Chatbots now outscore physicians on empathy in blinded, text-based evaluations, but those findings are limited to written responses rather than bedside care. The surprise isn’t that AI can read images or support diagnosis — it’s that it appears to now outperforms physicians on empathy in these settings, a quality medicine assumed it would always own.
That’s the uncomfortable starting point for this JAMA viewpoint, published by Martinelli and colleagues. Their argument isn’t that AI has become compassionate — it’s that clinical work has been reorganized in ways that pull physicians away from direct patient care. Four decades of documentation requirements, prior authorizations, billing workflows, and inbox management have left physicians spending 49% of their office day on EHR and desk work and only 27% in direct clinical contact. The empathy gap, they argue, isn’t primarily a technology story. It’s a workforce design story.
The piece makes a distinction worth sitting with: the empathy studies showing AI outperforming physicians were all text-based evaluations — no physical exam, no reading a patient’s face, no staying with someone through fear and uncertainty. The highest empathy ratings occurred when AI-generated responses were attributed to a physician, suggesting participants expected that level of communication from their physician. The algorithm met that expectation — but the physician did not.
The authors frame the issue as one of governance rather than replacement. They describe AI as an excavation tool — something that can absorb administrative burden — but only if physicians remain present enough to oversee it. As they write: “AI does not replace physician judgment, it preserves it.” An absent physician can’t audit an algorithm. A present one can.
The risk is that health systems could just as easily deploy AI to accelerate throughput, generating faster documentation and higher volume while the physician stays just as removed from the bedside. The technology creates a fork in the road, but the profession chooses the path.
Among more than 20,000 clinicians surveyed in prior research, feeling valued by one’s organization was the strongest burnout mitigator — reducing odds by 78%. Institutions serious about restoring the bedside may need to start there.
The authors declared having no competing interests.
Source: JAMA
