Keeping Physicians in Charge of Oncology AI: Johnetta Blakely, MD, MS

Any artificial intelligence (AI) function that touches a patient in a high-stakes way has to pass through the physician first, including the final click that places an order, according to Johnetta Blakely, MD, MS, MMHC, of Tennessee Oncology and chief medical officer, Community Oncology Alliance.

In an interview with The American Journal of Managed Care^®, Blakely discussed how AI tools are evaluated, how patients respond to use of AI in their care, and the physician’s responsibility for orders that carry the physician’s name.

How AI Tools Are Evaluated in Practice

When looking at different AI tools, one central question is whether the tool does what it says it does, Blakely said. That question shapes how the tools are tested before they are put to use.

She noted that many of the tools in use today do not interact with patients directly. Ambient AI for transcription and the ingestion of medical records are 2 examples. For those functions, Blakely said it is unclear whether tuning a tool to a specific patient population applies and acknowledged not having a firm answer on that point.

How Patients View AI in Oncology Care

Blakely described the question of AI and patients as increasingly relevant. In the exam room, many patients arrive having already consulted AI themselves, which affects how they react when a clinician says a tool helped inform a decision.

“They understand that because they’re using those tools to help them make decisions as we give them options,” Blakely said. Patients are therefore generally comfortable hearing that a tool played a role.

Oncology also has a long habit of shared decision-making among clinicians, Blakely said. The specialty relies on consultation with colleagues and on tumor boards rather than on any single clinician working alone. “It’s not an area of medicine where you can really live on an island,” Blakely said. As a result, patients have come to expect input from multiple sources, and Blakely suggested that AI-supported input fits within that existing expectation.

Why Physicians Must Own High-Stakes Orders

Blakely drew a firm line around anything high stakes that reaches the patient. Whether an order is actually placed should depend on the physician reviewing it and clicking the button, according to Blakely, who said the point is one of strong personal conviction.

The reasoning comes down to accountability. A physician’s name appears on each order, and with it comes the physician’s license and professional responsibility. “If my name is on an order, it’s my responsibility to make sure that was the right order for the patient at the right time,” Blakely said.

That principle leaves room for AI to assist with documentation, records, and decision support, but not to replace physician review where patient care is directly affected. For Blakely, the physician stays the final checkpoint, and no tool changes that.