AI redefines the physician's role by reducing cognitive overload

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Dr. Kevin Poe.

Hi, and welcome to the show, subscribe to KevinMD.com slash podcast.

Today, we welcome back Todd Stilson, family physician, and healthcare entrepreneur.

Today's KevinMD article is AI in medicine, why it won't replace doctors, but we'll redefine

them.

Todd, welcome back to the show.

Kevin is great to be with you.

I love being on your show and kind of putting out some ideas in the audience to think

about when it comes to, in this case, AI.

All right.

So the latest article, why did you decide to write it and then talk about the article

itself for those who didn't get transferred media?

Yeah.

So 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's here.

We've all experienced it in different ways.

And in fact, the stats show that the average about 80% of doctors even use it every day

now, right?

And so physicians are very aware of it.

And 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.

And what does it look like when physicians lead the charge when it comes to adopting AI?

Yeah.

I think when they lead it, they, there's several elements to what I think are the core responsibilities

that we as doctors, when it comes to this, one is we need to be system aware, right?

We all operate in different electronic or digital systems in terms of our interface

with the medicine.

So we need to be aware of where we're at in space with that.

We need to be technically literate.

So we can't let others sort of 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 really the engineering and technology involved with how healthcare

leans into that now.

I believe we need to be the overseer seers of engineering the pathways.

Okay.

I think we're the ones that really have the most awareness of how that should look and

behave in the real clinical space.

And then I think we need to be the guardians of safety and judgment.

Be very frank.

We're the ones that know what it's like to have an accountable relationship of the patient.

And we're the one that should be involved in the clinical decision mating, not letting

a technology AI or any other corporate entity make the decisions for us.

Now, you're very intimate with the space.

Do you see that happening with our medical institutions today?

Oh, absolutely.

I do.

And in fact, you know, if you look back over the past 30 years as part of the challenge for

physicians, we've lost our agency on autonomy and because corporations are telling us what

to do, right?

And it's in the form of policies and the form of big brother looking over your shoulder.

Now it's going to potentially be orchestrated in a technological format.

And we need to stand up during this moment of time and not letting big corpse define

that for us, but letting us be the authors and people who build it.

That's what I've done.

I've stepped away from my day-to-day rural family medicine position and created an AI company

that treats acute infections called Cheddar X.

And I spent the last two years developing it.

And I believe that's the best of technology that we can give to patients, but also put

the physician in the loop.

This is really fundamental to any AI technology today is physician in the loop models.

So for physicians, like you said, they have to be technically literate when it comes to

AI.

So for busy physicians that see 20 to 30 pages a day or into hospital all the time in the

operating room, what would that look like?

How can they become technically AI literate when they're so busy being overwhelmed with

their clinical responsibilities?

Yeah.

Well, I think that's true for any element of a physician life, whether it be learning

the business of medicine, learning the technology of medicine, or learning how to be a better

doctor of period.

We go to conferences.

We spend time on personal development.

And we really need to set aside time a little bit to grow and develop those skills.

One thing that can happen to doctors, they can be fearful of stepping into it, 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'll find it to be a great assistance

technology, not technology to take over their job or their role.

But as an assistant, as I was preparing for this meeting with you, I was thinking about

this, you know, back in the days, I would use my medical assistant, my nurse.

She would spend the evening prior prepping for the patients to come in, right?

They're using another human being to prep for visits and 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, had all the information available, and it made you much more efficient

in the process, right?

In essence, that's 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.

But if we do, just each experience gets us more comfortable with it.

Physicians can make the same mistake like they would deal with electronic medical records

right?

Absolutely.

That's the initiative there and look at how it's controlling our lives, right?

100%.

I think that is the best example of there was a moment in time for those of us who've been

in practice long enough like you and I, we may remember those days.

And we passively let it come at us.

We didn't let it enter into the arena to define it.

And we were the losers in that and the corporations were the winner.

And so I'm not anti-corporation.

We all have to work together as stakeholders in delivering the best level of care that

we can.

But frankly, between patients, doctors and the corporations out there, doctors need to

be the leader when it comes to the clinical information and how that's applied to patients.

We can't let technology make decisions for us nor can we make it strong armor, put our

arm behind her back when it comes to the best decisions for the patients.

That's the human human piece.

And one of the things that excites me quite honestly the most about AI is, like when

I use ambient technology as a classic, low-hanging fruit when it comes to the exam room, right?

If you go back five years ago, my computer was wedged between me and the patient, okay?

Because I was looking at data and entering things into the EHR, et cetera.

But now, I can lay the computer to the side.

I can look the patient eye to eye.

I can enter in the computer sort of ambiently helping me in that AI technology.

And it allows me to get back to the human, the human piece when it comes to the patient.

And I think that's at the end of the day what physicians long for is back to human human.

You mentioned earlier that approximately 80% of physicians are using AI in their professional

workflow.

What would you say to the other 20% and they may be interested in how would you get them

involved in?

They may be fearful of AI or maybe not want to use AI on a moral ethical basis.

But how do you get that other 20% of physicians involved with AI?

I think first of all, they can just get more comfort with it in their everyday life, right?

And so using a chatbot, like classically GPT Gem and I pilot any of those out there that

people use, Claude, just kind of begin using it and day-to-day life activities and skills.

It reminds me of when I taught my kids how to drive and use a map, right?

And now I had to teach them how to do something in a certain way.

And now they all use Google Maps, right?

It's all started to, and I do, too, as finally, frankly, as great as a whole lot of

easier than a regular map.

But I learned how to navigate the use of my phone and the digital technology and other

interfaces.

And 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 doing it, I think the already beginning to ease into it.

I think the most hanging fruit is using companies like OpenEvidence where you can look up

information about a particular clinical case and find what the guidelines are when it

comes to data that is not making decisions for you, but is simply empowering you very rapidly

to help you make decisions.

I mean, those are easy ways to ease into it.

In your article, you mentioned things like Ambient AI and how AI has a potential to

reduce some of that cognitive noise.

And 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.

Yeah, I think we don't know this, but we know this.

And that is that cognitive load that we manage every day with patients involves that 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.

And we are cognitively loaded down with not just what's in front of us with the patient,

the information they're telling us, but trying to merge into that encounter all those

experiences.

That cognitive load is massive.

I mean, physicians are, they're one of the most amazing humans on the earth physicians

are because of our ability to so quickly and rapidly assimilate that.

But one of the risks that we have, the blindspots we have, Kevin, is if we're missing information,

if we oversee things, if we're trying to work too hard to pull all that together.

And to me, a classic example of this is the interfaces with me and the acute care world.

We know there's a thing called decision fatigue.

And when the studies look at physicians at 4 p.m., versus physicians at 10 a.m., when

it comes to seeing a patient with an acute viral illness, whether or not they dispense

antibiotics, guess why at 10 a.m., they're less likely to at 4 p.m., they're more likely

to.

Okay.

Even though it's not the right thing to do, but they've got so much fatigue, they just

can't bear the message again to say, hey, I don't think you need medicine for this.

And they just do it.

And it's a sad state, but we cognitively are overloaded.

So engineering systems that allow us to reduce our cognitive loads so that we can operate

in the best space possible and really maximize and enjoy and get back to the meaning and

purpose of what we do in medicine, which are patients and taking care of them clinically.

Anything we can do to engineer that, we need to do it, Kevin.

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 how and change how we do things?

I think the risk is that you blindly allow it to take control and you accept the outcomes

that it supports or the support it provides you or the assistance it provides you.

And the risk is that for nefarious companies and organizations to sort of blindly rubber

stamp it and say that it is an accurate, right?

Every piece of data and information, whether it's a note that AI assembles for you are

as an assistance technology to help you make an accurate diagnosis, it's incumbent upon

us as physicians to review it, be the clinical decision maker, have the autonomy and professional

control to make that decision, and then the accountability to support it.

And lastly, the power to deliver it human to human, right?

That's what AI and technology can never do is those things I just described.

But if we passively allow systems to be created to let that do that for us and we believe

them, that's the risk.

So we have to maintain our control and involvement in it and that's why designing and engineering

it ourselves to keep us in the loop, I think, is the real secret.

So your article talks about how AI won't replace doctors but will redefine them.

Yeah.

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?

Yeah, so in a typical clinical scenario, I mean, there's a lot of, a lot of futuristic

options we can get into here.

But at the end of the day, I think what we're, what we're talking about is, is a physician

who comes into a clinic who, when they get ready to get into an encounter with a patient,

A, the patient's subjective information has been assembled and prepared for you prior

to you going into the room.

So there's some prep book that goes in as well as the AI technology using its access as

we're getting more and more better and better with systems that can pull records and medical

information together that's all assembled for you to review.

Before you go into that room, then you go into the room with Ambi and AI with you, the

year eye to eye with the patient.

You may verify some of the data points, but you get to then be the clinician that you

are trained to be and the specialty you're trained to be to address the issue or issues

that are important to that patient.

And then at the end of the process, right, AI can help you execute some of the orders

and execute some of the deliverables that occur after a patient visit.

And there's obviously follow-up communication and AI can assist patients on that side

of the equation with follow-up communication.

This is like, possible now, okay, it's 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 in purpose for us as doctors is this isn't about technology

for the sake of technology.

This is about technology assisting us with being able to more winsomely and capably

deliver the care that we know we can and really reducing some of the cognitive overload

that's just not necessary.

Quite frankly, I would say it's been placed there by corporations who have their own agendas

and want us to be their scut monkeys to complete it, so to speak.

And it's time for us to reduce some of that cognitive burden in engineer systems that

help us.

We're going to Todd Stilson, Family Physician and Healthcare Entrepreneur.

Today's Kevin MD article is AI in medicine, why it won't replace doctors, but we'll redefine

them.

Todd is always will end with take-home messages they want to leave with the Kevin MD audience.

Yeah, so Kevin, one of the take-home messages I want to leave for you is that AI can reduce

cognitive chaos and restore cognitive meeting for doctors.

And I don't think we need to fear that it's 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.

And if physicians can get their mind wrapped around that and then join me in the marketplace

to create those and in engineer those products like we do a chat or X2 to provide the best

level patient care, patients and doctors will win in that process and it's time for us

to do that.

Todd, as always, thank you so much for your insight.

Thanks again for coming back on the show.

Thanks, Kevin.

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