Douglas Flora, Executive Medical Director of Yung Family Cancer Center at St. Elizabeth Healthcare, President-Elect of the Association of Cancer Care Centers, and Editor-in-Chief of AI in Precision Oncology, shared a post on LinkedIn:
“Drafting Not Drifting: Exploring the distinction between losing a skill and preserving it.
‘The deskilling worth fearing is the atrophy of empathy.’
As we navigate the age of AI, certain physician skills may diminish, but this does not necessarily spell disaster. In the latest issue of AI in Precision Oncology, I address this concern. With machines managing variables, drafting notes, and recalling trial data, there is a legitimate fear that physicians may forget how to perform these tasks themselves. Yet, we have encountered similar fears before.
In 1868, Carl Wunderlich demonstrated that fever is a symptom, not a disease, after taking a million temperature readings by hand. Soon after, there were worries that the thermometer would render the physician’s trained hand obsolete – a fear known as deskilling.
Decades earlier, a New York physician identified “the multiplicity of books” as the greatest threat to medicine. Today, we can substitute the Washington Manual with ChatGPT, and the concern remains largely unchanged.
I argue that this fear conflates two different concepts. DRIFTING refers to a pilot who can no longer fly manually because the autopilot is always engaged. DRAFTING, on the other hand, is akin to a cyclist who conserves energy by tucking in behind another rider for the crucial moments of the race. One represents erosion, while the other embodies strategy.
In oncology, this distinction is vital. A machine will always excel in recalling PD-L1 and driver mutations, but it cannot empathize with a pianist fearing neuropathy or a grandmother hoping for one more Christmas. It cannot override a mathematically sound plan when the human values in the room differ from the data. I’d agree that judgment is not the skill we lose; it is the skill we finally have the opportunity to refine – especially when we have more time available to do so, as we’ve automated the mundane and replaced those precious recovered moments with the humane.
While some skills may fade, similar to how palpating a forehead for fever has diminished, the real question is how we utilize the focus that machines allow us to reclaim. Wunderlich dedicated fifteen years to collecting those readings so that future physicians would not have to. We are those physicians.
The full editorial is available here.
The insights in this piece are influenced by Andrew Lea, whose essay “Cognitive Aids, Artificial Intelligence, and Deskilling in Medicine: The History of an Enduring Anxiety” (NEJM AI, December 2025) has sharpened my perspective. Well done, Dr. Lea!”
Other articles featuring Douglas Flora on OncoDaily.
