Bridging Two Centuries of Medical Evolution
Our Nature Medicine cover art submission seeks to link arguably the biggest artifact of epistemic change in medicine – the stethoscope – with the next big epistemic shift, artificial intelligence technologies.
Historical Context: The First Great Shift
Over 200 years, medicine underwent an epistemic shift, from conceptualizing diseases as a symptom-based taxonomy (best characterized by Syndenham’s nosology) to a pathological-anatomy based model. This idea — that disease was colocated in the body — allowed the development of germ theory, modern pharmaceuticals, and all sorts of diagnostic testing.
While this shift — described in Foucault’s Birth of the Clinic — happened over decades from roughly 1790-1820, the enduring symbol has become the stethoscope — a tool that, from Laennec’s own words, allowed physicians to see disease “with a better eye.”
The Next Frontier: Beyond Human Understanding
Perhaps most provocative is the suggestion that AI may create a “machine nosology” of disease that operates beyond human interpretability.
Just as the shift to pathological anatomy redistributed the boundaries of medical knowledge in the 19th century, AI may again redraw these boundaries—potentially classifying and treating diseases in ways that human physicians could never conceptualize on their own.
The Creative Process
We commissioned our artwork to explicitly make that historical connection — from the stethoscope to GPT-4 (similarly, the most visible example of a coming machine nosology).
These preliminary sketches represent different models of physician-technology interaction, progressing from current practice to our vision for the future.
Technology in Today’s Context
This sketch depicts a surgeon working with today’s surgical tools and technologies – representing the current state of medical practice where physicians utilize advanced equipment but remain the primary operators. The composition frames the surgeon among the robot arms to depict them working in harmony with technology.
Technology as Physician Assistant
This concept illustrates an advancement where AI takes a more active role – selecting and handing appropriate tools to the physician during procedures, enhancing the doctor’s capabilities through intelligent assistance. This is a more literal representation of the technology mimicking or advancing human abilities. The drawback of this idea is the potential implication that the tech is replacing human abilities which is not the case.
Future Collaborative Vision
This sketch explored the relationship between the clinician’s hand and the stethoscope – the enduring symbol of the 19th century epistemic shift toward pathological anatomy in medicine. The composition includes geometric elements that suggest the computational frameworks of modern AI. This is the most succinct representation of the potential fluidity with which humans and the technology can operate.
From Concept to Final Artwork
Artist: Anuj Shresta | “Epistemic Bridges” | Digital Illustration, 2025
The final illustration brings together the key elements from the conceptual sketches. The stethoscope remains a central visual reference to traditional medical practice, while the illuminated node represents emerging AI diagnostic systems.
The composition maintains the human element as the bridge between these technologies, suggesting that despite technological advancements, the physician continues to be the essential interpreter between traditional diagnostic approaches and emerging AI systems – connecting the epistemic shifts in medicine from the 19th century to today.
This concept represents our vision for the future: physicians and AI working together as partners, analyzing trillions of data points to provide optimal patient care outcomes.
Looking Forward
As we consider this visual metaphor, we’re reminded that medicine has always advanced through technological innovation that extends human capabilities.
From Laennec’s simple wooden tube to the complex neural networks of today’s AI systems, the goal remains the same: to see disease “with a better eye” and improve patient outcomes.
Study team: Ethan Goh, Robert J. Gallo, Eric Strong, Yingjie Weng, Hannah Kerman, Jason A. Freed, Joséphine A. Cool, Zahir Kanjee, Kathleen P. Lane, Andrew S. Parsons, Neera Ahuja, Eric Horvitz, Daniel Yang, Arnold Milstein, Andrew P. J. Olson, Jason Hom, Jonathan H. Chen & Adam Rodman
About the Artist:
Anuj Shrestha is an illustrator and cartoonist currently residing in Philadelphia after having lived in nearly all four corners of the United States. He completed his BFA at The University of Colorado at Boulder in 1999 and his MFA in Illustration at The School of Visual Arts in 2005. His illustration work has appeared in The New York Times, The New Yorker, and The Washington Post; and has been featured in the Society of Illustrators and American Illustration annuals.
This artwork was commissioned by Stanford Hospital Medicine and Stanford BMIR.
