The Health Care Blog – Read More
By DAVID KIRK
My father called me from a hospital bed a few years ago. He had been admitted to a small hospital with an abdominal infection, and his surgeon had offered him an open operation. He wanted my clinical perspective. I knew that in his condition, he was unlikely to survive general anesthesia and the open procedure. I spoke to the surgeon myself and asked why he wouldn’t ask interventional radiology (IR) to drain the infection instead.
The surgeon told me that the hospital lacked the equipment required for IR, and without IR, the open operation was the best option on his menu. After hearing my assessment, he agreed and helped arrange the transfer to a hospital that could drain the infection.
I still think about how that single phone call may have saved my father’s life. His surgeon wasn’t negligent. He made the best decision based on the information in front of him. However, my father was able to put another option on the table because he knew a physician to call.
Most families don’t have a physician to consult when their doctor makes a recommendation. For generations, patients have only known what the person in the room with them chose to share, bounded by what their equipment and offerings could provide. Today’s patients, however, have artificial intelligence options in their pocket. A patient can now ask their preferred AI model, “Is surgery really my only option?” and get an answer that sounds confident and informed. Hungry for options, patients are asking these questions in enormous numbers.
In many ways, this is a welcome rebalance. It puts information in patients’ hands and allows them to play a more active role in their own healthcare, but it also opens the door to misinformation and distraction, and that can be life-threatening. Researchers at Mass General Brigham found that when given only a patient’s presenting symptoms, general-purpose AI chatbots failed to produce an accurate initial or differential diagnosis 80% of the time. In July, a Florida pastor sued OpenAI after ChatGPT provided him with “extremely dangerous medical recommendations” that delayed his treatment for pulmonary embolism. My primary care colleagues have shared how the presence of an AI-suggested diagnosis has transformed a 10-minute prescription refill into an hour-long conversation about something unrelated to why the patient came in that day.
Patients are also adopting AI much faster than their physicians. The West Health-Gallup Center on Healthcare in America reports that among US adults who use AI for health information or advice, 59% use AI tools to research on their own before visiting a doctor, and 56% use them to research after visiting a doctor. Physicians are using AI too, but for a different job. According to the AMA, more than 80% of physicians now use AI professionally, mostly for administrative work, yet only 13% are using it for diagnosis, the very thing their patients are asking it to do. The reality is that without AI support, most physicians are realistically only able to review 3% of a patient’s chart.
Now that patients have AI to help them advocate and question, the physician is at risk of becoming the least-informed person in the room.
Patients will keep consulting AI, and they should. The answer is to get our clinical teams up to speed with it, too. Consider the stethoscope, now the very symbol of a physician. When René Laennec introduced it in 1816, many doctors wanted nothing to do with it. Some felt that listening through a tube put distance between them and the patient. Others simply did not trust what they heard, because no one had taught them what a healthy lung or a failing heart was supposed to sound like. It took the better part of a generation, and a great deal of training, before the instrument changed care at the bedside. The tool was never the hard part. Learning to use it was.
We are already seeing this. The same Mass General Brigham researchers who measured that high rate of missed initial diagnoses also found something hopeful: AI’s diagnostic accuracy jumps to 90% once it’s given the entire medical chart to review. This points to an important distinction. Consumer AI reasons from what the patient can describe, like their symptoms and their memory of their own history. Clinical AI reasons from what actually happened, with the full record in front of it and a physician reading over its shoulder.
I have spent more than twenty years as an ICU doctor, and my ask of health system leaders is clear. First, equip physicians with clinical AI that surfaces the full patient record before a visit, so that when patients arrive with their own hypotheses, physicians can consider them against all available information.
Second, encourage clinicians to use consumer AI themselves, so they learn its failure modes. The one they will meet most often shows up across the exam table, when a patient arrives fresh off a conversation with a chatbot, speaking in clean clinical language, rattling off a differential, naming the test they think they need. They will sound like a clinical colleague, but the fluency is borrowed and the understanding isn’t there. My colleague Shawn Stapleton, PhD, calls this “cognitive spoofing,” when AI makes a person appear far more expert than they actually are.
Finally, healthcare systems must develop the procedures and policies that keep the clinician deeply engaged. This is not new territory. Medicine already has guardrails that protect patients from human error across every tool we use, from the timeout before surgery, to a second signature on high-risk medications, to a read-back on a critical lab value. AI is no different. It is a powerful new tool, and it needs its own checklists, training, and clear accountability so the physician stays the decision-maker.
My father survived because a better treatment option existed, and he knew to ask for it. Although the rollout is imperfect, consumer AI is starting to give every patient the opportunity to consult an outside source, as my father once did. Our job now is to make sure the physician still has the better answer. We all suffer if the physician is the least-informed person in the room.
David Kirk, MD, is Chief Medical Officer at Regard and has spent over 20 years as an intensivist at WakeMed
