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We sit down with Farhan S. Imran, a hematology-oncology physician. Join us as we explore the evolving landscape of health care and technology, discussing the impact of computers on the doctor-patient relationship, the role of AI in medicine, and the ethical questions surrounding artificial intelligence in health care.

Farhan S. Imran is a hematology-oncology physician who blogs at Did I Ask?

He discusses the KevinMD article, “Is Elon Musk right about the future of medicine?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Farhan Imran. He’s a hematology-oncology physician. His KevinMD article is titled “Is Elon Musk right about the future of medicine?” Farhan, welcome back to the show.

Farhan S. Imran: Thank you, Kevin. It’s always good to be back on your show.

Kevin Pho: So Farhan has been on multiple times. Go to KevinMD.com/podcast; in the upper right-hand corner there’s a search icon, and you can search for his prior episodes and hear his story. But today, let’s jump right into your article about Elon Musk. Tell us, how did this article come together?

Farhan S. Imran: Kevin, the reference to Elon Musk actually comes a little later in the article. The story started one day when I walked into work and a colleague of mine had forgotten to bring her laptop. Being a nice guy, I offered her my laptop, but that meant I would have a computer to work on in the work area but not in the patient room. So for the first time in a very long time, I ended up seeing a patient without having a computer in the room, and that was actually very profound, because multiple things happened. First of all, I understood how important technology and the computer have become in the practice of medicine. You can get by without a stethoscope or a tuning fork, but you cannot get by without a computer.

That led to a number of thoughts, which I have elaborated in the article. There are several pieces to it, but I can put them into two broad categories. One is that in this day of artificial intelligence and ChatGPT, which is a hot topic nowadays, we don’t know how the world is going to change, and it’s changing so rapidly right in front of our eyes. How will medicine change? I know there are a lot of criticisms of the EMR and the computer systems, but I am not looking at what it is doing to medicine now. I’m looking at what medicine would look like, let’s say, 400 or 500 years from now. You zoom out and go 400 or 500 years back, when there were no antibiotics or vaccines, and then you zoom 400 or 500 years forward. What would be some of the benefits and some of the downsides? That is the overall thrust of this article.

Going into a futuristic model, and I know this sounds like sci-fi, just imagine the job that I do, the job of an oncologist, from taking the history to the physical exam, the pathology, the radiology and the treatment options. Imagine that in a few hundred years the doctors lose their jobs, even though we think our jobs cannot be taken over by computers. You walk into some sort of a booth and say your symptoms, and just as Siri and Alexa hear what you’re saying, it already has the algorithms to ask you the follow-up questions. Then, instead of a physical exam from head to toe, you have an absolute anatomical picture of all the normal and abnormal things going on, and there are already studies coming out showing that AI is getting better than radiologists at reading images. Then they take one drop of blood that is analyzed, and all the tests known to us are done in one single panel. All that information is plugged into the algorithm, and you get a diagnosis, a stage and the most accurate treatments, which are injected into your body without the need for a human; it just treats it. A lot of us, when we’re having these discussions, don’t believe in that, and I’m just thinking out loud here, since we believe our jobs can never be taken over by the computer. But it looks like maybe in a few hundred years, that’s where we’re headed.

Kevin Pho: So let’s talk about the next, say, 6 to 12 months, rather than a few hundred years. Like you mentioned, ChatGPT has been out less than a year, and it’s made seismic changes just within medicine itself. How about your world of hematology-oncology? How has AI impacted you personally in the exam room, and what do you envision the immediate future, the next 6 to 12 months, bringing?

Farhan S. Imran: Well, right now, I don’t think there’s been any direct impact in the patient room or on our functioning as of yet, but I think everybody is taking it with some level of confusion. Let me give you an example. Look at the Writers Guild and all the creative people who are going through these protests, and at the creators of artificial intelligence, who are calling for a stop or some regulation on it. For writers, who are creative people, it has already had a big impact. For us as scientists and clinicians, it has not had a direct impact yet, but everybody can feel that it is coming.

For example, yesterday I was reading about a study involving tumor removal. When a tumor is removed, it’s sometimes instantly reviewed by a pathologist in something called a frozen section, which tells the surgeon whether to proceed with the surgery or not. Now they’re having AI do it, and AI is doing it better than a pathologist. So if I’m a pathologist, let’s say, and it has taken me 15 years of training to reach that expertise, and now a computer comes along and can do it in five seconds, more accurately than I can, how would I feel? Compare it with the past, when the calculator had not yet been invented. If you tell someone today, “Well, why don’t you multiply by 78,000?” they will not do it by themselves. They’ll say, “Let me have a calculator do it. It will do it more accurately.” So basically there’s this shadow looming in the exam room and in our conferences: “Hey, at what point is the job that I’m doing going to be taken over by the computer?”

Kevin Pho: What exactly did Elon Musk say about artificial intelligence, and what can you extrapolate from what he said as it relates to medicine?

Farhan S. Imran: Elon Musk did not speak directly to medicine, but I did hear him say in one talk, “Mark my words, artificial intelligence is more dangerous than nukes.” So these are some of the biggest minds in the world right now, and they are worried about what artificial intelligence can do. Taking that into context, the later part of my article goes like this: Fine, you have a technology that is now giving you much more accurate care compared to humans. But what if that technology starts making decisions for you? What if it starts choosing when to give you medicine and when not to? What if it starts saying that this life is not worth living, that this person is too old to be given these treatments, or that this person is a drug seeker versus someone with real pain? What if artificial intelligence starts making those decisions? If it does, are we as humans in medicine prepared? What are the stopgaps and measures we are going to have to take to put an end to that?

We joke around and say, remember the movie Back to the Future? Everything that happened in Back to the Future came true within our lifetime. Nobody expected that, but it came true. So who says that The Terminator will not come true, and that these cyborgs, or these artificial beings who are so smart, will not start making decisions for us? And then some may argue, well, aren’t there some humans doing the same, politically? There’s so much controversy going on about issues like abortion and gender identity. So if humans can put restrictions on humans based on those complex medical issues, how would humans face it when artificial intelligence starts making these decisions for us?

Kevin Pho: So in your world of oncology, or with your physician colleagues, are they discussing these ethical considerations of AI yet?

Farhan S. Imran: No, because I feel that nobody thinks it has gone to that extent. When I have these discussions with my colleagues, and I’m pretty sure it’s the same for many of your listeners on the podcast, many of them are at a point where they’ll brush it away and say, “Oh, this is all sci-fi. This doesn’t even make sense. We don’t know how this will turn out.” Whenever I say among my colleagues, “Hey, our jobs are going to be taken over,” I get a lot of folks saying, “I don’t think that can happen.” People say that artificial intelligence cannot give you sympathy, empathy and things like that. But you know what? You never know where this thing goes.

Kevin Pho: So how can physicians stay relevant? In your scenario, where you envision health care 300 or 400 years from now, I didn’t see physicians continuing to play a role, because AI has gotten to a point where it does pretty much everything we can do. So as AI rapidly evolves, what are some things we physicians can do to stay relevant going forward?

Farhan S. Imran: Well, first of all, I think that instead of opposing it, we should embrace it. If it is leading to improved health care, then we would all love it. Hey, if I lose my job as an oncologist because a computer is doing a much better job, fine. It’s bad for me, but it’s better for the hundreds and thousands of patients I see. So we should be humbled by what these technologies are doing. But like other industries, we should come together, and for whatever AI technologies are arriving in medicine, we should already start working on the laws and the ethics. Perhaps we could bring that in as a chapter, a topic or a course in medical education, and bring it into our ethics rounds with more cases. Right now we’re not seeing many cases, because it has not infiltrated medicine that much. But with the pace it’s going, you’re going to start seeing them very soon, within the next few years. I can envision, in a radiology conference, “Hey, the computer is doing a better job with MRI, so we don’t need this person. What should we do?” We cannot play out too many unknown scenarios in our minds, but at least we can be prepared to deal with it as it comes and not let it go beyond our reach.

Kevin Pho: Now, what are you seeing among physician trainees and medical students? I’m sure they’re incorporating things like ChatGPT into rounds and into their learning. Are you introducing these concepts during your own teaching rounds, in medical education, and teaching them how to use and embrace AI responsibly?

Farhan S. Imran: Yes, we in our department are having a big debate about this. For example, a student comes in who has already reviewed all the information about the patient, has maybe already put it into ChatGPT and has come up with the right treatment algorithms, without even seeing the patient. They’ve just gotten all the data and put it in. That is where we are trying to bring out the human side of medicine.

So I’ve made a rule: At the beginning of a rotation, I tell my students that at the end of the week I will grade them on the amount of time they have spent with the patient, not just on the treatment options they have come up with. I tell them, “Tell me one thing about the patient that is not yet documented in the EMR,” and I grade them on how many personal connections they make. It’s not enough to know that the patient is a carpenter. I need them to know where the patient works, how many kids they have, what they have made, and to make some sort of personal connection. I can’t ask my students not to look things up. If they’re looking it up and coming up with the right answer medically, I’m happy. But on the other hand, the more they look things up, the more they are losing that personal connection, so we are trying to work on that and bring it back as much as possible.

Kevin Pho: We’re talking to Farhan Imran. He’s a hematology-oncology physician. Today’s KevinMD article is titled “Is Elon Musk right about the future of medicine?” Farhan, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Farhan S. Imran: I just want to say, Kevin, that we are living in very, very interesting times. We are living in a digital revolution, and our generation is the one seeing the change. When we were kids, we were using cassettes and VCRs. Now you see that Las Vegas dome they built, such an excellent thing. So we should embrace innovation. We should not get in the way of the progress of the good side of artificial intelligence. But on the other hand, the onus is on us, the burden is on us, to keep up the human side of medicine. For centuries, since the beginning of time, this has been a very, very sacred profession, and there are emotions, tears and fears involved. So as the computer takes over and improves that care, we should bring out the humanism and the art of medicine even more, each one of us, as much as we can.

Kevin Pho: Farhan, once again, thank you so much for sharing your time and perspective, and thanks again for coming on the show.

Farhan S. Imran: Thank you.