The Changing Landscape of Medicine: Five Insights from Middlemarch to AI

    17. Mai 2023 von Diana Heinrichs

    The changing landscape of medicine – George Eliot’s classic novel, Middlemarch, may seem worlds apart from the modern era of artificial intelligence (AI) in medicine. It was published in 1871 and tells the story of the social life in Mid-England right before the advent of the industrial revolution. When the world was and wasn’t prepared for it. Who is ready for AI today? 

    The novel’s exploration of the ethical and financial aspects of healthcare provides valuable insights into the ongoing transformation of the medical field. As we embrace AI technology in healthcare, we must critically analyze the implications of compensation and treatment decisions.

    Let’s examine the lessons we can size from Middlemarch and how they relate to the changing dynamics of medicine today. For, AI is about prediction and decision making, the main tasks of a physician since the 19th century.  

    Shifting Perspectives on Compensation: 

    In Middlemarch, the discussion surrounding a physician’s compensation sparks debates about fairness and the value of medical services. Similarly, with the integration of AI in medicine, we face questions about how to compensate for the use of technology. As AI becomes an integral part of healthcare, there is a need to establish frameworks for determining the value and compensation of AI-assisted medical services.

    Where and with whom can we discuss our resources? Every advanced society is spending between 15-20 percent of its GDP on health care – and it’s never sufficient. Can we start working bottom-up from the given budget and design an intelligent system with the given resources of budget and (wo)manpower?  

    Balancing Human Expertise and Technological Advancements: 

    Middlemarch highlights the importance of individual expertise and human judgment in medicine. Today, AI can analyze vast amounts of medical data and providing valuable insights. However, it is essential to strike a balance between relying on AI recommendations and the expertise of healthcare professionals. The challenge lies in integrating AI technology without undermining the critical role of human judgment in healthcare decision-making.

    Where do we currently discuss this confront? Is it in Brussels, at the German Bundestag? Is it with your local physician? Or is it just through the fact that we as a patient start using AI-driven technologies such as DiGA / DiPAs and create a new reality?

    Ensuring Equitable Access to AI-Driven Healthcare: 

    In Middlemarch, the discussions surrounding compensation touch upon issues of affordability and access to medical services. As AI technology advances, it is crucial to address concerns of equity and accessibility. Implementing AI in healthcare should not widen existing disparities but should strive to provide equal opportunities for all patients, regardless of their socioeconomic status. How much is a government in charge and able to provide access? The goal is very clear however the track record of government-driven digital projects is less promising. How can we cope with AI-innovation in an inclusive society? 

    Ethical Considerations in AI-Driven Healthcare: 

    Ethics play a central role in Middlemarch, and the same holds true for AI in medicine. AI algorithms must adhere to ethical guidelines, ensuring patient privacy, maintaining transparency, and avoiding biases. Transparent protocols for data handling, algorithm development, and decision-making should be established to foster trust and address potential ethical dilemmas arising from AI-driven healthcare. Is the dilemma about the regulation itself, its evolution, or the way the regulating bodies are equipped in a digital world? 

    Continual Learning and Adaptation: 

    Middlemarch depicts characters who evolve, learn, and adapt within the changing social and economic landscape. Similarly, the integration of AI in medicine calls for a culture of continual learning and adaptation among healthcare professionals. The ability to understand and leverage AI technology effectively will require healthcare providers to engage in lifelong learning and stay updated with the latest advancements in AI-driven healthcare. That sounds too banal to be true.

    But how can we improve our health care system in <4 years of a government? How can health care become a winning duty for a politician in our times?  


    While Middlemarch was written long before the advent of AI, it offers valuable insights into the ongoing transformation of medicine and our society. By considering the discussions around compensation, expertise, access, ethics, and learning from Middlemarch, we can navigate the changes brought about by AI in healthcare. Ultimately, by embracing AI technology while upholding the principles of fairness, human expertise, accessibility, ethics, and continual learning, we can leverage the full potential of AI to improve patient care and shape a better future for medicine.

    This blog post was written in collaboration with ChatGPT. The reasoning and questions were developed for coliquio CONNECTS #3 in Berlin.