‘The machine is only a tool after all.’

In his seminal and hugely prophetic 1950 novel I, Robot, Issac Asimov made this memorable distinction when describing how he envisaged the relationship between humans and the then emerging technology of robotics. 

In Asimov’s analysis, robots would exist to support and enhance the actions and advances of human beings, rather than seek to supplant them.

More than 75 years on, robotics, and latterly AI, do indeed play an increasingly significant role in all areas of day-to-day life, with medicine and healthcare very much part of this phenomenon.

Many people are quick to champion these innovations as ‘gamechangers’ that will facilitate a positive transformation in the delivery of medical care.

NHS England last year asserted their ambition that the next decade will see millions more patients benefitting from ‘cutting-edge NHS robotic surgery’. 

This vision includes nine out of 10 keyhole surgical procedures being delivered with robot assistance with robotic surgery becoming the default across other operations.

For all the potential clinical improvements and advances posed by cutting-edge technologies, there are growing concerns among members of the medical profession that today’s tools will ultimately be turned against those who wield them.

Central to the development of robotic technology is the data gleaned through the recording of human-conducted surgical procedures. 

The use of this data, which is harvested by tech platforms for developing AI-based training models, is raising increasing concerns over the exploitation and theft of doctors’ experience and skills and ultimately the undermining of their professional autonomy.

Speaking at the association’s annual representative meeting in Brighton, surgical senior house officer Ross Nieuwoudt (pictured top) presented a hypothetical future scenario in which a doctor having spent years training with the aid of robotics and AI would see their skills appropriated by the very same technology.

‘It's 2035 and during a medical conference you watch a surgical AI that can perform a robotic cholecystectomy start to finish with no surgeon required,’ said Dr Nieuwoudt.

‘It's good, efficient, familiar, really familiar, and that's when the penny drops. You’re watching yourself operate except it isn’t you, it’s the robot you trained on, the one that wouldn’t unlock your training modules until you clicked agree on the terms and conditions and signed away 20 years of experience for free to a company now selling it back to the NHS as their innovation.’ 

Dr Nieuwoudt said the unchecked risks posed by the increasing adoption of robotic technology required a series of urgent actions if doctors’ independence and autonomy were to be preserved.

This included the creation of legal frameworks acknowledging surgical technique as the intellectual property of the operating surgeon, along with a review of ‘all existing and proposed contractual arrangements between NHS hospital trusts, integrated care boards, and robotic surgery platform providers’, around the ownership and use of surgical procedure data.

In addition, the motion called for the lobbying for legislation to ensure an immediate halt to the unauthorised collection, distribution or commercial use of robotic surgical data, with Dr Nieuwoudt warning that otherwise all medical specialties would ultimately be at risk of such intellectual theft.

‘It [AI and robotics] will come to the psychiatrists too, why fund a clinic when there’s an app and a phone line that never burns out? GPs aren’t safe. Why pay a partner when a machine can take the history, make the referral, and never once ask for a pay rise?’, warned Dr Nieuwoudt.

‘There’s a huge difference between teaching the doctor beside you and having your skills harvested without your knowledge and sold to the highest bidder. 

‘Every specialty in this room will be recorded, transcribed, and quietly fed to something learning to be you without you, and without ever asking for a thing. 

He added: ‘This motion is the first line that we draw in the sand, and it forces our union to act to win legal protection for our craft to drag every dark contract into the light and to shield our patients' data from being taken without their say.

‘It's how we protect our profession from exploitation, from theft, and from being quietly replaced, and we must protect it now, before it's too late.’