Tag: medicine

  • The Whole Patient: What AI in Medicine Risks Forgetting

    A short video has been circulating in our circles: two people stood before a machine that renders the human body in shimmering cross-section. Waveforms, a rotating skull, the nervous system laid bare. It is genuinely impressive technology. It is also, I think, a good place to pause and ask a question that medicine has not answered well in two hundred years. What is a patient?

    The worry I want to put on the table is not that this technology is bad. It is that it quietly trains us to mistake a part for the whole.

    Reductionism is medicine’s great strength, and its blind spot

    Modern medicine works because it reduces. It breaks a sick person into systems, organs, tissues, cells, and finally biomarkers, numbers that can be measured, compared, and acted upon. This is not a flaw. The reduction is precisely what gave us antibiotics, imaging, vaccines, and the ability to catch a tumour before a patient feels a thing. Anyone who has done public health knows that a population only becomes tractable once you can count it.

    But a method that succeeds by abstraction carries a permanent temptation, which is to forget that the abstraction was ever a person. A biomarker is not a patient. An organ is not a patient. A scan is not a patient. Each is a true part of the patient, and a part mistaken for the whole is how good medicine quietly becomes incomplete medicine.

    AI does not create this problem. It inherits it, and then accelerates it. A machine that diagnoses from images and labs is doing, faster and at scale, exactly what reductionist medicine already does. The danger is not that the machine is wrong. Often it will be more accurate than the tired clinician beside it. The danger is that its very fluency makes the reduction feel complete, as if, once the cells and the curves have been read, nothing of medical importance remains.

    The part of the argument that does not survive contact

    Let me be honest about where the easy version of this worry breaks down, because a worry worth holding should be able to withstand its own strongest rebuttal.

    It is tempting to say that the machine only sees cells and organs, never the whole being. That was true of yesterday’s tools and is becoming less true every year. Modern systems already fold in family history, longitudinal records, medication patterns, and increasingly the social conditions a person lives in. If the entire complaint is that the AI cannot see enough, then the complaint dissolves with the next model, and we will have built our ethics on sand.

    So the durable objection cannot be about what the machine can see. It must be about what the machine can be.

    What a machine cannot do is be responsible

    Medicine is not, at its root, an information-processing task. It is a relationship of responsibility. A doctor is answerable: to the patient in front of them, to that patient’s family, to the community that sends its sick to be cared for and expects them back. The clinical encounter is a covenant, not a calculation. When something goes wrong, a person bears it.

    A model can correlate. It cannot be accountable. It does not sit with fear, hold a hand, weigh a frightened family’s hopes against a hard prognosis, or carry the moral weight of a decision afterward. These are not gaps in its training data. They are not problems a larger model fixes. They are simply not the kind of thing a model is. The whole-person dimension of medicine, the patient as someone embedded in family and community, with a life that the disease is only one thread of, lives precisely in this relational and moral space that no amount of computation reaches.

    This is the point Prof. Aasim Padela has spent a career pressing, and it is worth noting who makes it: a practising emergency physician with a background in biomedical engineering and in classical Islamic scholarship. He is not a romantic standing outside the technology shaking his fist. He understands the machine, and still insists that a human being is not reducible to what the machine can measure.

    A caution against the opposite error

    There is a lazy version of this argument I want to refuse, the one where the human doctor is holistic and wise, and only the machine is cold and reductive. That is not true, and pretending it is weakens the case.

    A seven-minute consultation, a clinician who never looks up from the screen, a referral that treats a person as a throughput to be cleared: these are reductionism too, committed by humans, every day, in every health system including ours. The contrast that matters is not human versus machine. It is whether the system of care, whoever or whatever staffs it, still treats the patient as an end in themselves or as a problem to be processed.

    AI could, in fact, make us more holistic, by absorbing the pattern-matching that exhausts clinicians and freeing them to do the irreducibly human work of presence, judgement, and care. Or it could do the opposite, making the reduction so efficient that the human encounter is optimised away as a costly inefficiency. Which future we get is not a technical question. It is a question of what we believe medicine is for.

    Integrating, not surrendering

    In the Islamic tradition, the human being is not a sum of organs but an integrated whole. Body, mind, and spirit, held within family and community, owed dignity for what they are and not merely for what their biomarkers say. That is not nostalgia. It is a standard against which to measure any tool we adopt.

    So the task is not to reject the machine. It is to keep it in its place, a powerful servant of care, never its substitute. We should let it read the cells better than we ever could, and refuse to let it convince us that reading the cells is the same as knowing the patient.

    The technology is not the threat. Forgetting the whole person is. We would do well to understand that clearly, and to build our medicine, and our use of AI within it, around it.

    Wallahu a’lam.

  • To my young doctors

    (Drafted officiating speech for my session during MMA Pahang meet & greet to all medical students in Pahang)

    Assalamualaikum warahmatullahi wabarakatuh, and a very good day to all of you.

    It is truly an honour to be here with all of you, the future doctors of our nation. You are standing on the brink of an incredible journey, one that demands not only your knowledge and skills but also your unwavering dedication to serve humanity. Being a doctor in Malaysia is more than just a profession; it is a calling. It is a role that carries immense responsibility and purpose, as you hold the trust and hopes of countless individuals in your hands.

    The challenges we face in our healthcare system today are significant. The number of medical graduates has been declining, and what is even more worrying is that many of those who do graduate choose not to register with the Malaysian Medical Council. This reality places an even greater burden on those who step forward to serve. The country needs you. Your commitment, your passion, and your compassion are vital for the future of our healthcare system. You have the opportunity to make a real difference, not just in the lives of your patients but in the well-being of our nation.

    As you prepare to take your place in this noble profession, remember that competence is your foundation. You must continually strive for excellence, mastering the knowledge and skills required to care for your patients. But competence alone is not enough. Without compassion, medicine loses its soul. It is compassion that allows you to truly connect with your patients, to see them not just as cases to solve but as individuals with fears, hopes, and dignity. It is compassion that turns a good doctor into a great one.

    You are about to step into a world that will demand much of you. There will be moments when the weight of responsibility feels overwhelming. In those times, remember this: fulfil your obligations before you demand your rights. Focus on serving your patients, your community, and your nation with sincerity and humility. When you do this, the rights and recognition you deserve will follow naturally. Let your actions speak louder than your words, and let your dedication define you.

    As doctors, you must also be aware of the world beyond the hospital walls. The challenges we face are not limited to individual patients but extend to our communities and the planet as a whole. Be informed. Understand the issues that affect healthcare globally and locally. From the sustainability of our environment to the evolving landscape of public health, your role extends far beyond the clinic. You are not just healers but also advocates for a better world.

    Above all, never lose sight of the higher purpose of your work. Medicine is not merely a career; it is a form of ibadah. Every patient you care for, every life you touch, is an opportunity to bring people closer to the Creator. Align your actions with the values of faith, integrity, and accountability. Let your work be a reflection of your submission to Allah, and let it remind others of His mercy and compassion.

    As you prepare to graduate, I want you to know that the path ahead will not always be easy, but it will always be meaningful. You are not just becoming doctors; you are becoming leaders, role models, and a source of hope for those in need. Embrace this responsibility with courage and determination. Carry with you the values of competence, compassion, and a commitment to serve humanity and Allah.

    You are the future of our healthcare system, and I have every confidence that you will rise to meet the challenges ahead. May Allah bless you in your journey, guide your hearts and hands, and grant you the strength to fulfil your noble mission.

    Thank you.

  • Recalibrating Careers in Medical Education: A Call for Change in Appraisal and Promotion Systems

    The role of a medical educator or clinical lecturer goes beyond disseminating knowledge; it embodies the spirit of mentorship, guidance, and the holistic development of future healthcare professionals. However, the current landscape in medical education appraisal and promotion systems appears to shift this focus, often prioritising individual achievements over collective institutional goals. This article argues that such systems, heavily influenced by university ranking metrics, could undermine the very essence of education and teamwork within academic institutions.

    The Shift Toward Personal Achievements

    Medical educators once prided themselves on their role as mentors and nurturers of student growth. In the Islamic tradition, this role aligns with the concept of murabbi—a teacher who fosters not just academic knowledge but also spiritual and ethical development. Unfortunately, modern appraisal systems place less emphasis on these nurturing aspects of education. Instead, faculty members are often encouraged to pursue individual accolades, primarily through research publications and citations.

    The increasing focus on research outputs as the primary criterion for academic advancement has led to what many term a “publish or perish” culture, where quantity often supersedes quality in scholarly work. According to research, universities are driven by global ranking systems that primarily focus on research outputs, leading to a shift in faculty priorities from education and mentoring towards securing personal research achievements (Macfarlane, 2011). This change has contributed to the diminishing role of faculty as murabbi—those who mentor with a view to nurturing holistic, well-rounded graduates.

    The Dangers of Ranking Games

    University rankings have gained disproportionate influence in shaping the behaviours and strategies of academic institutions. Metrics such as the number of publications, citation counts, and journal impact factors have become the dominant benchmarks for academic success. A study by Hazelkorn (2015) highlighted the problematic reliance on such rankings, which often fail to account for the teaching mission of universities. The tendency to align institutional goals with these metrics, regardless of context or educational mission, is creating an environment where educators are pressured to focus on individual performance at the expense of broader educational goals.

    This pressure can lead to unintended consequences. For instance, Macfarlane (2011) noted that academic staff are incentivised to prioritise activities that boost their individual research profile, potentially leading to a neglect of their teaching responsibilities. This imbalance risks reducing the overall quality of education and mentorship that students receive.

    The Neglect of Teaching and Real Collaboration

    A career in medicine and medical education is about more than research output. Yet, the current systems undervalue teaching excellence, mentorship, and institutional service. Lecturers may feel demotivated to invest in these areas if they do not contribute directly to promotion prospects. This not only stifles the quality of education but also discourages real collaboration between faculty members. In medical education, where interdisciplinary cooperation and teamwork are essential, such an environment can be detrimental to both faculty cohesion and student outcomes.

    Collaboration is crucial in fostering innovation and holistic educational approaches, particularly in clinical settings where teamwork is a fundamental part of patient care. If academic reward systems are misaligned, these efforts may go unrecognised. In their study, Berthelsen and Hølge-Hazelton (2016) discuss how institutional cultures that prioritise research output over collaborative teaching can lead to a siloed approach within faculties, impeding teamwork and collegiality.

    The Need for Systemic Change

    To address these issues, there must be a recalibration of the appraisal and promotion systems in medical education. Institutions need to re-emphasise the importance of teaching and mentorship, not just as supplementary activities, but as critical components of academic careers. Moreover, universities should develop frameworks that recognise and reward collaborative efforts and interdisciplinary initiatives.

    By valuing the role of a murabbi—the educator who shapes not only the intellect but also the ethical and moral compass of future healthcare professionals—institutions can foster a more holistic and balanced academic environment. According to van Schalkwyk et al. (2015), including student feedback and peer evaluations in promotion criteria can help re-establish the importance of teaching and mentorship in the academic appraisal process.

    Conclusion

    If medical education is to stay true to its purpose, the current focus on individual achievement in appraisal systems must shift towards a more balanced approach that values education, collaboration, and mentorship. Faculty members should be empowered and motivated to contribute to the overall vision of their institutions, embracing their roles as educators and murabbi. Without such systemic changes, teamwork, collaboration, and the essence of medical education risk being eroded, ultimately compromising the quality of healthcare professionals we produce.

    References

    Berthelsen, H., & Hølge-Hazelton, B. (2016). Interdisciplinary collaboration: Barriers and facilitators across disciplines. Nursing Education Today, 40, 32-37. https://doi.org/10.1016/j.nedt.2016.02.007

    Hazelkorn, E. (2015). Rankings and the reshaping of higher education: The battle for world-class excellence. Palgrave Macmillan. https://doi.org/10.1057/9781137446671

    Macfarlane, B. (2011). The morphing of academic practice: Unbundling and the rise of the para-academic. Higher Education Quarterly, 65(1), 59-73. https://doi.org/10.1111/j.1468-2273.2010.00467.x

    van Schalkwyk, S., Hafler, J., Brewer, T., et al. (2015). Fostering communities of practice: A qualitative study of the role of academic institutions in advancing education scholarship. Academic Medicine, 90(6), 802-808. https://doi.org/10.1097/ACM.0000000000000698