Artificial intelligence and the future of healthcare

Article by Linda Lombi, Eleonora Rossero and Nicolò Amore

Greater accuracy and timeliness of diagnosis, more personalized care, development of preventive medicine, less invasive interventions: these are just some of the aspects that will characterize the healthcare of the future thanks to the increasingly widespread use of artificial intelligence (AI) and machine learning systems. While these are the consequences described in the literature at the clinical level, it has not yet been clarified what the impact of these systems will be on the work of health professionals, on the one hand, and on the doctor-patient relationship, on the other. To fill this gap, a joint research project involving Università Cattolica del Sacro Cuore (project "Public functions/private powers. Interdisciplinary profiles on governance without government in the algorithmic society", coordinated by Professor Gabriele Della Morte) and the Laboratory of Fundamental Rights of the Collegio Carlo Alberto, in collaboration with the Department of Cultures, Politics and Society of the University of Turin (heads Vladimiro Zagrebelsky and Professor Mario Cardano).

The study, conducted through the administration of 34 interviews with healthcare professionals and patients, focused on two clinical areas particularly affected by digital transformation: radiology and robotic surgery. The preliminary results of the research highlight some interesting aspects, such as those related to the issue of autonomy and professional responsibility: "The studies that explore collective representations on the subject of AI," says Linda Lombi, sociologist of health and member of the research team for the Catholic University group, "highlight a widespread fear of the risk that algorithms and artificial intelligence devices replace workers. However, in the medical field, the health professionals interviewed recognized artificial intelligence systems applied to healthcare as valuable allies for clinical practice, capable of improving clinical outcomes and workflows, without however making the doctor's work obsolete."

In the first instance, this depends on the fact that even where AI systems are used, the responsibility for the clinical decision or the outcomes of a surgical intervention remains with the professional: "Reasoning on the basis of the 'smart' medical devices currently used or in the experimental phase, in fact, the doctor still maintains a good level of control over the outputs of the machine - argues Nicolò Amore, criminal lawyer and member of the research group of the Laboratory of Fundamental Rights - however, it is already necessary to rethink training courses, management models and regulatory tools to manage the advent of AI-medicine more efficiently, also with a view to averting risks of hyper-responsibility of the health care provider and consequent, pernicious, defensive medicine".

However, AI is destined to profoundly change clinical practice, especially with respect to the possibility of reducing – once the use of new technologies has become familiar with the use of new technologies – the working time allocated to routine activities or the organization of work. Time that could be dedicated to clinical research and communication with the patient who today is increasingly contracted, with very negative consequences on the relationship between professional and patient. "Both the specialists and the patients involved in the study," observes Eleonora Rossero, a health sociologist within the Laboratory of Fundamental Rights project, "recognize the doctor-patient relationship as an essential element of care, even in the case of technologically dense treatments such as those carried out in robotic surgery. Trust in the human professional, which is structured through the relationship with the specialist and his team, is as important as trust in the opportunities that the most advanced technology can offer."

In light of the imminent if not already observable changes that will occur in clinical practice, the need to understand the consequences of the introduction of new technological actors at the micro level (the therapeutic relationship), meso (professional boundaries) and macro (the evolution of the health system and the legal system, national and international, in terms of AI) appears more current and urgent than ever.