, retrieving laboratory results, writing referrals and reply letters etc. will be taken up by AI. Diagnosis can be made much easier, with AI taking up analysis of symptoms and laboratory findings, combining with image-interpretation of radiographs, retinal image, endoscopy pictures, histology slides for instance, and suggest the most fitting diagnosis and offer prediction of outcomes, based on the latest information from the literature. Reading and memorising tons of information from huge textbooks in Medicine and Surgery might be totally unnecessary. On the other hand, working with AI and robots, analysing data and deciding on what to believe and what not to believe becomes an important daily duty. Then we have to deal with the ethics, the social issues and the potential legal issues of human-AI combined healthcare. How to convince ourselves when the “black box” in AI does not reveal all the scientific rationale in the algorithm nor make biological sense of their recommendations? What to tell patients when we are not entirely clear why the diagnosis is made and why one treatment is better than the other? How to balance the social and psychological needs of patients and their families, alongside the technological and scientific advancements? How to choose between the convoluted neural network and our own intuition and experience? And how does one handle the conflict of AI decision versus our own “professional” judgement and discretion? Unfortunately at this point, irrespective of which medical school you graduate from and which hospital you received training, very few of us will have sufficient knowledge and professional training to answer these questions. The physiology, pharmacology, pathology and all the classical teaching may not be good enough to help us in making clinical decisions. Are we still fit for practice? If we do not get ourselves prepared today, could we be replaced in our job one day? I would imagine that if we, doctors, nurses, pharmacists and physiotherapists choose not to prepare for this fundamental change, we can be replaced, or at least be displaced, by technology. 

For those of you who watched the famous TV series Star Trek produced in the 60s by Paramount Pictures, you may be experiencing de ja vu. The show was so successful in attracting generations of people worldwide before becoming a film series from 2009 – 2016. Those familiar with the series will remember the spaceships Voyager and Enterprise taking the crew of the Federation to “Where no man has gone before”. I still have vivid memories of the brave and charming Captain Kirk (William Shatner), Spock (Leonard Nimoy) the Human-Vulcan hybrid who had special powers and an analytical mind, the marvelous engineer Scotty who solved every mechanical and electronic problem, and the pilot who spoke English with a strong Japanese accent (Sulu). But among this stellar cast, the one I remember the most is the doctor with a warm heart but somewhat cool face known as Dr McCoy (DeForest Kelley). I still remember one scene where Kirk was injured in one of his expeditions and ran into a coma,  and McCoy taking out a small black box from his pocket and putting it on the forehead of the captain. In a split second, the machine voiced out a diagnosis and performed ‘virtual surgery’ to remove the subdural hematoma of the unconscious patient. Within seconds, Kirk opened his eyes and recovered. Well, that was science fiction but isn’t it a bit like our portable CT equipped with AI and robotic surgery? I am relieved to see that there is still a role for doctors in the spaceship, but his ‘practice’ is definitely quite different from that of the doctors in our time. The day will come when doctors, nurses, pharmacists and others in healthcare will work hand-in-hand with AI and robots. And the day is closer than you can imagine. 

Dean's Blog - June 2023

Get yourself prepared. For that, come and learn about the future in our inaugural International AI in Medicine (iAIM) conference taking place from 5 – 7 August. During these three days, our speakers, internationally renowned experts in AI Engineering, Medical Futurists and Social Scientists will show you a glimpse of “Where No Man Has Gone Before”.  Register here