Karches Kyle E
Department of Internal Medicine, Saint Louis University Hospital, 3635 Vista Ave, Saint Louis, MO, 63110, USA.
Theor Med Bioeth. 2018 Apr;39(2):91-110. doi: 10.1007/s11017-018-9442-3.
Experts in medical informatics have argued for the incorporation of ever more machine-learning algorithms into medical care. As artificial intelligence (AI) research advances, such technologies raise the possibility of an "iDoctor," a machine theoretically capable of replacing the judgment of primary care physicians. In this article, I draw on Martin Heidegger's critique of technology to show how an algorithmic approach to medicine distorts the physician-patient relationship. Among other problems, AI cannot adapt guidelines according to the individual patient's needs. In response to the objection that AI could develop this capacity, I use Hubert Dreyfus's analysis of AI to argue that attention to the needs of each patient requires the physician to attune his or her perception to the patient's history and physical exam, an ability that seems uniquely human. Human physician judgment will remain better suited to the practice of primary care despite anticipated advances in AI technology.
医学信息学专家主张将越来越多的机器学习算法纳入医疗保健中。随着人工智能（AI）研究的推进，此类技术引发了“智能医生”的可能性，从理论上讲，这是一种能够取代初级保健医生判断力的机器。在本文中，我借鉴马丁·海德格尔对技术的批判，以展示医学的算法方法如何扭曲医患关系。除其他问题外，人工智能无法根据个体患者的需求调整指导方针。针对人工智能可以发展这种能力的反对意见，我运用休伯特·德雷福斯对人工智能的分析来论证，关注每个患者的需求要求医生使自己的感知与患者的病史和体格检查相协调，而这种能力似乎是人类独有的。尽管人工智能技术有望取得进展，但人类医生的判断力仍将更适合初级保健实践。
