We had no way of anticipating how the car would revolutionize the landscape. With it came highways, streets, drunk driving, day trips to the sea, road rage, etc etc. We weren't intentional in how we adopted the car nor how we adopted the EMR. What culture do we intend to create with AI? 10/10

(It is both more mundane and more laborious to double-check the output of someone/something else than to just do it yourself, as any attending earnestly reading over a trainee's notes can testify) 9/10

So, too, with the rest of medicine: all standardized technique. What we want is to make the red numbers black; the dispel the shadows on the CT scan. Humans are in the loop - for now, and practicing a form of medicine that is itself a shadow of what once was. 8/10

We're prepared for it because the practice of medicine is already a desiccated technical endeavor. A healthcare leader can discuss doing away with medical interpreters as if they're parts in a machine and offer no human value to the encounter itself. Translation is all technique and no culture. 7/10

I would suggest that we both are and are not prepared for this. We're prepared for it in the same way a turkey is prepared for Thanksgiving; the culture of medicine has fashioned the clinical encounter into one that is ripe for harvesting by various stakeholders. 6/10

There's also growing interest in AI surrogate decision-makers. For years this was a theoretical and nuanced debate relegated to ethics journals. Now proof-of-concept trials have been published in NEJM AI. Are we prepared for this? familymeetingnotes.substack.com/p/a-machine-... 5/10

What I didn't hear discussed in this convo was how AI scribes will almost certainly increase the degree of surveillance within the clinical encounter. Nothing from recent decades would suggest otherwise: the EMR was used by various stakeholders to pry into that space, why not AI scribes? 4/10

But saddled with the burdens of modern technopoly - the challenges and admin oversight of the EMR, the "always on" access of inbasket messages, etc. - have driven clinicians to embrace the promises of AI. 3/10

Clinicians are desperate for "faster horses" - a phrase that reflects early 20th century expectations of what the next advance after the horse-drawn carriage might offer. The automobile wasn't a faster horse; it was something altogether different. 2/10

It probably shouldn't be surprising to me anymore that clinicians are absolutely enamored with AI, just as they're usually enamored with technology more broadly (as evidenced by, e.g., allure of interventionalist specialities over primary care). 1/10

Clinicians talking with admin in several years:

“What would you say you do here?”

“I told you! I take the clinical recommendations from the AI so the patient doesn’t have to. I have people skills! I HAVE PEOPLE SKILLS!”

I think Derek Thompson is right to claim Alasdair MacIntyre was only half right when he argued our society had lost moral cohesion. We're still bound by a moral framework: the market. www.derekthompson.org/p/the-26-mos...

familymeetingnotes.substack.com/p/where-the-...

It will maximize the oversight and intrusiveness of the EMR by placing admin ears in every clinical encounter.