Physician of the future

Regardless of how far into the future one goes to imagine a medical clinic, it seems to me that there will always be a need for a physician behind it all. Someone to show their face to the patient, someone to physically assess, someone to ensure that the art of medicine is not completely lost to an algorithm. When I think about the most rewarding aspect of my job, it is always in the moments when I get to connect with a patient on a personal and emotional level. Unfortunately, as the demand for physician work continues to increase, and and new technology, AI capabilities and superb clinical advancements are introduced to make clinics more efficient, I fear that the emphasis on the human aspect of medicine is forcefully relegated to the back burner of our minds.I don’t often get to know my patients very well beyond their challenges with fertility. Interestingly, it’s usually the patients with the longer, more difficult, often heartbreaking situations whom I get to know the best. Although our followup appointments are filled with disappointment and frustration about another failure or uncertain next step, the minutiae of those appointments include hard emotions, vulnerability, compassion and a sharing of ourselves that goes beyond the scope of their infertility. It’s with these patients that one truly gets to experience the honour and rewards of being someone’s physician.Alex (not her real name) wasn’t my patient, but it happened I was on duty every time she came in. I liked her and as I got to know her more, I felt strongly that if we had met under different circumstances, we might have been friends. Once, early on in her journey through our clinic, she even told me that she admired me, being so young, accomplished, kind, with three kids and obviously time to exercise. I remember trying to feel flattered only to hear myself say, “If you knew what was really going on in my life, you wouldn’t think that.”On this particular day, almost a year after she started seeing us, she was coming in for an early obstetrical scan to confirm the location and viability of a pregnancy she achieved after months of failed embryo transfers and miscarriages. I knew—we all knew—that this appointment was not going to be easy for her. I felt for her; deeply. I also felt for myself, worrying that the scan had to be good because she deserved it so completely, but also because I didn’t think I had the mental and emotional reserve to break bad news and sit with her in such a moment.Alex showed up that morning with her mom, when usually she comes alone. The moment she stepped into the clinic, she broke down, as if she was able to ignore reality as long as she was outside the walls of the fertility clinic. In her panic-laden anxiety, we brought her into the ultrasound room and before she sat down on the bed she said to me, “I know this is going to be bad. I know I am not pregnant.”Her mother tried to comfort her, reassured her that she could be wrong and to wait for the doctor to do the ultrasound. But Alex got onto the bed, opened her legs and put her head straight back toward the ceiling, not able to look at the screen in front of her. It doesn’t take me more than a few seconds to know if an early pregnancy looks as it should, and it’s only a couple more seconds after that when my heart responds to the images and begins processing the emotions of how I will handle the next steps. I took the ultrasound probe away without saying a word and Alex slowly let her legs close as she crumpled into herself and cried.I touched her bare feet and invited them out of the stirrups and onto my lap in front of her and we sat like this for some time. Her mother began to ask me questions, like how I could possibly know in such a short time, and how could I be sure, and don’t I think I should look again to be sure. I told her that when Alex was ready, I would answer all of those questions for them.When she was ready, she gave me permission to look again and this time she was watching the screen with me. I completed the ultrasound properly this time, checking all the boxes of the early pregnancy scan checklist, making the appropriate measurements, and formulating the words for the next part of the conversation. When I was done, she asked me: “What do I do next? Dr. Mills, I need you to be honest with me.”It’s easy in these moments to revert back to the safety and comfort of the clinical world of medicine. I often (rightfully) reference the guidelines for diagnosis of a non-viable early pregnancy for the patient and explain that in almost all situations, it’s usually best to repeat the ultrasound in a week to ensure we are 100% certain. I started telling Alex this same safe, clinical, logical approach to her situation. But she cut me off.“Dr. Mills, I don’t want to hear about the guidelines or the recommendations. I want to hear what you believe is the truth—based on your knowledge, your experience, and your honesty. I know you’re going to tell me to come back in a week just to be sure. But I am already sure, and I need to know if you are sure, too.”“Alex,” I started, “I can never presume to be 100% certain about these things. I can tell you that based on everything I know about this situation, I am not optimistic that waiting a week will change anything. While I cannot tell you what to do, I will support whatever it is that you need in this moment.” Alex’s mom cut me off to ask how I could take away any hope she possibly had of this pregnancy working, and I replied that her daughter did not ask me for hope—she asked me for honesty, and that’s what I was giving her.I never saw Alex in the clinic again after that day. It’s been many months now and I am no longer part of her medical care team. Because we live in a small community and are part of a similar age and socioeconomic demographic, I happened upon her in a non-clinical setting. I reached out to her privately in that moment and let her know that I think of her often. We chatted about life and she told me about her pause from fertility and her decision to take a step back from everything for a while. I told her that I find her to be inspiring, that I would have loved to know her under other circumstances and that I would love to stay connected if she felt comfortable.The shock on her face was quickly overcome with gratitude as she said: “I was such a trainwreck whenever I saw you. I’m not sure how any of that can be inspiring to you or how you would still want to be my friend knowing who I really am.”“Alex, you are inspiring to me because of your humanness—I got to see the best parts and the worst parts of you, and together they make a very remarkable person.”As I said these words to her, I was reminded of my reaction to her being inspired by me and I realized that I am also not only defined by what people see on the outside, but also by those parts that make me human. And, it is this aspect of being a physician that makes it worth it for me every time.While the future of medicine is full of new technology, advances in science and AI integration to help us become more efficient and offer better clinical care, I have yet to see a technological advance that will be able to adequately replace the human side of medicine. I welcome technology that is meant to make our lives as physicians easier so that we can experience less burnout while still offering excellent patient care. However, we should be cautious about conflating “excellent patient care” with “technological offerings.” We can’t forget that the clinic of the future will still require a human physician who, because of their tech support, can have better capacity to sit with patients in their humanity.