Do Patients Want Artificial Intelligence or Human Intelligence?

One thing that the COVID-19 pandemic taught us is that good healthcare does not mean a patient has to deal with traffic, parking, and waiting room issues. In fact, for some types of problems, patients have preferred video visits from their home over an in-person office visit [1]. Convenience and cost are major factors in that decision. But how far removed from direct contact with their healthcare provider are patients willing to go for the sake of convenience and cost? Are they willing to let artificial intelligence (AI) guide their medical care? The answer is a resounding “Yes!” Patients are accepting, and, in some cases, preferring the medical guidance that they can receive from AI.

Reliant Medical Group first tested the waters of AI-assisted patient care with the development and implementation of a symptom checker in 2021. Unlike other symptom checkers available on the internet or offered by some electronic health record (EHR) vendors, this system leverages the patient’s known medical history to reduce the number of questions needed to give guidance on over 800 conditions that could be causing their symptoms. It provides education on what each condition is, how to undertake self-care if appropriate, and when to seek medical care if the condition gets worse. Patients love it because half of them use it after hours and on weekends when the offices aren’t open, and a quarter of them get enough self-care information that they do not need input from Reliant’s providers or staff. This frees up Reliant’s providers and staff to help serve other patients who have more acute needs. If patients do want to schedule a video visit, they can do that directly from the app. All the symptom history they already entered will be available to the clinician within the EHR, so they don’t need to give their history again. The symptom checker has also potentially saved several lives, referring some patients to the ED who were originally planning to undertake self-care, resulting in admissions for serious conditions.

In the past year, a form of AI known as “Generative AI” has hit the headlines. One version known as GPT-4 by OpenAI has been able to surpass humans on many standardized tests [2] (Figure 1) and specifically outperform most physicians in the United States Medical Licensing Exam [3].

Even more remarkable is that GPT-4 scored higher on communication skills such as empathy and professionalism than the average physician [4,5]. This has indeed been the experience as EHRs such as Cerner and Epic have implemented GPT-4-generated draft responses to online patient portal questions. As these messages appear in the In Baskets of physicians and nurses, the EHR displays an optional draft response.

This response can be edited and sent back to the patient. Early studies show that these responses are longer and felt to be more empathetic by patients compared to a prior baseline. This has led to physician concerns that when doing subsequent visits, the patients will expect the physician to speak longer and appear more empathetic!

Patients are starting to benefit from AI in other ways as well. For instance, AI is making real-time ambient transcription and summarization of office visit dialogue a reality. A microphone recording the conversation in the exam room allows the physician to focus their attention on the patient and keep good eye contact without having to worry about writing their notes. AI is also performing translation of physician communications to patients, making them more understandable by lowering the reading grade level and translating into other languages. AI is similarly automatically creating timely after-visit summaries and discharge summaries that are more patient-friendly. And, of course, the use of AI in EHR clinical decision support is helping patients to receive higher-quality and safer care.

So yes, patients do want artificial intelligence to assist in their care. Sometimes they even prefer it over human intelligence. But will AI replace physicians in caring for patients? That answer is “No”. However, as Dr. Karim Lakhani, a professor at Harvard Business School, pointed out, “AI is not going to replace humans, but humans with AI are going to replace humans without AI.”

Dr. Garber is an internist, the Medical Director for Informatics, and the Associate Medical Director of Research at Reliant Medical Group.

References

1. Predmore ZS, Roth E, Breslau J, Fischer SH, Uscher-Pines L. Assessment of Patient Preferences for Telehealth in Post–COVID-19 Pandemic Health Care. JAMA Netw Open. 2021;4(12):e2136405. doi:10.1001/jamanetworkopen.2021.36405

2. https://openai.com/research/gpt-4

3. Nori, Harsha & King, Nicholas & McKinney, Scott & Carignan, Dean & Horvitz, Eric. (2023). Capabilities of GPT-4 on Medical Challenge Problems. https://browse.arxiv.org/pdf/2303.13375. pdf

4. Brin D, Sorin V, Vaid A, Soroush A, Glicksberg BS, Charney AW, Nadkarni G, Klang E. Comparing ChatGPT and GPT-4 performance in USMLE soft skill assessments. Sci Rep. 2023 Oct 1;13(1):16492. doi: 10.1038/s41598-023-43436-9. PMID: 37779171; PMCID: PMC10543445.

5. Ayers JW, Poliak A, Dredze M, et al. Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum. JAMA Intern Med. 2023;183(6):589–596. doi:10.1001/jamainternmed.2023.1838