“Many roads lead to Rome and the Artificial Intelligence only shows me one road”: an interview study on physician attitudes regarding the implementation of computerised clinical decision support systems

Abstract

Research regarding the drivers of acceptance of clinical decision support systems (CDSS) by physicians is still rather limited. The literature that does exist, however, tends to focus on problems regarding the user-friendliness of CDSS. We have performed a thematic analysis of 24 interviews with physicians concerning specific clinical case vignettes, in order to explore their underlying opinions and attitudes regarding the introduction of CDSS in clinical practice, to allow a more in-depth analysis of factors underlying (non-)acceptance of CDSS. We identified three general themes from the results. First, ‘the perceived role of the AI’, including items referring to the tasks that may properly be assigned to the CDSS according to the respondents. Second, ‘the perceived role of the physician’, referring to the aspects of clinical practice that were seen as being fundamentally ‘human’ or non-automatable. Third, ‘concerns regarding AI’, including items referring to more general issues that were raised by the respondents regarding the introduction of CDSS in general and/or in clinical medicine in particular. Apart from the overall concerns expressed by the respondents regarding user-friendliness, we will explain how our results indicate that our respondents were primarily occupied by distinguishing between parts of their job that should be automated and aspects that should be kept in human hands. We refer to this distinction as ‘the division of clinical labor.’ This division is not based on knowledge regarding AI or medicine, but rather on which parts of a physician’s job were seen by the respondents as being central to who they are as physicians and as human beings. Often the respondents’ view that certain core parts of their job ought to be shielded from automation was closely linked to claims concerning the uniqueness of medicine as a domain. Finally, although almost all respondents claimed that they highly value their final responsibility, a closer investigation of this concept suggests that their view of ‘final responsibility’ was not that demanding after all.

Performance of Multimodal GPT-4V on USMLE with Image: Potential for Imaging Diagnostic Support with Explanations

“…Previous studies have shown limited utilization of current CDSS as most of them offered limited decision explanation and thus gained limited trust among physicians (unlike their colleagues). [43][44][45][46] In comparison, GPT-4V could enhance the effectiveness and trustworthiness of CDSS by providing high-quality, expert-preferred explanations, encouraging broader adoption and more confident utilization among physicians.…”

Stakeholder perspectives towards diagnostic artificial intelligence: a co-produced qualitative evidence synthesis

“…Across 44 studies, 689 participants were interviewed and 402 participated in focus groups. 31 studies conducted interviews, 16 , 24 , 25 , 31 , 32 , 34 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 48 , 49 , 50 , 51 , 53 , 55 , 57 , 59 , 60 , 61 , 62 , 63 , 64 nine conducted focus groups, 18 , 26 , 27 , 29 , 30 , 33 , 52 , 56 , 58 , 65 five conducted ethnographic studies with interviews, 17 , 46 , 47 , 54 , 66 and two conducted both interviews and focus groups. 35 , 47 The mean number of participants in interview studies was 20 (IQR 15–24), and in focus groups 40(IQR 15–37).…”

“…Cultural van Cauwenberge et al. (2022) 63 Mixed-methods, thematic analysis Think-aloud interviews Physicians working in a large tertiary care academic hospital in the Netherlands, purposive sampling 30 16 (53%) female; 7 (23%) in training, 8 junior (27%), 15 (50%) senior General Hypothetical AI for general clinical and diagnostic support Four themes were developed: 1. Transparency, 2.…”

Physician’s autonomy in the face of AI support: walking the ethical tightrope

“…It is easier to agree with a recommendation from AI than to disagree. Physicians interviewed also see a real threat that the accuracy of their judgment and decision-making skills could be questioned in the face of AI statements ( 7 , 10 ). Such hurdles to resolving contradictions can discourage people from challenging algorithmic outputs ( 21 , 36 ).…”