EP451: Hey, Let’s Not Talk About Artificial Intelligence, With Spencer Dorn, MD, MPH, MHA

Before we kick in to the show today, I just want to make two points. Here’s the first point. Together, we can do it. No one said transforming healthcare and elevating patients over profits would be easy. And it is not. It’s really, really hard. I just want to say thanks for all that you have accomplished, Relentless Health Value (RHV) tribe members. These are the things that matter to, really, our entire country, friends, family, patients, members, and in so many ways is really worth it.

For a full transcript of this episode, click here.

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Second point I want to make is to thank everybody who has left a tip in our tip jar. Some people have even left recurring donations, which, wow, my faith in humanity is restored when I see my people offering their financial support this way. I feel this way because (a) I don’t usually ask for financial support on the pod, even though it’s something that is certainly on my mind a lot, and (b) those who offer financial support, at least at this time, don’t get anything other than knowing that their help helps this podcast continue, which, again, just warms my heart.

The show today is a companion, I’m gonna say, to episode 446, also with Dr. Spencer Dorn. In the first show, we didn’t talk about the impact of EHR (electronic health record) systems; and in a similar vein today, we’re not gonna talk about the impact of artificial intelligence.

I’m phrasing this in this kind of odd way because that earlier conversation with Dr. Dorn was about Kranzberg’s First Law of Technology. And this one is, too, where Melvin Kranzberg says, “Don’t ascribe any given technology a label of good, bad, or even neutral.”

Point being, let’s not sit around blaming or crediting a technology for downstream consequences. After all, I mean, if we’re thinking about just EHR instances, there’s EHR instances where it takes 60 clicks for a doctor to order a patient Tylenol—60 clicks!

Then, same EHR system installed in a different hospital? It can take 2 clicks. Those excess 58 clicks aren’t because of the technology itself. They’re because the technology was configured poorly by humans involved in configuring the technology.

And if that technology then results in burnout or moral injury or someone insisting on measuring 58 quality measures in the most labor-intensive way possible, that’s a function of how that tool is used or configured, not anything inherent in that technology itself. So, yeah … watch where those fingers are pointing.

And all of this is equally relevant to artificial intelligence. As Dr. Dorn says, there’s no intrinsic property of the technology—any technology—that determines the outcome. It’s how we use it, how we implement it, how we put it into daily practice that really ultimately is the arbiter of what happens and how it impacts lives.

I’d also just add even if the tech itself has some glitches or hallucinates, someone decided to use it in the current form it’s in. So … yeah.

So, the first takeaway from this short show focused on artificial intelligence is gonna be the same, really, as it was in episode 446 about EHRs. Do not ascribe any given technology a label of, as I said, good, bad, or even neutral. That is, as I just said, Kranzberg’s First Law of Technology; and it applies here, too.

Second major takeaway—and again, this is the same as in that earlier show about EHRs, but today we’re talking about AI—if you’re thinking about the ultimate impact of the people and the processes that have some technology in their midst (technology, again, such as AI, artificial intelligence), the ultimate impact will not be a black-and-white binary.

We talk about some of these nuanced not binaries in the 10 minutes that follow, but for more, I’ve put some links below for some newsletters et cetera to check out.

One last thing before we get into the show today. Speaking of AI, I asked Google about myself; and this is what the Google AI bot replied: “Richter is also co-president of Aventria Health Group, a consultancy, and QC Health, a public benefit corporation.”

Okay, so far so good.

“She has also been recognized for her work on Relentless Health Value by winning the Edward R. Murrow Award.”

Hmmm … Just for the record, I did not win the Edward R. Murrow Award, which is actually a really prestigious broadcast media award. So … yeah.

This podcast is, in fact, factually sponsored by Aventria Health Group. And with that, here is my conversation with Dr. Spencer Dorn about, but not about, artificial intelligence.

Dr. Spencer Dorn is a practicing gastroenterologist. He also helps lead a large academic practice and works in healthcare IT and clinical informatics.

Artificial intelligence links from the past couple months to check out, as promised:

AI Health Uncut newsletter by Sergei Polevikov, ABD, MBA, MS, MA 🇮🇱🇺🇦

AI-based Selection of Individuals for Supplemental MRI in Population-based Breast Cancer Screening: The Randomized ScreenTrustMRI Trial (Nature Medicine)

In Constant Battle With Insurers, Doctors Reach for a Cudgel: A.I. (New York Times)

Tech in Diabetes: What’s Going Wrong? (MedPage Today)

Also, Dr. Spencer Dorn writes fairly often about AI. For sure, follow him on LinkedIn for more; but here’s one post he wrote recently that I thought was interesting.

Also mentioned in this episode are UNC Department of Medicine; Sergei Polevikov, ABD, MBA, MS, MA 🇮🇱🇺🇦; Marc Andreessen; and Marty Makary, MD, MPH.

You can learn more at the UNC Department of Medicine Web site and by following Dr. Dorn on LinkedIn.

Spencer Dorn, MD, MPH, MHA, is vice chair and professor of medicine at the University of North Carolina (UNC), where he works to develop care models that best support clinicians and meet patients’ needs, serves as a UNC lead informatics physician, conducts clinical trials, and examines the broad forces shaping healthcare. Clinically, he works with adults experiencing disorders of gut-brain interaction and GI motility.

05:23 What could happen with AI in healthcare if we aren’t thinking about how we’re deploying it?

05:58 How could the lessons from digitizing healthcare help us with employing AI?

08:25 How could artificial intelligence make things better and simultaneously worse?

10:55 Why is it important to look beyond the hype and pessimism and make a clear-eyed assessment?

Recent past interviews:

Click a guest’s name for their latest RHV episode!

Marilyn Bartlett, Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9), Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn (EP446), Dr Tom Lee, Paul Holmes (Encore! EP397)