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This very interesting article by Gordon Shiff elegantly lays out a lament for primary care and for that matter the primacy of cognitive clinical medicine. It is a truism AI is a tsunami throughout the world’s economies and it is no surprise clinical medicine will be effected as well. However the changing industries incorporating robotics and other forms of AI raises the specter of impacts on workers and the type work they will do in the new economy. The value of AI as a vast marketing tool for social media, support for automation of repetitive tasks, causes concern that AI will have the same function on clinical person centered medicine. Here clinical medicine diverges from potential for automation at the person level unlike automation appropriate at industrial scale. AI unchecked at the person level will force the industrialization of clinical medicine. This is the source of Dr. Schiff’s lament as he witnesses how AI has impacted the cognitive practice of younger colleagues in training through the vehicle of AI enhanced electronic medical record.

The role of AI in our society is under intense debate about the spectrum of potential benefits and harm. The harm succinctly put happens when machines talk to machines without the input of humans; the benefit comes from structurally organizing vast amounts of information beyond the capabilities of humans to understand for purposes of operational efficiency in healthcare social and industrial processes. Uniquely known inputs may or may not be within the realm of machines but are within the realm of clinicians. Day to day features of clinical medicine such as wisdom, experience, patient preferences and other features of an endless list cannot be reduced to data points, and are therefore unseen when training sets are created for AI applications. Human intelligence can do discovery of unknown patterns, provide judgments under conditions of uncertainty, and build novel relationships among humans as collaborative entities. There are many human qualities that resist pattern making by machines, but this is not to say  algorithms cannot do a reasonable job of presenting data to humans functioning as communities of knowers to add the human dimension to AI output.