“Artificial Intelligence (AI) has its strong points: intelligence isn’t one of them.”
— Mark O’Connell, The Irish Times (June 8, 2024)
AI is everywhere at present — including in healthcare. Despite a proven propensity to offer false information, and the potentially serious risks this poses to patients, AI has some health system advocates.
There are potential applications for artificial neural networks in research, information transfer and retrieval, as well as in clinical decision systems. And there are some early positives for the use of AI in primary care.
Dana Sidney is a Nurse Practitioner in Ottawa, and a recent graduate of the NBM Lab’s Foundational Certificate. She started using an AI scribe to shorten the time spent in administrative tasks. In a major plus she has found that the tool enables her to listen to patients directly, with less in-appointment engagement with the computer.
However, for those of us who practice Narrative-Based Medicine (NBM), and are observing its rise, a key question is: Will AI have the capacity to listen closely to patients, and even more importantly, respond in a natural, empathetic way to the issues raised by them?
Close listening and close reading are essential elements of Narrative-Based Medicine. By realigning consultations to place the patient more at the centre of clinical interactions, we value the importance of active listening and the use of reflective summarizing statements that focus on people’s emotions.
The technology behind AI systems such as ChatGPT (GPT-4) is known as a large language model (LLM). These are artificial neural networks, a type of AI designed to mimic the human brain. They can generate general purpose text and perform language processing tasks such as classifying concepts, analyzing data, and translating text.
However, we are told its next iteration (GPT-5) will have an improved ability to interpret the context of dialogue and interpret the nuances of language. It will reputedly feature a higher level of emotional intelligence, allowing for more empathic interactions with users.
I’m afraid I just cannot see AI being able to undertake these complex tasks. In fact, I reckon an untrammeled AI could lead to a significant risk to patients’ health.
I decided to ask ChatGPT if it saw a role for itself in Narrative-Based Medicine. It came back with a confident “Certainly!” Asked for examples, this is the response I received:
“AI in narrative medicine can involve sentiment analysis of patient narratives to understand emotional states, natural language processing for extracting relevant medical information from stories, and machine learning models to identify patterns in patient experiences that may contribute to more accurate diagnoses or treatment recommendations. Additionally, chatbots or virtual assistants can engage with patients to collect their narratives, aiding in more comprehensive healthcare support.”
The last sentence is interesting. Could we reach a point where the human receiver of stories becomes obsolete? Will the very nuance, empathy and humanity we value as part of current NBM be found to be overly subjective? Could the virtual collecting of narratives be favoured because of its objectivity? Might AI enable us to record NBM conversations more faithfully and with a certain consistency?
My reaction to these questions is that I hugely value the individuality and fluidity that is reflected in two humans conversing freely with each other. And as an NBM practitioner I don’t want to lose this.
But, like it or not, AI is coming to all parts of healthcare and medicine. AI is not deus ex machina, just machina. It’s a machine I believe we, in Narrative-Based Medicine, must engage with very carefully indeed.
About the author
Dr. Muiris Houston is especially interested in the stories patients tell, which led him to complete a master’s degree in medical humanities at the University of Sydney, Australia. Muiris is adjunct professor of narrative-based medicine at Trinity College Dublin, his alma mater, where he teaches narrative medicine modules to first- and third-year medical students. He is an award-winning medical writer and health analyst with The Irish Times. He is also a member of the NBM Lab’s International Advisory Board.