As vascular surgeons involved with reading vascular ultrasound, we are no strangers to innovation in our clinical practice. Endovascular innovations have revolutionized this specialty and allowed our patients to recognize longer, more enjoyable lives as a result. I would say that as a specialty, vascular surgeons are generally embracing of new technology with the required amount of skepticism to ensure what we are doing actually helps our patients.
In recent years, there has been a boom in the use of artificial intelligence (AI) in many areas of practice. This includes surveillance of aneurysms, cannulation of vessels, as well as vascular ultrasound. Like many innovations, I think that as kinks get worked out the innovation and speed that AI brings will benefit our patients. I support the move forward.
However, we need some caution as we move forward. At our busy institution, we run our sonographers and radiologists off their feet with ultrasound studies of patients who have had increasingly complex open and endovascular treatments, often bilateral and often following other procedures. When my phone rings with one of our vascular radiologists on the phone, I can be assured of 3 things. The first is they are more than likely calling about one of the patients with a case similar to what I have mentioned above. The second assurance is that we will have a very fruitful conversation, while viewing pictures, about exactly what the sonographic findings are, what they mean for the patient, and how they may be worked up further, if necessary. I am also sure that I will engage with details of the procedure and the rationale for why it was done. This free-flow discussion will result in the third assurance, our patients will receive better care.
I am quite sure these conversations are happening all over the world. They bring two specialties together; they meld the art with the science, resulting in better patient care. My concern is that with the increasing use of AI, especially in the complicated cases, we will lose this connection and the ability to exchange information. We see this to some extent already; “In basket me!”, “text it over”, “check your email”. (Please don’t view this as an anti-technology rant, it really isn’t. Please view it as a pro-discussion rant!)
My concern is that the natural extension of AI use will be the elimination of experienced specialists who can engage in discourse about challenging problems and the specialists’ innate ability to leverage each other’s natural intelligence and experience. The very nature of widespread AI use in vascular ultrasound discounts this important exchange and actually rewards it for not occurring. It’s a system designed for speed and throughput, and its natural extension will be less conversation as the images are not passing the eyes of an experienced clinician but rather a microchip.
As I stated, I am not anti-technology, but I am pro-discussion! It behooves our specialties to celebrate this unique relationship we have had over decades. Call each other; support and explain things to each other. Be an example to others of true collaboration between “competitive” specialties. Embrace the technology as a means to showcase the true value of our different, yet complementary skills: excellent patient care. Besides, a cheerful phone call beats an “in-basket” any day.
Jonathan Cardella, MD, FRCS, is an Associate Professor of Surgery (Vascular) and Program Director of the Vascular Surgery residency at Yale School of Medicine.
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