The Attitude of This Report

Three commitments govern everything that follows.

First, this report approaches the question of the future physician from an entirely different plane. It does not ask which tasks will survive automation, nor how to defend existing scope. It asks what new human, scientific, ethical, and integrative capacities medicine will require when it becomes a technology-enabled health ecosystem, and it then works backward to the physician such an ecosystem needs.

Second, there is a willingness here to cede territory, to others and to machines, facing the inevitable earlier. Defending indefensible ground is the surest way to lose the defensible. Much of what physicians do today will migrate, and should migrate: to AI, to robotics, to advanced practice colleagues, and to patients themselves. A profession confident in its distinctive contribution can afford to say so plainly.

Ceding is not surrender, and it requires a criterion. What can be fully specified, independently verified, and audited after the fact may be delegated, to a machine, to a colleague, or to the patient. What requires a judgment under irreducible uncertainty, for which someone must afterward answer, may not. A reading that can be checked against ground truth, a step that can be scripted and logged, a titration that follows a rule: these are candidates for migration, and holding them is nostalgia rather than strategy.

Deciding that this person should accept this risk, in the absence of any rule that settles it, is not delegable, because there is no specification against which to verify it and no one else who can be held to the consequence. Chapter IX takes up that residue in detail. The criterion matters more than any list of tasks, because the list will be rewritten every few years and the criterion will not.

Third, notwithstanding that encroachment, the view taken here is decidedly optimistic. The forces now gathering will not extinguish the physician's role but will transmute it, concentrating human contribution where it is most distinctive and most needed. The future is a more interesting version of the present, not a diminished one.

We are losing part of the best of the past, humanistically, socially, and relationally, while failing to be sufficiently imaginative about a radically different future looming before us. The aim of this report is to correct both errors at once.

We begin where the pressure originates, at the biomedical frontier itself.