AI开药需具备信心机制、区分不确定性类型并透明决策过程,才可获医生信任。
The Clinician's Veto: Navigating Trust, Liability, and Uncertainty in Autonomous AI Prescribing

- 引入置信度阈值触发人工介入,避免盲目自主决策。
- 对模型无知型不确定应放弃推荐,对临床模糊应提供备选方案。
- 透明推理过程是医生承担责任的前提,提升采纳意愿。
自主AI系统正从辅助角色转向独立处方。美国众议院法案H.R. 238与犹他州处方续签试点项目均允许AI以代理身份开药。当前监管指南仅关注整体模型性能,未要求:一、基于置信度的行动门限校准;二、区分模型无知(表征不确定性)与真实临床模糊(随机不确定性);三、决策时刻的可解释性以支持责任分配。本文论证这三项为安全自主处方的最低架构要求,并通过136名美国处方医生调研验证。结果表明:医生不会接受无置信度升级机制的自主开药;面对表征不确定性偏好放弃推荐,面对随机不确定性则倾向提供替代选项;仅当推理透明且明确承认不确定性时,才愿承担决策责任。这些发现显示,上述架构特征可显著提升医生对自主AI开药的采纳率,实质重构了“自主性”的内涵。
原文摘要 · Abstract (English)
Autonomous AI systems are transitioning from advisory roles to autonomous ones for medication prescriptions. Recent U.S. bill H.R. 238 and Utah's prescription-renewal pilot program both authorize AI to prescribe medications in an agentic capacity. While many regulatory guidelines suggest aggregate model performance metrics at the point of clearance, they do not require i) calibrated per-prediction confidence for action-gated thresholds, ii) differentiated communication between uncertainty arising from model ignorance (epistemic) from genuine clinical ambiguity (aleatoric), and iii) inferential transparency at the moment of decision enabling liability allocation. Here, we argue these three architectural features are minimum conditions for safe autonomous prescribing, and validate them with a survey of 136 U.S. prescribing clinicians. Our results suggest prescribing clinicians i) would not permit autonomous prescribing without a confidence-based escalation mechanism, ii) preferred a competing-options summary for aleatoric uncertainty but preferred abstention for epistemic uncertainty, and iii) were only willing to accept liability when inferential transparency enabled them to make a decision under acknowledged uncertainty. These findings indicate that our recommended architectural features would encourage higher rates of clinician adoption of autonomous AI prescribing, largely through collapsing much of what "autonomy" conventionally means.
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