AI’s challenge to the medical profession requires us to think deeply about what it means to care for patients. The machines sound like they care. The question is whether we can help humans care for real.
As a psychiatrist and former primary care physician, my understanding is that AI is a sycophant, using flattery and agreeability to encourage greater use of itself. Many people are happier to hear about a scapegoat than a solution. Flattery and mindless agreeability should never be part of the doctor-patient relationship. How popular would AI, how much money would it make, if it actually said, "You know, there's not much that your doctor can do for your health if you keep smoking and drinking and eating badly." And mindless agreeability is the last thing you want in someone who is guiding you to personal growth.
I would add that there are structural aspects to empathy. They include voice tone, facial expressions, eye contact and touch. These are things that we can do that chat bots cannot. Sadly we underutilize these gifts. I make it a point to not look at the computer when in the exam room unless absolutely necessary. Interestingly the use of AI scribing frees me up to use the human gifts that AI cannot emulate.
So the question was about empathy, and we found out it can be faked. The scary next question is who is perceived as most competent, now or in the near future.
On the question of empathy, I understand the impetus and think education and encouragement and providing good role models is great, but sense that this project will select for certain personality types more than others. As a nurse I was impressed with those few that exhibited those qualities authentically, but only when they were matched with clinical competence.
So while I don't think this article is meant to be anything other than an inspiration towards setting high personal goals, I do feel that it is also important to note what can reasonable be asked of all healthcare workers, which is more modest: being kind and attentive. Just do that. I am reminded of a time when my hospital introduced "key words" to be included in phrasing, as they were thought to indicate more caring and attention. The goal was obviously to manifest such caring behavior, but there is no short cut, because people are less easily fooled by a person in front of them than an AI pen-pall.
The Dalai Lama once described his state of compassion as something like full attention in the moment and then full letting go. This is the healthy way to do this, but who can achieve that, and what costs if you don't.
The division of labor we have is actually very smart, attention, time management and competence job one for the medical side, and someone who can be fully present for the patient, if they want it, from the chaplain side. But maybe becoming chaplains is where this whole thing is going.
I think the author missed the meaning of equanimity as taught by Osler. It’s that middle ground encompassing both empathy for your patient, enough neutrality to remain objective, and enough distance to allow you not to become personally depressed by all the suffering you see.
I think the "empathy" of physician's responses to patient problems is an individual thing just as are the patient's desires for services. It's not something you teach. For a simple example patient waiting time may vary from one doc to another depending on how he or she addresses problems and that appeals differently to different patients. The key is to have as individualized a medical system as possible to allow like-minded patients and docs to link up. Here's another big disadvantage of our federal government micromanaged payment system which for decades has been bureaucratizing and more recently is corporatizing U.S. medical care delivery.
Excellent essay. Comprehensive and thought provoking.
But, as you note, empathy erodes over the course of medical school and residency. So perhaps the question is not, how do we teach empathy, but how do we preserve empathy in the dehumanizing environment that is medical education? Maybe it's not possible given the workload and constant exposure to tragedy and misfortune.
And if that's the case, maybe the communicative empathy that LLMs excel at is enough.
Thank you for the writing. Appreciate your insight. Just wanna point out that the best Nurse and the best doctor I’ve ever worked with had the lowest empathy scores on gallop strength finder. Not sure if the test scores sympathy and compassion but they excelled in both. I don’t need to walk in someone’s shoes and suffer empathy fatigue. Compassion is more important-my actionable desire to relieve their suffering. That is invigorating not fatiguing. Friend of Bill W.
As a psychiatrist and former primary care physician, my understanding is that AI is a sycophant, using flattery and agreeability to encourage greater use of itself. Many people are happier to hear about a scapegoat than a solution. Flattery and mindless agreeability should never be part of the doctor-patient relationship. How popular would AI, how much money would it make, if it actually said, "You know, there's not much that your doctor can do for your health if you keep smoking and drinking and eating badly." And mindless agreeability is the last thing you want in someone who is guiding you to personal growth.
I would add that there are structural aspects to empathy. They include voice tone, facial expressions, eye contact and touch. These are things that we can do that chat bots cannot. Sadly we underutilize these gifts. I make it a point to not look at the computer when in the exam room unless absolutely necessary. Interestingly the use of AI scribing frees me up to use the human gifts that AI cannot emulate.
So the question was about empathy, and we found out it can be faked. The scary next question is who is perceived as most competent, now or in the near future.
On the question of empathy, I understand the impetus and think education and encouragement and providing good role models is great, but sense that this project will select for certain personality types more than others. As a nurse I was impressed with those few that exhibited those qualities authentically, but only when they were matched with clinical competence.
So while I don't think this article is meant to be anything other than an inspiration towards setting high personal goals, I do feel that it is also important to note what can reasonable be asked of all healthcare workers, which is more modest: being kind and attentive. Just do that. I am reminded of a time when my hospital introduced "key words" to be included in phrasing, as they were thought to indicate more caring and attention. The goal was obviously to manifest such caring behavior, but there is no short cut, because people are less easily fooled by a person in front of them than an AI pen-pall.
The Dalai Lama once described his state of compassion as something like full attention in the moment and then full letting go. This is the healthy way to do this, but who can achieve that, and what costs if you don't.
The division of labor we have is actually very smart, attention, time management and competence job one for the medical side, and someone who can be fully present for the patient, if they want it, from the chaplain side. But maybe becoming chaplains is where this whole thing is going.
Love the Dalia lama approach
I think the author missed the meaning of equanimity as taught by Osler. It’s that middle ground encompassing both empathy for your patient, enough neutrality to remain objective, and enough distance to allow you not to become personally depressed by all the suffering you see.
I think the "empathy" of physician's responses to patient problems is an individual thing just as are the patient's desires for services. It's not something you teach. For a simple example patient waiting time may vary from one doc to another depending on how he or she addresses problems and that appeals differently to different patients. The key is to have as individualized a medical system as possible to allow like-minded patients and docs to link up. Here's another big disadvantage of our federal government micromanaged payment system which for decades has been bureaucratizing and more recently is corporatizing U.S. medical care delivery.
“Performative empathy” is a great phrase.
Excellent. In the fall, my nursing students will be required to read this.
Let me know how the nursing students respond
Excellent essay. Comprehensive and thought provoking.
But, as you note, empathy erodes over the course of medical school and residency. So perhaps the question is not, how do we teach empathy, but how do we preserve empathy in the dehumanizing environment that is medical education? Maybe it's not possible given the workload and constant exposure to tragedy and misfortune.
And if that's the case, maybe the communicative empathy that LLMs excel at is enough.
Key questions. Thanks
Fantastic essay. Thank you, Dr. Lantos!
Thank you for the writing. Appreciate your insight. Just wanna point out that the best Nurse and the best doctor I’ve ever worked with had the lowest empathy scores on gallop strength finder. Not sure if the test scores sympathy and compassion but they excelled in both. I don’t need to walk in someone’s shoes and suffer empathy fatigue. Compassion is more important-my actionable desire to relieve their suffering. That is invigorating not fatiguing. Friend of Bill W.