Antoni Sisó is a general practitioner and the chairman of CAMFiC, the Catalan Society of Family and Community Medicine
Antoni Sisó is a general practitioner and the chairman of CAMFiC, the Catalan Society of Family and Community Medicine. He will be one of the participants at the 10th International Conference on Digital Health, organized by the Salud Digital Association (ASD) and the Signo Foundation, to take place from 11 to 15 September. The Universitat Oberta de Catalunya (UOC), through its eHealth Center, will host the conference on the 12th. There, Sisó will join other speakers in a round table on the impact of generative artificial intelligence (AI) on health promotion. In this interview, he discusses some of the present and future impacts of AI on primary healthcare.
The artificial intelligence debate has been heating up recently. What are the implications of AI in medicine, and more specifically in health promotion? Is the outlook one of concern or one of enthusiasm about the benefits?
An equal mix of both. AI's impact on health promotion has been significant and will only continue to grow. Some see only benefits: early detection and improved diagnosis, personalized treatments, decision support and patient monitoring. Others see only concerns: data privacy and security, misdiagnosis and unreliability, technology dependence and inequalities in access to technology, especially for the most vulnerable. The challenge will be to strike the right balance, but we will get there. Europeans are (unfortunately) not known for creating: the US does that. We're not known for manufacturing or development either (the Chinese and Indians do that). But we are very good at legislation, good practice and ethical reflection. We will reach that balance.
What AI applications have already been implemented in primary healthcare that patients may not be aware of?
There are quite a few, including:
● Diagnostic support. AI systems have been developed to help diagnose common diseases and disorders, such as skin conditions (dermatoscopy), eye conditions and specific symptoms. These systems can analyse photos, as they do with CAT scans and ultrasounds, and make suggestions to doctors to aid in the diagnostic process.
● Online triage platforms. Virtual assistants have been created to ask patients about their symptoms and provide initial guidance on the type of medical care that may be best for their condition. This could help reduce the burden on A&E departments and provide patients with more effective care.
● Chronic disease management. AI applications and systems have been developed to remotely monitor patients with chronic conditions, such as diabetes or cardiovascular disease. These systems can monitor a patient's vital signs and alert doctors if they detect changes that require immediate medical attention.
● Treatment recommendations. AI systems have been created to analyse a patient's profile and clinical data to deliver personalized treatment recommendations. This can help doctors to make more informed decisions about treatment.
● Health tracking. Wearable, AI-connected devices have been developed to track patient health data, including heart rate, blood pressure and physical activity. This information can be shared with doctors to more closely monitor a patient's health.
Of particular note and benefit are devices that allow remote monitoring of the frail population, such as those living in nursing homes or patients on home care programmes.
Dr ChatGPT: a present reality or a possibility of the distant future? Either way, what risks does it pose? If the doctor-patient relationship requires a more human component and knowledge of the person, how can we become familiar with an AI-powered doctor?
Breakthroughs in medical artificial intelligence have been impressive, and there are projects and research initiatives under way to develop AI-driven healthcare systems that could assist medical professionals in future clinical applications. But I think there are still some important issues to consider:
● Accuracy and safety. AI accuracy is crucial in the healthcare field. AI systems need to be highly reliable and validated through extensive clinical trials before being used in real-world medical settings. Misdiagnoses or mistreatments could have serious consequences for patients.
● Ethics and privacy. The use of AI in medicine raises ethical questions about whom should be held responsible for mistakes, how to protect patient privacy, and how to ensure informed consent for the use of medical data.
● Communication with patients. AI systems lack empathy and emotional understanding, both of which are important in the doctor-patient relationship. When dealing with an AI system, a balance must be struck to ensure that patients receive clear and understandable information and have their emotional needs met.
● Training and supervision of medical professionals. The introduction of AI into medical practice may require healthcare professionals to undergo proper training in the safe and effective use of these tools.
As a general rule, if an AI-derived medical component were to be involved in patient interaction in the future, these issues would absolutely need to be addressed in order to ensure safe, high-quality medical care. However, it is worth noting that even with advances in technology and AI, the human doctor-patient relationship is unlikely to be replaced completely, as it has a human, emotional and personal dimension that is difficult for AI to replicate. Perhaps the future will see us integrating medical technology and human interaction to achieve the best outcomes for patients.
How do medical professionals view the integration of AI in their field?
From a distance in many cases, and from opposing sides among those in the know. Some see it as an area of opportunity and optimism for higher-quality medical care and more efficient diagnosis and treatment. The ability to analyse large amounts of clinical data can provide valuable information. Meanwhile, others are concerned about accuracy and reliability. There is a fear that technology could make mistakes and harm patients if decisions are not overseen. Some have negative views about the impact on the doctor-patient relationship, believing that the overuse of AI will disrupt this relationship and eclipse the importance of the human side of medical practice. Privacy and security of patient data is a particular concern when it comes to using AI in healthcare: we as doctors want to ensure that patient data are protected and used ethically.
Could over-regulation of AI limit the further development of initiatives that may benefit fields such as healthcare?
The way I see it, yes. Over-regulation can lead to red tape and costly requirements that hinder or slow down research and innovation in this area. So it will be a question of striking the right balance, taking into account all voices and opinions: the public, policymakers, and scientific and professional organizations.
Research into how AI can improve the lives of patients and the work of medical professionals is important. Is this research being taken up adequately or is there a need to step up efforts?
AI research has focused on improving diagnostic processes, personalizing medicine and optimizing care processes. In addition, the availability of medical data from large databases, with access to electronic medical records, medical images, biometric signals and so on, has made it possible to train AI algorithms. It would be a good idea to open up public calls for specific research and innovation focused on improving accuracy, interpreting results, protecting patient privacy, and integrating AI into clinical practice in a safe and ethical way.
Is AI the type of resource that will allow us to redistribute public health budgets in some way? In other words, will it lead to savings in one area so that more resources can be allocated elsewhere?
Absolutely. One of the immediate benefits I've seen is that it helps to reduce healthcare professionals' repetitive workload, allowing them to focus on more complex, higher value-added tasks. This also applies to administrative tasks, such as scheduling appointments and managing patient flow. However, I don't believe that AI can replace traditional medical care completely. The combination of technology and human interaction is key to providing patients with comprehensive and compassionate care.
Speaking as its chairman, how does CAMFiC view AI? What new AI-related knowledge do medical professionals need? Does AI pose a challenge for them?
AI matters to us because general practitioners need to stay in touch with everything that's going on in society. They need to do this in order to better understand the people they treat in today's rapidly changing social environment. CAMFiC sees it as an opportunity and has organized itself around it, setting up a specific working group of professionals who are highly interested and motivated to advance in the field of AI. CAMFiC is the largest scientific society in Catalonia, with close to 4,900 members and 53 working groups. Many of the working groups are taking a cross-disciplinary approach to AI. However, we have also set up a digital health working group to improve knowledge resources by producing content, support material for healthcare professionals and quick reference guides that go well beyond AI.
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