Primary Care: It’s About Time
Primary care is essential and woefully under-resourced. In Singapore where I spend most of my time, a primary care doc may have no more than 5 minutes per patient. Besides the fact that this may leave no time for anything more than a simple problem, it highlights the need for a model of service that allows primary care to do its essential task: to identify and meet needs in a way that is human and affordable.
It has been estimated that if primary care doctors were to provide all recommended services, it would take more than 24 hours per day. My own primary care doctor in the US stays up to the wee hours reading patient emails, writing notes, checking on test results. Were it not that he has more capacity than the Energizer Bunny, he’d be thoroughly burned out. And many of our best providers are burning out and leaving primary care.
We need a new way.
Which raises the issue of the role of artificial intelligence (AI) in enhancing patient care. While some may fear that AI will ultimately replace physicians – or worse includes trashy applications that waste time – a more nuanced perspective suggests that this technology could serve to augment and empower the frontline clinicians to use their time in a way that is most valuable for patients.
Before considering AI applications that would be useful, consider where a human has a comparative advantage. Humans can intuit and empathize. Humans have 5 coordinated senses. Patients prefer humans.
In this context, the role of AI would be to complement humans by allowing them to do what they are good at, while assuring that needs are identified and addressed, and to improve patient outcomes – all in a reasonable workday.
There are three key ways in which AI can be leveraged to empower physicians and improve patient outcomes.
Rapid access to up-to-date recommendations relevant to the patient at hand
One of the most valuable applications of AI in healthcare is its ability to serve as an intelligent, constantly updating reference tool. With the volume of new medical knowledge growing exponentially, it has become increasingly challenging for individual physicians to maintain comprehensive, real-time familiarity with best practices and the latest treatment modalities.
Consider the example of a primary care physician seeing a patient who noticed a nodule in their neck. The clinician palpates the thyroid and confirms the presence of a nodule. But what’s the current evidence-based recommendations? They go to “Up to Date” – a wonderful resource from the American College of Physicians – which bounces the doctor through multiple hyperlinked entries. After 15 minutes, the doctor is indeed “up to date” but that was a poor use of patient contact time. Not to mention that unlike a lawyer, the doctor can’t charge by the quarter hour for research. Here an AI tool that could perform the task with a single query and the doctor can do a more in-depth search in time set aside for education (and they can get continuing medical education credits to boot.)
Streamlining Administrative Tasks
Physicians often find themselves burdened by a range of administrative responsibilities that do not directly contribute to patient care, such as documentation, order entry, and prior authorization processes. While these tasks are necessary, they can detract from the time available for meaningful interactions with patients.
AI can be leveraged to automate many of these repetitive, time-consuming administrative functions. By offloading these responsibilities to intelligent software systems, physicians can reclaim valuable time to focus on personalized care delivery, patient education, and care coordination. This has the potential to improve both physician and patient satisfaction, as the clinical encounter can be centered on the unique needs and concerns of the individual.
A prime example of this type of AI-driven administrative automation is the use of natural language processing (NLP) to streamline clinical documentation. Rather than manually typing notes, physicians could simply dictate their observations and recommendations, with the AI system automatically translating the audio into a formatted, structured clinical note. This not only saves time, but also ensures greater accuracy and completeness of the medical record.
Similarly, AI can be leveraged to handle the bane of existence in a doctors life (at least in the US), complex prior authorization process, which requires physicians to obtain approval from insurance providers before prescribing certain medications or ordering specific tests or procedures. An AI system could autonomously interface with payer portals, submit the necessary documentation, and track the status of authorization requests. This would spare the physician from having to navigate these bureaucratic hurdles, freeing them up to focus on direct patient care.
Ensuring Comprehensive, Holistic Care
Even the most diligent and experienced physicians can sometimes overlook or fail to fully consider important details about a patient's overall health and social circumstances. The fast pace of a typical clinic visit, combined with the sheer volume of information that must be processed, makes it easy for crucial contextual factors to slip through the cracks.
AI systems could ask a limited number of focused questions to identify flags needing further discussion. Or perhaps, with their ability to rapidly synthesize large amounts of data, can help ensure that the full scope of a patient's needs are identified and addressed. By drawing from the patient's complete medical record, as well as other relevant sources, an AI assistant could surface important details that the physician may have missed - such as medication interactions, social determinants of health, or psychosocial barriers to care. This would support a more holistic, patient-centered approach to treatment planning and care management.
Consider a hypothetical scenario where an elderly patient visits their primary care physician for a routine checkup. During the visit, the physician notes that the patient's blood pressure is elevated and adjusts their medication accordingly. However, an AI system integrated into the electronic health records detects multiple providers prescribing additional and potentially conflicting medications. The doctor asks how the patient is able to coordinate across all these providers and learns that the patient has recently experienced a significant life event, such as the loss of a spouse. The physician can now spend the time saved from research, note writing, and calls to insurers to explore ways to coordinate amongst providers, and to identify strategies to support the patient through their stressful loss.
Can AI use the electronic health record to ensure that the patient's full range of health and social needs are identified and addressed, beyond the immediate presenting concerns? Until we have better electronic records, this is likely a “no”.
The Impact of AI on the Future of Healthcare
Ultimately, the strategic integration of AI into the healthcare system has the potential to empower physicians, enhance the patient experience, and drive improved outcomes. Rather than fearing AI as a replacement for human clinicians, we should embrace those applications that augment and support the tireless efforts of those on the frontlines of medicine.
As AI continues to advance, applications in healthcare should be considered if they are demonstrably valuable. One can envision a future where clinicians are seamlessly supported by intelligent software assistants that handle the administrative burden, provide real-time access to the latest medical knowledge, and surface critical insights to inform personalized care plans.
This AI-powered approach could yield a wide range of benefits, including:
Improved clinical decision-making and patient safety, by ensuring adherence to evidence-based guidelines and catching potential errors or oversights
Enhanced patient engagement and satisfaction, as physicians can devote more time to listening, educating, and collaborating with their patients
Better care coordination and continuity, as AI systems maintain a comprehensive, longitudinal understanding of each patient's health status and needs
Reduced clinician burnout, by alleviating the administrative workload and cognitive burden that often contribute to stress and job dissatisfaction among healthcare providers
Of course, the successful integration of AI in healthcare will require careful consideration of important issues such as data privacy, algorithmic bias, and the appropriate role of human oversight. But when implemented thoughtfully and with robust safeguards in place, the potential benefits of AI-augmented care could be immense.
Rather than fearing AI as a replacement for human clinicians, we should embrace it to the extent it elevates the practice of medicine. This means that there must be a strong form of governance over the introduction of new applications that indeed ensure that every patient encounter is grounded in the latest knowledge, tailored to individual needs, and focused on delivering the highest standard of compassionate, holistic care.
