by David B. Kartzman, DC
I have just completed reading a book titled “Deep Medicine” by Eric Topol, MD. The premise I expected as I read the title was how computer technology, including artificial intelligence (AI), was the next wave of revolutionizing healthcare. If you have ever listened to an Andrew Ng podcast (Stanford, Google, entrepreneur in AI), the career of a radiologist is short lived. After all, couldn’t a computer with the advent of deep learning, better and more cheaply interpret a diagnostic scan?
As I started the book I looked at different reasons for wanting to read it. First, I really enjoy the wonkiness of process. So this naturally would be an interesting read. Second, for the healthcare of me and my family, what could be done so we could be better advocates for ourselves? By the time I finished the read I was surprisingly grateful that the book was also a chance to reflect back on my almost 30 years of practice and consider what I can provide to my patients over the remaining duration of my career.
For those of you who know me and are even tired of hearing me, the role of peer reviewed journal “evidence” in driving health care standards is an issue to which I have devoted much time. The effectiveness of this type of care or lack of effectiveness of that type of care can be important in case management.
What is missing from many or all of these studies, and perhaps reasonably a confounding variable, is the humanistic or human interaction part of health care. In an age of impersonal electronic health records (HER) and short duration office visits, how much further can we be from interacting directly with people who need us at difficult times in their lives?
For chiropractic, the argument could be correctly made that ours is a profession which will not soon be given over to robots. This is true for a number of reasons. First, there is great variation in techniques and approaches between practitioners. Second, there is not a strong evidence base which supports application of one technique over another. Third, and this is where I believe quality chiropractors stand out, is that robots are not yet able to display empathy.
What is the secret sauce which makes our profession stand out as distinctly as it does? I would argue that the answer exists in the first few seconds of the patient visit. It is that time when we look at them and not at the computer. It exists when we want to know about, not solely their pain, but how they as a person came to experience this problem. As we know pain is immeasurable as a sign and for each patient their level of pain is personal. So, as chiropractors, we have learned to see each patient as a person.
After completing this book, and poring over the final chapter of humanistic healthcare, I believe more strongly that the chiropractic contribution to healthcare is empathy. After all, how many people use the terms about believing in chiropractic? How many are possessive and talk about my chiropractor?
Let me be very clear here, many physicians also possess this appreciation of the human interaction but are hamstrung by working within a corporate structure. In fact, perhaps this is one reason physician burnout is such a real problem. As most chiropractors are not part of health care corporations, we have the luxury of time and not being as focused on production.
As I noted, if I had to describe only one trait which the chiropractic profession possesses to stand out from the current direction of healthcare, I would say it is empathy. Empathy, as I see it, includes an emotional connection of “I’m listening and I’m interested.” It also includes education: let me give you a reasonable answer to your question of why it hurts and what we can do to alleviate your pain. To be clear, empathy is not paternalism. We can be empathetic while we respect the boundary between doctor and patient.
Will artificial intelligence (AI) change healthcare? It is and it will continue to do so. What is so interesting is that the unintended consequence of the AI revolution is our collective introspection as health care providers, and at sometimes we will also be patients. Is the humanistic side of what we do necessary and not subject to change? It is as we are not robots and computer algorithms.