To Operate or Not? Balancing Advanced Imaging, Machine Learning, and the Doctor–Patient Relationship in Complex Clinical Decision Making

Abstract

Advances in high-resolution, cross-sectional imaging have changed the practice of medicine. These innovations have clearly benefited patient care yet have also led to a decreased dependence on the art of medicine, with its emphasis on obtaining a thoughtful history and thorough physical examination to elicit the same diagnosis that imaging provides. What remains to be determined is how physicians can balance these technological advances with their own ability to use clinical experience and judgment. This can be seen not only with the use of high-level imaging but also with the increasing use of machine-learning models throughout medicine. The authors contend that these should be seen not as a replacement for the physician, but as another tool in their arsenal in determining management decisions. These issues are salient for surgeons, who, given the serious undertaking required to operate on a person, must develop trust-based relationship with their patients. Navigating this new field brings with it several ethical conundrums that must be addressed, with the final goal being to provide optimal patient care without sacrificing the human element involved, from either the physician or the patient. The authors examine these less-than-simple challenges, which will continue to develop as physicians use the increasing amount of machine-based knowledge available to them.