Who Will Direct Patient Care: Physicians or Technocrats?

Not long ago, a physician’s most powerful instrument was not a machine, an algorithm, or a digital platform. It was presence. Listening with intention. Judgment shaped by experience and compassion. Today, as medicine is being reshaped by artificial intelligence, predictive analytics and digital systems, technologies are advancing at remarkable speed.

These innovations promise earlier diagnosis, greater precision and improved efficiency by augmenting the knowledge and insight that health professionals develop through years of care. Yet beneath this progress lies a more difficult question. Will we use technology to strengthen the physician–patient relationship, or allow it to redefine the nature of care?

As written in Healing the Sick Care System: Why People Matter, “…the system is not broken because it lacks innovation, talent, or investment, but because it has lost sight of the people it exists to serve.” Technology is not the epicenter of care. It is meant to support communication, deepen relationships, and strengthen the human bond at the center of medicine.

Yet as artificial intelligence becomes embedded in diagnostics, decision support, documentation, reimbursement and care navigation, extraordinary clinical potential is accompanied by a growing tension.

Two Encounters, One Technology

For instance, in a primary care practice, a physician begins a routine visit with a patient in their mid-50s who has diabetes and hypertension. An ambient AI system seamlessly documents conversations, captures symptoms, updates medications, and generates a clinical note. The physician no longer turns toward a screen. Connection with the patient is essential. The patient speaks openly about fatigue, stress, and concern about long-term health.

Midway through the visit, the electronic record surfaces an AI-generated prompt suggesting an adjustment in therapy based on predictive risk modeling. The physician pauses, not to mindlessly follow the algorithm, but to ask additional questions about daily routine, financial constraints, and willingness to adopt lifestyle changes. Technology informs conversation. It does not replace it.

When the visit ends, documentation is complete, the treatment decision is shared, and the patient leaves with confidence, clarity and a sense of partnership in care. The physician directs the encounter. Technology supports judgment and understanding. The visit feels thoughtful, personal and grounded in relationship.

Now imagine the same technology in a different environment. The documentation remains seamless. The prompts still appear. The system functions efficiently. But here, the pace is set as much by operational demand as by clinical judgement. The schedule tightens. The visit is short. The physician moves quickly from one room to the next, guided less by the patient’s story and more by the system’s tempo. The encounter becomes transactional and compressed. Technology has not changed. What has changed is who is directing the care.

This is the quiet divide now shaping modern medicine. One path preserves physician-directed care, where technology supports human understanding. The other reflects system-directed transaction, where efficiency begins to overshadow the relationship. The difference lies not in the tool but in the priorities that shape its use.

This question of direction is not theoretical. It reflects a deeper shift in how technology may shape human judgment itself. Innovation theorist John Nosta, whose work has long been rooted in the health sector and now spans a broader landscape, cautions in his Psychology Today column: “Artificial intelligence is far from neutral, and we need to be careful by calling it simply a tool. By simulating understanding, it may reshape what humans expect from thinking itself. Over time, it can erode the habits required for discernment. And this danger is cumulative. It doesn’t announce itself as failure. It arrives as convenience.” Nosta is also the author of the upcoming book: The Borrowed Mind—Reclaiming Human Thought in the Age of AI.

When Technology Reflects the System Around It

Technology itself is not the challenge. When developed in partnership with physicians, nurses, and other health professionals, it can be transformative. Many of the most effective innovations emerge when developers observe the realities of care and design tools that strengthen human interaction rather than disrupt it.

John Whyte, MD, MPH, CEO of the American Medical Association, has emphasized that artificial intelligence must support physicians and care teams, not replace clinical judgment, and that technology should strengthen, not weaken, the physician–patient relationship.

A clear example of this tension is emerging in the context of prior authorization. Health professionals and administrative staff often spend more than a dozen hours each week navigating authorization requirements, time taken directly from patient care. New AI-enabled platforms, such as Optum’s Digital Authorization Complete powered by Humata Health, are designed to remove that burden by embedding real-time automation into clinical workflows and reducing manual steps. These innovations restore something invaluable: time.

Now, the deeper question is not technological but human. When time is returned to the system, how will it be allocated to the health professional? Will it allow clinicians to deepen their understanding of patient needs and strengthen their connection? Or will it simply enable the system to see more patients during their shift? The technology is neutral. Its meaning is shaped by people’s intent.

Health care operates within systems shaped by financial and operational pressures. In a transactionally driven environment, even well-intentioned technology can be redirected toward productivity rather than connection. A tool designed to restore time can become a mechanism to increase throughput. A system intended to support thoughtful care can accelerate volume in a fee-for-service environment. Technology inevitably reflects the values and objectives of the system in which it is deployed. It is not the technology that directs decisions and action; it’s the leadership.

The scale of investment underscores the stakes. The global AI in health market, estimated at roughly $36–39 billion in 2025, is projected to grow substantially in the coming decade. Investment shapes priorities. Priorities shape design. Design shapes experience. And experience shapes trust.

Emerging guidance aligned with the American Medical Association emphasizes that artificial intelligence must remain under meaningful clinical oversight. Technology must support physicians and care teams, not replace judgment or responsibility. Governance, transparency, and continuous evaluation are essential to ensure that technology strengthens patient safety, clinical reasoning, and trust.

This perspective aligns with participatory medicine. Dr. Danny Sands of the Society for Participatory Medicine has described health care not as a service transaction, but as a collaboration between patient and clinician. In that view, technology should support relationship-centered care, not redirect medicine toward system-driven throughput.

The Direction of Care

Health systems face real pressures: workforce shortages, clinician burnout, chronic disease, and financial strain. These realities demand smarter and more scalable solutions. Artificial intelligence offers meaningful progress. It can detect disease earlier, reduce administrative burden, and support more informed decisions. But efficiency is not healing.

Healing occurs when patients feel understood, supported, and guided by clinicians who have the time and space to listen and respond with care. When technology restores time and that time deepens connection, it fulfills its promise. When reclaimed time becomes additional volume, something essential is diminished.

Artificial intelligence will continue to shape medicine. The deeper question is not whether technology will advance, but who will decide how it is used and for what purpose.

If guided primarily by efficiency, care risks becoming faster but less human. If guided by partnership with physicians and patients, it can restore time to listen, space to understand, and the ability to decide together. Technology is not the healer. People are.

When guided by clarity of purpose, with the patient at the center of effort, and grounded in physician-guided judgment, technology becomes what it was always meant to be: a force that strengthens knowledge, deepens understanding, and restores the bond between physician and patient. Systems matter. They enable scale, coordination, and progress. Yet their purpose is fulfilled only when they serve people. Health care is at its best when human connection and well-designed systems work together in the service of healing.