From “The Radiologist Faces Automation,” Dr. Laurence L. Robbins’ Holmes Lecture, presented at the annual meeting of the New England Roentgen Ray Society in Boston on May 18, 1956 (a great find shared by Dr. Joseph D. Janizek).
A lot has changed over 70(!) years, and yet portions of this talk are prescient and surprisingly germane to our current times:
In selecting today’s subject, not an easy task, I reached the conclusion that although the recently coined word “automation” is not yet recognized by Webster, it is expressive and to a certain extent self-explanatory. In future dictionaries the word will no doubt be described as deriving from “automaton,” which is now variously defined, one meaning being “A person acting mechanically, especially one unintelligently following routine. Cf. Robot.” This, of course, is the last goal at which a radiologist would aim. To me the word “automation” means a speeding-up process, but it is more commonly used to indicate mechanical replacement of one or more persons at the sacrifice of such factors as individual thought, logic and reason. Increased rapidity of work is highly commendable if efficiency of method does not replace quality of product. As mechanization becomes more widespread we must awaken from our smug, self-satisfied dreams and ask ourselves, “Are we making any real effort to advance in our chosen field?”
And when it comes to training:
The primary objective in the entire course of education should be to help the student to think for himself.
Which I think remains exactly true today in the age of AI.
Our modern desire for medicine to be as convenient and quick (“on demand”) isn’t new either:
All the scientific advances experienced by the man in the street today have led him to expect as a matter of course a continuous flow of miracles, along every line of life. Medicine, he thinks, has not kept abreast of the times. The average American is not content with having the best medical facilities in the world; he wants them served to him as these other marvels are served, “on demand.” Since we physicians are being “weighed in the balance,” let us too throw our weight on the scales and try to regain the balance by broadening and bettering our public relations.
Dr. Robbins also points out the negative trend of radiologists ceding control of the radiology department. Again, in 1956:
…in certain hospitals there is a tendency for the supervision of the department of radiology to be taken away from the radiologist and placed in the hands of the hospital administration, with emphasis on income to the hospital rather than on the professional quality of the work.
And predicts the move to professional (not technical) fee reimbursement:
As radiologists we are bound to submit ourselves to a certain amount of investigation of attitudes toward and relations with our colleagues, many of whom are incensed over the radiologist’s insistence on contracts that are believed to serve simply as a means of placing him in a position that the inquiring colleague regards as invulnerable. If we consider ourselves consultants aiding in the care of the patient, we should be willing to put ourselves on a status exactly comparable to that of our fellow practitioners of medicine. Possibly the best method of accomplishing this would be to have an “open staff” in the field of radiology and to put our fees entirely on a professional basis. It cannot be overemphasized that the technical aspects of the examination, however, must remain under the control of the radiologist.
I wonder how he would view the consolidated macrosystems of today.
At the end, we get his overarching point and conclusion about automation, efficiency, and radiology practice that feels timeless:
Because our colleagues desire more rapid work from us and since we are living in an age in which equipment available in many fields is lavish and luxurious far beyond the dream of our grandfathers or fathers, it is well that we put the best of the potential improvements to use.
[…]
Each new advance offered by mechanization — processes, procedures or equipment — must be reviewed and appraised critically, its advantages being tested against its disadvantages. If the advantages prove worth while for the patient, they should be adopted routinely; disadvantages should not be forced by “popular demand” upon the patient, the physician or the public. If speeding-up processes in radiology merely mean examining more patients a day with an eye to more profit, if they mean going through the motions of an examination without intent or effort at the best possible study of the patient, if they mean division of a department into misdirected, isolated, totalitarian parts that have lost relation with the whole, or if they mean turning the radiologist from a physician into a technical charlatan seeking primarily fees for himself or the hospital, automation will harm the patient and ultimately ruin a department of radiology as well as a hospital.
The wisdom with which we face mechanization, the inevitable and often valuable accompaniment of scientific discovery, will do much toward determining our future.
How will we as radiologists face automation? The strongest and best answer is, “by continuing to be physicians.” Perhaps, as I believe Dr. Holmes would agree, this discussion should have been entitled “The Real Radiologist Rejects the Role of Robot.”
1956. Incredible.