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Family physician and health care entrepreneur Tod Stillson discusses his article “AI in medicine: Why it won’t replace doctors but will redefine them.” Tod argues that the binary debate between AI as a savior or a threat misses the point. The real issue is that modern medical complexity has outgrown human cognitive limits. The conversation explores how AI can reduce the “cognitive noise” that leads to burnout and error by handling data synthesis and repetitive tasks. Tod emphasizes that while AI can structure information, it cannot assume moral responsibility or build trust. Discover why the future of medicine depends on building systems that honor human limitations while leveraging machine precision.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Tod Stillson, family physician and health care entrepreneur. Today’s KevinMD article is “AI in medicine: why it won’t replace doctors, but will redefine them.” Tod, welcome back to the show.
Tod Stillson: Kevin, it is great to be with you. I love being on your show and putting out some ideas for the audience to think about when it comes to AI in this case.
Kevin Pho: All right. Why did you decide to write this latest article? Tell us about the article itself for those who didn’t get a chance to read it yet.
Tod Stillson: The article really brings forth the idea that physicians need to be in the lead when it comes to how artificial intelligence is integrated into the new redesign of medicine. It is here. We have all experienced it in different ways. In fact, the stats show that about 80 percent of doctors use it every day now. So physicians are very aware of it. As it continues to infiltrate the new form of medicine, I believe physicians need to lead it and not passively let others define it for us.
Kevin Pho: And what does it look like when physicians lead the charge when it comes to adopting AI?
Tod Stillson: I think when they lead it, there are several elements to what I think are the core responsibilities that we as doctors have when it comes to this. One is we need to be system aware. We all operate in different electronic or digital systems in terms of our interface with medicine. We need to be aware of where we are in space with that.
We need to be technically literate, so we can’t let others define what that literacy looks like. We need to lean into it just like we did going to medical school and learning about the body. We need to learn about the engineering and technology involved with how health care leans into that now. I believe we need to be the overseers of engineering the pathways. OK. I think we are the ones that really have the most awareness of how that should look and behave in the real clinical space.
Then I think we need to be the guardians of safety and judgment. To be very frank, we are the ones that know what it is like to have an accountable relationship with the patient, and we are the ones that should be involved in the clinical decision-making. We must not let technology, AI, or any other corporate entity make the decisions for us.
Kevin Pho: Now you are very intimate with the space. Do you see that happening with our medical institutions today?
Tod Stillson: Oh, absolutely I do. In fact, if you look back over the past 30 years, part of the challenge for physicians is we have lost our agency and autonomy because corporations are telling us what to do. It comes in the form of policies and Big Brother looking over your shoulder, and now it is potentially going to be orchestrated in a technological format.
We need to stand up during this moment in time and not let Big Corp define that for us, but let us be the authors and the people who build it. That is what I have done. I have stepped away from my day-to-day rural family medicine position and created an AI company that treats acute infections called ChatRx. I have spent the last two years developing it. I believe that is the best technology that we can give to patients, but it also puts the physician in the loop. This is really fundamental to any AI technology today, which are physician-in-the-loop models.
Kevin Pho: So for physicians, like you said, they have to be technically literate when it comes to AI. For busy physicians that see 20 to 30 patients a day or are in the hospital all the time in the operating room, what would that look like? How can they become technically AI literate when they are so busy and overwhelmed with their clinical responsibilities?
Tod Stillson: I think that is true for any element of a physician’s life, whether it be learning the business of medicine, learning the technology of medicine, or learning how to be a better doctor period. We go to conferences, we spend time on personal development, and we really need to set aside a little time to grow and develop those skills. One thing that can happen to doctors is they can be fearful of stepping into it. They are fearful of trying it because it does change their paradigm of how they operate and think each day.
But I think, Kevin, if they will step into it, they will find it to be a great assistant technology, not a technology to take over their job or their role. It acts as an assistant. As I was preparing for this meeting with you, I was thinking about this. Back in the day, I would use my medical assistant or my nurse, and she would spend the evening prior prepping for the patients to come in. You are using another human being to prep for visits, to organize data, and to systematically prepare you for a visit so that when you came in the next day, your nurse had all the records available and had all the information available. It made you much more efficient in the process.
In essence, that is what AI is able to provide in these environments for us if we lean into it. So we do have to be willing to change how we do things and not fear it. Just each experience gets us more comfortable with it.
Kevin Pho: Physicians can’t make the same mistake like they did with electronic medical records, right? We absolutely lost the initiative there and look at how it is controlling our lives.
Tod Stillson: One hundred percent. I think that is the best example. There was a moment in time, and for those of us who have been in practice long enough like you and I, we may remember those days. We passively let it come at us. We didn’t enter into the arena to define it. We were the losers in that, and the corporations were the winners. I am not anti-corporation. We all have to work together as stakeholders in delivering the best level of care that we can. But frankly, among patients, doctors, and the corporations out there, the doctors need to be the leader when it comes to the clinical information and how that is applied to patients.
We can’t let technology make decisions for us, nor can we let it strong-arm us or put our arm behind our back when it comes to the best decisions for the patients. That is the human-to-human piece. One of the things that excites me quite honestly the most about AI is using ambient technology as a classic low-hanging fruit when it comes to the exam room. If you go back five years ago, my computer was wedged between me and the patient. I was looking at data and entering things into the EHR. But now I can lay the computer to the side and I can look the patient eye to eye. The computer is sort of ambiently helping me in that AI technology. It allows me to get back to the human-to-human piece when it comes to the patient. I think that is, at the end of the day, what physicians long for, which is getting back to human-to-human interaction.
Kevin Pho: You mentioned earlier that approximately 80 percent of physicians are using AI in their professional workflow. What would you say to the other 20 percent? They may be interested. How would you get them involved? They may be fearful of AI or maybe not want to use AI on a moral or ethical basis, but how do you get that other 20 percent of physicians involved with AI?
Tod Stillson: I think first of all, they can just get more comfortable with it in their everyday life. Using a chatbot like ChatGPT, Gemini, Copilot, or Claude and just beginning to use it in day-to-day life activities and skills helps. It reminds me of what I taught my kids when learning how to drive and use a map. I had to teach them how to do something in a certain way, but now they all use Google Maps. It is all sort of intuitive, and I do too. Frankly, it is great. It is a whole lot easier than a regular map. I learned how to navigate the use of my phone, that digital technology, and other interfaces.
When you get more comfortable in those environments, I think you can then begin to see more easily the application in the clinical world. For those who are already easing into it, I think the lowest-hanging fruit is using companies like OpenEvidence where you can look up information about a particular clinical case and find what the guidelines are. That data is not making decisions for you, but is simply empowering you very rapidly to help you make decisions. Those are easy ways to ease into it.
Kevin Pho: In your article, you mentioned things like ambient AI and how AI has the potential to reduce some of that cognitive noise. I think there have been some studies about ambient AI in terms of reducing that cognitive load on physicians. So talk more about that potential and how that can move forward.
Tod Stillson: I think we know that cognitive load that we manage every day with patients involves the assembly of information from all sorts of sources, from the latest guidelines and studies to the medical records from the three specialists that they may have seen that interface with you. We are cognitively loaded down with not just what is in front of us with the patient and the information they are telling us, but trying to merge all those experiences into that encounter. That cognitive load is massive.
Physicians are some of the most amazing humans on the earth because of our ability to so quickly and rapidly assimilate that. But one of the blind spots we have, Kevin, is if we are missing information, if we oversee things, and if we are trying to work too hard to pull all that together. To me, a classic example of this involves interfaces in the acute care world. We know there is a thing called decision fatigue.
When studies look at physicians at 4:00 PM versus physicians at 10:00 AM regarding seeing a patient with an acute viral illness, whether or not they dispense antibiotics, guess what? At 10:00 AM they are less likely to prescribe antibiotics, and at 4:00 PM they are more likely to do so. Even though it is not the right thing to do, they have so much fatigue. They just can’t bear the message again to say that they don’t think you need medicine for this. They just do it. It is a sad state, but we are cognitively overloaded.
So engineering systems that allow us to reduce our cognitive load so that we can operate in the best space possible is important. It helps us really maximize and get back to the meaning and purpose of what we do in medicine, which is taking care of our patients clinically. Anything we can do to engineer that, we need to do it, Kevin.
Kevin Pho: Now, do you see any red flags? Do you see the path perhaps turn a little bit darker for physicians? What are some risks as AI infiltrates and changes how we do things?
Tod Stillson: I think the risk is that you blindly allow it to take control and you accept the outcomes that it supports or the assistance it provides you. The risk is for nefarious companies and organizations to sort of blindly rubber-stamp it and say that it is accurate. Every piece of data and information, whether it is a note that AI assembles for you or assistance technology to help you make an accurate diagnosis, requires our involvement.
It is incumbent upon us as physicians to review it, be the clinical decision-maker, and have the autonomy and professional control to make that decision. We need the accountability to support it, and lastly, the power to deliver it human-to-human. That is what AI and technology can never do. But if we passively allow systems to be created to do that for us, and we believe them, that is the risk. So we have to maintain our control and involvement in it, and that is why designing and engineering it ourselves to keep us in the loop is the real secret.
Kevin Pho: So your article talks about how AI won’t replace doctors, but will redefine them. Give us a story or a vision of how a physician will be redefined by AI. What would that look like in a typical clinical scenario?
Tod Stillson: In a typical clinical scenario, there are a lot of futuristic options we can get into here. But at the end of the day, I think what we are talking about is a physician who comes into a clinic and gets ready for an encounter with a patient. The patient’s subjective information has been assembled and prepared for you prior to you going into the room. So there is some prep work that goes in.
The AI technology uses its access as we are getting better and better systems that can pull records and medical information together. That is all assembled for you to review before you go into that room. Then you go into the room with ambient AI. You are eye to eye with the patient. You may verify some of the data points, but you get to be the clinician that you are trained to be in the specialty you are trained in to address the issues that are important to that patient.
At the end of the process, AI can help you execute some of the orders and some of the deliverables that occur after a patient visit. There is obviously follow-up communication, and AI can assist patients on that side of the equation. This is possible now. It is not a futuristic scenario. These are the ways that we can connect the dots, and at the end of the day, Kevin, deliver better care to patients. That comes back to the core meaning and purpose for us as doctors. This isn’t about technology for the sake of technology. This is about technology assisting us with being able to more capably deliver the care that we know we can and really reducing some of the cognitive overload that is just not necessary.
Quite frankly, I would say it has been placed there by corporations who have their own agendas and want us to complete it, so to speak. It is time for us to reduce some of that cognitive burden and engineer systems that help us.
Kevin Pho: We are talking to Tod Stillson, family physician and health care entrepreneur. Today’s KevinMD article is “AI in medicine: why it won’t replace doctors, but will redefine them.” Tod, as always, we will end with take-home messages that you want to leave with the KevinMD audience.
Tod Stillson: Kevin, one of the take-home messages I want to leave for you is that AI can reduce cognitive chaos and restore cognitive meaning for doctors. I don’t think we need to fear that it is going to replace us. I think we can be aware that it can reduce that chaos and improve our cognitive and purposeful meaning to deliver the best patient care. If physicians can get their mind wrapped around that and then join me in the marketplace to engineer those products like we do at ChatRx to provide the best level of patient care, patients and doctors will win in that process. It is time for us to do that.
Kevin Pho: Tod, as always, thank you so much for your insight. Thanks again for coming back on the show.
Tod Stillson: Thanks, Kevin.
