“Dr. Hope Kestrel was the only person who knew the patient in Room 132 wasn’t responding to the algorithm-selected treatment. She shuffled forward in the hospital security line, wanting to ger her day started already yet dreading how she’d tell her patient the unexpected and devastating news.” So begins The Algorithm Will See You Now, a charmingly dark near-future novel by JL Lycette, MD.
Title: The Algorithm Will See You Now
Author: JL Lycette, MD
Publisher: Black Rose Writing
Publication Date: March 2023
Price: $21.95, paperback, 273 pages
Set in the year 2035, where artificial intelligence (AI) serves as a medical diagnostician, the author serves up a deeply informed and assiduously researched narrative that rips into our health-care malaise, in which an aging population must navigate a world on increasingly limited resources. The specter of the dangers of unfettered AI, which is slowly gaining traction in our current political discourse, is the dark heartbeat behind this engaging medical thriller.
AI Takes Center Stage
Dr. Lycette, a board-certified hematologist and medical oncologist with a clinical focus on rural community oncology and hematology, brings her medical experience to life on the pages, giving authenticity throughout. The story is propelled by surgery resident Hope Kestrel, MD, who works for the Seattle-based health system Prognostic Intelligent Medical Algorithms (PRIMA), where she has earned the official title of high resident; PRIMA uses high resident instead of chief resident in its OASIS unit (Oncologic and Surgical Intervention Success). On the first few pages, we learn the medical system is close to a breakthrough that would “render tumors like her mom’s curable.” We also learn that the “breakthrough” is being driven by AI.
As the title subtly suggests, an omnipotent AI voice–powered chart assistant algorithm is the conceit driving the story. Its name is Osler, and like the infamous Hal from 2001: A Space Odyssey, its penchant for mission has its dark side. Early on, readers sense trouble is brewing when hearing about disgruntled nonresponders trying to get back into the hospital. Nonresponders are patients the algorithm has identified as refractory and therefore won’t be offered treatment at PRIMA.
Readers of The ASCO Post will identify with the tension of moving a patient with cancer from curative therapy to palliative care and hospice. It could be ham-handed in an author unfamiliar with tough conversations and shared decision-making, but not so here, as Dr. Lycette uses the complex medical scenario to build pulse in her narrative. And it works.
“The specter of the dangers of unfettered AI, which is slowly gaining traction in our current political discourse, is the dark heartbeat behind this engaging medical thriller.”—
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See, it’s the AI that’s really making the decision, letting the doctor off the hook. Hope tells her new intern that Osler, the AI, recommended their patient be transferred to HEARTH, the Hospice and Restful Transitions House, which is its form of hospice. The intern questions this move, saying, “But what if it’s a mistake?” Hope reassures her the algorithm had reexamined all options for him, and there was no mistake, his cancer was incurable.
Dr. Lycette writes: “PRIMA was everything Hope had wanted, the health-care system she’d dreamed of, the one she wished had existed for her mom. The AI kept doctors on track. It ensured that she’d be the right kind of doctor and represented her life’s work.”
Lots to Root for and Against
In Chapter 1, the setup and dramatic tension are complete, giving readers just enough but not too much, the mark of an accomplished storyteller. The book is organized into 35 brisk chapters with an epilogue. Each chapter has a date and time stamp, giving it a feel at times like a film script, which is not a bad thing, given this intriguing story would make a terrific low-budget flick.
There are times when the author uses her novel as a platform for many of the topical medical issues of today (eg, medical racial bias, sexism, and reproductive freedom). A careful reader will catch on that the real-life oncologist behind the book has plenty of passion for her profession, which includes pointing out inequities in the system. There is also the industry angle, as the power-hungry PRIMA executives make deals with the goal of privatizing the entire health-care system—AI-driven capitalism run amok. It’s a lot of fun, even though the theme skirts the unpleasant boundaries of our own system.
Every good dark tale needs people to root for and people to root against. In the former category, is an anonymous podcaster who is sharply critical of PRIMA. Toward the end of the book, the podcaster returns after an ordeal and reaches out to her audience: “Hi everyone. I’m Rachel and this is Algorithm Anarchist. Where we remember, the most dangerous lies are those that use the truth to sell themselves.”
Blend of Fun and Seriousness
Throughout this fast-paced, fun read, the cancer experience is evident; the toll it takes on our human experience makes the book more relatable. There are also valuable take-aways, subtle yet poignant.
In her author’s note, Dr. Lycette writes: “As so happens in books and elsewhere, life imitates art. I had no sooner come up with my plot twist when I received a mailer at my medical office advertising postmortem genetic testing. Please note that I do not believe the concept to be inherently harmful, as long as done with informed consent and with the intent of gaining knowledge to help the individual or collective humanity—not for the sake of profit, which, you may have noticed is one theme of my book.”
Readers will have noticed for sure. This timely and well-crafted book is highly recommended for readers of The ASCO Post, the perfect book for a flight to a medical meeting.