Paranoid or ….?
“It’s incredibly obvious, isn’t it? A foreign substance is introduced into our precious bodily fluids without the knowledge of the individual. Certainly, without any choice. That’s the way your hard-core Commie works.”
- Brig. General Jack D. Ripper, from “Dr. Strangelove”
Am I being paranoid? Certainly, every motivation fictional General Ripper suspected of the godless commies was true … but he did also use that knowledge as a rationale for Armageddon, which is bad.
Decades after physicians were effectively reduced from trusted counselors to a corporate commodity, it’s interesting that the anachronism of their once-trusted role is still maintained in the public imagination as a convenient way to keep them targeted and to heal (sic). My attitude wouldn’t get me a lot of speaking invitations at medical school graduations, but I think that every newly bullseye’d doctor should be paranoid as hell. To the traditional assailants of government, Big Insurance, Big Hospital, specialty boards, marrow-sucking carrion feeding malpractice lawyers, patients, and each other, we can now add … The Terminator.
Okay, not Skynet, not yet anyway, but AI may be coming for us quickly. In a professional class already conditioned to the dictates of protocols because of the above list, doctors will be easy pickings for a savvy insurance-AI cooperative that predicts what we should have seen, how it should have been treated, zaps us for any deviation, and then is used to market our extinction through the smartphone as a “doc in your pocket”: subscribe to the app, plug in your complaint, the answer spits out, scripts are called in, Blue Humana Permanente saves a ton on redundant doctor visits, and you get to figure out what sort of vitamins to market in the lobby to keep the lights turned on.
And worse still …
Twenty years ago, I was musing that when the technology allowed an individual to plug in his or her own likeness to a movie adaptation program, we could see ourselves star in classic movies (AI predicts that over 90% of dudes will watch themselves star in the coke-and-grenade launcher climax in “Scarface.”) For a society that is already seriously reality-impaired, this would be an entirely new sub-specialty for psychiatry. That day is knocking on the door according to The Federalist: “Deepfake Pornography Reveals Yet Another Risk Posed By Artificial Intelligence.” AI has now progressed to allowing creepy users to take the faces of public figures or personal friends, and graft them onto live action sex. The legal questions in the article ask whether this is truly a violation of an individual and how that may be specified, and if so, how it may be fought with “only a smattering of existing civil and criminal laws that may apply in very specific situations. If a victim’s face is pulled from a copyrighted photo, it’s possible to use IP law. And if the victim can prove the perpetrator’s intent to harm, it’s possible to use harassment law. But gathering such evidence is often impossible … leaving no legal remedies for the vast majority of cases.” Why should doctors care?
Because there is no way in hell that this stuff will remain confined to the obviously fake blue material. Patients and nosy family increasingly try to whip out the smartphones in the exam room. A few seconds of video, and they have an image that can be visually and audibly manipulated. Many years ago, in the ER, I stabilized a patient who had arrested and then sadly died in the ICU several days later. Everyone got sued, and the relatively small settlements paid out indicated the lack of malpractice. While in deposition, surviving family members entered completely fabricated statements that they swore had come from me, inventing stupid language that I would never have used, but crafted no doubt by their compassionate lawyer to fit the timeline of the case and the known medical facts. Is it really farfetched to think a plaintiff’s attorney might know a digital guy working on a cash basis to provide helpful video, photos, or phone conversation? Do we really think that grieving family members with dollar signs in their eyes wouldn’t gladly “remember” those pieces of evidence?
“In Italy, the AI chatbot company Replika … was initially developed to provide people with AI-simulated ‘friends’ they could banter with online…” Wouldn’t Big Insurance or CMS love to get their own version, far cheaper than buying TV ad time, to visit with patients via text, phone, or some disturbing Meta-type avatar, to cajole Uncle Zeke to take his pills and transmit his glucose readings to the collective? What if a mom’s digital “health buddy” kept reminding her of the discounted premiums she would enjoy if she gave in and got her kids every single new (ahem) vaccine recommended by CMS, and badgered her so much she gave in?
It seems like an increasingly valuable advantage of DPC would be the ability to run a practice with no digital connection to any third party. That wouldn’t eliminate all threat of malfeasance, but at least Big Government or Big Insurance couldn’t reverse the stream and monkey around with your records.
Okay, I know, I sound kinda out there with all this crazy speculation, and we can’t go through life being afraid of every little bug crossing the road. It’s not like the government or their crony corporations would ever use individuals to set up the uncooperative, or fabricate digital imagery to target a disfavored class. Forget I even mentioned it.
I bailed at age 77, having left full-time clinical academics in my 50s to start my own solo practice, which lasted until the economics of 3rd-party “reimbursement” made it a largely charitable hobby. Medicine is great and noble; medical organization and economics are a stench upon us.
Another reason to make my peace with age and retirement (2017.)
#envious
I left a couple of years ago and have not regretted it one iota. Used to be a fallacy in the much “olden” days that a Doc didn’t want to retire since they felt needed. That is loooooong gone now. The vast majority of primary care docs can’t wait to retire. My advice to them is get married later in life like early 30’s, have two kids and bail out of medicine as soon as one has enough money saved up. Only docs I know who might be better off are those who do office only practice but they limit their income production by not doing hospital or taking call (as long as they get call pay besides the production of on call H&P’s.)
There’s a saying in the computer industry, “Sure i’m paranoid; we all are; the question is, am I paranoid enough?”