The Lost Aura of the Doctor in the Age of AI

Artificial intelligence can now make difficult diagnoses, detect drug interactions, read medical images, predict outcomes, counsel patients — and even write peer reviews. As these capabilities expand, doctors risk becoming supervisors of autonomous systems, retaining responsibility while ceding autonomy.

To understand what is being lost, we might turn to an unlikely guide: the philosopher Walter Benjamin.

Writing in the 1930s about photography and cinema, Benjamin asked whether the mechanical reproduction of images would render painting — and painters — obsolete. His answer was subtle and, it turns out, remarkably applicable to medicine today.

THE CONCEPT OF AURA

Benjamin argued that original works of art possessed an "aura" — something bound up in the uniqueness of the original's creation and display. It reflected, as he put it, "the essence of all that is transmissible from its beginning, ranging from its substantive duration to its testimony to the history which it has experienced."

Historically, physicians possessed a comparable aura. Professional authority was grounded in practical wisdom accrued painstakingly over time and manifested in face-to-face presence and nuanced judgment. Like an original painting, medical expertise appeared singular and inseparable from the clinician who exercised it.

"Telepresence is not the same thing as presence."— Jeremy Greene, historian of medicine

Defenders of the human doctor emphasize empathy, accountability, and trust. They point to the cautionary history of telemedicine — once heralded as a way to lower cost and widen access, it stumbled not for technical reasons but because something essential was missing from the screen. Face-to-face encounters between healer and sufferer seemed to carry something irreducibly human.

A LONG HISTORY OF DEPERSONALIZATION

But AI is only the latest chapter in a longer story. The tension between humanistic care and technological efficiency has been building for two centuries.

Michel Foucault traced the origins of what he called the "clinical gaze" to late 18th-century French physicians who reimagined disease as an objective, observable entity — and consequently began to treat patients' subjective experiences as, in his words, "disturbances that can hardly be avoided." The patient's story became secondary to measurements, quantification, and standardized pathology.

The rise of anesthesia in the mid-19th century accelerated this transformation. Surgery on an unconscious body made it easier — and professionally necessary — for physicians to bracket empathy, reframing emotional distance as competence rather than coldness.

"One of the first things that commonly happens to him is that the patient loses his personal identity."— Francis Peabody, JAMA, 1927

By the 20th century, the modern hospital organized care around technologies and administrative practices that made patients into passive recipients of therapeutic interventions. Then came evidence-based medicine, which privileged reproducible population-level data over individualized clinical judgment. Guidelines became algorithms. Algorithms became embedded in electronic health records. Doctors began communicating more with their screens than with their patients.

By the time AI arrived, physicians had already been trained to think in ways compatible with machine logic. AI did not initiate this transformation; it arrived to perfect it.

WHAT MAKES AI DIFFERENT

Two features distinguish AI from all prior medical technologies.

First, it is interactive. AI can now perform non-technical tasks once thought beyond the reach of machines — obtaining informed consent, counseling patients about end-of-life decisions, providing psychotherapy, expressing attentiveness and concern. Perceived compassion no longer depends on the capacities of individual clinicians.

Second, AI democratizes medical knowledge in a way no prior technology did. It is available to everyone, on their phones, without the expensive superstructure of a hospital. Patients and doctors can experiment below the radar of traditional regulatory mechanisms.

THE RECKONING AHEAD

When a profession's core competencies become reproducible, the central question is not whether the profession will disappear, but how its social role will be redefined.

Importantly, in Benjamin's account, photography did not kill art. Freed from the obligation to reproduce reality faithfully, painters reinvented their social role — exploring new forms of perception, expression, and critique. Impressionism, abstraction, and conceptual art emerged from the shock of mechanical reproduction.

Medicine faces its own version of this reckoning. It will require hard thinking about which skills are uniquely human, which should be handed to technology, and what new forms of clinical excellence might emerge. The disruption will raise deep controversies about what medicine is, what it should do, and how quality should be judged. Medicine may fragment into different schools, each with a different relationship to technology.

Oliver Sacks, writing about his work with encephalitis patients in Awakenings, recognized that "all of us entertain the idea of another sort of medicine... which will restore us to our lost health and wholeness." Whether physicians can dare to reinvent their social role and professional identity is, at this moment, an open and urgent question.

For more - see https://jamanetwork.com/journals/jama/article-abstract/2845756