Bedside Manners and Artificial Intelligence

Abstract

The patient is always more anxious to talk than to listen. Theodor Billroth (1829–1894) Revolutionary evolution in Artificial Intelligence (AI) is being matched by its equally revolutionary adoption in all domains of civilization. Since, a random event ‘big bang’ or a divine design of our creator, Almighty or Goddesses or Gods, the existential life has evolved with essentialities of existence. Most of these civilizational essentialities, like ideologies, administrative structures, finances, economies and regulations etc., are nonphysical, thus merely narratives. Yuval Harari, suspects, that, AI being bereft of a body or physical control, could create narratives having existential threat to these civilizational essentialities. Thus, navigating society to an existential hara-kiri. Some AI experts have even opined that mitigating the risk of extinction from AI should be a global priority alongside other societal-scale risks such as pandemics and nuclear war.[1] However, Prof Jurgen Schmidhuber, called ‘Dad’ by AI, feels that AI aims to make human lives healthier, longer and better. He feels the AI tools that are meant to better lives can be used by bad people, but the same tools can then be used to neutralize their threat.[2] Healthcare, not willing to be left behind, is infatuated with AI too, wooing it vigourously to incorporate it in domains from administration to research. Clinical care, the sole purpose of healthcare, has already experienced the benefits of AI in higher than human sensitivity in picking pathologies on radiology/microscopic images.[3] ChatGPT, the ‘Generative pre-trained transformers’ AI tool, has gained rapid currency in our lives, including the clinical domains. It is a language model pre-trained on a large body of sentences, words, subwords, punctuation, semantics and communication flowing on internet. Continuous accumulation of communicative bits and bytes helps in progressive improvement of GPTs by ‘natural reinforcement learning from human feedback.’[4] ChatGPT has already become very popular with younger colleagues, especially residents in training, using it not only to answer questions on ward rounds but also using it to prepare their academic presentations and seminars. Healthcare professionals, despite their best efforts in clinical welfare of community, are sometimes suspected to be driven by market dynamics manipulated by industrial and corporate interests. They get led along the garden path laid by big players inadvertently, usually by coercive journalism. One such news titled ‘Google AI has better bedside manner than human doctors – and makes better diagnoses’ appeared recently.[5] Despite the researchers themselves acknowledging the primacy of doctor-patient communication with good history taking, the news reporter titled the coverage of research as an advocate of ‘Google AI has better bedside manner than human doctors.’[6] Effective communication between patients and doctors in clinical care is as vital as the air we breathe. It serves as more than just a means to gather information for accurate advice; it acts as a doorway for patients to express emotions unrelated to their clinical issues – feelings for which they may not be seeking a solution. This communication opportunity extends beyond the clinical necessity of ‘history taking’, creating a safe space for patients to articulate their experiences and concerns beyond their health. A patient harbors many fears that are not directly related to their illness, but rather a consequence of manufactured concerns to mitigate the social disruptions caused by the illness. When confronted with health-related challenges, a feeling of helplessness, cluelessness, and loss of control often prevails. During such times, patients yearn the listening ear of their doctor. One that doesn’t judge or scrutinize. The healing process starts from this moment of “being heard” and culminates in delivery of exceptional clinical care during this ‘Golden Window’. Beyond