Human accountability remains essential as healthcare adopts AI

With artificial intelligence making deep inroads into healthcare, two top doctors are urging physicians to embrace the technology but to remember that only humans can serve the best interest of individual patients.

The University of Virginia School of Medicine's Andrew S. Parsons, MD, MPH, and Harvard Medical School's Adam Rodman, MD, MPH, note in a new commentary that AI is growing increasingly sophisticated at an astonishing pace. The technology can already match or exceed human doctors at certain tasks, such as making diagnoses from written cases and electronic health records. That has prompted debate about whether AI will soon replace doctors for many applications.

Parsons and Rodman, however, note that deciding how to manage a patient's care -- choosing treatments, tests and follow-up that fit the patient's goals and circumstances - cannot be reduced to a "correct" answer. AI may be able to identify a patient's medical condition, but deciding what to do next means choosing which risks a particular patient should accept, and a recommendation that works in theory can fail in practice.

"Guidelines and trials skew toward the populations studied, and real patients frequently fall outside those norms because of complex comorbid conditions and social circumstance or because their goals differ from a trial's end points," Parsons and Rodman write. "Deviating from the technically correct answer is often good medicine, and someone must answer for that deviation."

And there lies the real role for human doctors in the medicine of tomorrow, the authors argue. Even as AI takes on more of diagnosis, doctors must consider each individual's circumstance, work with patients to make hard choices, then shoulder the responsibility for the outcomes.

"We contend that the clinician's enduring role is accountability: owning the risk of acting under uncertainty and answering for the decision that follows," Parsons and Rodman note. "That ownership is real only when the clinician still reasons about the decision and holds a stake in its outcome."

This work, they say, cannot be delegated to AI, however accurate its diagnoses become.

"A clinician who knows they will answer for the result weighs options differently than a system with nothing to lose," Parsons and Rodman write. "A clinician who expects to see the patient again also considers which choices will preserve the relationship if things go badly. Artificial intelligence will keep improving the information that feeds these decisions, but it cannot take ownership of what happens next."

Human doctors, they conclude, should welcome AI's growing accuracy while continuing to own the risk of acting for each patient. It is, after all, the patient and not the computer who will have to live with the consequences.