“The secret of the care of the patient is in caring for the patient.” The American physician Francis Peabody wrote those words a century ago, and after more than a decade of practicing medicine, I believe them now as much as ever. I also believe that large language models are the most powerful tool ever invented for patients to engage in their own health. Most people assume these two convictions must be in conflict. They aren’t. My recommendations, which I wrote about in a recent guest essay, have real urgency behind them. Artificial intelligence is already here in medicine, and it’s not going away. Right now, there are two competing models for the future of health care. In the first, care becomes dyadic: Patients interact directly with A.I. with no humans involved, except as remote safety oversight. Even if A.I. could serve as a primary care doctor (which it cannot do right now), I doubt that anyone wants a future in which a life-altering diagnosis like cancer is delivered by an algorithm. The second model is triadic, one in which patient, doctor and A.I. work together. A.I. extends the doctor-patient relationship, helping to prepare for visits, making medication adjustments and addressing new concerns, all while keeping the doctor in the loop and turning things over to the doctor when human judgment and compassion are necessary. We don’t get to this future by pretending that A.I. isn’t already in the clinic. If we do nothing, we get dyadic care, and there are plenty of A.I. doctor start-ups more than willing to take us there. But by being open and transparent — and encouraging safe and appropriate use of A.I. — we can take the first steps to a future medicine that uses this new, powerful technology without abandoning its foundation: human relationships.
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