Will AI Replace Your Doctor?人工智能会取代医生吗？

马克·西格尔/文　云天/译

Fear of lawsuits might intimidate doctors and cause them to avoid going against artificial intelligence recommendations for treatment， even if their judgment tells them to do so.

出于对官司的恐惧，医生可能被迫接受人工智能的治疗建议，即便他们的判断与人工智能的相悖。

Artificial intelligence can be a useful scientific tool， but it also could threaten a doctor’s essential role.

人工智能可以是一个实用的科学工具，但它也可能威胁到一名医生的关键职责。

Medical school provided a similar kind of intelligence for me in that my brain was bombarded with a billion factoids1， which laid a tapestry2of information. Buried in my unconscious mind was the minutiae3 of nephrology， which I could bring to bear4 when I had a sick kidney patient， or the physiology of a failing heart when my patient’s lungs filled with fluid.

醫学院赋予了我类似的智能，我的大脑中存储着十亿条医学事实陈述，它们编出一匹信息织锦。接诊肾病患者时，我可以调用埋藏在我潜意识中的肾脏病学小知识；遇到双肺充满积液的患者，我的头脑中又会出现有关心脏衰竭的生理学知识。

But the medical applications of computerized artificial intelligence are different. AI is based on a more precise pattern recognition5 from retinal analysis of diseases such as dia-betes or heart disease before it occurs， or even the kind of mutations of a glioma （one of the worst kinds of brain tumors） while surgery is still going on.

计算机化人工智能在医疗领域的应用却有所不同。人工智能基于一种更精确的模式识别技术。这种技术可以通过视网膜分析，在糖尿病、心脏病等疾病发生前识别出疾病，甚至还可以在手术过程中识别出神经胶质瘤（最严重的脑部肿瘤之一）的突变类型。

Recent studies also have examined pre-cancerous stem cells in the blood as well as other factors for AI to analyze that could help with diagnosis and treatment.

近来的研究还检验了血液中的癌前干细胞，以及其他可供人工智能分析的、有助于疾病诊疗的因素。

Nonetheless， what AI will always lack is my clinical judgment formed from years of experience， not to mention my empathy for my patients. Increasingly， AI threatens that.

尽管如此，人工智能始终缺乏我从多年行医经验中形成的临床判断力，更不可能拥有我对病人的同情心。人工智能对同情心构成的威胁甚至日益加剧。

Boundary between computer and doctor is easily blurred

计算机和医生之间的界限很容易模糊

You have only to look at a study published in Nature Biomedical Engin-eering that looked at intraoperative video monitoring to instruct surgeons to understand that the boundary between doctor and computer is too easily blurred in a way that could intimidate or even threaten a surgeon’s abilities.

《自然·生物医学工程》杂志上发表了一项关于术中视频监测技术指导外科医生进行手术的研究，你只需看看这项研究就会明白医生和计算机之间的界限太容易模糊，以至于计算机可能会胁迫医生，甚至有损医生的能力。

And what about malpractice risk？ If you are a radiologist， a dermatologist or a surgeon who decides to disagree with your AI feed， based on years of clinical judgment and experience， and you end up being proven wrong in retrospect6， what is to prevent your patient from suing you and using the AI recommendations as evidence？

那么，是否存在治疗失当的风险呢？如果你是一名放射科、皮肤科或外科医生，根据自己多年的临床判断和经验，决定拒绝采纳人工智能的建议。事后证明你判断有误，那么如何防止你的病人以人工智能的建议为证据起诉你呢？

This might well intimidate doctors from going against AI recommendations for treatment， even if their judgment tells them to do so.

这很可能会让医生不敢违背人工智能的治疗建议，即便他们的判断与人工智能的相悖。

Consider that AI， when applied to clinical medicine， can give you only general answers. It cannot know the nuances7 of your case or history.

人工智能应用于临床医学时，只能给医生普遍适用的答案——它不可能了解医生手中的病例或病史与其他的有何细微差别。

ChatGPT is a popular new AI bot that answers users’ questions. Patients already are using it for medical advice.

ChatGPT是一款很受欢迎的新型人工智能机器人，可以回答用户的问题。病人已经在向它寻求医疗建议了。

As Dr. Isaac Kohane， chair of the Department of Biomedical Informatics at Harvard， told The New England Journal of Medicine， “Now with these large language models like ChatGPT， you see patients going to and asking questions that they’ve wanted to ask their doctors—because， as is commonly the case， you forget things when you go to the doctor， perhaps because you’re stressed， and because， unfortunately， doctors don’t have that much time.”

正如哈佛大学生物医学信息学系主任艾萨克·科汉博士在接受《新英格兰医学杂志》的采访时所说，“现在有了像ChatGPT这样的大型语言模型，你会看到病人向这类语言模型询问原本想问医生的问题——因为，通常情况下，你去看医生时容易忘记要说的话，也许是因为你焦虑不安，也许是因为你很不幸地碰上医生没有那么多时间。”

I’m concerned about how patients will use advice from AI

我对患者将如何应用人工智能的建议感到担心

Kohane is excited about this advancement， but I am deeply concerned about it. While he is right that my availability in the office for face time with my patients is limited， especially because of electronic health records documentation requirements， the solution is definitely not after-visit consultations with artificial intelligence， which could easily provide information that misleads rather than helps a patient.

科漢为人工智能的进步感到兴奋，但我却对此深感忧虑。他说得没错，我在诊室与病人面对面交流的时间有限，特别是由于电子健康档案存在诸多要求，但解决方案绝对不是让病人在就诊后咨询人工智能，因为人工智能很容易提供误导而非帮助病人的信息。

In the same New England Journal of Medicine article， another AI expert， Dr. Maia Hightower， chief digital and technology officer at University of Chicago Medicine， pointed out the growing role of AI as an administrative tool in the opaque8 interface9 among doctors， patients and insurance companies.

在同一篇《新英格兰医学杂志》文章中，另一位人工智能专家、芝加哥大学医学中心首席数字和技术官马娅·海托华博士指出，在医生、患者和保险公司之间非透明的相互沟通中，人工智能作为一种管理工具的作用越来越大。

“So in order to communicate with payers， with our insurance companies， we’ll often have bots or automation that transfers information from the health system to the insurance company and back，” Hightower said. “In the case of insurance companies， we know that they often will use AI algorithms for prior authorization of procedures， whether or not to cover a particular medication or test. And in those cases， there isn’t much transparency on our side as a provider organization.”

“因此，为了与付款人和保险公司沟通，我们通常会使用机器人程序或自动化技术将信息从医疗系统传输到保险公司，然后再传回。”海托华说，“就保险公司而言，我们知道他们通常会使用人工智能算法来处理预授权程序，无论最终是否承保特定的药物或检查。在这些情况下，作为医疗服务提供者，我们这边的透明度并不高。”

As a practicing internist， I have a big problem with this and can envision a future where fights for insurance coverage become even more escalated than they are already—and where personalized medicine is replaced by algorithms. What’s to stop insurance companies from replacing me with a cheaper， more predictable AI robot， who practices some of the science but none of the art of medicine？

作为一名执业内科医生，我对此有很大的意见。我可以预见，未来有关承保范围的争斗将比现在更加激烈，个性化医疗将被算法所取代。有什么能阻止保险公司用一个更便宜、更可预测的人工智能机器人来取代我呢？这个机器人的确会进行一些科学实践，但它不懂医学的艺术。

At best， AI will be like the automatic pilot in a commercial jet. It can help fly the plane， but passengers still want a human pilot in the cockpit ready to take control when needed.

人工智能充其量就如商用飞机上的自动驾驶仪。这种仪器可以帮忙驾驶飞机，但乘客仍然希望驾驶舱内有一名人类飞行员，随时准备着在需要时控制飞机。

（译者为“《英语世界》杯”翻译大赛获奖者）

1 factoid仿真陈述（很可能不真实但使人信以为真）；（尤指有关不太重要事情的）有趣消息。  2 tapestry挂毯；织锦。  3 minutia微小的细节（复数minutiae）。  4 bring to bear應用，使用。

5 pattern recognition模式识别，指计算机根据特征、属性或结构，确定一个物体、行为或现象属于某个模式类别或模式个体的过程。一般分为数据获取、基元分析、特征抽取、对象分类和后续处理等步骤。

6 in retrospect回顾。  7 nuance细微差别。

8 opaque不透明的。   9 interface相互联系；相互作用。

Thought-Provoking Quotes About AI

Nobody phrases it this way， but I think that artificial intelligence is almost a humanities discipline. It is really an attempt to understand human intelligence and human cognition.

—Sebastian Thrun

As society and the problems that face it become more and more complex and machines become more and more intelligent， people will let machines make more of their decisions for them， simply because machine-made decisions will bring better results than man-made ones. Eventually a stage may be reached at which the decisions necessary to keep the system running will be so complex that human beings will be incapable of making them intelligently. At that stage the machines will be in effective control.

—Ted Kaczynski

It is customary to offer a grain of comfort， in the form of a statement that some peculiarly human characteristic could never be imitated by a machine. I cannot offer any such comfort， for I believe that no such bounds can be set.

—Alan Turing