Vital Intelligence.

Photo by Brett Jordan on Unsplash

Lately, I’ve been immersed in technology. It’s why I haven’t written. Perhaps that seems like an odd excuse, but I’m not referring to screen time.

Over the past few weeks, while lying on my back, I’ve been gently transported into the open mouth of MRI machines and CAT scanners. I stay inside their tunnels, sliding back and forth as clanging metallic noises mix with upbeat streaming music. Like an explorer in a small cave, my body is surrounded by hard surfaces only inches from my skin. Closing my eyes, I yield to the rhythm of the room.

Other days have lab draws, ultrasounds, X-rays and procedures. Robotic reminders ping my phone daily, alerting me to appointment schedules and test results. My medical chart is not thick—there is no paper—but it yields an increasingly robust amount of information accessed by a phone icon the size of my smallest fingernail.

The current world of medicine is almost unrecognizable compared to the teaching hospitals of my training days. No more holding an X-ray up to the light to get a better view or straining to read a consultant’s opinion in scrawled blue ink. The digital divide is so sharp that my clinic now has emergency preparedness drills in the event of electronic chart outages.

I’m mostly grateful for these changes. There is no question that our investigative technology allows us to examine the human body with far more depth and precision than ever before. We regularly describe how a disease may produce changes at the gene level—an astounding claim that is typically communicated in the most ordinary of ways.

Artificial Intelligence (AI) at its basic level isn’t new, but generative AI—that which learns and improves as it goes—offers much to the medical world. Diagnostic possibilities, recognition of abnormalities on scans, and cautions regarding medical risk of complications are a few of the ways AI can quickly assist the human medical team.

Some suggest advanced AI will replace health care providers. I don’t see that happening in a whole cloth sort of way, but robotic devices already complement many areas of medicine. A common concern is how bias shapes AI. If the machine doesn’t learn from a representative sample of humans, it will have no experience with norms within diversity of gender, culture, age, etc.

I’m no expert on AI. But the current conversations about it have me wondering how wisdom is perceived in medicine. One of the graces of being at the end of a long career is that one accumulates years of stories collected as histories and physicals, medical outcomes, unusual presentations, and changing patterns. Additionally, most of us have encountered families from multiple social, cultural and ethnic backgrounds. Angry, sad, carefree and cautious patients populate our clinics. At its best, the practice of medicine invites the world into the exam room.

Expert physicians quickly draw upon this storehouse of knowledge as they encounter new patients. Further, they likely limit technology use to its most necessary application, as much discernment takes place in initial meetings with patients. These clinicians sift through possibilities rapidly, aware of rare events, but also well-versed in the ordinary.

The skills of the seasoned professional, who keeps abreast of medical knowledge while also developing well the art of medicine—that which cannot be reduced to an algorithm—are what comprise wisdom in older clinicians. Though it may mirror the condensed experience of machine learning, there is a missing vitality in AI.

Indeed, vitality is, by definition, limited to the living. Some of the most profound learning in medical settings happens when technology is far from sight. Data patterns may show the patient often skips appointments, doesn’t take their medication, or refuses vaccination. But human encounters with the family and patient reveal meaning behind the statistics. We come to know the roles of fear, mistrust, anger and grief as they affect access to medical care and adherence to health recommendations. The hesitation in a patient’s reply may indicate there’s a deeper concern under the surface. Curiosity and humility may yield results that a machine could never reproduce.

Recently, I met with an expert physician who reviewed my treatment course, the medications I take, and the risks of an upcoming stem cell transplant. For over an hour, I heard in-depth summaries of prognostic factors, side effects, controversies in care, and current research outcomes. The appointment was termed a “data conference.” During this time, I was asked to sign informed consent papers conveying that I understood the risks and ramifications of my therapies.

The physician was flawless in presenting the data. Described as brilliant by her colleagues, she is known to be a world expert in myeloma. Senior in age, she draws upon many years of patient care and can state exactly how many people she has seen with each stated complication.

I left that conference desperate to catch the next plane to Spain—a place I hoped to live before cancer showed up. I wondered why anyone would agree to a transplant when it—and subsequent therapies—wreaked so much destruction and had so many potential complications. I double-checked her statements, and they all were supported by current research statistics.

No AI summary could have done a better job in showing me the data related to my disease. Conversely, my doctor did no better than AI in transmitting that communication. Not once did she say, “But we expect you to do well.” Or, “You are strong and that is helpful.” Or, “Despite the statistics showing 15% of people get a second—and bad—cancer, remember that 85% don’t.”

There was no awareness of how overwhelming the data might seem to a listening patient. There were no words of comfort or pauses to make sure I was okay. All the statistics were presented in their worst light. That is, the data never presented the positive percentages—those who did not get a cancer, who did go into complete remission, and who handled the treatment without hospitalization or major side effects.

It is in these areas that we have a vital need for compassionate, ethical and experienced clinicians. The meaning of the data matters. My doctor was accurate. But she lacked the human element of care. “How does this information make you feel?” might have been a good question. Where was her wisdom? In all those years of her practice, how could she not have understood the need to balance statistics with stories? Story is at the heart of good medicine.

Data is meaningless unless embedded in story. Every statistic represents lives lived. My world is full of stories of families who, despite horrible socioeconomic, racial, and cultural barriers to health, have met life with grace, beauty, and power. There is flourishing that defies grim statistics. That is where we derive hope. And hope is necessary for healing—maybe it is even the most necessary factor when faced with an incurable disease.

My sister helped me reframe the gloomy outcomes. She reminded me that Roger Federer, one of the greatest tennis players of all time, won fewer than 85% of his serves. (Data shows he “only” won 69%.) No one talks of Federer by commenting that he was the guy who missed 30% of his service points. Why would we? His service numbers are embedded in his career story. He is the GOAT (with Rafa and Djokovich, too) who mesmerized us with his superhuman ability to control a tennis ball.

All those statistics we gather in medicine are population based. The person we see in the exam room is an individual. Their outcome won’t be 85% or 18% or 69%. It will be 100% or 0 in each realm of diagnosis, side effect, relapse, and mortality. Human clinicians must balance these two truths—the data is important to convey and the person before them is a totality apart from the data.

I am grateful for the nurse who helped me breathe again after that conference. I am grateful for the physician assistant, care coordinator and spiritual health staff who reminded me of how many people have walked through this event with support, expert care, and good results. Any rational person would be afraid, they reflected. Look at all the blessings you have had to get to this place, they observed. We are here for you, they emailed. It is in these spaces between scripts and data, in the domain of vital intelligence, that we find the strength to heal.