Human‐computer symbiosis: enhancing dermatologic care while preserving the art of healing

In 1997, the International Business Machines supercomputer Deep Blue defeated world chess champion Garry Kasparov in what was widely viewed as a symbolic event for the coming of age of artificial intelligence (AI). Since that time, AI applications have been explored across medicine. In dermatology, for example, researchers are evaluating the potential of deep convolutional neural networks to classify skin lesions. These new technologies have heightened concerns that AI will displace dermatologist jobs or disrupt the doctor–patient relationship. In fact, this discussion has been ongoing since the first Electronic Numerical Integrator And Computer was built in the 1940s. Many notable scientists have sought to develop AI applications to match or surpass human intelligence. Others, such as J.C.R. Licklider, have focused on understanding how humans and computers can work together to augment human intelligence. In “Man-Computer Symbiosis,” Licklider outlined a strategy in which humans provide strategic input while computers provide depth of analysis. As AI applications improve, rather than competing, we should strive to identify how best to integrate them into our practice, potentially improving efficiency, patient outcomes, and access to dermatologic care. At the same time, we must remain attuned to possible and inherent weaknesses, such as inaccurate/incomplete training or validation data, improper use, and inability to view the patient holistically. Moreover, the dermatology landscape is shifting under the pressure of forces ranging from evolving pathogens to novel therapeutics. While computers are adept at solving formulated problems, humans need to formulate and prioritize the problems to be solved. Another advantage of a collaborative approach between humans and AI is maintaining the doctor–patient relationship. In his plenary address at the 2018 annual meeting of the American Academy of Dermatology, Dr. Abraham Verguese referenced an 1891 painting by Sir Luke Fildes entitled, “The Doctor.” The subject of the painting, devoid of any diagnostic tools or treatments, is training his attention on a sick child. The attention of a dermatologist may have unique import for patients with skin diseases that are often socially stigmatizing and have a profound impact on health-related quality of life. For example, in a well-known study by Rapp and colleagues, patients with psoriasis reported similar Short Form-36 Health Survey Questionnaire (SF-36) scores to other chronic diseases like arthritis, cancer, chronic lung disease, congestive heart failure, depression, dermatitis, type two diabetes, hypertension, and myocardial infarction. Only congestive heart failure had a worse Physical Component Summary score, and only chronic lung disease and depression had worse Mental Component Summary scores. For many of us, the call to practice dermatology comes from a desire to improve patients’ lives through the healing power of human interaction. We have witnessed the emotional impact of touching the skin of a patient whom others are afraid to touch and experienced the satisfaction derived from a longitudinal patient relationship. Our intuitive understanding of this healing power is borne out by epidemiological data. In a meta-analysis of 148 studies including 308,849 participants, Holt-Lunstad and colleagues found a statistically significant 50% decreased likelihood of all-cause mortality for participants with stronger social relationships. This finding remained consistent across age,