AI can offer patients a starting point | Expert Opinion

A friend’s medical odyssey recently prompted me to ask whether AI could have helped. As an experienced primary care doctor, I was surprised to discover how much potential a chatbot has to serve as your true partner navigating the healthcare maze.

My friend, a middle-aged woman, was experiencing numbness and tingling in her hands and torso. A week went by, with no relief — occasionally the symptoms caused her to lose hand grip strength. She sought an evaluation at a busy urgent care clinic, which showed only a borderline elevated blood sugar. She was bewildered to receive a preliminary diagnosis of nerve inflammation from diabetes, since she was diligent about regular checkups and had no history of diabetes.

She decided to schedule both primary care and endocrinology visits. The specialist could see her first and ordered extensive blood testing which showed only prediabetes unlikely to cause nerve injury. She left with a follow-up plan to prevent her from developing overt diabetes, but no diagnosis for her symptoms. She was encouraged to pursue nerve testing and meet with her primary care physician (PCP).

It took her an agonizing three weeks to get an appointment to see her PCP, who reviewed the prior tests and agreed she should see a neurologist. By now, she had already self-scheduled the specialist appointment. Her symptoms resolved by the time she saw the neurologist, who was concerned that this may have been a sign of a chronic condition such as multiple sclerosis. For a third time, she left a medical appointment without a clear diagnosis.

My friend’s story shows how difficult it can be to get a timely and accurate medical evaluation when new symptoms arise. Access to primary care is constrained, and self-referral to specialists can sometimes land you in a rabbit hole of testing.

I was curious to see how an AI chatbot might have helped in my friend’s scenario, so I logged onto Microsoft Copilot and typed in the following prompt:

I have had numbness and tingling in my hands and torso for 1 week and occasional loss of grip strength. What could be wrong with me?

I received a warning that the chatbot could not formally diagnose me, followed by a list of possible diagnoses that were stunningly relevant. Next, the chatbot generated a list of warning signs that would require emergency care, and some tests that a clinician would likely order to zero in on the diagnosis.

As a doctor, I know it is still important to avoid trying to diagnose yourself. My advice is to continue to view your PCP as the best starting point when you have new symptoms that aren’t an emergency. Your PCP can perform an initial assessment and guide you toward appropriate specialty care. Your primary care office is also the medical “home” you can always return to if you encounter a follow-up problem, or develop new or worsening symptoms. But AI chatbots can help you along the way by proposing questions to ask and giving you a sense of what your doctor may be concerned about. It is important to be open with your doctor about your AI query, so you can have a thorough discussion together about the diagnostic possibilities and why some of these may require further evaluation while others do not.

Physicians today expect patients to use technology to advocate for themselves, so your AI findings should be received with curiosity and concern, especially from a doctor with whom you have a well-established trusting relationship. If you are met with dismissal or defensiveness, this may be a sign of a nonideal physician-patient partnership. A few months ago, I wrote about my first office encounter with a patient who openly discussed her use of an AI chatbot as a health advocate. That patient visit left me with cautious optimism about the role of AI in clinical care, with a caveat that these tools are designed to profit in a rapidly changing healthcare marketplace, not necessarily to keep you well. But they can still help you get there.

Some health systems, like the one where I work, are developing plans for personalized chatbots built into the electronic health record. Patients might interact with a bot in preparation for a visit, following prompts to answer questions about their health history or current symptoms. These advances may help with way-finding within the system, continuity of care, and tee up a more useful clinic appointment.

Doctors themselves use AI platforms like OpenEvidence, which helps us to quickly parse the latest medical research, to enhance their own diagnostic skills. AI tools like ambient listening are even being woven into medical school curricula to help students develop clinical reasoning and communication skills. The hope is that instead of spending time memorizing and re-memorizing facts, energy can be shifted to active listening and thoughtful problem solving.

The collaboration between patients, doctors, and AI is a new frontier with great potential to improve clinical care. It may have saved my friend a lot of time and angst searching for the right specialist, even as she continues to search for a diagnosis. But the promise of AI in patient care still hinges on effective communication, trust, and human connection. Sir William Osler’s famous adage will always remain our true north: “A good physician treats the disease; the great physician treats the patient who has the disease.”

Jeffrey Millstein is an internist and regional medical director for Penn Primary and Specialty Care.