The AI Doctor Will Message You Now
if you'd like
I am not an artificial intelligence skeptic or pessimist. I am confident that AI will improve healthcare, and I look forward to seeing how. I’ve been following the general conversations and have been particularly interested in AI’s potential to improve diagnostic performance. Two good reads are here and here. I do not think that we can yet really imagine how we will incorporate AI into our practice in five or ten years.
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One place that I am skeptical is AI entering into the doctor/patient communication. We covered an early, ingenious article by John W. Ayers and his colleagues on this topic on the Sensible Medicine Podcast. Whatever great advances are ahead, I cannot foresee a time that people will be comfortable receiving counseling from a computer or receiving recommendations about diagnostics or treatments.
Diagnostically, I cannot imagine that a computer will be able to understand the nuance of a patient’s history: what issues need to be focused on; which can (or need to) be ignored; is this person a complainer or a stoic; how do I incorporate a patient’s relation to her symptoms into her report of those symptoms. The test characteristics of most data from the history is poor. Dyspnea is neither sensitive nor specific for pulmonary embolism; (LR+ 1.7, LR- 0.3). Imagine, now, not even knowing if dyspnea is present or important as a symptoms. AI will not improve the quality of the input. We will be left practicing, at best, veterinary medicine.[i]
Therapeutically, for the simplest decisions, AI will be (already is) an enormous asset. What is the best antibiotic for culture positive strep throat? My Pap and HPV are, and have always been, negative. When should my next one be? But imagine a patient trying to decide about whether to have a hernia repaired, what should be the initial therapy for myeloma, should pharmacological therapy be initiated for diabetes?
To give you a taste of where we are now. Here is an example of three notes. A query from one of my patients, the reply suggested by AI, and my actual reply.[ii] I know this is unfair. Judging AI’s performance in December of 2023 is like looking at a college applicant’s APGAR scores. I know the performance will improve. (We have an amazing physician expert working on this). But this does give you a sense of the present.
Patient “James Smith”
In January 2022 I had a severe episode of sciatica. I'm starting to feel a similar twinge in my back.
1. Could you please order a series of visits with Physical Therapy? I do daily PT exercises, however a refresher course may help.
2. Could you please put in an order for a multi-day series of steroid pills? I started with a steroid two years ago, but the pain was too severe and I ended up with an injection in my back. I'm thinking that if I start a steroid series now, before the pain is severe, it might mitigate the situation.
Thank you for reaching out and being proactive about your health.
1. Regarding your request for a series of visits with Physical Therapy, I would recommend discussing this during your upcoming appointment on 2/5/2024. This will allow us to assess your current condition and determine the best course of action.
2. As for your request for a multi-day series of steroid pills, it's important to discuss this in person as well. Steroids can have side effects and it's crucial to evaluate if this is the best option for you at this time.
Please remember that it's always important to discuss any changes in your health or new symptoms with your healthcare provider. If your symptoms worsen before your scheduled appointment, please don't hesitate to schedule an earlier visit. You can do so by following this link: "epichttp://visits[Click here to view or schedule an appointment.]"
Doctor Adam Cifu
Order for PT is in.
I put in the order for a medrol dose pack as well. We generally use steroids if there is really acute, severe, neuropathic/radicular type pain. Yours would be a somewhat "nontraditional" approach. I am OK with it if you want to give it a try though. Let me know if you want to talk. Since it’s the weekend, just text me if you need.
Convinced? If not, how about this one. What follows is the suggested reply to the partner of a patient of mine. She wrote me because the patient was hospitalized and doing poorly and she needed to discuss the situation. I called her on the phone.
I'm sorry, but I'm unable to assist with your request as it doesn't contain a specific question or concern. If you have any health-related questions or need to discuss something, please don't hesitate to schedule an appointment. You can do so by following this link: "epichttp://visits[Click here to view or schedule an appointment.]"
[i] No shade cast on my veterinarian colleagues. I can’t imagine the talent and knowledge necessary for that work. It is, however, different work.
[ii] My patient was happy for me to share this exchange.