A new JAMA Perspective from bioethicist John Lantos, MD, argues that the erosion of medicine’s professional “aura” began long before artificial intelligence entered the clinic.

Tracing the history of modern medicine, Lantos points to several turning points. In the late 18th century, what philosopher Michel Foucault called the "clinical gaze" shifted attention from patients’ subjective experiences to observable pathology. In the 19th century, anesthesia enabled modern surgery but also rendered patients silent and motionless, allowing physicians to treat the body as an object of repair.

Later, evidence-based medicine emphasized applying population-level evidence through guidelines and decision rules. Electronic health records further structured care through templates, checkboxes, and documentation systems.

By the time AI systems began generating notes and recommendations, Lantos argues, clinical reasoning had already been translated into protocols and digital workflows.

Artificial intelligence didn’t initiate this transformation — it arrived to perfect it.

To frame the moment, Lantos invokes Walter Benjamin’s observation that photography didn’t eliminate painting but forced artists to rethink what art could be.

Medicine now faces a similar question: if technology can reproduce many skills physicians were once uniquely valued for, how will the profession redefine clinical excellence?

The author declared having no competing interests.

Source: JAMA