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

John W. Ayers; Adam Poliak; Mark Dredze; Eric C. Leas; Zechariah Zhu; Jessica B. Kelley; Dennis J. Faix; Aaron M. Goodman; Christopher A. Longhurst; Michael Hogarth; Davey M. Smith

doi:10.1001/jamainternmed.2023.1838

Original Investigation

April 28, 2023

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

John W. Ayers, PhD, MA^1,2; Adam Poliak, PhD³; Mark Dredze, PhD⁴; et al Eric C. Leas, PhD, MPH^1,5; Zechariah Zhu, BS¹; Jessica B. Kelley, MSN⁶; Dennis J. Faix, MD⁷; Aaron M. Goodman, MD^8,9; Christopher A. Longhurst, MD, MS¹⁰; Michael Hogarth, MD^10,11; Davey M. Smith, MD, MAS^2,11

Author Affiliations Article Information

¹Qualcomm Institute, University of California San Diego, La Jolla
²Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
³Department of Computer Science, Bryn Mawr College, Bryn Mawr, Pennsylvania
⁴Department of Computer Science, Johns Hopkins University, Baltimore, Maryland
⁵Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
⁶Human Longevity, La Jolla, California
⁷Naval Health Research Center, Navy, San Diego, California
⁸Division of Blood and Marrow Transplantation, Department of Medicine, University of California San Diego, La Jolla
⁹Moores Cancer Center, University of California San Diego, La Jolla
¹⁰Department of Biomedical Informatics, University of California San Diego, La Jolla
¹¹Altman Clinical Translational Research Institute, University of California San Diego, La Jolla

JAMA Intern Med. Published online April 28, 2023. doi:10.1001/jamainternmed.2023.1838

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Key Points

Question Can an artificial intelligence chatbot assistant, provide responses to patient questions that are of comparable quality and empathy to those written by physicians?

Findings In this cross-sectional study of 195 randomly drawn patient questions from a social media forum, a team of licensed health care professionals compared physician’s and chatbot’s responses to patient’s questions asked publicly on a public social media forum. The chatbot responses were preferred over physician responses and rated significantly higher for both quality and empathy.

Meaning These results suggest that artificial intelligence assistants may be able to aid in drafting responses to patient questions.

Abstract

Importance The 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.

Objective To 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 Participants In 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.

Results Of 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.

Conclusions In 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.

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5 Comments for this article

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April 29, 2023

Chatbots can simulate empathy through pre-programmed responses, they cannot truly understand the emotions.

Ediriweera Desapriya, PhD | Department of Pediatrics, faculty of medicine, UBC-BC Children's Hospital

Empathy, which is the ability to understand and share the feelings of others, is a complex emotional and cognitive process that involves more than just providing information. It involves active listening, genuine concern, and the ability to understand and respond to the emotional needs of patients. While chatbots can simulate empathy through pre-programmed responses, they cannot truly understand the emotions and needs of human users in the same way that a human healthcare professional can. While chatbots may not be able to fully replicate the human element of empathy, they can still be useful tools for training healthcare professionals and improving patient communication and engagement.

The study results suggest that longer responses from healthcare professionals are more popular and, therefore, there might be a correlation between the length of chatbot responses and their ratings. While it is true that longer responses may provide more information and be perceived as more informative, it is not necessarily true that longer responses are always better or more empathetic.

Furthermore, I have a question and a concern whether longer chatbot responses are simply a result of the machine having more time to respond, rather than providing more empathetic or informative responses and machines have a plenty of time (as compared to busy clinicians), it is important to ensure that the responses provided by chatbots are not simply longer for the sake of being longer, but rather, provide relevant and useful information to researchers.