The golden retriever who arrived for a DHPP vaccine seemed to smile up at her family, and then she wagged her tail. That’s when one of her owners, Melissa, started sobbing and screaming. The entire appointment had been a disaster. It was supposed to be a standard vaccine visit for Sophie, an 11-year-old spayed golden retriever. It turned out to be a quality-of-life consultation for a nonambulatory patient who soiled herself and cried when her owners left the room but who otherwise seemed to be having a great time.
Her owners were a young couple. Sophie had come to live with Melissa 10 years earlier. Details on when Toby, Melissa’s husband, joined the picture were sketchy. It was obvious, however, that Sophie and Melissa had fallen in love with Toby at some point, and now they were a family.
Sophie had terrible osteoarthritis in her back, hips and knees, rendering her unable to walk. She ate and drank normally and greatly enjoyed her owners’ attention. She cried whenever her family left whatever room she was in, and she routinely soiled herself. She also required extensive nursing care to manage her lack of mobility. Toby and Melissa wanted to know if Sophie was suffering and how they would recognize when it was time to put her down.
The worst part was that Sophie put on displays that seemed to communicate happiness. She would wag her tail excitedly whenever Toby or Melissa looked at her. She would nose nearby hands as if demanding to be petted, and she would excitedly gobble up any treats offered to her.
Still, nursing this 95-pound dog was a challenge, and it was only getting worse, as Melissa was five months pregnant and getting less and less mobile herself. (She told me that was why she was reacting emotionally in the exam room and struggling to decide what to do with Sophie).
It’s a strange feeling to stand in an exam room, holding a DHPP vaccine, and realize that the vaccine appointment is actually a life decision and possibly a euthanasia appointment. I think most veterinarians can remember a time when they discovered that some pet owners scheduled a vaccination because they couldn’t bring themselves to say “euthanasia.”
After the initial examination, Melissa looked at me tearfully and asked, “Is my dog suffering?” I had no idea what to say, so I took a deep breath, steadied myself and replied, “Well, it depends. Let’s talk about this.”
That’s when Toby leaned forward, phone in hand, and said, “I’m going to ask ChatGPT what to do.”
As I tried to process what Toby had just said, I couldn’t help but wonder if that was our future. Will a tide of technology lift us all from uncertainty and deliver us to clarity and bliss? Looking at Melissa’s suddenly sour face, I wasn’t convinced that everyone is sold on the idea that technology is the solution to all our problems.
What Will Remain of the General Practice Vet?
Most of us imagine society’s progress as a straight line. After all, over the past 200 years, industries like manufacturing, medicine and technology have gotten steadily better. But the reality is that material or technological advancements do not equate to any sort of moral, spiritual or intellectual progress. Sure, the industrial revolution brought us assembly lines to crank out products, but it also turned workers into cogs in a single-purpose machine. Cellphones gave us the ability to always be connected and opened the path for us to be chained to our work in ways we never imagined. The advancement of capitalism has driven unprecedented innovation and extreme (and growing) wealth inequality. For every advantage we have gained, there seems to be a cost.
- As I look at how veterinary medicine is advancing today, I see things like:
- Technicians being better leveraged (and compensated) than ever before.
- Veterinary specialists engaging the most challenging cases.
- Artificial intelligence in scribe and diagnostic equipment churning out differential diagnoses, educational resources for clients and recommendations for next steps.
- Websites promising telehealth consultations and the subsequent home delivery of products.
- People pushing for midlevel veterinary professionals to address the perceived demand for services.
I am not condemning any of those advancements. Few people have championed the effective utilization of and higher compensation for techs more than I have. I routinely refer cases to specialists, worry about keeping care affordable for pet owners, and think convenience is a vital component in making sure pets get the medications they need. I’m also a fan of AI scribes and don’t want to go back to practicing without them. I recognize that all these advancements demand sacrifices.
The question now is, “What will these sacrifices entail, and will they be worth the downside?” Once we delegate our technical work to our fully competent technicians, our simple wellness cases to midlevel professionals, our advanced cases to specialists and our requests for medications to online providers (and then run all remaining cases through AI for advice), what will remain for the general practitioner to do? When pet owners have reliable, informed artificial intelligence support that has endless time and patience and a willingness to dive deeply into the specifics of a single pet’s health status, how will the GP be perceived in the exam room?
As I reflect on ChatGPT’s sudden appearance at Sophie’s appointment, I think it makes sense to be concerned about how the role of veterinarians in animal health care is changing.
I don’t think veterinarians will disappear like the lamplighters, ice deliverymen and telegraph operators did when technology made them obsolete. I do worry, however, that we will suffer from a crisis of purpose, growth and utility. Yes, this is unfortunately the position that professionals across other industries find themselves in, but many of us chose veterinary medicine specifically to avoid such a fate.
The Temptation of Support
Imagine, for a moment, that you know a brand-new veterinarian named William. On William’s first day in practice, he is paired with an experienced doctor. This doctor has an incredible breadth and depth of knowledge, was trained with medical standards and sources you find acceptable, sees no cases, is immediately available to William 24/7, and happens to work for the tiniest of salaries. This mentor answers every question William has. She writes William’s records for him, gives him helpful tips about things to consider, and is ready to consult on any case William asks about. Also, her assignment to William is indefinite, so there is no expectation that William will ever need to work without his mentor.
My question for you is this: Do you think William will turn out to be a great doctor?
We can see how William might get into trouble here. It’s possible he will allow himself to become a pair of hands for his mentor as opposed to an excellent clinician in his own right. Some will say this risk is so high that William should shun his mentor to avoid becoming reliant on her. But when have we ever benefited from turning our backs on useful information? Who among us has rejected help because it was too effective? Not utilizing an adviser made so available to us almost feels unfair to our patients.
Fortunately, William can use this mentor to make himself more valuable, not less. He can turn his mentor into the teacher she is intended to be rather than the supervisor and director she could become. It all depends on William, though, and the choices he makes hour after hour and day after day. It will come down to the path on which William spends his time walking.
We are headed into a world where every veterinarian (and technician and pet owner), regardless of experience level, will have ever-present advisers, mentors and helpers through AI and other technological advancements. We will then have a choice to make regarding how we will allow these tools to affect our careers. Most of us will choose the path of least resistance. We will focus on completing our job in the most efficient, predictable and comfortable way possible, as that approach will be immediately easier and maximally profitable. Some of us, however, will opt to take a much harder path. We will decide that being great is not the same as getting easy answers, hitting the “Approve invoice” button as quickly as possible, or making whatever choices are most comfortable.
The Road to Ruin
There’s an old saying that the road to ruin is broad, gently sloping and full of friends. The idea here is that long-term pain often comes from pleasurable short-term decisions, and there’s no shortage of people who will do what feels best in the moment. As I look at society, I can see the road to ruin stretching out seductively before us, and it would just be so easy to —
As I write these words, I glance at the top of my Google document and see an AI button that could generate a paragraph or two for me in a matter of seconds. In my pocket, my cellphone promises that I need not experience a single moment of boredom in my day. On my laptop, I can ask ChatGPT almost any question that comes to mind and have an immediate answer. There’s not a single point in my week when I am more than two minutes away from a snack. I can be picked up by an Uber whenever I get tired of walking, and I can hand my kids an iPad whenever I need a moment of peace. All my friends are doing these things as well.
What an easy lifestyle I can have. What a smooth path. But where does this road go? Will we become better people if we don’t have to learn anything because we can just ask AI? Will we be happier when we and our family members are constantly distracted? Will we be more fulfilled in veterinary practice when we have an adviser like William does?
I do not think so, and I want to get off this road.
The Dangers of Comfort and Convenience
When I was in my first year in practice, I joined a large hospital along with five other new vet school graduates. We all wanted to be great doctors, to learn and grow, and to do so while keeping a reasonable work-life balance. One day, a senior doctor mentioned to me and another new vet that he would be doing an interesting surgery the next day. He asked if we wanted to watch. We both had the day off and told the senior doctor we would be there if we could. The next day, I stayed home and enjoyed my day off. My colleague set aside his free time and went to the clinic.
A few days later, I asked my friend about the case. Turns out it was quite interesting. My friend talked about scrubbing in, assisting with the procedure, and learning not just about the case but about the senior doctor’s experience with and philosophy on veterinary surgery in general. I regretted not being there.
I have always believed in not letting work take over one’s life, and sometimes we all genuinely need a break. On that day, however, I could have made time if I’d wanted to. I just wanted to have an easy day instead. I wanted to be comfortable, and staying home was convenient.
The desire for comfort and convenience isn’t unusual or difficult to understand. After all, society’s march toward reducing discomfort has been tireless and wildly successful. Just think about the comforts and conveniences that people a mere century ago were denied that we take for granted: air conditioning, indoor plumbing, nonscratchy clothes, refrigerators, washing machines, escalators, automobiles, television, Wi-Fi, endless libraries of electronic books and streaming music, restaurants for every type of food, and the ability to email instead of interacting with an actual person, just to name a few.
The march of comfort and convenience has been amazing! How many stairs have we not had to climb because of the creation of the elevator? Think of the sore hamstrings and burning buttocks we have avoided and all the times we didn’t have to break a sweat.
I recently wondered whether anyone thinks elevators are a bad thing. We are, after all, a now-sedentary nation wrestling with obesity and heart disease. I wondered how professional mountain climbers feel about elevators. If your job and passion were trudging upward, would you sing the praises of elevators? Would you shun them and condemn them as an affront to the art of working hard to move vertically? Probably not. I suspect you would recognize that elevators are an efficient way to get a job done. You would also probably realize that if you don’t make sure to put in decent time and effort trudging upward the old-fashioned way, then you’re not going to be very good at your job for very long.
That is how I think veterinarians need to look at AI and other professional advancements. We are intellectual mountain climbers. What makes us special is our ability to push ourselves upward through our capacity to focus, reflect, synthesize, empathize and explain. Yes, we could skip the hard work and take the AI elevator, and in some cases, that’s what we should do. Just as a mountain climber who only uses elevators is merely a button-presser, a veterinarian who only follows AI’s directives is simply a pair of hands. We must avoid both the inefficiency of always taking the stairs and the loss of competency that comes from never challenging ourselves.
Going forward, great veterinarians will be those who have no problem utilizing AI for their patients’ benefit but will resist turning to AI for every possible convenience it offers. Great vets will not be the students who ask their adviser what to do next. Instead, they will devise a plan and then ask their adviser for feedback. They will make time and space to do the uncomfortable mental lifting that is required to stay intellectually strong, even when they could kick back and ask ChatGPT what it thinks.
“But wait,” you say. “Using AI to get immediate answers to any and all questions I have isn’t going to make me a worse doctor! It’s not the same as mountain climbers riding elevators instead of hiking. Using AI is going to make me supersmart.”
Unfortunately, that’s not what is happening. As people leverage AI for more complex or creative applications, we are beginning to see what is known as the automation paradox.
The automation paradox is a situation where increased automation causes reduced human involvement and, ultimately, reduced human competency. The paradox arises as this automation is intended to improve efficiency and reduce human involvement. Still, it also increases the likelihood of humans becoming less skilled and less equipped to handle unexpected issues. In medicine, it looks like a profession of caregivers who become so comfortable getting answers from AI that they lose the ability to act effectively without it.
A MIT Media Lab study found that people who used AI chatbots like ChatGPT to write essays showed significantly lower neural activity and brain engagement in areas related to memory, creativity and language processing compared to those who wrote essays without AI. The research also found that the AI-using group had a much harder time recalling pieces from their essays, possibly indicating that the deep-memory processes required for long-term retention had been bypassed. This type of cognitive atrophy should terrify anyone who sees themselves as a professional thinker and fixer of problems.
Relatedly, I saw someone online celebrating that, with the help of AI summaries, he could read more than one classic novel every day. He was thrilled with the ease and efficiency with which he could devour classics such as War and Peace, Ulysses, The Brothers Karamazov and Jane Eyre. As I pondered those words, I thought back to the mountain climber riding up and down in the elevator.
Is riding in an elevator the same as being a mountain climber? No.
Is using AI to create an essay the same as crafting one with our own hands? No.
Is reading a summary of To Kill a Mockingbird the same as consuming and considering each line? No.
Is handing our cases over to AI the same as being a great caregiver? The answer has to be no.
There’s nothing wrong with elevators, summaries or AI suggestions of differential diagnoses. There is, however, something wrong with mountain climbers who only ride elevators, authors who don’t actually write, avid readers who consume only summaries and doctors who outsource their thinking to an app.
The good news is we all have the choice of whether and how much to use these capabilities. In that choice, the path to greatness in medicine and to a meaningful life in the modern world remains accessible. The passage is narrow and steep, and few will choose it, but it is there for those who desire it. We must intentionally decide how much time we spend on the comfortable and convenient road and how much we dedicate to climbing the steep, challenging path to greatness in our chosen field. There is still a need, after all, for great clinicians.
The Golden Retriever Visit
Back in the exam room with Sophie, Melissa did not want to hear what ChatGPT had to say about her beautiful, nonambulatory golden retriever. It turns out that not everyone wants to put their trust and the fate of beloved family members entirely in the hands of technology.
“I want to hear what Dr. Roark thinks,” she told her husband.
In that moment, there was no objectively right or wrong answer. There was no dataset to be searched. There were only questions about what mattered to the family at a human level. There were only considerations about what Melissa and Toby wanted, what they were afraid of, and what they believed made a good life, a loving death and lifelong memories. There was only a need for support that another human can provide and a deep desire for wisdom, which is not the same as information that can be Googled.
As I talked to Melissa and Toby about my experience with cases like theirs, and they told me and each other how they felt, I understood the power of a great caregiver.
I might not always be the best veterinarian, although I try my best. I can always be a human being, though. I can always empathize and share the wisdom I have picked up from laying my hands on pets and asking people about the experiences and emotions that make life and death matter to them. I can always work to improve myself, painful as that process is. And I can always choose to do what will make me better rather than what will make me comfortable.
We may all come up short some days in measuring what it means to be great, but we can try to climb that steep and narrow path rather than drift gently along the comfortable and convenient road to ruin. That is our choice, and no one can take it away from us.
DEFINING A GOLDEN
The American Kennel Club’s breed standard for a golden retriever says this about its general appearance:
“A symmetrical, powerful, active dog, sound and well put together, not clumsy nor long in the leg, displaying a kindly expression and possessing a personality that is eager, alert and self-confident. Primarily a hunting dog, he should be shown in hardworking condition. Overall appearance, balance, gait and purpose to be given more emphasis than any of his component parts.”
Other criteria are at bit.ly/3JfTFjl.
SELF-ASSESSMENT
Ask AI for a few fun facts about AI, and it responds this way in less than a second:
- AI can read emotions.
- AI writes its own music.
- AI is used in sports.
- AI helps discover new planets.
- AI is already all around us.
- AI can help combat climate change.
- AI can diagnose diseases.
- AI can help reduce bias.
- AI can predict the future (sort of).
STORY ACHIEVE
Veterinarian and award-winning columnist Dr. Andy Roark has contributed to Today’s Veterinary Business since 2017. Among his articles are these:
- “Our Profession’s Growth Spurt,” go.navc.com/growth-TVB
- “Rekindling the Love of Work,” go.navc.com/love-TVB
- “Strategic Stress,” go.navc.com/stress-TVB
BE A BETTER LEADER
Dr. Andy Roark has partnered with VetFolio to release the Uncharted Leadership Essentials Certificate. The program provides training appropriate for anyone who leads or manages others. The topics covered include setting a team’s vision and values, building trust, achieving team buy-in, delivering feedback, understanding communication styles, setting priorities, delegating effectively and managing time. Learn more at bit.ly/Uncharted-VetFolio.