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Logan Z. J. Williams
School of Medicine
Faculty of Medical and Health Sciences
University of Auckland
Professor Eric Topol has
had his finger on the pulse
of digital medicine for over
a decade. An American
cardiologist and distinguished
academic, Topol has been an
early proponent of digitalising
the health-care sector. In his
third book Deep Medicine:
How Artificial Intelligence Can
Make Healthcare Human
Again, Topol surveils the
new health-care landscape
emerging as disruptive
technologies become standard.
For any future-focused health
professional, Deep Medicine is
a detailed and balanced exploration of the current state-of-play of
artificial intelligence (AI) in medicine. Moreover, it serves as a guide
on how to advocate for a health-care sector that benefits patients,
not the pockets of financial stakeholders.
The reader is taken on a journey that explores how digitisation of the
health-care system may be an unlikely, yet promising candidate for
allowing clinicians to provide humanistic patient-centred care. At the
outset, Topol laments the shortcomings of the current health-care
climate, which prohibits clinicians from truly engaging with patients.
Clinical decision making is fraught with cognitive biases and our men-
tal bandwidth is pushed to the limits. The observation that we are
‘attending to keyboard rather than our patients’ confirms that our em-
pathy is slowly but surely fading. We have somehow found ourselves
trapped practicing shallow medicine. The judicious use of screening
and diagnostic tools is becoming a lost art in a health-care sector that
is increasingly focused on efficiency and productivity. Our culture of
overuse is harming patients ‘physically, psychologically and financially,
and could threaten the viability of health systems by driving up costs
and diverting resource’. 1 We have forgotten our commitment to ‘pri-
mum no nocere’.
The remedies for shallow medicine have so far been reactive and in-
cremental. For Topol, the overarching solution lies at the intersection
of medicine and AI. Proponents of AI have claimed that “the AI revo-
lution is on the scale of the industrial revolution”, and Topol discusses
several areas where the synergy between AI and health care has
created tangible results. Details of machine-learning algorithms that
can outperform radiologists in detecting pneumonia on chest x-rays
leave the reader feeling that a health-care revolution is just over the
horizon. Yet, Topol’s optimism for what a digitised health-care system
might look like is tempered by a wealth of clinical knowledge and
research experience. He is quick to remind us that even though the
use of electronic health records represented one of the first efforts
to digitise the health-care sector, it is still viewed by many, including
Topol himself, as an ‘abject failure’.
The digitisation of medicine impacts us all, with some fearing that it’s
adoption will lead to a system devoid of empathy and connection.
Throughout Deep Medicine, one senses that Topol’s primary motive
is profoundly humanistic. We are reminded that the consequences of
these technologies extend beyond quantitative health-care metrics,
like the length of hospital admission. Sir William Olser noted that
it is “more important to know what sort of a patient has a disease
than what sort of a disease a patient has”. 2 With the current state-
of-play, it is difficult to imagine that AI will ever truly understand the
patient narrative like nurses and physicians can. Yet, Topol doesn’t
envision a system where doctors are replaced by machines. Rather,
he advocates for one where health-care workers are liberated from
administrative burdens through augmented decision-making and the
automation of mundane obligations.
Personally, this book underscores the idea that conversations about
the future directions of a digitised health-care system shouldn’t be
reserved for high-profile internet technology companies. For those
at the coalface, and receiving end of medicine, it is much easier to
criticise the shortcomings of such technologies. Sadly, we remain
ill-equipped to engage in conversations and contribute to their de-
sign. There is a paucity of teaching dedicated to understanding the
intersection of AI and health care in medical school, and navigating
the literature is an onerous and overwhelming task. Deep Medicine
brings the reader up to speed on current advances and outstanding
questions in the domain of digital medicine. More importantly, Topol
sows a seed inside the minds of our future health-care advocates. The
much-needed overhaul of the current health-care climate may be just
over the horizon, but it is imperative that all stakeholders – especially
patients and future health professionals – take initiative in curating a
system centred upon deep humanism rather than shallow medicine.
References
1. Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath
I, et al. Evidence for overuse of medical services around the world.
Lancet [Internet]. 2017;390(10090):156–68. Available from: http://
www.sciencedirect.com/science/article/pii/S0140673616325855
2. Israni ST, Verghese A. Humanizing artificial intelligence. JAMA
[Internet]. 2019 Jan 1;321(1):29–30. Available from: https://doi.
org/10.1001/jama.2018.19398
Conflicts of Interest
Logan is the Editor-in-Chief of the New Zealand Medical Student
Journal. This article has gone through a double-blinded peer review
process applied to all articles submitted to the NZMSJ, and has been
accepted after achieving the standard required for publication. The
author has no other conflict of interest.
Correspondence
Logan Z. J. Williams, lwil274@aucklanduni.ac.nz
Logan Z. J. Williams
School of Medicine
Faculty of Medical and Health Sciences
University of Auckland
Professor Eric Topol has
had his finger on the pulse
of digital medicine for over
a decade. An American
cardiologist and distinguished
academic, Topol has been an
early proponent of digitalising
the health-care sector. In his
third book Deep Medicine:
How Artificial Intelligence Can
Make Healthcare Human
Again, Topol surveils the
new health-care landscape
emerging as disruptive
technologies become standard.
For any future-focused health
professional, Deep Medicine is
a detailed and balanced exploration of the current state-of-play of
artificial intelligence (AI) in medicine. Moreover, it serves as a guide
on how to advocate for a health-care sector that benefits patients,
not the pockets of financial stakeholders.
The reader is taken on a journey that explores how digitisation of the
health-care system may be an unlikely, yet promising candidate for
allowing clinicians to provide humanistic patient-centred care. At the
outset, Topol laments the shortcomings of the current health-care
climate, which prohibits clinicians from truly engaging with patients.
Clinical decision making is fraught with cognitive biases and our men-
tal bandwidth is pushed to the limits. The observation that we are
‘attending to keyboard rather than our patients’ confirms that our em-
pathy is slowly but surely fading. We have somehow found ourselves
trapped practicing shallow medicine. The judicious use of screening
and diagnostic tools is becoming a lost art in a health-care sector that
is increasingly focused on efficiency and productivity. Our culture of
overuse is harming patients ‘physically, psychologically and financially,
and could threaten the viability of health systems by driving up costs
and diverting resource’. 1 We have forgotten our commitment to ‘pri-
mum no nocere’.
The remedies for shallow medicine have so far been reactive and in-
cremental. For Topol, the overarching solution lies at the intersection
of medicine and AI. Proponents of AI have claimed that “the AI revo-
lution is on the scale of the industrial revolution”, and Topol discusses
several areas where the synergy between AI and health care has
created tangible results. Details of machine-learning algorithms that
can outperform radiologists in detecting pneumonia on chest x-rays
leave the reader feeling that a health-care revolution is just over the
horizon. Yet, Topol’s optimism for what a digitised health-care system
might look like is tempered by a wealth of clinical knowledge and
research experience. He is quick to remind us that even though the
use of electronic health records represented one of the first efforts
to digitise the health-care sector, it is still viewed by many, including
Topol himself, as an ‘abject failure’.
The digitisation of medicine impacts us all, with some fearing that it’s
adoption will lead to a system devoid of empathy and connection.
Throughout Deep Medicine, one senses that Topol’s primary motive
is profoundly humanistic. We are reminded that the consequences of
these technologies extend beyond quantitative health-care metrics,
like the length of hospital admission. Sir William Olser noted that
it is “more important to know what sort of a patient has a disease
than what sort of a disease a patient has”. 2 With the current state-
of-play, it is difficult to imagine that AI will ever truly understand the
patient narrative like nurses and physicians can. Yet, Topol doesn’t
envision a system where doctors are replaced by machines. Rather,
he advocates for one where health-care workers are liberated from
administrative burdens through augmented decision-making and the
automation of mundane obligations.
Personally, this book underscores the idea that conversations about
the future directions of a digitised health-care system shouldn’t be
reserved for high-profile internet technology companies. For those
at the coalface, and receiving end of medicine, it is much easier to
criticise the shortcomings of such technologies. Sadly, we remain
ill-equipped to engage in conversations and contribute to their de-
sign. There is a paucity of teaching dedicated to understanding the
intersection of AI and health care in medical school, and navigating
the literature is an onerous and overwhelming task. Deep Medicine
brings the reader up to speed on current advances and outstanding
questions in the domain of digital medicine. More importantly, Topol
sows a seed inside the minds of our future health-care advocates. The
much-needed overhaul of the current health-care climate may be just
over the horizon, but it is imperative that all stakeholders – especially
patients and future health professionals – take initiative in curating a
system centred upon deep humanism rather than shallow medicine.
References
1. Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath
I, et al. Evidence for overuse of medical services around the world.
Lancet [Internet]. 2017;390(10090):156–68. Available from: http://
www.sciencedirect.com/science/article/pii/S0140673616325855
2. Israni ST, Verghese A. Humanizing artificial intelligence. JAMA
[Internet]. 2019 Jan 1;321(1):29–30. Available from: https://doi.
org/10.1001/jama.2018.19398
Conflicts of Interest
Logan is the Editor-in-Chief of the New Zealand Medical Student
Journal. This article has gone through a double-blinded peer review
process applied to all articles submitted to the NZMSJ, and has been
accepted after achieving the standard required for publication. The
author has no other conflict of interest.
Correspondence
Logan Z. J. Williams, lwil274@aucklanduni.ac.nz