More and more patients arrive at Southwest Plastic Surgery having already asked a chatbot about their symptoms. A reader recently asked Dr. Frank Agullo whether AI could take over part of a doctor visit. His answer, in his own words.
“Your reader is actually right, and that’s making a lot of doctors uncomfortable. With AI, you have unlimited time and patience, and there are no interruptions. The limitation, and the benefit, is that AI can fill in the gaps during the doctor visit, but it cannot fill in what the doctor can actually do or prescribe or treat.”
What It Prepares Well
“I feel AI is a great tool for preparation for a doctor’s visit, and it’s even a good tool to summarize and review the information afterward. It’s generally good at explaining and simplifying medical information and complicated words. It’s really good at gathering information and putting it in a timeline, which can be very helpful when you’re describing your problems to the doctor. It’s also great at putting together questions you may want to ask during the visit.”
Dr. Agullo points to the end of the appointment as the moment this pays off.
“This is where most patients stumble. Once the visit is over and the doctor says, ‘Do you have any questions before stepping out?’, a lot of patients blank out, and having something written down definitely helps. Doctors actually like it when patients have questions ready. Sometimes patients feel like they have to make up a question when they don’t have one.”
What the Exam Still Decides
“I would never trust it with anything that requires a physical exam. AI has now been trained to recognize photos and evaluate lesions, but it cannot touch and feel the way we do when we perform a physical exam, to evaluate hernias or rectus diastasis, masses or lumps in the body or breast, skin laxity, and quality of skin.”
Skin laxity and skin quality are assessed by hand at every consultation, surgical or not. They are what separate a patient who will do well with a resurfacing or tightening treatment at the MedSpa from one who needs surgery, and they are also what determines whether a tummy tuck is the right operation. No uploaded photograph answers either question.
“It’s also not good at predicting results, especially in cosmetic or plastic surgery, where a patient may upload a photo and ask for the postoperative result, which may or may not be a good expectation or even a possible one. This is where the surgeon’s experience and assessment of each patient’s anatomy and tissues comes in.”
Confident, and Sometimes Wrong
“It’s really difficult to recognize hallucinations or wrong information, because AI always feels like an authority, all-knowing. I’ve had experiences where I’m researching a topic and AI comes up with completely false references to support what it’s saying. So this is really the difficult part, and the one where the doctor can come in and rectify and explain what is actually happening, or what’s actually in the literature. So many times when I’m researching a topic, after I receive an answer I’ll ask for references, and then I’ll go look for the source to see if it exists, and read about it to make sure it’s factual. Sometimes, if the information seems strange, I’ll ask again in another question, and a lot of times it will recognize that it made a mistake and rectify it.”
“And one of the most dangerous answers AI can give is false reassurance, that you shouldn’t be worried, that it’s really nothing, when in fact it may be, and only a doctor can make that determination.”
A Supplement to Care
“I don’t think AI would realistically replace office visits. The main factor is the physical exam, which is absent. A lot of times there’s no check of the vitals either, unless a patient has a way to measure these and upload them at the same time. I think it’s a supplement to medical care.”
Patients sometimes hesitate to bring their research into the room. Dr. Agullo encourages it, and the same applies to a surgical consultation on the Agullo Plastic Surgery side of the practice.
“Patients worry that if they research too much and come into the office with information, it seems like they know more than the doctor, and that it may undermine the doctor-patient relationship. But as doctors, we’re up to date on the most recent technologies, and we’re aware that patients are using AI, so most of us are very open to it. I’ve always said that an educated patient is a better patient. I’m a proponent of educating patients, and the use of AI is a way to educate yourself more efficiently than going to the library and reading a bunch of books and articles.”
Privacy
“In terms of privacy, you have to assume that none of your information is private. The AI programs I use in the office are all HIPAA compliant, and we have a business agreement with each of them that protects the patient’s information. This is not the case with most chatbots and AI tools available to the public. You should really keep your name, date of birth, Social Security number, address, and anything identifiable out of it, because you have to assume the companies are using these to train their AIs and may also be sharing it, and it could end up in their own hands.”
When to Skip the Chatbot
“What I would skip discussing with a chatbot is anything that seems like an emergency. An unstable patient, chest pain, difficulty breathing, severe headache, facial droop, a new breast lump, a mole that’s changing, fever, spreading redness. If you believe you might have to go to urgent care or the emergency room, or you’re really worried about something, those are all signs that you need to go to the hospital or a doctor as soon as possible.”
Two Prompts to Save
Before a visit: “I am having the following symptoms, and I have a doctor’s visit. Can you give me five questions I should ask my doctor about?”
After a visit: “My doctor diagnosed me with [blank], recommended the following tests, and started me on the following medications. Can you explain this to me, and what questions should I ask at the next visit?”
The Short Version
Prepare with it, build your timeline with it, and use it afterward to understand what you were told. Keep identifiers out of it. Ask for references and confirm they exist. Treat reassurance from a chatbot as worth nothing. Anything that has to be touched, felt, or measured belongs in the consultation room, whether the answer turns out to be body contouring or something much simpler.
Dr. Frank Agullo is a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center.
Ready to Talk?
Bring your list of questions. For a straight answer about what applies to you, let’s talk. Call the office at (915) 590-7900, text us at 1-866-814-0038, or request a consultation.
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