<scp>AI</scp> in medicine: an introduction to the potential benefits and challenges, and why doctors need to be involved

Abstract

The term artificial intelligence (AI) describes machines that are designed to emulate human intelligence.1 AI can be trained to perform tasks that humans would consider basic, such as reading or spellchecking, but recently we have seen AI take on increasingly complex tasks, from self-driving cars and robotics to the generation and understanding of natural language. One recent driver of the prominence of AI in the public consciousness has been the release of natural language models, such as ChatGPT, which are designed to understand and generate human-like text. Clinically, AI has the potential to benefit health care but there are issues that would first need to be addressed. This article discusses scenarios in obstetrics and gynaecology, and wider medicine, where the application of AI has the potential to improve patient care. As part of this, it will briefly discuss the development of an AI model and how it operates through a cardiotocography (CTG) interpretation case study. It will explore some risks to the use of medical AI around safety, bias and liability. Finally, it argues the importance of clinician engagement in the development of AI, with a key role in advocating for patients and themselves, ensuring its optimal implementation into healthcare. AI in medicine is not new. Diagnostic programs appeared as early as the 1970s, such as the rudimentary AI ‘MYCIN’, designed to assist physicians with the management of patients with bacterial infections.2 MYCIN identified probable bacterial infections using factors such as a patient's symptoms and blood test results and recommended appropriate therapies, failing to see widespread adoption owing to technological limitations. However, AI in health care has also benefitted from the recent advancements and higher profile of the technology, illustrated by the frequent media coverage of the medical use of AI.3, 4 The areas of development in health care are vast, including medical imaging, genomics, telemedicine and surgery. It is also important to remember the non-clinical roles AI can have in health care. AI can be used in medical education; for example, ChatGPT-based programmes are already available to help medical students practice history taking.5 It is also being used in explorative research, such as in drug discovery to help identify promising candidates for real-life testing.6 However, potentially the most significant impact AI may soon have is facilitating patients’ access to, and control over, their own health data. Many emerging AI-driven technologies in health are patient-facing and integrated into consumer products like wearables and apps, designed to monitor patients’ vital signs or symptoms away from healthcare settings. While current data show a mixed reception from patients, this shift could empower patients to take more control over their health and may in future help facilitate truly personalised health care.7, 8 Medical imaging is a key area of health care with a comprehensive literature base investigating the use of AI in various radiological specialties, with a particular interest around cancer detection.9, 10 Applications primarily focus on image interpretation, appealing because of the increasing number of images being generated relative to a limited number of radiologists.11 Preliminary evidence of the performance of AI in this area is promising, and in some cases, such as the interpretation of chest radiographs, there is even evidence suggesting AI can match or surpass humans.12 AI can achieve this as it can be remarkably good at identifying patterns among large datasets and can ignore factors such as fatigue which contribute to human error. Additionally, AI can also assist with several non-diagnostic tasks, such as quality control of images.9 Another area of interest for the development of AI is medical triage. AI that could quickly and effectively triage patients has the potential to reduce the burden on clinical staff and make sure the right patients are se