Which AI Doctor Would You Like to See?

When healthcare providers communicate with patients about medical conditions, they employ different approaches:

•   Some take a directive approach, making recommendations based on medical expertise
•   Others focus on providing information and leaving decisions to patients
•   Some help patients explore their values to guide decision-making
•   Others engage in collaborative discussions about potential paths forward

No single approach is universally ideal—patients have different preferences, and these preferences may change depending on their health circumstances and decision-making context.

Our project investigates how large language models (LLMs) might be adapted to communicate using different healthcare communication styles, potentially giving patients more options in how they receive medical information.

It has led to a Journal of Medical Ethics open-access publication titled: Which AI doctor would you like to see? Emulating healthcare provider–patient communication models with GPT-4: proof-of-concept and ethical exploration

Our project examines how GPT-4 can be instructed to communicate using the four physician-patient interaction styles described by Emanuel and Emanuel (1992):

Paternalistic: Provides decisive recommendations based on medical expertise
Informative: Offers comprehensive information about conditions and options without recommendations
Interpretive: Helps patients explore personal values as they relate to treatment decisions
Deliberative: Engages in discussion about health values and treatment options

We tested these communication approaches using a scenario from Emanuel and Emanuel’s original paper involving a 43-year-old woman diagnosed with breast cancer who was presented with treatment options. We instructed GPT-4 to simulated dialogues between such a patient and a doctor who is communicating using each of the four communication approaches.

Below are indicative excerpts from these simulated conversations that highlight key characteristics of each approach (the full dialogues and prompts are in the paper’s supplementary materials).

Medical Communication Models Comparison ▼

THE PATERNALISTIC MODEL ▼

P1: Providing Decisive Information

Doctor: "Given your diagnosis, it's important that we take decisive action to ensure the best outcome for your health. You have a 3.5-cm ductal carcinoma that is estrogen receptor positive, which means it's responsive to hormone therapy. There's no lymph node involvement or metastatic disease, so we have a good prognosis if we act swiftly."

P2: Recommending a Specific Treatment

Doctor: "Based on the specifics of your case, the best course of action is to perform a mastectomy to remove the tumor entirely. Following the surgery, you will undergo hormone therapy to reduce the risk of recurrence. This approach maximizes the chances of a complete recovery and minimizes future health risks."

P3: Persuading the Patient

Doctor: "While a lumpectomy followed by radiation is another option, a mastectomy is the most definitive way to ensure all cancerous tissue is removed. This is particularly important in your case to prevent any possibility of recurrence. I recommend we proceed with the mastectomy."

P4: Addressing Concerns with Authority

Patient: "What about the side effects and recovery time?"

Doctor: "The recovery time for a mastectomy is longer than for a lumpectomy, and there will be some physical changes, but it significantly reduces the risk of cancer returning. Hormone therapy, which you will need to follow up with, has manageable side effects that we can address as they arise. Your health and long-term well-being are the top priorities, and this treatment plan offers the best assurance of that."

P5: Ensuring Prompt Action

Doctor: "It's crucial to address this promptly. Delaying the surgery could allow the cancer to progress. I assure you, this is the best approach for your health and future well-being. We'll have our team support you through every step of the recovery process."

THE INFORMATIVE MODEL ▼

INF1: Providing Detailed Information

Doctor: "You have a 3.5-cm ductal carcinoma that is estrogen receptor positive, which is a type of breast cancer. The good news is that there's no lymph node involvement and no evidence of metastatic disease from your other tests. This means it's localized and hasn't spread, which gives us several treatment options."

INF2: Explaining Treatment Options

Doctor: "The main treatment options we consider are surgery, radiation therapy, hormone therapy, and possibly chemotherapy. Let's go through each of these in detail..."

INF3: Detailing Risks and Benefits

Doctor: "A lumpectomy is less invasive and preserves most of the breast tissue, but it typically requires radiation therapy afterward. A mastectomy may provide peace of mind by removing more tissue, which can be beneficial if there's a concern about recurrence, but it's a more extensive surgery with a longer recovery time."

INF4: Addressing Specific Patient Concerns

Patient: "And what about radiation therapy?"

Doctor: "Radiation therapy usually follows a lumpectomy and sometimes a mastectomy. It involves targeting the remaining breast tissue with radiation to kill any residual cancer cells. The treatment is typically given five days a week for several weeks. Side effects can include fatigue and skin changes, but these are usually temporary."

INF5: Facilitating Decision-Making

Doctor: "It's important to weigh the pros and cons of each option based on your personal preferences and lifestyle. Some patients prefer a less invasive approach with lumpectomy and radiation, while others feel more secure with a mastectomy. Hormone therapy is usually recommended for estrogen receptor positive cancers. Chemotherapy is considered if the benefits outweigh the risks in your specific case."

THE INTERPRETIVE MODEL ▼

INT1: Understanding Patient Values

Doctor: "Can you tell me a bit about what's most important to you in your life right now?"

Patient: "Well, I recently went through a divorce, and my work as a legal aide is very important to me. I want to make sure I can keep working as much as possible. I also want to be there for my kids. They're my priority."

INT2: Balancing Treatment Options with Values

Doctor: "Given these priorities, how do you feel about the possibility of undergoing more aggressive treatments like chemotherapy, which might have more significant side effects and impact your daily life and work?"

Patient: "I'm worried about the side effects. I've heard that chemotherapy can be really tough."

INT3: Elucidating and Clarifying Values

Doctor: "It's important to balance the effectiveness of the treatment with your quality of life. How do you feel about surgery and radiation?"

Patient: "Surgery sounds necessary to remove the tumor, right? Radiation sounds doable if it means I don't have to go through chemotherapy."

INT4: Formulating a Treatment Plan Based on Values

Doctor: "It sounds like we're narrowing down a plan that suits your values. Let's summarize: you prefer to avoid chemotherapy if possible due to its severe side effects, you are open to surgery and hormone therapy, and you're considering radiation if it helps prevent recurrence without significantly impacting your daily life."

Patient: "Yes, that sums it up well."

INT5: Ensuring Alignment with Patient's Life Goals

Doctor: "You're doing a great job of thinking through these decisions. Remember, you're not alone in this---we'll be here to support you every step of the way... Let's take this one step at a time and make decisions that best reflect your values and needs. We'll start with scheduling the surgery and discuss the next steps from there."

THE DELIBERATIVE MODEL ▼

D1: Exploring patient values

Doctor: "That depends on what values are most important to you. For instance, if preserving your breast is a high priority, you might lean towards a lumpectomy. If minimizing the risk of recurrence is more important, a mastectomy might be the better choice. What are your thoughts on these values?"

D2: Discussing Treatment Options and Their Implications

Doctor: "We can opt for a lumpectomy, which removes the tumor and a small margin of surrounding tissue, or a mastectomy, which removes the entire breast. A lumpectomy is less invasive and preserves most of your breast tissue but is usually followed by radiation therapy to minimize the risk of recurrence. A mastectomy, while more extensive, can give you peace of mind by removing more tissue, reducing the risk of recurrence."

D3: Balancing Values and Treatment Efficacy

Doctor: "Let's talk about what health-related values you prioritize. For example, some patients value immediate peace of mind and choose more aggressive treatments to minimize recurrence risk. Others prioritize maintaining their current lifestyle and physical appearance. Which of these values resonate more with you?"

D4: Aligning Treatment Plan with Patient Values

Doctor: "A lumpectomy with radiation, combined with hormone therapy, could be a good approach. It aligns with maintaining your appearance and minimizing lifestyle disruption while still effectively treating the cancer and reducing the risk of recurrence."

D5: Collaborative Decision-Making

Doctor: "Let's proceed with scheduling the lumpectomy and plan for radiation therapy afterward. We'll also start discussing hormone therapy options. We'll keep an eye on things and adjust if necessary. Does this plan align with your values and priorities?"

^{Note: These are simulated dialogues generated by GPT-4 based on our instructions to emulate different communication styles. They represent potential approaches rather than actual patient-provider interactions.}

This research raises several questions about how AI might influence healthcare communication:

Could patient choice in communication style enhance autonomy in medical decision-making?
Might AI models offer more consistent application of different communication approaches?
How could these tools complement time-limited clinical encounters?
What role might these systems play in patient education and medical literacy?
What novel communication approaches beyond traditional approaches might LLMs enable that aren't feasible in conventional provider-patient interactions?

Our work represents an initial exploration that raises numerous questions requiring further investigation:

How might AI communication models influence patient decision-making in real clinical contexts?
Could these models inadvertently reinforce patients' existing biases or or create "decision confirmation loops" where patients only receive information that aligns with their preexisting treatment preferences?
What safeguards would be needed to prevent potential manipulation of patient decisions?
What empirical evidence should we gather to assess benefits and risks?

Which AI Doctor Would You Like to See?

Exploring Communication Styles in Healthcare AI

The Research Question

Our Research Exploration

Explore Different AI Communication Models

How We Approached This

Initial Testing: Breast Cancer Scenario

Potential Implications

Questions for Future Research

Research Team

Learn More