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15 Aug 2019

 

BY DR RODERICK MCRAE, CHAIR, AMA COUNCIL OF PUBLIC HOSPITAL DOCTORS

Every day may appear the same as the last in the public hospital system, but technology does alter. The equivalent of changes to your first clunky mobile telephone to the mobile computer/camera currently in your pocket yet more powerful than that which brought the astronauts back from the moon 50 years ago is occurring across the medical crafts.

Through your AMA Council of Public Hospital Doctors (AMACPHD), combined with the contribution of your AMA Council of General Practice, we will be developing our position on the transformational implications of Artificial Intelligence (AI), new technology(s) and robotic machines for the AMA Federal Council endorsement along with our recommendations about AI etcetera’s implications for doctors’ practice of hands-on medicine and the structure of doctors’ workplaces. This contemporary AMA response will emphasise that AI etcetera is always an adjunct to human decision making and goals and provide guidance to the medical workforce and employing organisations about work implications that the changes are likely to bring.

The AMA National Conference May 25, 2019 session Artificial Intelligence in Health Care considered the reality of AI and related technologies. I was persuaded that there are virtually limitless effects coming our way, all of which are mighty expensive, so I don’t know when they will arrive. At the very least, AI at some point will change clinical decision-making processes, and disease detection, and will “mainstream IT” and machines for surgery assistance, precision medicines development, and remote patient monitoring. Even health administrative and management systems will not escape the reach of change in specific areas of, for example, patient triage, workforce planning and resource allocation. The activities of public health will also be facilitated to become 24/7 (potentially with greater efficiency, accuracy and cost-effectiveness but watch out for the associated terms and conditions employers may want to unfairly press onto us).

To paraphrase one of our AMACPHD members, following debate on these matters during our 15 July 2019 meeting, four thoughtful fundamentals of which the profession must take heed were conveyed: 
  • be alert – new technologies are coming, will affect your life, and will be disruptive;
  • be cautious – new technologies aren’t always successful, don’t always deliver as promised and may actually (and expensively) fail;
  • be optimistically sceptical – ensure that your workload and importantly that of others actually reduces and doesn’t increase; and
  • be guarded – that new technologies do not impinge on doctors’ privacy or time off.

Now in its third iteration, sadly changing more slowly than some technological changes themselves, the AMACPHD policy document we are working to finalise (with AMACGP assistance) aims to frame the AMA’s values about human aspects of care not being degraded and professional autonomy, clinical independence, career paths and training models not being undermined. 

Also, from a medical workplace perspective, we aim to highlight the importance of all of us being upskilled to integrate and use new technology for our patients’ and our own benefit, and concurrently ensure we are properly engaged by decision-makers about the sensible and safe implementation, integration and appropriateness of AI etcetera. Also, key are Members’ industrial rights and conditions that fairly remunerate new ways of working, ensure we are involved in employer-led change and protect us against de-skilling, fatigue and exploitation. 

The introduction of new technologies will likely change the way all medical practitioners interact with patients, how we undertake clinical assessments and make therapeutic or diagnostic recommendations, conduct certain treatments and procedures, manage administrative tasks, deliver health services and more. 

Your AMACPHD, along with you, the Member, are being asked to grapple with very rapid advancements that produce cumulative effects and unpredictable change.  So, while there are many perceivable potential benefits of such change, I am all too conscious of the many pitfalls we must identify early and resist.  In response, our finalised AMA position statement will need to be comprehensive but simultaneously nimble; perhaps a perfect job for AI to help design.


Published: 15 Aug 2019