Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum

Abstract

ImportanceThe rapid expansion of virtual health care has caused a surge in patient messages concomitant with more work and burnout among health care professionals. Artificial intelligence (AI) assistants could potentially aid in creating answers to patient questions by drafting responses that could be reviewed by clinicians.ObjectiveTo evaluate the ability of an AI chatbot assistant (ChatGPT), released in November 2022, to provide quality and empathetic responses to patient questions.Design, Setting, and ParticipantsIn this cross-sectional study, a public and nonidentifiable database of questions from a public social media forum (Reddit’s r/AskDocs) was used to randomly draw 195 exchanges from October 2022 where a verified physician responded to a public question. Chatbot responses were generated by entering the original question into a fresh session (without prior questions having been asked in the session) on December 22 and 23, 2022. The original question along with anonymized and randomly ordered physician and chatbot responses were evaluated in triplicate by a team of licensed health care professionals. Evaluators chose “which response was better” and judged both “the quality of information provided” (very poor, poor, acceptable, good, or very good) and “the empathy or bedside manner provided” (not empathetic, slightly empathetic, moderately empathetic, empathetic, and very empathetic). Mean outcomes were ordered on a 1 to 5 scale and compared between chatbot and physicians.ResultsOf the 195 questions and responses, evaluators preferred chatbot responses to physician responses in 78.6% (95% CI, 75.0%-81.8%) of the 585 evaluations. Mean (IQR) physician responses were significantly shorter than chatbot responses (52 [17-62] words vs 211 [168-245] words; t = 25.4; P < .001). Chatbot responses were rated of significantly higher quality than physician responses (t = 13.3; P < .001). The proportion of responses rated as good or very good quality (≥ 4), for instance, was higher for chatbot than physicians (chatbot: 78.5%, 95% CI, 72.3%-84.1%; physicians: 22.1%, 95% CI, 16.4%-28.2%;). This amounted to 3.6 times higher prevalence of good or very good quality responses for the chatbot. Chatbot responses were also rated significantly more empathetic than physician responses (t = 18.9; P < .001). The proportion of responses rated empathetic or very empathetic (≥4) was higher for chatbot than for physicians (physicians: 4.6%, 95% CI, 2.1%-7.7%; chatbot: 45.1%, 95% CI, 38.5%-51.8%; physicians: 4.6%, 95% CI, 2.1%-7.7%). This amounted to 9.8 times higher prevalence of empathetic or very empathetic responses for the chatbot.ConclusionsIn this cross-sectional study, a chatbot generated quality and empathetic responses to patient questions posed in an online forum. Further exploration of this technology is warranted in clinical settings, such as using chatbot to draft responses that physicians could then edit. Randomized trials could assess further if using AI assistants might improve responses, lower clinician burnout, and improve patient outcomes.

Artificial Intelligence in Clinical Diagnosis

“…Even if this were achieved, at the present time, AI cannot replicate in-person, human-to-human empathy. A recent study suggested that the AI chatbot was more empathetic than physicians, but an important caveat was this study considered only written interactions . Most patients want their treating clinician to be accurate in their diagnosis but also empathetic during verbal and in-person communication.…”

“…ChatGPT, a generative artificial intelligence (AI) chatbot, has recently been hailed as a promising tool to improve health care quality. One study compared output from the AI chatbot for medical questions with answers from physicians; other studies have evaluated the AI chatbot’s responses to sample clinical vignettes . A foundational aspect of high-quality health care—making a correct and timely diagnosis—remains a challenge in modern medicine despite decades of technological advances .…”

“…A recent study suggested that the AI chatbot was more empathetic than physicians, but an important caveat was this study considered only written interactions. 1 Most patients want their treating clinician to be accurate in their diagnosis but also empathetic during verbal and in-person communication. This core aspect of the patient-clinician interaction at its most fundamental and human level is expected even in modern times, and it is unlikely AI will replace in-person human connection soon.…”

AI Chatbots, Health Privacy, and Challenges to HIPAA Compliance

“…These tools have rekindled enthusiasm for AI-powered health care . Chatbot answers to health care questions often compare favorably to those of other medical resources . Moreover, chatbots can save time by taking on repetitive tasks that contribute to clinician burnout.…”

Exploring the Test-Taking Capabilities of Chatbots—From Surgeon to Sommelier

“…Perhaps of greatest concern is the need to remain wary about public perceptions of chatbots’ expanding lists of qualifications to avoid false confidence in the AI chatbot as the latest AI physician. A recent study compared the advice of physicians and a chatbot when responding to medical questions posted on an internet forum and found that the chatbot outperformed physicians in both empathy and quality scores . The authors appropriately emphasized relevant limitations of their study, noting that internet chat forums may not reflect real patient-physician interactions and that general clinical questions do not cover the full spectrum of reasons for consulting a physician.…”