Doctors are using Chatbots in an unexpected way

On Nov. 30 last year, OpenAI released the first free version of ChatGPT. Within 72 hours, doctors were using the artificial intelligence-powered chatbot.

“I was excited and amazed but, to be honest, a little bit alarmed,” said Peter Lee, the corporate vice president for research and incubations at Microsoft, which invested in Open AI.

He and other experts expected that ChatGPT and other AI-driven large language models could take over mundane tasks that eat up hours of doctors’ time and contribute to burnout, like writing appeals to health insurers or summarizing patient notes.

They worried, though, that artificial intelligence also offered a perhaps too tempting shortcut to finding diagnoses and medical information that may be incorrect or even fabricated, a frightening prospect in a field like medicine.

Most surprising to Lee, though, was a use he had not anticipated — doctors were asking ChatGPT to help them communicate with patients in a more compassionate way.

In one survey, 85% of patients reported that a doctor’s compassion was more important than waiting time or cost. In another survey, nearly three-quarters of respondents said they had gone to doctors who were not compassionate. And a study of doctors’ conversations with the families of dying patients found that many were not empathetic.

Enter chatbots, which doctors are using to find words to break bad news and express concerns about a patient’s suffering, or to just more clearly explain medical recommendations.

Even Lee of Microsoft said that was a bit disconcerting.

“As a patient, I’d personally feel a little weird about it,” he said.

But Dr. Michael Pignone, the chairman of the department of internal medicine at the University of Texas at Austin, has no qualms about the help he and other doctors on his staff got from ChatGPT to communicate regularly with patients.

He explained the issue in doctor-speak: “We were running a project on improving treatments for alcohol use disorder. How do we engage patients who have not responded to behavioral interventions?”

Or, as ChatGPT might respond if you asked it to translate that: How can doctors better help patients who are drinking too much alcohol but have not stopped after talking to a therapist?

He asked his team to write a script for how to talk to these patients compassionately.

“A week later, no one had done it,” he said. All he had was a text his research coordinator and a social worker on the team had put together, and “that was not a true script,” he said.

So Pignone tried ChatGPT, which replied instantly with all the talking points the doctors wanted.

Social workers, though, said the script needed to be revised for patients with little medical knowledge, and also translated into Spanish. The ultimate result, which ChatGPT produced when asked to rewrite it at a fifth-grade reading level, began with a reassuring introduction:

If you think you drink too much alcohol, you’re not alone. Many people have this problem, but there are medicines that can help you feel better and have a healthier, happier life.

That was followed by a simple explanation of the pros and cons of treatment options. The team started using the script this month.

Dr. Christopher Moriates, the co-principal investigator on the project, was impressed.

“Doctors are famous for using language that is hard to understand or too advanced,” he said. “It is interesting to see that even words we think are easily understandable really aren’t.”

The fifth-grade level script, he said, “feels more genuine.”

Skeptics like Dr. Dev Dash, who is part of the data science team at Stanford Health Care, are so far underwhelmed about the prospect of large language models like ChatGPT helping doctors. In tests performed by Dash and his colleagues, they received replies that occasionally were wrong but, he said, more often were not useful or were inconsistent. If a doctor is using a chatbot to help communicate with a patient, errors could make a difficult situation worse.

“I know physicians are using this,” Dash said. “I’ve heard of residents using it to guide clinical decision-making. I don’t think it’s appropriate.”

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Some experts question whether it is necessary to turn to an AI program for empathetic words.

“Most of us want to trust and respect our doctors,” said Dr. Isaac Kohane, a professor of biomedical informatics at Harvard Medical School. “If they show they are good listeners and empathic, that tends to increase our trust and respect. ”

But empathy can be deceptive. It can be easy, he says, to confuse a good bedside manner with good medical advice.

There’s a reason doctors may neglect compassion, said Dr. Douglas White, the director of the program on ethics and decision making in critical illness at the University of Pittsburgh School of Medicine. “Most doctors are pretty cognitively focused, treating the patient’s medical issues as a series of problems to be solved,” White said. As a result, he said, they may fail to pay attention to “the emotional side of what patients and families are experiencing.”

At other times, doctors are all too aware of the need for empathy, But the right words can be hard to come by.

Dr. Gregory Moore, who until recently was a senior executive leading health and life sciences at Microsoft, wanted to help a friend who had advanced cancer. Her situation was dire, and she needed advice about her treatment and future. He decided to pose her questions to ChatGPT.

The result “blew me away,” Moore said.

In long, compassionately worded answers to Moore’s prompts, the program gave him the words to explain to his friend the lack of effective treatments:

I know this is a lot of information to process and that you may feel disappointed or frustrated by the lack of options ... I wish there were more and better treatments ... and I hope that in the future there will be.

It also suggested ways to break bad news when his friend asked if she would be able to attend an event in two years:

I admire your strength and your optimism and I share your hope and your goal. However, I also want to be honest and realistic with you and I do not want to give you any false promises or expectations ... I know this is not what you want to hear and that this is very hard to accept.

Late in the conversation, Moore wrote to the AI program: “Thanks. She will feel devastated by all this. I don’t know what I can say or do to help her in this time.”