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共生:AI时代的医学技术腾飞与Medical Professionalism的传统回归

2019-01-16 佚名 医路跑手周嫘

这是一个科技腾飞的时代,1月9日从Boston飞来的David Roberts院长带来了来自哈佛医学院的全新教育与医学技术腾飞的响应能力,当下的时代,科技高度融入医疗各领域,远程技术支持下的远程医疗、远程ICU,家庭医疗场景应用等等,高科技正在改变传统医疗,改变未来,让未来的医疗向着精准化、个体化、数字化发展,尤其是达芬奇这样的手术机器人技术进来后,AI诊断技术的变革,Google、Amazon这

这是一个科技腾飞的时代,1月9日从Boston飞来的David Roberts院长带来了来自哈佛医学院的全新教育与医学技术腾飞的响应能力,当下的时代,科技高度融入医疗各领域,远程技术支持下的远程医疗、远程ICU,家庭医疗场景应用等等,高科技正在改变传统医疗,改变未来,让未来的医疗向着精准化、个体化、数字化发展,尤其是达芬奇这样的手术机器人技术进来后,AI诊断技术的变革,Google、Amazon这类超级科技公司的加入,医疗的边界将变得越来越宽泛,而医疗的场景也将变得越来越模糊。与之带来的教育挑战是,哪怕是像哈佛医学院这样的顶级学府都很可能无法快速传授给学生最新的知识,而教授学生如何可持续获得知识,掌握知识的能力,以及如何面对未来飞快变化而不掌握处理不确定性的能力将成为新型教育的挑战。

在Roberts的讲演中,科技更新深刻影响医疗技术的发展从而影响教育的创新成为一种必然,而同样的,在科技高速医疗技术发展的进程中,带来更深远的影响是医疗技术和服务边界模糊,从医院作为医疗技术的主要场景到家庭、多地;医疗主体从传统的医生和患者的直面沟通模式到机器人医生或电子屏技术和患者的人机交互模式;医疗中的主体责任也随之变得模糊而有了争议余地。而这个争议的余地更多的来自于对医疗伦理的争论,对医疗专业精神的反思。如汽车行业的无人驾驶技术在面临无人驾驶汽车撞死路人时,谁来负责的争议一样。而基于伦理层面的讨论,梁嘉杰院长切入的医患信任危机的背景下,Social Contract成为构建Medical Professionalism的基础。

梁嘉杰说,医疗专业精神是一种信仰体系,而医学院很难教授和评估,但他能传导一种正确的价值观引导其行为,建立其在专业领域内的地位和核心竞争力。

医疗专业精神强调的是病人利益优先原则,而病人的疾病时利益优先的前提条件是医生的日常利益得到有效的保障;而这里的医生的利益不只是经济利益,还有社会地位,等等。为什么必须成为信仰体系的Medical Professionalism是以Social Contract为基础呢?Social Contract里的契约,涵盖着:契约自由、利益平衡、互利或多方权利义务关系、功利性和理性等要素;而利益平衡的基础前提却是从保障私利开始,为什么重拾信任需要回归传统?重拾Social Contract呢?因为,Social Contract中的信任、互助基于的前提是互利,而互利的双方契约的形成的前提条件是保障一方的私利而建立的利益平衡,为了谋得更好的利益而建立的交易行为(经济和伦理行为)。当然,自17、18世纪盛行的Social Contract构建了西方政治制度的基础,其理论的演化和复杂程度、对法律、政治、社会的深远影响远不是我这样三三两两说说就能以偏盖全的。

当梁嘉杰院长说出 belief systems时,我笑了,把Medical Professionalism当作一种信仰,这样的话也只有放在普通法背景下的香港,才会真的掷地有声。而不是说说罢了的笑话,更不是以道德或正义的名义,饱含情绪而高喊的口号。

把Medical Professionalism放在以Social Contract为基础条件时,医疗专业精神所要应对科技融入医疗技术后带来的医学腾飞的挑战时,执着于医疗专业精神的信仰才能让医生群体在面对高技术背后可能衍生的高利益和高风险冲突时,更具有审慎精神,而融入契约精神的医疗专业化精神才能让医疗服务其本身更富有理性的人文关怀。

科技让未来更美好?!融入科技的医疗技术让未来更美好?!未知的世界让我们充满好奇的同时也充满了迷茫,甚至恐慌……在面向未知的未来时,如果信任是已知的,互利是契约前提和值得坚守的,互助的美好将一路温暖着迈向未知未来的你我。

向左是医生对Medical Professionalism的信仰坚守,向右是飞速发展的来不及了解的先进医疗技术,这样的互利共生,才是世界上最珍贵的礼物。

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    2019-04-15 jeanqiuqiu
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    2019-06-02 nymo
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    2019-01-18 海豹
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    2019-01-18 智慧医人
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