Why did the Godfather of AI change his mind?

His foundational work on artificial neural networks gave him the title, ‘The Godfather of AI’. He picked up the 2024 Nobel Prize in Physics and the 2018 Turing Award. Sir Geoffrey Hinton is a name known to anyone who has looked into artificial intelligence for more than five minutes.

So imagine the noise in 2016 when Hinton predicted that deep learning would soon outperform radiologists within five years and that medical schools should stop training them. He thought that today, radiologists wouldn’t be reading scans anymore. Now given that I spent half of my shift yesterday on the phone to the radiology reg, receiving better teaching on the paediatric elbow than anything I’ve received in my training so far, we can conclude that the prediction didn’t exactly play out.

Last month Hinton spoke on the Big Technology podcast and said the following:

So, Hinton admitted that he wasn’t privy to all the roles of a radiologist such as: deciphering a rushed and vague request from A&E, turning it into an appropriate protocol, deciding the clinical significance of a finding in that context, having an in-depth conversation with another speciality for a second opinion, performing fluoroscopy and ultrasound, performing interventional procedures and running an MDT.

But Hinton believes radiologists aren’t out of the woods yet…

When pressed on whether eventually we will have fewer radiologists, he conceded: “I don’t know for sure.”

For what it’s worth… at On-Call we agree. We have the classic AI discussions with our team, which includes Radiology registrars, and arrive at the inevitable answer of who knows. The Royal College of Radiologists will no doubt have to oversee a shift in the profession. The generalist radiologist sat in a dark room smashing through 150 plain films in a day is likely in trouble.

It is likely that the future of radiology belongs to those who can provide the greatest clinical value in their reports and perform image-guided interventions, such as iliac artery stenting or facet joint injections.

If radiologists remain purely biological pattern-recognisers, they are in trouble. AI will inevitably win the pattern-recognition game (and that’s a reality that every non-procedural specialty also needs to consider). So, what does the radiologist of 2050 actually look like?

Maybe a highly visible clinical consultant leading MDTs, an expert risk-manager vetting AI-generated reports, and a hands-on, image-guided interventionalist.

Is Anonymity Hurting or Helping Our Profession?

The reputational cost of making outlandish and irrational statements is huge, especially as a doctor. The ability to have your face and name put to a statement acts as a huge check on the things we say. Anonymity has long been associated with one of the central tools in facilitating evil. At the individual level, someone standing in the middle of a crowd feels a sense of anonymity. There are studies that show that within this environment, the propensity to engage in immoral acts increases.

Anonymity is a dangerous tool which social media has used to its full advantage. We have all seen the comments, the ones that make us sit back in surprise, contemplating whether a real human has clicked send on it.

Such comments include asking Wes Streeting to walk the plank or threatening to pull a stunt like the Joker’s in The Dark Knight on Gotham General Hospital if FPR wasn’t awarded.

But, as with most fierce debates, the truth about anonymity isn't so black and white. Throughout history, the ability to speak anonymously has been central to political and social activism. Many significant movements were born precisely because individuals could share their perspectives peacefully, without the fear of destroying their careers or livelihoods.

Countless whistleblowers have drawn attention to injustice existing both inside and outside the NHS, precisely because their anonymity allowed them to.

So, are we condemned to suck up the side effects of anonymity as necessary costs for the benefit it brings, or is there an alternative path for us to take?

The recoil that exists, but no one talks about

We are big fans of GP and writer Jonathon Tomlinson here at On-Call.

In one of his recent essays, he picks up on a quote by Dr Jens Foell that all doctors should read:

Foell describes this scent as an instantly recognisable signature, half-jokingly suggesting it should be bottled as the "Deep End." Even if it makes you uncomfortable to admit, most doctors can recall a moment on a ward round where the air grew heavy, and we instinctively recoiled in disgust.

Tomlinson goes on to note that many doctors arrange their careers specifically so they never have to encounter it again, seeking refuge in affluent practices, private medicine, or NHS posts in highly desirable areas.

Our training teaches us to greet suffering, but from a safe professional distance. We are trained to sanitise sight and sound. For example we learn to examine a necrotic wound or take a harrowing history without flinching. But smell is different. It bypasses the cortex and hits our emotional limbic centres before we can even begin to rationalise it.

You cannot professionally compose your way out of a smell the way you can with a visual stimulus.

There is a thin boundary between you and your patient that allows you to safely occupy the role of "doctor." You are the one who examines, diagnoses, and treats; they are the one who is ill and vulnerable. If this boundary were to collapse, you would be forced to confront the uncomfortable reality that the patient’s failing body is fundamentally no different from your own.

That patient’s suffering and deterioration would serve as a constant reminder of your own vulnerability. If you lived constantly in that reality, your ability to answer the next bleep would quickly vanish.

Clever people have echoed this idea before. The philosopher Julia Kristeva’s spoke about the concept of abjection as the idea that bodily fluids, profound scents, and screams actively threaten to dissolve the protective boundaries that allow us to function.

Tomlinson goes on to suggest that over the course of a career, these reactions harden into “lifestyle” or “work-life balance considerations”. They give us a desire for virtual consultations over home visits, into subspecialties that tend to attract middle-class patients, and hospitals in green-leafy suburbs.

We all know the Inverse Care Law - that the deprived areas that most desperately need proficient healthcare receive the least. But when we discuss it, notice the reasons we reach for: funding formulas, political choices, or a recruitment crisis.

No one ever mentions the simple unexamined, olfactory reflex that we have touched on here. It is far more comfortable to believe that doctors are above being pushed away by the visceral reality of the "deep end." But perhaps our collective career choices tell a different story.

“Just been sat down speaking to new Radiology Consultant who recently CCT’d. He’s 31 years old. Someone calm me down.”

“What do you make of this take from Cardiologist Dr John Dean: private practice creates a perverse incentive to increase your NHS waiting times. After all, the longer they are, the more private practice will accrue.”

“On online forums, there are doctors openly discussing ‘exam recalls’ in their Royal College exams - is this normal? Have we reached a place where recalls and similar practices are so widespread, that candidates freely discuss them online without a care in the world? Where does this leave the credibility of exams like MRCS? Surely the Royal Colleges know this type of behaviour is widespread?”

“It’s crazy the scenarios this job puts you in. Didn’t feel normal that I, as the ENT SHO, was there with my nasendoscope scoping a stridulous patient in resus whilst two ITU consultants stood behind me watching the monitor with folded arms.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

When I say Harley Street, what comes to mind? Probably cosmetics, botox and whatever else people inject in their joints and soft tissues these days right? Well, it may surprise you to know that Harley Street has become a world-leading hub for cancer care. Cancer accounts for 28% of all treatments on Harley Street, with chemotherapy being the most common treatment of them all. Cosmetic treatments make up just 7% of treatments on Harley Street.

Headline after headline talks about the greatness of the ‘family doctor’ and long for its return. We enjoyed reading this article in the BMJ from Stephanie Santos Paulo on why bringing back the family GP may be harder than we think. In our running of general practice, we need to decide between access and continuity.

Last week’s poll:

Do you think we over scan patients in medicine?

…and whilst you’re here, can we please take a quick history from you?

Something you’d like to know in our next poll? Let us know!

NHS England estimates that half of its consultants do some form of private work. Ask a qualified doctor what keeps them going through the punishing rota, and many will admit that the prospect of eventually supplementing an NHS salary with private fees is a part of the appeal.

This, of course, isn’t illegal.

While some may debate the ethics of private healthcare, most agree that doctors have a right to leverage their expertise. Few would begrudge a consultant, who spent over a decade training at public expense to reach the peak of their profession, the opportunity to earn what the market will bear.

What is interesting is the silence behind it. There is no legal requirement for doctors to inform their NHS trusts of their private work patterns or vice versa, tell their private provider of their NHS commitments. So that is two employers, sharing a stretched consultant, operating in total ignorance of one another.

But what do we do when we open our news outlet of choice and see NHS scandals involving poor care or tragic stories of consultants who have taken their lives as a result of burnout and overworking themselves? Perhaps a private hospital has every reason to know if a surgeon has spent the previous night on-call on an NHS rota? Surely, if they don’t care, then at least patients should expect someone to be tracking this sort of thing.

It seems to us that with every passing tragic news story, we move closer to a transparent system where NHS trusts and private providers cease looking away from each other.