The “Fine Art” of Medicine

Clinical Scenario

You are seeing Reverend Smith today for a follow-up appointment after he completed radiation therapy for a unilateral T2 glottic cancer. He is a 71-year-old minister and still leads his church’s congregation, so preservation of vocal function was very important to him in his decision for primary radiation therapy. He is accompanied today by his wife of 50 years. During the greeting, you indicate to Reverend Smith that you will be using a virtual scribe today for the visit if he approves. After you provide a detailed description of the artificial intelligence-based ambient scribe system, Reverend Smith gives his approval.

Following your evaluation, Reverend Smith inquires about his prognosis for the future. You indicate that you obtained AI-generated statistics on his particular cancer and proceed to relate the evidence-based prognosis to him and Mrs. Smith. When he questions how those statistics apply specifically to him and his disease, and what would be his remaining longevity of life, you laughingly indicate that you are “not God,” so you cannot give more information than the population evidence you retrieved. As an early-career otolaryngologist, you personally believe that evidence is the most important factor in patient care.

Reverend Smith then indicates to you that Mrs. Smith was just diagnosed with stage III breast cancer, and their individual cancer outcomes will be very impactful for them and their family. You briefly extend your condolences to Mrs. Smith, followed by an indication that your schedule is very busy today, and you will now need to schedule the next appointment for Reverend Smith. You inform the Smiths that while the use of the virtual scribe has saved time for you, you have instructed the schedulers to fill the saved time with more patients, and you must stay on schedule.

Reverend and Mrs. Smith glance at each other, and with a sad gravity, Reverend Smith says, “Too bad you aren’t using this extra time to spend talking with your patients, Doctor.” This statement lingers expectantly in the air, awaiting a sincere response.

Discussion

Perhaps the state of AI’s influence on the practice of medicine in general, and otolaryngology specifically, is currently at a seminal point of inflection. As AI becomes increasingly embedded in the everyday practice of patient care, the enduring human elements of medicine (the “fine art”) remain faithful reminders for us. Empathy, understanding, compassion, and our therapeutic presence enhance our altruistic approach to patient care. These fundamental virtues, however, face unprecedented challenges in the milieu of AI integration into nearly every facet of our specialty. This recognition raises the question of whether the use of innovative technology and the duty to provide compassionate patient care can effectively coexist. For otolaryngologists who practice relational medicine, the answer to this question is at once existential and an ethical imperative.