From the initial days of Dr Google and his ubiquitous knowledge base, computerised medicine has come a long way with instant diagnosis and treatment guidelines.The art of clinical medicine involves carefully listening to the history of the patient, teasing out occult symptoms and weaving a story of their illness. Silent listening with intelligent interrogation often gives you the diagnosis. After this armchair act, getting to the bedside and diligently examining them is not only pertinent to their complaints, but also to the hunches that may have emanated in the mind of the physician when he brought out clues that the patient had overlooked in their recounting as insignificant.For what does not hurt is not expressed and what the mind does not know, the eye does not see and the tongue does not tell.Bedside medicine has no substitutes and that’s why medicine is not learnt in the library but in the wards. It’s after putting the findings together with the story that the plan unfolds in the mind of the doctor who prescribes the investigation, plausible differential diagnoses and the interim treatment.Now fast forward to the ‘Chat’ world of modern patients who punch in their symptoms and then pop comes the outpouring of likely probabilities, including the list of investigations linked to each of the causes and, of course, the treatment plan/s.The reading between the lines of hidden symptoms and signs and the interruption to the storytelling by asking a relevant question, often to the accompanying partner, are missing.Clinically, the ordering of investigations is stepwise and orderly, depending on the regular add-on reports, so like a treasure hunt, the puzzle is solved piecemeal with relevant pathology, imaging and specialised tests in ascending order. With the advent of rapid reporting, this plan and process leading to near affirmation doesn’t take longer than a few days and the ‘disorder’ is addressed in a systematic fashion with appropriate expenditure.To do every test for each symptom, besides being time-consuming, is cumbersome, painful and immensely expensive, which AI doesn’t bother with. Not only that, but the various adjunctive investigations surrounding the primary problem can throw up confusing possibilities which could make matters complicated and delayed.It’s not uncommon to face a group of eager beavers armed with software devices on the other side of the consulting table, going through the endless possibilities lauded (Clauded?) down to them after data-feeding.Armed with these possibilities (common and rare), the chance of increasing your investigation burden is high which, as discussed above, may be difficult to explain in Mediclaim for reimbursement.AI orders everything simultaneously and the poor aspirant is caught between reality and artificiality, looking up to the ‘Gemini’ in his horoscope to not miss that iota of chance in diagnosis.Being inside the mind of a sick patient or his anxious relative, the human doctor sitting opposite comprehends and helps to systematise, guides and holds the hand with soft tones and kind eyes, often allowing for an outburst with patience.The AI is heretofore unable to sense the despair and hopelessness and produces what it is asked to do.To describe the perils of the hypochondriac who often precipitates more problems after getting his virtual opinion is pathetic to describe.I’m not here to undermine AI in any way, for it can be that tool which rekindles the physician’s mind to enlist the endless possibilities, but in the misinformed hands, it can stir confusion pretty much like firefire, which is a good servant but a bad master.While AI has immense potential and ability, for it to supplant clinical medicine and drive therapy is unthinkable at this time.Every physician has silently seen the erosion in practice culture, but to exchange the physician with a robot is still a mirage.Clinically, hearing, questioning, touching, often conferring before arriving at the next step — it beats me how AI can master and deliver all that instantly.But then senior physicians belong to the traditional genre of patient care and maybe a hybrid product can be postulated.Only time can and will tell.Till then this ‘Ramayana’ of clinical practice will deliver its crusade against illness while ‘Border’ing too (2) on Artificial Intelligence.So help me God!(Dr Hemant Thacker is a consultant physician and cardiometabolic specialist practicing in Mumbai and affiliated to TOI. Email:dochpt@gmail.com)
