At The Brooklyn Hospital Center in New York, artificial intelligence is already shouldering the real work of digesting reports, surfacing patterns in spreadsheets and taking on the kind of routine tasks that once ate up an executive’s afternoon.
The hospital is pushing it further into clinical territory, from flagging secondary diagnoses for physicians to documenting patient visits. But Sam Amirfar, MD, the community hospital’s senior vice president and chief medical and information officer, has set a condition on all of it: the person using the tool has to be able to do the job without it.
“It feels like we’ve been doing multiplication by hand for our whole lives, and all of a sudden someone comes up with the calculator and you’re like, ‘Woah, this makes things a lot easier,'” Dr. Amirfar said. “But at the same time, you don’t want to forget how to do multiplication.”
Dr. Amirfar has seen the ramifications of leaning too much on technology in his own household, where the stakes are lower but still important.
“My kids, when they go to class, they don’t use calculators. They learn how to do multiplication and division the old fashioned way, so they know how to do it,” Dr. Amirfar said. “Once you’re very, very comfortable with doing it and you just know inherently how to do multiplication, know how to do division, then I think a calculator is appropriate because it just saves you time.”
The same sequence has to govern how a hospital adopts large language models. The tools are useful precisely because they compress work that would otherwise take hours, but speed is only a benefit to someone who already understands what they are looking at; it’s less helpful for someone who doesn’t have the foundational knowledge and experience in healthcare delivery.
“We have to make sure that the people that are using these tools inherently know how to do that task anyway and that these tools are helping them do that task faster,” Dr. Amirfar said. “They might have a lot on their plate. Our hospital is often resource-strained, so wherever we can get a little productivity for our employees, that’s great. We can have them do these tasks much easier. But they have to fundamentally know how to do the tasks in the first place.”
That line separates a tool that empowers from one that erodes competence, and Dr. Amirfar has turned his attention to this issue as the hospital folds AI into more of its work. He wants to make sure everyone on the team, from seasoned veterans to new recruits, has the right background and grasp of decision-making processes to command large language models effectively.
“If you know how to do this task and you’re very comfortable with it, then I think a large language model is great,” he said. “You know how to use them and know what you need to do. If you don’t know how to do something and you’re not comfortable with the concepts, then throwing it into either ChatGPT or Cowork doesn’t really make sense because you won’t be able to understand the output. You’re not sure how you got there and you’re putting something out there that you can’t inherently defend or discuss intelligently.”
The stakes are climbing as fast as the tools. For now, he sees a window in which AI makes clinicians sharper at their work rather than redundant. Healthcare is in a “golden period” where AI is supporting clinicians with their jobs, but the next era isn’t as clearcut. When the AI seems like it can replace humans, it becomes threatening.
“Healthcare professionals and patients need to be incorporated in the discussion of the role of AI, and it can’t be dictated, either by the government or by insurance companies,” Dr. Amirfar said.
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