AI Has Human Doctors Asking: What’s Left for Us?
AI Has Human Doctors Asking: What’s Left for Us?
人工智能让医生们开始自问：我们还剩下什么？
Don’t be fooled by the question mark in the title of an article published this month in the Journal of the American Medical Association. When the authors, including medical superstar Ezekiel Emanuel and venture capitalist Vinod Khosla, asked, “Will Autonomous AI Exceed AI-Physicians as the Best Medical Care?” they were being rhetorical. Their answer is an emphatic YES. Many in the medical world are begrudgingly coming to terms with the premise that patients can get the best treatment by a hybrid approach where doctors work in consultation with well-trained bots. But this article’s thesis is that AI alone can deliver the best outcomes.
不要被本月发表在《美国医学会杂志》（JAMA）上的一篇文章标题中的问号所迷惑。当包括医学界大咖伊齐基尔·伊曼纽尔（Ezekiel Emanuel）和风险投资家维诺德·科斯拉（Vinod Khosla）在内的作者提出“自主人工智能是否会超越‘人工智能辅助医生’，成为最佳医疗护理方案？”这一问题时，他们其实是在进行反问。他们的回答是肯定的：是的。医学界的许多人正不情愿地接受这样一个前提：通过医生与训练有素的机器人协同工作的混合模式，患者可以获得最好的治疗。但这篇文章的核心论点是，仅靠人工智能本身就能提供最佳的医疗结果。
“Review of all published articles on AI in medicine since January 1, 2024, shows that medicine is rapidly approaching the transition point at which AI alone will exceed physicians and physician AI-hybrids in providing the best care at five fundamental medical tasks,” they write. Those tasks include taking medical histories, establishing a diagnosis, identifying what tests are needed, prescribing treatment, and managing chronic diseases. You know, doctoring. AI is now so good, they argue, that clinicians should refrain from meddling, because “humans in the loop degrade AI performance.” Stand back, doc, and let AI do its thing. Which used to be your thing.
他们写道：“对2024年1月1日以来所有关于医学人工智能的已发表文章进行回顾后发现，医学正迅速接近一个转折点，届时在五项基础医疗任务中，仅靠人工智能的表现将超过医生以及‘医生+人工智能’的混合模式。”这些任务包括采集病史、确诊病情、确定所需检查、开具治疗方案以及管理慢性病。也就是我们所说的“行医”。他们认为，人工智能现在已经非常出色，临床医生应该避免干预，因为“人在回路中会降低人工智能的性能”。退后吧，医生，让人工智能来完成它的工作——这曾经是你的工作。
Lead author Emanuel—brother of Ari and Rahm, chair of the Department of Medical Ethics and Health Policy at Penn and a renowned oncologist—told me that for many years, he’d dismissed the idea that AI could perform core medical functions. He would run into Khosla at conferences in the 2010s, and the VC would bend his ear about how AI would be doing 85 percent of what doctors did by 2035. It was a hobbyhorse Khosla had been riding for years, writing a 2012 piece in TechCrunch asking, “Do We Need Doctors or Algorithms?” (again, rhetorical) and penning a 101-page treatise in 2016 to that effect. “I said bullshit, there’s no way,” says Emanuel. “What doctors do is too complicated.”
主要作者伊曼纽尔（阿里·伊曼纽尔和拉姆·伊曼纽尔的兄弟，宾夕法尼亚大学医学伦理与健康政策系主任，著名肿瘤学家）告诉我，多年来他一直不屑于认为人工智能能够执行核心医疗功能。在2010年代的会议上，他经常遇到科斯拉，这位风投家总是在他耳边念叨，到2035年人工智能将完成医生85%的工作。这是科斯拉多年来一直坚持的观点，他曾在2012年的《TechCrunch》上撰文问道：“我们需要医生还是算法？”（同样是反问），并在2016年撰写了一篇101页的论文来阐述这一观点。“我说这简直是胡扯，根本不可能，”伊曼纽尔说，“医生所做的工作太复杂了。”
But about a year ago, Emanuel’s friend Robert Wachter sent him galleys of his book A Giant Leap, where Wachter, who is head of medicine at UCSF, outlined a world where first-class medicine would be a collaborative process between AI and doctors, but the masses in “economy class” would mostly make do with AI alone. Emanuel began to think that Khosla might be right. He suddenly flashed on a frightening question: “If AI takes over, what’s left for doctors to do?”
但大约一年前，伊曼纽尔的朋友罗伯特·瓦赫特（Robert Wachter）寄给他新书《巨大飞跃》（A Giant Leap）的校样。身为加州大学旧金山分校（UCSF）医学系主任的瓦赫特在书中描绘了一个世界：一流的医疗服务将是人工智能与医生协作的过程，而处于“经济舱”的大众则大多只能凑合使用人工智能。伊曼纽尔开始认为科斯拉可能是对的。他突然闪过一个可怕的问题：“如果人工智能接管了一切，医生还能做什么？”
First he needed to validate the premise. He asked Khosla to collaborate, and the VC suggested that his son Neal Khosla join the effort, along with Emanuel’s researcher. Neal runs Curai Health, an online company that uses AI to treat patients, with a staff of doctors to prescribe medicine and handle more complicated issues. (This conflict of interest is disclosed in the paper, along with Vinod Khosla’s relevant investments and Emanuel’s various grants and consultancies.) The coauthors set out to look at all the studies on AI medicine that they could find from January 2024 to the present and concluded that, in many cases, a “superior autonomous AI” will likely surpass humans using AI by 2030. That prediction, they admit, is “unsettling but seems probable.”
首先，他需要验证这个前提。他邀请科斯拉合作，这位风投家建议他的儿子尼尔·科斯拉（Neal Khosla）以及伊曼纽尔的研究员加入这项工作。尼尔经营着一家名为Curai Health的在线公司，该公司利用人工智能治疗患者，并配备医生团队来开药和处理更复杂的问题。（论文中披露了这一利益冲突，以及维诺德·科斯拉的相关投资和伊曼纽尔的各项资助与咨询关系。）合著者们着手研究了从2024年1月至今能找到的所有关于医学人工智能的研究，并得出结论：在许多情况下，“更优越的自主人工智能”很可能在2030年之前超越人类使用人工智能的表现。他们承认，这一预测“令人不安，但似乎很有可能”。
Unsettling is an understatement. One of the loudest dissenting voices is John Whyte, CEO of the American Medical Association, which represents all those doctors who will be worrying about what’s left. When I talked to him, Whyte began by noting what he saw as the paper’s shortcomings, including that some of the studies it surveyed are simulations, not blind experiments, and they don’t all support the article’s conclusion. Notably, a February 2026 Nature article found that in real-life cases, most patients were unable to effectively converse with large language models to access their expertise. Whyte unsurprisingly不出所料 bristled at the idea of removing humans from the clinical loop. “The AMA does see the potential in these tools, but they have to be utilized in the context of a care plan that’s governed by a physician,” he says.
“令人不安”这个词都说轻了。最强烈的反对声音之一来自美国医学会（AMA）首席执行官约翰·怀特（John Whyte），该协会代表了所有那些担心自己未来处境的医生。当我与他交谈时，怀特首先指出了他认为该论文的不足之处，包括其调查的一些研究是模拟实验而非盲测，且并非所有研究都支持文章的结论。值得注意的是，2026年2月《自然》杂志的一篇文章发现，在现实案例中，大多数患者无法与大语言模型进行有效对话以获取其专业知识。不出所料，怀特对将人类从临床回路中剔除的想法感到愤怒。“美国医学会确实看到了这些工具的潜力，但它们必须在由医生管理的护理计划背景下使用，”他说。
Emanuel countered that he and his coauthors were careful in their conclusions. “It’s been less than four years since ChatGPT was introduced,” he said to me. “We’re making a prediction for four years from now. You don’t think that [AI is] going to be way more advanced than a doctor?”
伊曼纽尔反驳说，他和合著者在得出结论时非常谨慎。“ChatGPT推出还不到四年，”他对我说，“我们是在预测四年后的情况。难道你不认为（人工智能）会比医生先进得多吗？”
Seeking a second opinion, I consulted Wachter. He’s singled out in the paper’s first paragraph as the guy who wrongly argues that AI-only treatment will be “economy class.” (I know Wachter personally.) Surprisingly, Wachter concedes that the authors of the paper have a point. “The argument they’re making is important,” he says. AI is good, he says, and right now AI and humans together are better. “But that can no longer be chiseled into a tablet. There will be times when humans will muck up the performance.”
为了寻求第二意见，我咨询了瓦赫特。他在论文的第一段中被点名，称其错误地认为“仅人工智能治疗”属于“经济舱”。（我个人认识瓦赫特。）令人惊讶的是，瓦赫特承认论文作者确实有道理。“他们提出的论点很重要，”他说。他表示，人工智能很棒，目前“人工智能+人类”的组合更好。“但这不再是不可动摇的真理。在某些时候，人类反而会搞砸表现。”
Wachter is insistent, however, that the unique human attributes of trained physicians are vital and irreplaceable. AI may never be as effective in breaking the news of a grim prognosis than a human, and a patient may well be more likely to be guided to the best path of treatment by a real-life clinician.
然而，瓦赫特坚持认为，受过训练的医生所具备的独特人类特质是至关重要且不可替代的。在告知患者严峻的预后结果时，人工智能可能永远无法像人类那样有效，而患者也更有可能在现实临床医生的引导下找到最佳治疗路径。
Wachter invokes what he calls the doorman fallacy, named after the fear that people who opened doors for tenants in apartment buildings would be out of work once doors could open automatically. In fact doormen perform myriad tasks and are still an invaluable presence in white-glove buildings. Like accepting Amazon packages, feeding pets, and sometimes lending a sympathetic ear to a tenant sharing a gripe. “We’re going to find a version of the doorman fallacy for doctors,” says Wachter. “I can imagine a world where a doctor accepts the AI diagnosis but also performs a lot of other functions that have value.”
瓦赫特引用了他所谓的“门卫谬论”（doorman fallacy），这个名字源于一种担忧：一旦公寓大门的自动开启技术普及，为住户开门的门卫就会失业。事实上，门卫承担着无数任务，在高端公寓中仍然是不可或缺的存在。比如代收亚马逊包裹、喂养宠物，有时还会倾听住户的抱怨。“我们会在医生身上发现‘门卫谬论’的变体，”瓦赫特说，“我可以想象这样一个世界：医生接受人工智能的诊断，但同时也履行许多其他有价值的职能。”
What’s being displaced here, though, isn’t something as straightforward as opening a door. It’s the hard-won expertise that comes from years of training.
然而，这里被取代的并不是像开门那样简单的事情，而是经过多年训练才获得的、来之不易的专业知识。