AI and Thou
Earlier this week I read a plaintive post by a doctor who had found herself on the other side of the equation as a patient. She remarked on how impersonal her care was, how there were unnecessary delays from shift changes and even a shocking claim by one nurse that everything they needed to know about her was in the medical chart. The doctor noted that a chart makes no mention of posture or body language and cannot detect smells that experienced diagnosticians recognize as the onset of disease.
Perhaps it’s pedantic to say so, but it ought to be obvious that a chart is not a person.
The post reminded me of Martin Buber’s book I and Thou, where he distinguishes between mutually sustaining relationships, where we regard the other as “thou,” a being who is, in their wholeness, a mirror of the divine. The flip side of this is the I-it relationship, in which individuals regard one another as objects or means to selfish ends.
No matter how useful AI might be in streamlining diagnosis, reliance on it promises more of an I-it than an I-thou culture in medicine. I’m not familiar with the inner workings of the corporatized hospital, but I’ve heard other doctors speak about the upside-down priorities that place profits over people. And I’ve experienced them myself, most notably at convenient care clinics that charge higher premiums while offering subpar care.
I was recently misdiagnosed with strep at such a place and started a cycle of antibiotics that I later abandoned once the tests came back negative. All while paying 5x what I would have if I’d seen my primary care provider. Those suffering from graver ailments have it much worse (I am grateful that my throat healed eventually), but it seems more difficult than ever to build actual relationships with our healers – and quite complicated to find access to them when our need is acute and we can’t wait two weeks for the next available appointment. AI can’t solve those problems of access, either.
The I-it mindset is precisely the cultural malady that humanities education seeks to redress. Even if there is no guarantee that reading poems, stories, or novels and meditating on them with a group of peers translates to practical empathy, the act of creating space for mystery, acknowledgement of suffering, and regarding each other as thou, as one must do while inhabiting a literary text, is the antidote to the transactional mindset.
Impersonal care has plagued medicine since the birth of the clinic, where autopsy, as Foucault claimed, led doctors to “cadaverize life” by projecting the reality of the corpse onto a living person. Doctor-writers like Oliver Wendell Holmes, William Carlos Williams, Richard Selzer, Perri Klass, Atul Gawande, Danielle Ofri, and Damon Tweedy have tried to humanize their profession, sometimes by revealing their own frailties and imperfections, sometimes by attending to the dimensions of illness that don’t fit into a spreadsheet, sometimes simply by bearing witness to beauty.
We need these public figures to reassure us that our care isn’t left to bots and beeping tech. We need to hear from insiders that there are not just adults in the room, but human beings at the core of our healing enterprises.
This thought led to another, which is that as commercial publishers have consolidated and agents have grown wary of representing authors with no preexisting platform, assuredly fewer aspiring doctor-writers are finding their way into print. Who has time to build an Instagram following while completing medical school and residency? Writing a debut memoir on top of all that is hard enough.
What I’ve learned from history is that when doctor-writers disappear, or their voices grow faint, public distrust of medicine grows. When physicians show their human sides and what humane medicine looks like through writing, particularly through memoir and journalism, public trust grows.
For instance, if you have not discovered Bess Stillman’s series “Everything Is An Emergency,” I urge you to read her account of losing her husband to cancer just before their daughter was born. “Seeing as a doctor, seeing as a wife” ought to be required reading for all first-year medical students. Bess also writes some biting satires about what life in the ER reveals about American culture. You simply cannot come away from Dr. Stillman’s writing feeling that she would see you as an “it” or that she would think everything she needed to know about you came from your chart.
Amy Walsh is another ER doctor who writes about motherhood, herbalism, and spirituality at “The Nettle Witch, MD.” If I were teaching my old first-year seminar again, I’d love to use her essays on plants, such as this one about the medicinal benefits of Lemon Balm, to teach information literacy. Needless to say, you’re not going to hear about herbal remedies from many ER physicians, much less their folkloric histories, and if you read about those things from a different author, you’re not going to see so many links to peer-reviewed research. These are lovely reminders that empirical science need not exclude “I” and “thou.”
Who are some of your favorite medical writers — in print or on Substack — who bring their personal lives or the humane side of medical practice into their public writing? How do they restore your own faith in the I-thou model of medicine?
Most of my content in 2025 is free, but I appreciate the support of readers who make my weekly essays possible. Upgrading your subscription unlocks my monthly essays from a memoir-in-progress, as well as the entire archive. I’m also proud to be a Give Back Stack. 5% of my earnings in Q2 will go to Centre Volunteers in Medicine, a free clinic for those with no health insurance and annual income under $38K (individual) or $78K (family of four).
Very much in agreement and thank you for writing this. I think it’s also worth mentioning that the doctors I have known who understood the “thou” have all eventually left their profession because the business behind their practice wouldn’t allow them to spend more than three minutes per patient. That greed made it impossible for the doctors I have known who truly cared to take the time needed to see who was in front of them. I wonder how much of the seemingly indifferent behavior is really protection for the soul of a doctor who does care but has given up a belief that they will be allowed to act out of their own humanity.
From a practioner perspective, it can be challenging to enjoy the patient-doctor relationship when patients come in with AI recommendations and specific demands. It is frustrating to have patients watch TV and listen to various pharma ads and Dr Google and come expecting a quick fix. As patients, many of us cannot accept our own histological time frame for healing because health has been idealized with instant gratification.
My patient today wasn't loving my prescription of posture exercises, dynamic stretches and icing along with resting from tennis and switching to biking for 7-10 days--but prednisone did the trick of taking his pain away so he could continue with tennis. That was prescribed over an email! I have advised him through his knee, hip, and shoulder replacements, but my advice regarding his back pain wasn't good enough.
My attempts to discuss hydration and protein intake with patients is not razzle-dazzle despite the #1 side-effect of many of the 18 drugs my patients are on is dehydration. Discussing intake of sugar or processed food is definitely not the cause of their acid reflux and they read on the internet gallbladders are not needed... so the I-it relationship can be just as difficult from the practioner perspective.
I agree that when the human side of medicine is highlighted, trust grows. I read a lot of medical writing, unfortunately my understanding is that many books written by doctors that are on the shelves are only published if the book includes some sort of fad diet plan versus just presenting the science. I believe this may also contribute to the distrust and idea that there is one "right" answer.
Our healthcare system and attitude around what health actually means to each individual all needs an overhaul. I do agree that returning to medical practice as an art and humanizing care is part of that. There are practioners out there doing their best to do that in a "sick care" system, but as consumers of health, we may need to understand there is an art and patience to healing as well.