Theoretical Medicine and Bioethics

, Volume 39, Issue 2, pp 91–110 | Cite as

Against the iDoctor: why artificial intelligence should not replace physician judgment

  • Kyle E. KarchesEmail author


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.


Technology Artificial intelligence Electronic health records Physician judgment 


  1. 1.
    Parikh, Ravi B., Meetali Kakad, and David W. Bates. 2016. Integrating predictive analytics into high-value care: The dawn of precision delivery. Journal of the American Medical Association 315: 651–652.CrossRefGoogle Scholar
  2. 2.
    Weisberg, Jacob. 2016. We are hopelessly hooked. New York Review of Books.
  3. 3.
    Turkle, Sherry. 2015. Reclaiming conversation: The power of talk in a digital age. New York: Penguin.Google Scholar
  4. 4.
    Dreyfus, Hubert L. 1992. What computers still can’t do: A critique of artificial reason. Cambridge: MIT Press.Google Scholar
  5. 5.
    Heidegger, Martin. 1993. The question concerning technology. In Basic writings, rev. ed, ed. David Farrell Krell, 307–341. San Francisco: HarperCollins.Google Scholar
  6. 6.
    Polanyi, Michael. 1958. Personal knowledge: Towards a post-critical philosophy. Chicago: University of Chicago Press.Google Scholar
  7. 7.
    Borgmann, Albert. 1984. Technology and the character of contemporary life: A philosophical inquiry. Chicago: University of Chicago Press.Google Scholar
  8. 8.
    Heidegger, Martin. 1991. Nietzsche, Vol. 1: The will to power as art; Vol. 2: The eternal recurrence of the same. Trans. David Farrell Krell. San Francisco: HarperCollins.Google Scholar
  9. 9.
    Heidegger, Martin. 1991. Nietzsche, Vol. 3: The will to power as knowledge and as metaphysics; Vol. 4: Nihilism. Trans. David Farrell Krell. San Francisco: HarperCollins.Google Scholar
  10. 10.
    Thomson, Iain D. 2005. Heidegger on ontotheology: Technology and the politics of education. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  11. 11.
    Feenberg, Andrew. 1999. Questioning technology. New York: Routledge.Google Scholar
  12. 12.
    Heidegger, Martin. 1993. On the essence of truth. Trans. John Sallis. In Basic writings, rev. ed, ed. David Farrell Krell, 111–138. San Francisco: HarperCollins.Google Scholar
  13. 13.
    Verbeek, Peter-Paul. 2011. Moralizing technology: Understanding and designing the morality of things. Chicago: University of Chicago Press.CrossRefGoogle Scholar
  14. 14.
    Chi, Jeffrey, Maja Artandi, John Kugler, Errol Ozdalga, Poonam Hosamani, Elizabeth Koehler, Lars Osterberg, et al. 2016. The five-minute moment. American Journal of Medicine 129: 792–795.CrossRefGoogle Scholar
  15. 15.
    Dexheimer, Judith W., Thomas R. Talbot, David L. Sanders, S. Trent Rosenbloom, and Dominik Aronsky. 2008. Prompting clinicians about preventive care measures: A systematic review of randomized controlled trials. Journal of the American Medical Informatics Association 15: 311–320.CrossRefGoogle Scholar
  16. 16.
    Goitein, Lara. 2015. Training young doctors: The current crisis. New York Review of Books.
  17. 17.
    Caplan, Arthur L. 2016. Physician burnout is a public health crisis, ethicist says. Medscape.
  18. 18.
    MacIntyre, Alasdair. 1984. After virtue: A study in moral theology, 2nd ed. Notre Dame: University of Notre Dame Press.Google Scholar
  19. 19.
    Brenner, Hermann, Christian Stock, and Michael Hoffmeister. 2014. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: Systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ 348: g2467.CrossRefGoogle Scholar
  20. 20.
    Bourdieu, Pierre. 1977. The objective limits of objectivism. In Outline of a theory of practice, 1–71. Trans. Richard Nice. Cambridge: Cambridge University Press.Google Scholar
  21. 21.
    Searle, John R. 1979. Metaphor. In Expression and meaning: Studies in the theory of speech acts, 76–116. Cambridge: Cambridge University Press.Google Scholar
  22. 22.
    Lenat, Douglas B., and Edward A. Feigenbaum. 1991. On the thresholds of knowledge. Artificial Intelligence 47: 250–285.CrossRefGoogle Scholar
  23. 23.
    Merleau-Ponty, Maurice. 1962. Phenomenology of perception. Trans. Colin Smith. London: Routledge and Kegan Paul.Google Scholar
  24. 24.
  25. 25.
    Norman, G.R. 1988. Problem-solving skills, solving problems and problem-based learning. Medical Education 22: 279–286.CrossRefGoogle Scholar
  26. 26.
    Brody, Howard. 2012. On talking and touching in medicine. Journal of Pain and Palliative Care Pharmacotherapy 26: 165–166.CrossRefGoogle Scholar
  27. 27.
  28. 28.
    MacIntyre, Alasdair. 1999. Dependent rational animals: Why human beings need the virtues. Chicago: Open Court.Google Scholar
  29. 29.
    Lake, Christina Bieber. 2013. Prophets of the posthuman: American fiction, biotechnology, and the ethics of personhood. Notre Dame: University of Notre Dame Press.Google Scholar
  30. 30.
    Reich, Warren Thomas. 1996. A new era for bioethics: The search for meaning in moral experience. In Religion and medical ethics: Looking back, looking forward, ed. Allen Verhey, 96–115. Grand Rapids: Eerdmans.Google Scholar
  31. 31.
    Hauerwas, Stanley. 1990. God, medicine, and suffering. Grand Rapids: Eerdmans.Google Scholar
  32. 32.
    Heidegger, Martin. 1976. Only a god can save us: Der Spiegel’s interview with Martin Heidegger. Trans. Maria P. Alter and John D. Caputo. Philosophy Today 20: 267–28Google Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineSaint Louis University HospitalSaint LouisUSA

Personalised recommendations