An inclusive future for healthcare

The Noel Callaghan Guest Lecture at the Irish Neurological Association (INA) Annual Meeting was delivered by Prof Geraldine McGinty, Professor of Clinical Radiology and Population Health, Weill Cornell Medical School, US. The title of her lecture was ‘An inclusive future for healthcare: Provider-driven, patient-powered, AI-enabled’.

INA President Dr Helena Moore welcomed Prof McGinty to the stage, noting their shared time as students in Galway before Prof McGinty’s move to the US. She also paid tribute to Dr Noel Callaghan – the first neurologist appointed in Cork and a founding member of the INA – whose legacy the lecture commemorates.

A warm welcome was extended to Dr Callaghan’s daughter, Helen, and granddaughter, Ella, both of whom were in attendance for the occasion.

Prof McGinty, who trained as a radiologist in Pittsburgh, opened her lecture on the subject of inclusivity and detailed her work in trying to deliver positive change in the US healthcare system.

She outlined how the US provides the best medical care in the world “to some”, but not all, people.

Prof McGinty highlighted the stark contrast in life expectancy within New York City, noting that while residents of affluent Manhattan live on average to 85 years, just 10 miles north in the less advantaged Bronx, the average drops to 75 years.

“We spend a lot of money on healthcare in the US, about 20 per cent of our national output, and yet our outcomes are often nothing to be proud of, especially if you’re from certain demographic groups. People of colour in the US have dramatically poorer outcomes…. And our incredibly complex payments system means that the single most common cause of personal bankruptcy in the US is medical bills,” she said.

According to Prof McGinty, healthcare is most effectively delivered by teams – especially diverse ones.

“Physician-led hospitals, like the one I work in, do perform better… there is data that shows patients tend to have better experiences in those health systems,” Prof McGinty said, though she acknowledged that “it’s not something where there is P value”.

However, there is no doubt that if positive change is being sought in healthcare “we will not do it without the buy in and support of the doctors in that healthcare system”, she maintained. 

Unfortunately, doctors do not necessarily think of themselves intuitively as healthcare leaders, she added, and they are not taught how to be leaders in medical school.

“There is a mythology there about being the smartest person in the room being the person who has to take the hard decisions,” she said. Prof McGinty also pointed out that relationships medical professionals “have with non-physicians and non-healthcare providers on our teams or who lead our systems” can be  “fractured and fractious”.  “So how do we get comfortable thinking about ourselves as leaders?,” she asked.

According to Prof McGinty, the answer lies in greater self-awareness and team understanding – something that can begin with tools like personality assessments.

Pulling together teams of people who are different who can complement our skills can also help doctors drive change, she said.

“But we have to amplify the power of that diversity,” she stressed. Doctors can do this by fostering diverse teams and teams in which people feel comfortable “speaking up”.

Prof McGinty spoke about the importance of “psychological safety”, clarifying that it does not mean “everybody feels comfortable all the time”, but rather that a team unable to respectfully challenge one another cannot be truly effective.

Strong teams are built on the absence of fear, where problems and challenges can be openly acknowledged and discussed, she said.

Healthcare can often feel overwhelming due to its complexity and the multitude of stakeholder groups – each viewing the system through a different lens – which, she noted, can lead to friction.

Prof McGinty advised doctors to try to understand the levers of change in healthcare, particularly the “financial drivers” within health systems, in order to help
foster change.

Prof McGinty concluded by urging healthcare professionals to reflect on their own readiness for change, especially in the aftermath of the Covid-19 pandemic. While five years have passed since the beginning of the pandemic, the strain of physician and provider burnout remains a serious concern.

“We have to be thoughtful about our ability to pick ourselves up and make changes when we are feeling challenged by our day-to-day work,” she said.

She also pointed to evidence linking burnout to poorer clinical outcomes, including higher rates of surgical site infections and even mortality, as well as increased malpractice claims within healthcare systems.

She spoke about the “transformative” nature of mentorship – whether through career guidance, coaching, or psycho-social support.

“We need to take care of each other and ourselves,” she advised.

Prof McGinty then turned to the subject of patients, and the influential power they can have, both in a positive and negative way. Patients, she said, are the most important stakeholder in healthcare.

She discussed the lack of trust among some communities in healthcare.

Prof McGinty noted, in particular, the level of distrust among the black community in the US following decades of inadequate care.

“We have a maternal mortality scandal in the US and what’s really unfortunate and telling is that even black women who have resources are at a much higher risk of dying in childbirth,” she said.

She noted the power of social media in disseminating disinformation, which needs to be counteracted, she argued.

Shifting focus to artificial intelligence (AI), Prof McGinty, a radiologist, noted the widespread belief that AI could replace radiologists

However, she said, the majority of US radiologists are not using AI despite working in a specialty that “loves innovation”. AI adoption has been much slower in healthcare than initially envisioned.

Prof McGinty said there is a role for the technology, given the “severe workforce shortage” in radiology and “the volume of imaging” required due to ageing populations.

“There is ample evidence… that an algorithm can perform at least as well as me and, [speaking] candidly, at the end of the day, when I’m distracted… the algorithm can probably outperform me.”

However, she asked “why is it that after all this hype, we are not seeing AI not just replacing radiologists, but also featuring more prominently in how we deliver and transform healthcare?”.

The complex nature of stakeholders in healthcare has played a role in limiting the adoption of AI in healthcare, she said.

She added that AI tools often seek to answer just one question or one part of a puzzle when several issues are usually at play in assessing patients.

Access to datasets used to train AI algorithms is another limitation, along with regulatory barriers in sharing data outside hospital systems, she said.

“Until we start to see more data being shared that is going to limit it [AI],” she told delegates.

“That’s not to say we are not using any AI in the US. There is a lot of AI happening informally in health systems and a lot of academic systems are developing their own algorithms.”

Prof McGinty remains excited, however, about the potential of AI in radiology imaging and in helping to alleviate radiology workforce shortage that exists not only in the US, but worldwide.

“What we are seeing is the ability of AI to extend what we do as imagers across areas where there are simply never going to be enough human imagers.”

Note-taking places a significant burden on providers, affecting both their time and wellbeing, she said. AI-powered medical scribe tools can help ease this workload. She also emphasised that AI’s potential to streamline administrative tasks should not be underestimated. Additionally, AI could integrate siloed datasets to support more timely and accurate diagnoses.

However, she argued that significant concerns about the technology must be addressed. Prof McGinty questioned the potential negative effects of these innovations, warning against over-enthusiasm and stressing the importance of understanding how these imperfect tools operate. Among the key challenges she highlighted were AI bias – not just its presence, but the risk of amplifying existing societal biases – and misaligned incentives, which could further complicate responsible development and use.

“We have to be very clear when we consume information, when we make decisions, that we understand who is getting paid for what, and who is doing what for who, so we can…  understand what the incentives are,” she advised.

Post-market monitoring and governance are critically important in AI and AI algorithms need to be attuned to the needs of all patients, she warned.

Despite the challenges, all tools, including AI, should be used by doctors to help change healthcare, Prof McGinty said.