Will machines take our work? – Part 1: Healthcare and unempathetic artificial intelligence

The Finnish population is getting older, which is creating pressures in the healthcare system. Robots have been envisioned as a potential means for alleviating the workload of nurses. But is artificial intelligence suited for nursing? Would you want a robot to steer your physiotherapy? Can a surgical robot perform as well as a surgeon?

It is generally thought that robots steered by artificial intelligence (AI) will replace people in increasingly complex work tasks. I personally examine the matter from the perspective of work research. On this basis, I can sense if some suggested technological development path appears difficult to implement. On the other hand, work research offers a good perspective on the development of technology, because it offers a medium for identifying the needs of employees, and the division of labour between a human and a machine.

In this article, in addition to healthcare, I touch upon the meaning of empathy in practical work. People have their own experience of what it means to be a human being, so they are capable of placing themselves in some other people’s position, in other words, considering a matter with his or her situation, perspective and feelings in mind. Almost all work tasks require some sense of empathy, since work almost always serves other people’s needs. In most professions, you work for either a customer or an employer, and generally in collaboration with others.

Artificial intelligence is good at playing games

How people act at work is largely based on the expectations of other people and their more or less emphatic understanding of other people’s points of view. Robot, on the other hand, executes rules programmed in it. In addition, a machine can be programmed to edit its own rules, or to learn. Provided with a massive amount of data, a learning AI may develop quite extensive skills within operating environments with clearly definable rules, causal connections and goals. An AI may be good at playing games, and it can be used, for example, for increasing the productivity of a social media marketing campaign.

Even though there are certain rules in healthcare, nursing is not strictly steered by rules, since the work requires situation-specific flexibility. Every patient has a different body, mind and precise clinical status. Therefore, also the way the patient is medicated, washed, operated on, massaged or nursed in general varies. It is not advisable to treat patients with a formal routine. Even though the work may appear as being routine, research shows that nursing includes continuous and discreet micro-level decision-making and adaptation of working methods. Besides on medical training, this decision-making is based on intuition and – as I at least assume – the personal experience of an empathetic care worker of what it means to be a human being.

In a greater degree than most other sectors, healthcare is characterised by uncertainty, since, at an individual level, the outcomes are difficult to predict. Patient’s recovery from, say, a surgical procedure always involves an element of chance, regardless of how well the operation went.

Empathy enhances the quality of treatment

Even though it is not advisable for a care worker to start feeling what the patient is feeling, a good employee acknowledges that the patient’s feelings are of importance with a view to recovery and the quality of treatment. Without empathy, it would be difficult to calm down a patient verbally or by touching.

As a rule, being incapable of empathy, AI is not well suited to replace humans in care work, since care work is difficult to model in the language of mathematics due to the complexity of the phenomena involved. Feelings, the bodily and verbal interaction between people, and intuitive patient-specific decision-making at micro level are phenomena that are difficult to measure and control.

The existing care robots perform simple tasks in hospital logistics, provide entertainment and activate patients. Toylike robots with slight resemblance to humans may act as physical trainers for patients. Research results seem to indicate that patients find robots more motivating and pleasant than exercise videos. Some robot-like intelligence may be programmed in physiotherapeutic devices, i.e., the exact form and challenge level of therapy can be automatically adapted to the patient’s performance. However, the ability of AI to provide personal advice or guidance to patients is very limited or non-existent. In other words, robots will not replace physiotherapists. Devices are not capable of providing hands-on guidance or making comprehensive analyses of patients.

The surgeon’s responsibility and the patient’s destiny

I have personally studied surgical work in particular. In surgical procedures, good experiences have been gained from automation performing certain limited and precisely defined parts of an operation. This takes place under the surgeon’s close control, and the robot has no responsibility whatsoever for the overall performance of the operation. Surgical robots are devices surgeons steer with their hands and feet. The operation is performed through tubes, and the surgical robot also provides a 3D view inside the patient’s body. Viewed through a robot’s eyes the world looks strange and peculiar; object recognition is a real challenge for a surgeon in such an environment. Further development of sensor technology could be of assistance in this matter.

If I personally end up under a surgeon’s robot one day, I would not want the operation to be performed by a superficially skilful surgeon who is in a way playing a computer game with my body. A surgeon follows a pre-agreed surgical plan, but changes are made as the situation requires, because the view of the patient’s clinical status may become more accurate or even change during surgery. Furthermore, a surgical procedure always involves a difficult conflict: the goal is to treat the patient, but surgery always causes some damage as well. For example, in a prostate surgery, the aim is usually to remove the prostate gland containing cancer cells from the body. If you remove too much tissue, the nerves and muscles important for erection and continence may suffer, but if you do not remove enough, cancer treatment does not work. A comprehensive understanding of the patient helps in the decision-making, when the surgeon needs to solve this conflict during the surgery – sometimes the patient may even be so old that it does not matter much whether he maintains his erectile function or not. It is difficult to draw a scientifically established direct connection between sense of empathy and surgical decision-making, but I would personally hope that the surgeon performing the operation would understand at a personal level how important sex and continence are.

Mikael Wahlström
Senior Scientist, PhD (Soc Psych)


The author has participated in various automation projects and analysed security-critical work, for example, as a head of the Academy of Finland project called WOBLE that studied the work of surgeons who use robotic systems. WOBLE was funded by the Finnish Work Environment Fund and it was implemented in collaboration with the Finnish Institute of Occupational Health and Tampere University Hospital. The final report of the WOBLE project in Finnish can be found here.

The next two parts of the three-part series of articles will focus on logistics and on modelling machines after humans.

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