This is the fourth article in the series on ChatGPT in healthcare. You can read the first three articles here:
Recent articles have shown that ChatGPT:
1. Does a better job at MCAT (Medical College Admission Test) than the average test taker
2. Can pass the USMLE (United States Medical Licensing Exam)
3. Can provide responses to patient questions that are preferred over physician responses
So the question people are asking is:
Will ChatGPT replace doctors?
In my view, that is the wrong question to ask. A better question to ask is:
Will the role of doctors change in the age of AI and ChatGPT and how?
The answer is yes. In this article I will explain how the role of the doctor may change and how this will actually be better for doctors and for patients.
ChatGPT does a better job on MCAT than the average test taker
A recent preprint article (Performance of ChatGPT on the MCAT) showed that ChatGPT is better than the average human taking the MCAT (Medical College Admission Test).
ChatGPT performed at or above the median performance of 276,779 student test takers on the MCAT. Additionally, ChatGPT-generated answers demonstrated both a high level of agreement with the official answer key as well as insight into its explanations.
Performance of ChatGPT on the MACT
Simplified Summary of article: The New GPT-4 AI Gets Top Marks in Law, Medical Exams, OpenAI Claims
ChatGPT passed the Medical Licensing Exam
A research article in PLOS Digital Health, Performance of ChatGPT on USMLE, showed that ChatGPT was able to pass the medical licensing exam:
ChatGPT performed at or near the passing threshold for all three exams without any specialized training or reinforcement. Additionally, ChatGPT demonstrated a high level of concordance and insight in its explanations.
Performance of ChatGPT on USMLE
Chatbot responses are preferred over physician responses
A recent article in JAMA, Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions, showed that patients preferred the responses of a chatbot over responses of a physician.
Question: Can an artificial intelligence chatbot assistant, provide responses to patient questions that are of comparable quality and empathy to those written by physicians?
Findings: In this cross-sectional study of 195 randomly drawn patient questions from a social media forum, a team of licensed health care professionals compared physician’s and chatbot’s responses to patient’s questions asked publicly on a public social media forum. The chatbot responses were preferred over physician responses and rated significantly higher for both quality and empathy.
JAMA Intern Med. Published online April 28, 2023. doi:10.1001/jamainternmed.2023.1838
Simplified explanation of this article: The doctor is out, but it’s ok ChatGPT can answer your questions.
It is also very interesting that ChatGPT responses were considered much more empathetic than responses from physicians (45% to 5%). As explained later in this article, this is likely a factor of the doctors not having the time to provide empathetic responses rather than the assumption that doctors are not empathetic.
Note that we should be careful to acknowledge where the ChatGPT technology is today. Answering questions in public forums is not the same as a doctor working with a patient to answer their questions. However, we can also expect that the ChatGPT technology will continue to improve and be able to move beyond public forums to answering one-on-one questions by patients about basic healthcare.
What doctors actually do today?
To answer the question of how the role of the doctor will change. let’s first start with an understanding what doctors actually do today. (This covers the typical doctor and not specialized doctors such as surgeons.)
The outsider perception is that doctors act like the doctors on TV (e.g, House or ER) where they are spending all their time diagnosing complex conditions and treating them quickly.
Source: https://filmdaily.co/obsessions/house-md/
The reality is different. Doctors actually spent much of their time in tasks other than diagnosing and treatment.
An article in the Journal of General Internal Medicine, How Physicians Spend Their Work Time, showed that physicians spend only 66.5% of their time on patient care.
Physicians spend 45.0% of their time on an EHR alone or in combination with other activities that are very substantial.
Multitasking was common. For example, of the 45.0% of their total work time that physicians spent on the EHR, 57.7% was spent multitasking (e.g., interacting with a patient during an office visit).
This multi-tasking is so hard for doctors that many are forced to take time after the patient has left to fill out the documentation needed in the EHR.
According to a 2020 study in the Annals of Internal Medicine, doctors devote an average of 16 minutes and 14 seconds per patient encounter, with chart review (33%), documentation (24%), and ordering (17%) taking up the bulk of that time – leaving physicians less than 5 minutes for direct interaction with the patient.
Physicians spend 1.77 hours daily completing documentation outside office hours. In an expected but interesting twist, physicians who used EHRs spent 1.84 hours vs 1.10 among those who did not use EHRs.
Spending time on documentation outside office hours takes time away from spending with their family and is frequently correlated with physician dissatisfaction and burnout.
Keeping their skills and knowledge up-to-date
Today a new medical article is published every 26 seconds. Doctors have a hard time staying current because their time is overbooked with documentation in patient records and it takes a long time to read the available medical articles.
What do doctors want to be doing?
Multiple surveys (e.g., Most Physicians Wish They Could Spend More Time With Patients) have shown that doctors would prefer to spend almost all of their time on patient care and in interacting with their colleagues.
Some research has shown that when doctors spend more time with patients, they are less prone to commit medical errors and their patients have better outcomes.
Doctors also want to keep their knowledge up to date so they are providing the best care to their patients.
What do patients want from doctors?
Patients want doctors to provide them personalized care where the doctor knows them and cares about their whole health. Research (e.g., What patients want from their doctors) has indicated that patients want more eye contact, a feeling of partnership, better communication and more time.
Deloitte research, What Matters Most to Today’s Health Care Consumers, also showed:
Personalized experiences with doctors and other health care providers. Across the health care ecosystem, consumers want to be heard, understood, and given clear directions—tailored to their individual needs—by their doctors. Top interactions in this cluster included doctors who do not rush through an appointment, who listen and show they care, and who clearly explain what the patient needs to do next.
What Matters Most to Today’s Health Care Consumers: Personalized Care
Today the typical doctor-patient interaction involves the doctor sitting sideways from the patient or with their back to the patient, focused intently on their computer while asking the patient questions. It is hard to provide a personalized experience like this.
Patients also want their doctor to be knowledgeable about the information the patients find online about new treatments. Today in many cases, patients can find information on new treatments more easily than the doctors can find the detailed information on the new treatments.
Summary of the Problem
The doctors want to focus on patient care AND patients want them to focus on patient care but today the doctors are spending 45% of their time away from focused patient care.
There are a few reasons for this:
- EHRs are hard to use so the doctor has to switch from focusing on the patient to find and enter the information into the right place in the EHR.
- EHRs are designed to facilitate billing. As a result the information they require to be entered is more about justifying the bill rather than patient care.
- Leveraging medical research is hard in normal physician practice.
How ChatGPT solves this problem
While ChatGPT will not solve the problem on its own, it can make a big difference.
ChatGPT enables us to provide a natural interface to EHR. Doctors can focus on the patient, ask questions about the patient’s record using ChatGPT and update the patient’s record using ChatGPT. All while using normal language that the doctors use to communicate with their colleagues and without having to use a computer.
What is a Natural Interface?
A natural interface allows someone to ask questions in plain English without having to translate their question into the language of the EHR using buttons, drop-downs, tabs, lists and text-boxes.
Examples of natural language:
- Does this patient have a family history of diabetes?
- What is the trend of this person’s blood pressure over the past 18 months?
- When did I last increase the dose of Lipitor for this patient?
- Add a refill of Lipitor for this patient
Natural interfaces can greatly reduce the time the doctor spends in the EHR and allow the doctor to focus on the patient without needing to turn to the desk to enter information in the EHR.
ChatGPT allows us to build natural interfaces to the EHR. For more information on how ChatGPT enables natural interfaces, you can read Role of ChatGPT in Healthcare.
What is the role of the doctor in the age of AI and ChatGPT?
In the age of AI and ChatGPT, doctors will be able to use natural interfaces to focus on the patient, get access to data from the patient record easily and to update the patient’s record without using a computer.
AI and ChatGPT will also make the wealth of knowledge in medical research available to doctors easily so they can stay up to date on the new treatments and are able to answer questions from the patients about new treatments more easily.
The role of the doctor will go back to what it was in the early days. Focusing on patient care and not on finding and entering information into a computer as it has become today. This will give doctors what they want, more time spent with their patients and their colleagues. This will give patients what they want, a more personalized healthcare experience.
