The Importance of Patients
AI can be used to enhance care of our patients, and our patience.
I’ve written a bit about the use of AI in medicine. Work inspired by technologists and physicians and researchers, and I’ve focused on its utility in veterinary medicine. It can help to alleviate the mounting demand for productivity, diminish our decision and executive function fatigue, it can dramatically enhance diagnostic and prognostic accuracy, it can take the harsh or heavy emotions out of our communications, it can translate our technical language into simpler and more accessible terms.
But it can give us something more important than all of that: time.
While some folks in the veterinary industry - I suspect it’s often those who spend more time with spreadsheets than with animals - will cast the issues facing veterinary medicine as a crisis of productivity, I believe it’s more a crisis of time.
And not just “time” in the sense that a finite numerical value is entered into a calculator as part of the measure the productive, monetary, or rate of tasks completed, but “time” in the sense of focus, commitment, and lack of distraction in examining a patient, listening to and communicating with clients, and being mentally present in the exam room with the pet you’re charged with treating.
A lot of us driven, ambitious, high-achieving types always seem to be busy. There’s an event on the calendar, there’s an appointment in the room, the phone is ringing, the To Do list ever lengthening. And while it’s been known to wear us out, even burn us out, we don’t stop. Do we like it? Or do we feel like we need it? There’s a buzz about the hurry. An intoxicating thrill in the busy-ness of business. And no coincidence that the word “rush” means to act with urgent haste as well as a strong feeling of exhilaration. Notably, I am equally guilty of indulging in this sort of behavior as I am of admiring this sort of behavior.
Yet I write with enthusiasm and excitement about a technology that has the potential to help us do even more. It can make us faster! It can make us more accurate! It can take the humanity out of tasks so we’ll that you barely notice its absence!
And I think I very nearly missed the point. The power of this artificial intelligence, the real importance and value of it, lies in that by removing the human interaction from things that don’t require our humanity, we can then give it back a to the things that do in a way that enhances and adds to our genuine human connections and relationships rather than taxes them. It is a technology that has the potential to demand less of our attention (I write this article on my cell phone with “Do Not Disturb” on as my Alexa chimes that I got a package) rather than more. It can give us the time and focus we need to be attentive to our patients and our clients and even ourselves.
While we pursue the care of patients, we hold little regard for the importance of patience. Accountant Terence O’Neil, in a lecture at WVC on behalf of Veterinary Management Group, spoke with enthusiasm about the remarkable profitability of a veterinarian’s “drive thru” services. He also spoke critically of his own veterinarian, who spent six minutes with him talking about baseball and their own families instead of the minimum required two minutes to discuss his pet’s health. While I can complete a physical examination in two minutes, I wonder about its quality. And while I can express my findings almost simultaneously in that timeframe, I doubt that they’ve truly been communicated.
I believe that the argument that efficiency experts make more or less amounts to “if you’re more efficient with your time and make more money, you’ll have more time and money to do the things you want to do.” A decent point to make, I suppose, but the practice of medicine isn’t something I regard as a chore to be completed with greatest regard to maximizing speed and efficiency, or even as merely a job I do for money. This profession is my life’s work, a vocation I believe gives higher purpose to my time, and a vital part of this life I love. This isn’t what I do so I can do the things I want to do, it’s what I do because I want to do it. And even if it wasn’t, so great is the responsibility of caring for animals that I would want to do it as well as I can regardless of any other factors. We have to be comfortable acknowledging that doing some things properly just takes the time it takes. And, with respect to Mr. O’Neil’s perspective, I believe that most veterinarians believe as I do. We don’t do this just for the money, we do this because we find joy and fulfillment in it. (And, sadly and cynically, I suspect that the veterinarian who finds a way to see 20 patients an hour will be rewarded exclusively and inevitably with a request to see 30 patients an hour.)
“There is one fundamental rule that transcends all others, and I’ll tell you what it is,” wrote James Herriot of his mentor Siegfried Farnan’s instructions to him, “You must attend. That is it and it ought to be written on your soul in letters of fire.” Our attention is constantly taxed. We consume the informational equivalent, I’ve read, of nearly 200 newspapers a day. We are commanded to “pay attention,” constantly trying to make withdrawals from a finite account that offers no credit. To our patients, however, there remains an immutable mandate, “You must attend.” You must attend, must be attentive, must pay attention. In a world that levies expense after expense on our attention with the genius of miraculous technology engineered by psychologists and behavioralists to command our every blink and moment’s focus, suddenly there exists a software that can be used to take it back. And how we choose to spend our time and attention can make all the difference in the world.
In giving that reclaimed attention back to our patients, we give it back to ourselves. In offering it back to our charges and obliging Siegfried’s command, we find again our humanity, reforge and strengthen the human-animal bond, and not only do better medicine for our patients, but create more satisfaction and fulfillment for ourselves. The dream I want to see fulfilled by the usage and refinement of artificial intelligence in veterinary medicine is to remove the time demands of rote tasks like research and data entry from doctors’ lives so that they can once again find the enjoyment and satisfaction in their practice.
Great essay! I've experienced similar pressures on productivity in the pathology world. The focus is on ever-increasing benchmarks for reading cases and a fee-per-case bonus structure that incentivizes quantity over quality, to the point where spending ~5-7 minutes on a case is borderline "too long." How many of us would want our own loved ones to get a critical diagnosis in such a rushed timeframe? Admittedly, for some lesions, that time is more than sufficient, but for others I have caught subtle or rare diagnoses in academic labs when I had the (luxury of) time to think and cross-check some references that would never be possible in the corporate world.
Many articles have been written in recent years about physicians spending so much time on their EMRs and jumping through the hoops of record-keeping (both to guarantee insurance company reimbursement for their time and to defend against liability) that it is causing burnout as well as decreased quality of medical care. I wholeheartedly agree that AI has the potential to give us some of our time back. We already see this a little bit with voice recognition software dictation (powered by AI, but its become so established that like autocorrect we no longer think of it as such), but there is way more potential. I think of how much a tool like Elicit could help quickly find and filter published studies, among others.
But as you warn, this future is not guaranteed. A lot of the bean counters (who are rarely DVMs or even have a science background) see AI primarily as a tool to boost margins and increase ShArEHoLdEr VaLuE. It can--and should--be BOTH; it's up to veterinarians and allied professionals to ensure that it has benefits as much for patients and practitioners as the bottomline.
Side note: Definitely check out the books "Deep Work" by Cal Newport and "The Shallows" by Nick Carr. Each deals with the issue of how to retain a modicum of patience and attention in this hyperconnected digital world. It's challenging, but if you can pull it off it basically becomes a superpower in this ADHD world.