Podcast – Social Media and Artifical Intelligence in Medicine with Peter Brindley at LTC

Welcome to the St Emlyn’s podcast. I’m Iain Beardsall. 

and I’m Natalie May.

And we’re at the London Trauma Conference, and it’s an absolute delight to welcome Peter Brindley back onto the podcast, but to talk about something a little bit, maybe left field, I’m not sure. Peter, you and I have known each other, and you’ve been a friend of St. Emlyn’s for many years, and we spent a lot of time together at the SMACC conferences of old, which I’m sure some listeners will have either attended or heard about. And this is a little bit about social media and the internet in general, and perhaps even artificial intelligence, which I know you’ve been thinking quite deeply about for some time.

I know you even published a paper with our own Simon Carley, not so long ago about it. But perhaps you could go into a little bit after you’ve introduced yourselves back to our audience.

Thank you so much for having me. Can I say big fanboy of the podcast. This is, it’s very meta to talk about social media, misinformation, disinformation, and AI on a podcast. But nonetheless, this is, the absolute reality that these things are now the library, the lecture dais, the oracle of Delphi. This is where it all happens in cyberspace. So, we better understand our digital footprint and equally our digital search because even if we claim we’re not using social media a lot of the information we’re getting is being curated via it.

So, let’s delve straight into that. What do you mean by digital footprint? What is it? Have we all got one? What are we supposed to do with it?

Yeah, fair point. Yes, more and less. You know, there are people in our specialty that, perhaps we’ll get into the Kardashian Index soon, have more of a social media presence than they have an academic and I could certainly be accused of that. And in fact, I would argue, alongside your evidence, H index and your impact factor and your I 10 and the traditional academic metrics used at my promotion meetings, you could actually include something like a K index. And so certain people have lesser and greater. I’m just as shocked by people who have huge presences as people who have none whatsoever. There are members of our profession, it’s almost like they’re in witness protection and when our families, during very vulnerable times, seek reassurance that their doctor is out there in the greater discussion and taxpayers feel like the academics that they fund are giving back, I think they ought to also find something when you go looking for somebody. So, I think your digital footprint matters.

 If we go right back to 2012, I think it was ICEM, before FOAM really existed, the free open access medical education movement, before it existed as something called FOAM, which happened later in a pub in Dublin, I think, Mike Cadogan was talking about how we should all, as healthcare professionals, take control of our digital footprint.

So, what does that look like? What does that mean?

 You have a presence out there. Now, you have to police it and make sure you’re not all sizzle and no steak, but it is your shop window, and it is your department shop window, and in a place like where I work, where people don’t just fly in for the weekend, we have to attract them, we actually have to work on our shop window. Now, we have to make sure there are some goods in the back of the shop as well. And when I say police, I really do mean police. We now have the power to produce a pretty low impact factor paper and then sort of Joe Rogan the heck out of it and promote it too far more than it’s worth. So, I guess that’s what I mean by digital footprint You better have one, but it better be authentic and it better not be all or sizzling no steak.

So a lot about presenting ourselves through various social media, and by that I don’t just mean Facebook, Instagram, TikTok, the toxic wasteland formerly known as Twitter now Blue sky where everyone seems to be congregating, also in terms of our publications and how does that lead on to the way that we search for information then when we’re looking for the clinical information that we need?

How has that landscape changed?

There’s information, there’s misinformation, which is a sort of innocent mistake, and then there’s disinformation, which is a deliberate attempt. So, it matters greatly, and a lot of the information, and we’ve known this as clinicians, so there’s a difference between data, the sat is 80, information, the sats increased to 80, the sats dropped to 80, and meaning, therefore you ought to.

Just as a parcel of information, it’s fairly benign, it’s what you do with it that matters most. Edmonton, Alberta, my home city, is also where Marshall McLuhan is from, and he’s the, ‘Medium is the message’ guy, arguing back in the 60s that synergistically how you present something influences what is presented, what you present influences how it’s presented, and this sort of thing goes around and around.

And so, it’s even been argued, we’re on a podcast right now, it’s even been argued that the human voice can be more powerful, because it goes back to the days when we were all sitting around the fireplace, than reading something, cold words, on a piece of paper. Having said that, you got to be careful you don’t just say something in a charming way, and it takes on more importance than it should.

And similarly, you better be aware that on the paper, don’t be surprised if it doesn’t change medicine, just you publishing a paper and hiding it away somewhere.

Is there a way that we need to think about the way that we’re looking for information differently? I’ve noticed particularly when I now type something into Google, which was always a search engine of choice for me, now the first thing that comes up is an AI answer.

Was this the answer you’re looking for? How can we navigate that?

It’s very powerful and therefore it deserves our attention. We have a stalker now, 24 hours a day, even while we’re sleeping. And I think we should all be aware of that. If that was a real person, we’d be absolutely horrified and demand that it be shut down.

But we seem to allow it for the ease of, I don’t know, a taxi or a music recommendation, and the same thing happens medically. So, the belief is that these engineers are up all night, every night, trying to work out how to amplify rage and loneliness and shame and some pretty primitive, having said that, profoundly powerful emotions that we all have inside us, and it leverages those and it amplifies those.

And so, when you talk about people getting in parallel tracks of truth, how old am I thought there was empiric truth and that’s it and now people talk about having their own truth. That seems tautologic to me, but that is what it’s doing now. When I say it, I’ve been deliberately vague because You can’t just blame the medium, going back to, Marshall McLuhan’s idea.

We had populist, politicians’ way before the Trumps of this world. We look at religions, wherever you stand on those, those are belief systems. Whether information is sticky or not is something. people should start to learn about, both in terms of how you craft a message that people will hear, but also the messages that are curated and sent to you.

So, you can abandon all the social media platforms you want, and you probably should for the sake of your mental health, but the information you are receiving has already been curated through those things.

I once proudly said I don’t have a Facebook page, and somebody said, no, you do. The company keeps a Facebook page on you, triangulated from the people that have posted your picture and your interests. Just because you don’t subscribe to one.

So, that’s how, maybe we as healthcare professionals can navigate this space. What about when we have to meet our patients who are coming from a very different perspective?

Yeah, I think you have to acknowledge that this is the People’s Library, Town Square, Oracle of Delphi. When you and I used to go to the library, or when our patients went to the library, they had to go to the effort to get out of the chair, take the bus into town, go into the library, and know that the library had some level of peer review. And so, you had a higher level of trust of anything in the library must have met a certain bar.

Obviously, a click on your phone, and as you’ve already pointed out, the first predictive things that come up may not come up for accuracy, they may come up for popularity, or because the last 2, 000 people searched, and that’s what they looked for. And the evidence is pretty clear, most of us don’t go past the third search, and we certainly don’t go on to the second page of searches.

So, it forces us all to be extremely disciplined, in a world that just wants to speed up. The most rebellious act now, I think, is slow down.

 AI is it a friend or is it the inevitable downfall of humanity?

Yeah. Yeah, it certainly is. I think overall we are doomed if I have to take a stand on this one. You know Google or Goethe. Johan Goethe back in the 1700s wrote books wrote a poem that became the Sorcerer’s Apprentice. So, that’s why most people will know the idea. And it was about technology being let loose on humanity and how we would think we could control it, but we can’t. This being the Mickey Mouse cartoon of old. And so this idea’s been around for a very long time, and people have been saying the sky is falling for hundreds of years, they’ve been saying the next generation’s lousy for many centuries, and so we’ve got to be careful we don’t overstate this, but again, we’re all human factors friends here, we know that people will be as lazy as they can be, me included, look for patterns, because we’re programmed to do so, and sometimes looking for patterns saves us time, and sometimes looking for patterns sends us down the wrong route.

And so, it’s yet another technology exploiting that. I’m quite sure people said the sky was falling when the printing press came along. That doesn’t mean it isn’t now. The thing that I’m intrigued by is where expertise is going to go. Chat GPT has already passed the bar exam for law. It’s already passed the medical exams, and the belief is within five years, it, and I know it’s an amorphous term, but it will have achieved expertise in 90 percent of areas. And so, what do you do once expertise is not on the whole held by people, it’s accessed by people. Well, then it becomes about having the digital literacy to search things properly. Will we do that? Will we teach that? I fear we won’t. And that’s where overall, I think it will be more of a foe than a friend. It’s an old line, but the softest pillow can be a murder weapon, a hammer can break a window or build a house. So, it really is going to be how we use it. And that’s why you have to engage. If you’re an academic, you have to care about this stuff. If you’re a practitioner, you have to care about this stuff. And people are going to come to us with questions that we think are beyond the pale, and that’s just life now. This sounds patronizing, and I absolutely don’t mean it to sound so. It’s not their fault because the library they’re being allowed into is the same library you and I are. Think of an area you and I don’t know much about and think of the nonsense we’ve all shared. Peer review, and people saying you’re talking nonsense, and people saying, hang on, let’s slow down and really talk about this are going to become even more important.

So, I’m taking away two main things. The first is if you put your name into Google or another search engine, you should be aware of what the top three results are saying about you and try if you can to exert some sort of control over that, if that’s possible. But that’s what people are going to do, whether that’s patients, whether that’s people outside, whatever you need to have control of those top three results.

And then about AI, the thing that I’ve seen mostly is a real anxiety, I think, because, we’ve seen it in other areas of medicine, when we believe our, for want of a better term, power is being taken away from us because the knowledge belongs to somebody else, or actually the other person have the knowledge, we’re very reluctant to embrace it.

One good example, I did an interview with Steve Smith a few months ago about PM Cardio, the app that they’ve got that will help you analyse ECGs, which I am pretty sure, right now is better at doing ECGs than 95 percent of the population, but if you were to ask a cardiologist about it they’re incredibly nervous.

Where do you think the AI thing within clinical decision making is going and what is it about us as human beings that stops us wanting to embrace it? Is it just fear? That we will become unnecessary.

It is fear. and we disguise that with all sorts of no, no, I bring wisdom to the system. But I think it forces us to double down on what do you really bring? Do you bring wisdom, or do you just happen to have the knowledge? And there’s a big difference between wisdom and knowledge. It’s the application. What’s that old line? knowledge is knowing a tomato’s a fruit and wisdom is knowing you don’t put it in a fruit salad.

I think we need to force ourselves to say, what do I bring other than access? There’s a danger doctors will say, you got to get a consult with me if you want endoscopy. Even though we know other people could possibly perform it quicker, faster. And the same thing could happen with AI.

Oh, you want an ECG, you have to have a cardiology consult, rather than just the machine reviewing it. But a lot of life has gone to that DMV level, where, we have to go through people to get to things. And there’s been a lot of disruption. The legal profession has held out for a long time, even though we all secretly know they all use about 10 forms which we should be able to download, they are still the access to that, and we look down our noses as medics at that. We better make sure we’re better than that. We’re not just, you can’t have blood work without seeing me first.

The ethics we bring to medicine are going to be increasingly important. The judgment that we bring to it. Ethics, a sort of throwaway term or a throwaway topic you do in your first year of med school. There is a danger that if we don’t make decisions that AI will make them for us. And so, we may reach a future where no, you can’t have a kidney transplant. The computer has decided running big data algorithms. And we will be so disempowered that we don’t push back, or we don’t offer a yeah, but, or in fact, we just use the AI as an excuse and say, oh, computer says, almost Little Britain style, computer says no, and we can get very lazy.

There’s a phenomenon known as death by GPS, where people just decerebrate follow a GPS map off a cliff. I’m a little concerned about how people can’t do basic math anymore, because their computer can do that basic math for them. We’ve got to stay engaged. That’s going to require a new form of discipline that, many of us weren’t raised by and if you get into this horrible catch 22 of attention has been destroyed, but attention is what is needed and vigilance is what is needed that’s where these things truly do take over and that’s where I do worry.

But perhaps we can be positive and it’s about using these tools in a positive way I much to the college and schools dismay maybe for my children.

I have encouraged them to start using chat GPT because there is a skill in asking the right question. Just in the same way there’s always been a skill in us asking the right question of the patients. You’ve got to ask the right question of the AI. And I think we need to be part of that. We need to embrace that into medical education, both at undergraduate and postgraduate level.

Because we can’t continue to practice medicine the same way that you and I were taught it a few years ago. It is a different landscape.

And my last question, what is your Kardashian score?

My Kardashian score is about seven or eight. And so just to put that into context, above five, you’re becoming a bit of a scientific Kardashian. To go back, you sound quite familiar with it, not everyone will be. It was based on Twitter followers and citations. Now, one of the. Fascinating things about social media is, the minute something gets popular, people stop using it and they move on to the next one. X or Twitter isn’t used widely anymore. But the idea that you are more sizzle and not enough steak. Now, I use that number of, if five is a cutoff, my seven is a reminder to go back and do some boring, stodgy, empiric work. Now, the flip side of that, my dad started listening to podcasts. it’s quite an interesting phenomenon. He’s a traditional scientist; his Kardashian score is probably in the negatives. Now he’s the world experts on phosphatidate phosphohydrolase, an enzyme that nobody’s heard of except for him. And it’s magnificent, scientific, vigorous work, but I would argue that he needs to get that argument out there, because the taxpayer has supported his work for a very long time.

And I know why that enzyme matters, but other people don’t. So, it’s, it’s a bit Goldilocks. Be out there, but don’t be too out there.

 We do need people somewhere in that gap to help us to get those messages out in a way that people can understand. And even if it’s just signposting, using influence to signpost, that’s still a valuable addition.

Beautifully put, but that’s where things like podcasts, are fantastic because we need something between the stone-cold lecture and a chitty chat. And I think a podcast does that. It offers a bit of information, a bit of engagement, and calls people to account.

There’s an awful thing in investing called the hype cycle, where something, an investment is the greatest ever, the worst ever, and then eventually you get to, it’s fairly reasonable. Now, we know that medicine is best drug in the world, worst drug in the world, right patient, right treatment, right duration, right therapy.

Podcasts and social media can get you there a little bit quicker and all hail you guys for running this one.

Peter, as ever, thank you so much. Our parting shot would always be, don’t believe everything just because you’ve heard it on a podcast. Simon will always write on the blog post, don’t believe everything just because we’ve written about it.

It is about going off and investigating yourself, but this is a world we all need to live in. And I think if you’re not on the train, then you’re going to get left behind. And it’s great to hear your opinion about it, Peter, but particularly, because all of us in the room are not necessarily the young thrusting millennial generation, but we recognize that this is an important place to be.

And it’s great to hear it from you. Thanks again.