What Are Doctors For?

A surgeon's perspective on the patient and physician as fellow travelers.

There is an emerging sentiment that medical AI is challenging the core identity and relevance of physicians, most dramatically evidenced by recent articles in the mainstream press with titles like:

• If A.I. Can Diagnose Patients, What Are Doctors For? — The New Yorker

• A.I. Is Making Doctors Answer a Question: What Are They Really Good For? — The New York Times

Let’s set aside for now the surgeon’s technical performance in the OR; what I want to examine here is the relational work we do before the patient ever reaches the table. The growing public sentiment captured by these headlines is being exacerbated by those physicians who view AI as some sort of existential threat to our profession. They bristle when the patient arrives to their clinic appointment with chatbot logs or the patient’s spouse asks whether a particular test ChatGPT suggested might be helpful. At professional society meetings, they often point to the physician’s physical presence as something AI could never supplant: “sure the AI can give a diagnosis or recommend a course of action, but can it give the patient a hug, or hand their spouse a tissue?”

Meanwhile, multiple publications comparing the perceived empathy of chatbots vs. human clinicians have demonstrated that both patients and third-party evaluators often rate the chatbot as more empathetic and compassionate than the human. Whether or not the perceived empathy of these chatbots is being fueled, on some level, by sycophancy is a separate question — do people prefer the chatbot because it agrees with them, while the human will tell them they’re wrong? Are patients confusing validation with compassion? This distinction matters more than it might seem — a medical chatbot optimized for user approval may be doing something closer to the opposite of medicine, and the downstream consequences of that dynamic are only beginning to be understood.

Whatever the mechanism, patients don’t seem to care that the computer can’t give them a tissue; the human clinician is subject to constraints the chatbot never faces: finite patience, the inability to be in multiple places at once, human limits like hunger and exhaustion, etc.

So, with this shared context, allow me to answer the question at hand here by presenting an entirely different frame for the patient-physician relationship, borrowing a beautiful concept my own therapist shared with me from a senior psychiatrist’s book of advice to the next generation of therapists.

In his book The Gift of Therapy, Irvin D. Yalom presents an alternative view of the patient and therapist: not as the afflicted patient and the invulnerable healer, but instead as fellow travelers. The parable he uses to illustrate this is drawn from Hermann Hesse’s Magister Ludi. A young healer named Joseph, himself devastated and seeking spiritual guidance, goes on a pilgrimage to find the great elder healer Dion. Along the road he meets an old traveler, who, learning Joseph’s purpose, offers to guide him. As their long journey unfolds, the old traveler reveals his identity: he himself is Dion — the very man Joseph sought. And two decades later, on his deathbed, Dion finally confesses that on the very night they had met he was on a pilgrimage to a famous healer named Joseph, seeking salvation from the emptiness and spiritual void he could not cure within himself. They are not the afflicted and the healer, but instead fellow travelers seeking answers to what Yalom identifies as the four central concerns of human life: death, isolation, meaning, and freedom. Yalom goes on to lament the twenty years of Dion’s secrecy, positing that the real therapy occurs at the deathbed, when the façade of superiority finally gives way to honest and authentic humanity.

And do the surgeon and their patient not grapple with the same fundamental concerns as the therapist and his client? The possibility of death and disfigurement; the isolation of being the only one who will be sedated and naked in a sterile room of masked strangers; the question of whether recovery will restore meaning, form, and function; the terrifying freedom of agency and consent in the face of an inherently unknowable future. These fundamental concerns are not mere psychological constructs but instead components of the human condition that permeate every physician’s work, whether they are a psychiatrist or a surgeon.

Why then, do some surgeons and patients cling to the notion of the surgeon as an imperturbable oracle, all-knowing and decisive, dispensing answers to supplicants who must simply trust and comply? Perhaps remaining behind the curtain allows the surgeon to conceal their own humanity, to hide the agony and terror wrought by opening the flesh of another human being. Perhaps believing the surgeon is superhuman allows the patient to more peacefully submit their life to another’s control, allows them to be vulnerable by clinging to the fallacy of certainty.

Like Dion, however, we must shed the veil of performance before a genuine encounter can occur and true human connection can be found.

So, to answer those newspaper headlines, this is what I am good for: not for handing you a tissue or offering superhuman diagnostic capabilities, but instead to provide the accumulated, embodied, experiential knowledge of the wise fellow traveler who has dedicated a lifetime to walking these roads. Shared decision-making and informed consent are themselves invitations for co-navigation. As we sit in the clinic or in the emergency room and discuss your diagnosis and possible next steps, I am not an infallible oracle, but instead simply a wise traveler who has walked these paths before. I have seen what the road looks like around bends the patient hasn’t reached yet; I know which fears are well-founded and which are the mind’s night terrors. The surgeon and patient are fellow travelers — both human, both facing uncertainty — but the surgeon alone has stood at these crossroads with hundreds of other patients, each of them here for the first and only time, grappling with the exact same decision the patient now faces.

The physicians who feel threatened by the patient with the chatbot printout and the journalists asking what doctors are good for have both confused the performance of medicine for its substance. They see medicine as an information-delivery system, and measure us against tools that deliver information faster and more patiently than we can. Little of our inherent value as physicians is captured in a differential diagnosis or a recommended lab panel. It lives, instead, in the moment when a patient looks up from the bed and asks “what would you do if this were your mother?”

That is not a request for data or validation. It is Joseph at a crossroads, tired and vulnerable, looking for Dion.