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In this episode, we explore the pros and cons of integrating ChatGPT, an advanced AI technology, into our health care system. Our guest, Liudmila Schafer, a board-certified medical oncologist, guides us through the potential benefits, such as early diagnosis and improved medication adherence, as well as the potential downsides, such as incorrect predictions and increased anxiety for some patients. Join us as we discuss the role of AI in health care and its potential implications.
Liudmila Schafer is a board-certified, award-winning medical oncologist, an associate professor of medicine, and author of The Other Side of Oncology. She is CEO, The Doctor Connect consultancy specializing in helping physicians to unlock their full potential for passion-driven business and media appearances utilizing credentials through “national impact strategy.” She can be reached on Twitter @MdLiudmila, Instagram @dr_liudmilas, Facebook, and YouTube.
She shares her story and discusses her KevinMD article, “The pros and cons of using ChatGPT for your health care needs.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today on the show, we welcome Liudmila Schafer. She’s a board-certified medical oncologist, and she’s the author of the book The Other Side of Oncology. She’s also CEO of The Doctor Connect, a consultancy specializing in helping physicians unlock their full potential for passion-driven business and media appearances. She’s going to talk about her KevinMD article, “The pros and cons of using ChatGPT for your health care needs.” Liudmila, welcome to the show.
Liudmila Schafer: OK, thank you very much for having me.
Kevin Pho: So we’ll get into your article in a little bit, but first off, just briefly share your story and journey to where you are today.
Liudmila Schafer: I’m very grateful, Kevin, for what you’re doing, actually providing a forum both for our patients as well as physicians, because definitely our voices have not been heard. Let me take you back to early 2000, when I actually finished medical school and did my residency and fellowship back in Europe. And then 25 years ago, I took a bold step and moved to the United States. I had to repeat another residency and fellowship, because it’s required in order to practice as a physician, as we all know. And then I pretty much practiced all my life as an academic physician and did clinical research, and that was as faculty.
Initially, my story goes back to when I was five years old. When I grew up, we basically raised all our food ourselves, vegetables and fruits, and I grew up on a farm with my parents back in Europe. I was born on the border of Poland and Belarus. After I graduated, there were very limited resources, and there really were not that many opportunities to practice as a physician. So that kind of made me take this bold step and move over here. When I arrived in the United States, I didn’t really have money, no real support, I had a young son, and I had to start everything from scratch.
So moving forward, when my dad passed away in August 2021, I was flying back from the funeral, and sitting at the gate, I basically started reflecting and thinking back on everything in my life, and how we all go through training, residency, and fellowship. I felt that I actually wanted to teach and share my knowledge outside one patient room. And we all know it was exactly at the time of the pandemic, but it really was already boiling in me for the last several years, because I feel that academic institutions make physicians feel small, and we lack a little bit of our passion.
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Kevin Pho: So you are the founder of a medical consultancy, and I’m interested in hearing about it. It says here you help physicians unlock their full potential for passion-driven business and media appearances. Why is it important for physicians to have their voices heard outside the exam room, in media appearances, for instance?
Liudmila Schafer: Yeah, I feel that physician voices have not been heard. What happens is that every time we go, we speak most of the time about our expertise. We speak at our national meetings, let’s say the American College of Physicians or the American Society of Clinical Oncology, but not a lot of physicians actually speak in the media. You have to be really an A-plus media person in order for reporters and journalists to invite you, because physicians speak in complicated terminology, and we don’t come across with a specific message. Many of us don’t know how to approach reporters, because they also want to have a very positive and right guest, because that’s how media is done.
When they invited me to speak on Fox News about pancreatic cancer and colorectal cancer, which also happened in fall 2021, all of a sudden the reporter started asking me about my story. So I shared that when I was five years old, I drowned, and then 30 years later, I actually became an advanced open water diver. So then I started sharing my story, and the next thing you know, more media reached out and people started wanting to work with me. So that’s how The Doctor Connect was born.
So I started initially with patients, and then when I was working with coaches, I figured out that there are a lot of people teaching about cardiology, pulmonology, heart disease, diabetes, and cancer in my situation, and it was not really expertise that we would actually practice as evidence-based. So that is why I shifted purely toward board-certified physicians, and helped them discover not only how they can present themselves with expertise, but also marry their passion, because many physicians, as I found out, actually hide their passion inside. Unless it’s burnout, unless it’s maybe a death in the family or some crucial situation, we don’t actually come out. So that’s why I really advocate marrying your passion and expertise as a physician. We can discover a brand and present it as a team, with a strategically structured brand narrative within 60 seconds, so then the market will see you as an expert, and you can share your knowledge outside one patient’s room.
Kevin Pho: I’d love to get you back on the show and talk more about how physicians can be more comfortable in the media, but today I’m going to talk about your KevinMD article. You talk about ChatGPT, the pros and cons of using it for your health care needs. And for those, of course, who aren’t familiar, ChatGPT was released in November by OpenAI. It’s what’s called a large language model. Everyone has been using it, but I am certainly interested in hearing your perspective on how that intersects with health care. So talk about how your article came together.
Liudmila Schafer: When I was working a bit before at the previous institution, and even right now, we are using a platform for chemotherapy orders, and for one patient it actually requires 50 to 55 clicks to put in one patient order. So when I started sharing about this, then we realized we actually have AI, and ChatGPT is probably only a drop in the ocean among all the other platforms that are coming up, probably for the next five to 10 years.
So with ChatGPT, you know, I see patients every day. I still practice as a medical oncologist, and my specialty is GI oncology, but since I developed the consultancy, The Doctor Connect, now I do contract work as a medical oncologist. Patients bring information. They actually pull it up, and they tell me, “Well, not Dr. Schafer, but Dr. Google said this.” And then someone was actually asking how to treat thrombocytopenia, and for all of us, your audience knows that it’s a low platelet count. They pulled it up and brought me a differential diagnosis. So I started exploring, and I put into ChatGPT, “How do you treat pancreatic cancer?” And it came up with not a good answer.
So then we learned that it’s incorporated not only into what we see every day when we encounter patients; it takes more from the patient encounter. I have to waste more time with the patient then to explain that it’s not exactly what’s there in Dr. Google or ChatGPT or other platforms, and that we actually have other evidence-based information. And I really feel that we need to bring a little bit more awareness, because now ChatGPT will be incorporated into some platforms, as I heard, Epic, and there are some other platforms. There are some physicians who advocate for it, and well, of course there’s a lot of positive. We can save on radiology images, we can save maybe on writing grants, and we can maybe type or dictate something. But then on the other side, how about malpractice? I’ve heard that also, and I don’t know if it’s true, for full disclosure to whoever is listening to me, but the American Bar Association might be looking at this as a part of malpractice. So that’s why I felt that bringing up the pros and cons of ChatGPT is important, and to elevate voices about other AI platforms in the future.
Kevin Pho: So tell me, you mentioned one example of how ChatGPT intersected with your practice. Are you seeing patients come to you with information that they asked the AI, and asking you what you thought about it?
Liudmila Schafer: Absolutely, Kevin. In the past, patients used to bring articles, and now in addition to articles, they incorporate AI and they ask. And that was actually one of the reasons why, not only in my situation but maybe for other subspecialties, as you probably know, I also do a show once a month, so I try to see how we can elevate the voices of physicians.
Kevin Pho: So how else are you using ChatGPT on the clinic side? You mentioned that it helps sometimes with orders. How else are you using it today in the clinic?
Liudmila Schafer: Kevin, I do not use it, and it’s not incorporated, but patients bring it. OK, so I use ChatGPT, for example, with an idea. If I want to, let’s say, speak with some physician, and that physician tells me that he likes to climb mountains, maybe I know very little about climbing mountains, because I’m a scuba diver. So then I incorporate it and maybe I pull some points. So I feel that this generated data is not where we actually are in the clinics today. I think it would need to be way more evidence-based, and it would require way more platforms for us to legitimately implement it in the clinic. But I think in some specialties, it will be replaced fairly soon, in the next five to seven years.
Kevin Pho: Now, which specialties do you speculate would be most impacted by the rise of generative AI?
Liudmila Schafer: Yeah, we have to be very careful, because obviously I don’t do any programming and I don’t write it. But maybe reading images, that’s one, in terms of radiology. We love radiologists, but they are also overworked and stressed out, so we need to help them. Maybe writing certain NCI-designated grants, and maybe doing certain reports. There are some subspecialties, reading and incorporating next-generation sequencing, and maybe collecting data and seeing what the clinical information is. Because with the new molecular platforms, and oncology is one of the fastest, most dynamic, evolving fields, right now even a lot of oncologists have a difficult time reading next-generation sequencing and helping with the clinical trials.
Kevin Pho: So what area, and it doesn’t have to be oncology, what area of medicine do you think these AI systems have the most promise in, and which is going to impact your life most directly?
Liudmila Schafer: In fact, in my life, it would definitely be the pathology reports, collecting stages, and collecting all the molecular alterations, as well as generating much better clinical trials with data-driven information. Still, finding certain articles, if you want to incorporate something from molecular platforms, takes manpower in a clinic to find this information.
Kevin Pho: Now, for the patients who are using ChatGPT, and I see this all over social media on TikTok and Instagram, what kind of advice do you have for patients who are using ChatGPT to answer health care questions?
Liudmila Schafer: To ask the doctor the question, in a phrase of, “Would it be valuable?” and then bring that information in advance. So instead of taking time during a very busy appointment, where we have about 15-20 minutes per patient and are sometimes overbooked, if we get this information in advance, we could screen it during the same day or the same time. And as we know, right now a lot of notes are being shared with patients since the new regulations came in 2021. Prepare that information, so maybe they can send it early to the clinic. Then we screen it, have a specific answer for the patient in advance, evaluate it, and use this time during the appointment for your physical exam and to discuss more important options for diagnosis and treatment.
Kevin Pho: One of the things I read about the cautions of these AI platforms is the data, right? Because it’s only as good as the data that it collects. And sometimes if we put in patient information, things that are pretty sensitive, we’re not sure what happens to that data. So talk about that privacy component to generative AI, because I think sometimes that’s been overlooked in the discussion.
Liudmila Schafer: Kevin, I think there are several aspects. One is breach security, and I think cybersecurity and insurance would definitely take a completely different branch. Second, just like we use for clinical trials, is the incorporation of this data security. We used to put in just a passcode, and it’s just one computer, but now we are talking about not just hyperspace but a hyper cloud. As far as I know, some of this information will not only be stored on one individual computer, but it will also be in the cloud. So how do we protect the cloud? That’s one aspect. And on the other aspect, who is going to be responsible if anything is learned from ChatGPT or any platform and then generated? Ultimately, physicians are not very much protected from malpractice, so I think the next step may be to take it to Congress and look at this.
Kevin Pho: So let’s say I talk to you next year. Generative AI has been progressing so fast. So this time next year, what is your prediction of what will happen to that intersection between AI and medicine?
Liudmila Schafer: Probably it will be the incorporation of more AI into daily clinical practice. The question is, is it only ChatGPT? There are probably hundreds of other platforms coming that we don’t even know about right now, and like I said, it’s only one drop in the ocean. So which one will be better? And maybe some platforms will be more applicable for one discipline versus another discipline. So just because we hear about this in the media and it’s more popular, it might not be the most applicable for a certain discipline. So identifying that is maybe one of the important things that you can be on the lookout for.
Kevin Pho: We’re talking about Liudmila Schafer. She’s a board-certified medical oncologist, and her KevinMD article is titled “The pros and cons of using ChatGPT for your health care needs.” So tell us some of your take-home messages that you want to leave with the KevinMD audience.
Liudmila Schafer: Thank you, Kevin, for such a great interview, and you asked such great questions. One of them is that traditional medicine is overrated, and each physician has passion and expertise. I wish we would have more voices, that we physicians would go on TEDx and write more books and be a little bit more defined rather than being labeled, and also explore what else you can do with the resources, with your expertise. And know that there are peers out there, peers like you, who do such valuable work spreading a voice and helping us. So thank you.
Kevin Pho: Thank you so much for sharing your story, time, and insight, and thanks again for being on the show.
Liudmila Schafer: Thank you very much, Kevin, for having me.
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