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Wednesday, September 19, 2018

Doctors are known for their poor bedside manner. Robots might be the answer

I don't believe AI robots are anywhere close to understanding semantics much less the difference between syntax and semantics. Communication may be broken down into two things: syntax and semantics. The term syntax refers to grammatical structure whereas the term semantics refers to the meaning of the vocabulary symbols arranged with that structure. A robot may correctly interpret, "Let's eat, Grandma!" and incorrectly interpret "Let's eat Grandma!" But, a human appreciates the semantics and doesn't make Grandma the main course at dinner. Human communications also flexes for the recipient's communication style. That is, how I encode a message depends on how the recipient decodes the message. Personality traits may correlate with this type of communication flexing. For instance, I once walked into an ICU room my first day returning to service only to be greeted immediately with the patient's pointed question, "Am I going to die?" To which I said, "Yes." The patient responded, "Thank you. I've been trying to get that answer but everyone keeps pussyfooting around it and are marshmallows for not wanting to hurt my feelings." By outside perspective that initial interaction may seem "poor bedside manner." Who answers in such a way with zero patient relationship? I knew a few things which informed my response. One, she had a terminal condition which ultimately leads to death about five years after initial diagnosis (on average). Two, the patient had a one week ICU length of stay and counting. Three, she addressed me in a matter of fact manner (encoding). Four, although bed bound, her movements were quick, active, purposeful. She exercised command and control of the environment including of the health care team (nurses, ancillary staff, etc). And, five her eyes were bright, inquisitive, directed. I assessed all of this within moments of arriving outside her room to entering with the reception of, "Am I going to die?" No good morning, no introductions, no chit chat, no background clinical recap.... Our continued conversation progressed on a very productive tract. The patient made plans, mobilized family from out of state and died with closure and piece 3 days later. In other patient interactions I am that "marshmallow" taking a slower, gentler communication style because that's what their communication encoding required. How might a robot interpret my initial bedside manner?
from Rajesh Harrykissoon, MD

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