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The double-edged sword of AI in health care

Dike Drummond, MD
Tech
December 17, 2023
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What will your workday look and feel like when it has eliminated your need to document, answer messages, or deal with your inbox? Isn’t that what we all want: freedom from electronic medical records and all the other documentation tasks? Yes? For decades now, the physician’s lament has been, “I just want to see patients.” A recent article, revealing the Mayo Clinic’s AI task automation strategy, hints at a future that is screaming, “Be careful what you wish for.”

In a podcast interview with Becker’s Review, Sarah Poncelet, Mayo’s executive director of strategy development, announced the renowned clinic’s new strategy: to scale automation across Mayo’s three campuses to reduce pressures on areas with critical staff shortages or that are experiencing high turnover. “Thirty percent of health care has the potential for automation, so we really want to reduce administrative burden, reduce manual tasks and processes to free up our most valuable asset, which is our people, and make sure they’re doing human-related tasks versus things that could be potentially automated.” Ms. Poncelet says she and her team seek to ‘bring joy back’ to care teams and improve outcomes, safety, and patient experience.”

A noble goal indeed. Eliminate 30 percent of the tasks that are not human-related to “bring joy back.”

Wait a minute: Let’s conduct a thought experiment here and test out this AI utopian future before we dive right in. Imagine it is January 2025. Another 100,000 boomer physicians have retired in 2024. However, miracle of miracles, Mayo has come through on their 2023 goals and successfully AI automated 85 percent of all documentation tasks.

  • EMR – there’s a bot for that.
  • Answering questions from staff or messages from patients and families – there’s a bot for that.
  • All the other quality/safety alerts and inbox tasks – yup, bot for that too.
  • All you have to do is just see patients. (Hear the angels singing?)

Question: How many patients?

In this documentation-free environment, what is your new visit volume per RVU quota? If you look back at the beginning of this post, notice how you were assuming you would be 30 percent less busy than you are right now, once the automation improvements are complete. You would be seeing the same number of patients, while AI took away those pesky 30 percent of your time wasted on non-human-related tasks.

You know that is not true, right? Nope. 30 percent less documentation will translate immediately to 30 percent more patient volume. Notice we are creating a whole new set of overload problems that will give us a whole new burnout threshold in 2026. Here are a few of the issues I can imagine will bite physicians and staff in this new reality.

All the fatigues

If you speed up the pace of patient encounters, you will fatigue the physician faculties involved in patient care. The drain will be much higher than it is now. We know and understand several of these fatigue-able, doctor-specific “human-related” factors.

  • Decision fatigue
  • Compassion fatigue
  • The sheer cognitive overload of a 40-patient office day or caring for 26 as a hospitalist. Back-to-back-to-back patient interviews, especially in primary care, are literally trying to drink from a fire hose.

If you are a patient, you will want to have an a.m. appointment for sure. I am suspicious that this new reality will violate the limits of stamina for the doctors and staff on a daily basis. The physicians and staff will collapse, completely wrung out before the shift is over, unless we give them all “special pills” like the military does on the battlefield.

Massive boost to virtual

You can’t consistently shove 40 patients a day through meaningful face-to-face encounters in even the most advanced office designs unless we limit the patient contact to urgent care issues. Virtual visits must be liberally mixed in or scheduled in blocks during the doctor’s week. In many cases, I suspect face-to-face will be completely abandoned because of the time and motion friction of seeing patients in the flesh and blood. And we are only beginning to understand the negative impacts of virtual care.

The end of human triage

Bots will handle all first contacts from any source except an emergency patient brought by ambulance to the ER with lights and sirens. And I bet you won’t just be able to shout “representative” to get a live agent.

And the thought that all of this will bring joy back to the physicians and staff is Pollyanna, rose-colored glasses, short-term thinking. The documentation-free, touch-free, human-free future of health care will come with its own set of unique stressors – things you and I can only speculate about as we sit here on the front porch of this epic metamorphosis of health care. I am certain that more joy and well-being and a lowering of burnout are not guaranteed by any means.

Dike Drummond is a Mayo-trained family practice physician, burnout survivor, executive coach, consultant, and founder of TheHappyMD.com. He teaches simple methods to help individual physicians and organizations recognize and prevent physician burnout. These tools were discovered and tested through Dr. Drummond’s 3,000+ hours of physician coaching experience. Since 2010, he has also delivered physician wellness training to over 40,000 doctors on behalf of 175 corporate and association clients on four continents. His current work is focused on the 7 Habits of Physician Wellbeing. Dr. Drummond has also trained 250 Physician Wellness Champions, and his Quadruple Aim Blueprint Corporate Physician Wellness Strategy is designed to launch all five components in a single onsite day. He can also be reached on Facebook, X @dikedrummond, and on his podcast, Physicians on Purpose.

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The double-edged sword of AI in health care
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