Tell me and I forget, teach me and I may remember, involve me and I learn."
-Benjamin Franklin
Hi everyone,
I value artificial intelligence, while fearing the trap. On MICU rounds, I query OpenEvidence: Does Zosyn cover citrobacter? Not well. Should we treat fever? Nope. What can I try when midodrine fails? Atomoxetine! The answers come back faster than I can type the questions. But I worry about the unintended consequences of AI and other resources.
Modern medical resources are a godsend. Specialists abound. Nurses place IVs and titrate heparin and insulin. Pharmacists check drug levels, identify dangerous interactions, and nudge us to be better stewards. Technicians check blood sugars, measure vitals, and draw blood. MDCalc computes creatinine clearance, free water deficits, and FENas. Epic estimates GFR, calculates anion gaps, and shows abnormalities in red. Care Signature Pathways steer us to evidence-based treatments, and EMRs can write discharge summaries. What’s left for us to do?
I don’t doubt the merits of these resources. Our specialists are brilliant and nurses are lifesavers. Online calculators, best practice alerts, and data integration tools like eCart avert error and tragedy. Teamwork and technology make healthcare safer.
But over-reliance on resources creates a trap, particularly for trainees. Setting aside the specious claim that one day you might have to fend for yourself, practicing medicine on a desert island, the consequences are deep and insidious.
Resources are imperfect. AI hallucinates, confidently. Tools are only as good as the questions you ask and data you enter. Consultants are fallible and often focus on narrow questions rather than the whole patient, which is the primary team’s responsibility.
Procedural resources are also problematic. It’s great that you can always find someone to draw blood, perform a paracentesis, or place an IV, but asking others to do procedures pulls you away from the bedside and undermines the tactile, visceral, relational experience of practicing medicine.
College professors have raised concern about students using AI to write papers and take exams, which stifles learning. These concerns can be mitigated by emphasizing work in the classroom, where computers are locked out. But effective learning demands effort, and struggle.
Residents face similar temptations, given the abundance of tools and expertise available. Relying excessively on resources can make us passive bystanders and subvert learning, particularly when we’re tired, overwhelmed, and doubting ourselves. This is the resource trap.
So, how will you ensure rigorous learning despite the resources? If you are an intern, how much of your resident’s help will you take instead of developing your own skills? If you are a senior, can you resist completing your intern’s tasks in lieu of nurturing self-reliance? If you are a trainee at any level, can you hold off on asking attendings and consultants what they want to do and, instead, assert your own ideas (subject to feedback)? If you are an attending, can you prioritize intern and resident learning by asking probing questions instead of simply supplying answers?
Finally, can we all commit to “owning” core procedures for our own patients? Can we uphold the timeless value of reviewing and interpreting EKGs and images before reading the report? Can we resolve to unpack complex ABGs, calculate delta-deltas, and frame diagnostic and treatment plans before turning to online tools? And can we acknowledge that skipping to the bottom line on AI readouts is no substitute for mastering the literature?
We are blessed with an abundance of medical resources, but if we always choose the easier path—flat, well-paved, replete with shortcuts—we will be less prepared to succeed as independent internists. There are no easy paths on the road to independence; rather, the road is steep and littered with divots, rocks, and switchbacks. But since the dawn of residency training, this has been the only legitimate road to take.
Most of you already know it’s important to use resources as a tool and not as a crutch. So, take this note as a reminder that we face daily temptations to take the easy route, but that choice is a trap. There is no substitute for the work we do ourselves.
Enjoy your Sunday, everyone. I’m back from Europe and returning to the unit tomorrow for five days on MICU Blue. Today is catch up day, but first I’m heading out to the bike trail.
Mark
P.S. What I’m reading:
- I Knew My Writing Students Were Using AI. Their Confessions Led to a Powerful Teaching Moment By Micah Nathan
- Brown Professor Suspects Most of His Class Used AI to Cheat By Emma Whitford
- Stop Pathologizing Ordinary Life By Clay Routledge
- If You’re Over 40, You’re Ready to Use A.I. By Debbie Millman
- Can We Keep One Small Corner of America Technology Free? By J.R. Moehringer
- How We Speak Has Gotten Extravagant. Literally. By John McWhorter
- Christopher Nolan’s Trojan Horse By Ezra Klein