In 2023, researchers writing in JAMA Internal Medicine compared physician and chatbot answers to 195 patient questions posted on a public online forum. Blinded clinicians preferred the chatbot’s answers nearly 80 percent of the time and rated them empathetic almost ten times as often. The study had limits: The physicians were volunteers typing brief replies on Reddit, not clinicians writing to their own patients. Still, the finding unsettles me.
After a long career in medicine, I had never asked whether the compassion my patients receive is truly mine. Today, with AI-drafted portal messages and ambient scribes woven into our daily work, that question is no longer hypothetical. If a patient feels reassured by words I did not write, is that still true care? Or are we, one convenient click at a time, replacing the human side of medicine with a machine?
An old play comes to mind. In Edmond Rostand’s Cyrano de Bergerac, the title character is saddled with an unsightly nose. Although he loves the beautiful Roxane, Roxane cannot see past his appearance. Instead, she is infatuated with the handsome cadet, Christian. In the third act, Christian addresses Roxane from a balcony. Unbeknownst to Roxane, Cyrano is hidden in the shadows behind Christian, feeding his comely rival the eloquent verses that bewitch her. Roxane falls in love with the words, thinking they are Christian.
In this analogy, the portal software is Cyrano. When I sit at my desk after a long clinic day, faced with a screenful of patient messages, the AI helps me find the words. Some of its drafts are warmer and more empathetic than anything I can muster in that state. I hit the “accept” button, grateful for the help. But who or what is my patient getting in these replies?
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Ghostwriting is nothing new. Ancient Athenians had speechwriters, and successful politicians have long relied on staff to craft their messages. Most of us don’t feel deceived by that. But medicine is different. When a patient writes to her doctor, she isn’t looking for polished prose. She wants to know that a real person cares about her and is taking responsibility for her well-being.
The philosopher Emmanuel Levinas argued that ethics begins with an encounter between two faces. In his formulation, the faces make a claim on each other. Rostand’s play splits that encounter in two. Christian has the face but without the voice. Cyrano has the voice but is disgusted with his face. AI goes further still: It has the voice but not the emotional component.
There’s another key difference. When a physician offers comfort, a real person stands behind those words and can be hurt if things go wrong. AI can generate eloquent responses, but it doesn’t worry about the human impacts of the result. AI can mimic empathy without any real emotion; it may sound convincing, but it cannot perform the real empathy patients expect from their physicians.
Recently, a patient wrote back through the portal. She thanked me for my response, especially for my kind and thoughtful words. Little did she know those words were proposed by AI. I had merely adopted them by hitting my “approve” button. I had reviewed each sentence before I sent the message, and it accurately expressed my clinical reasoning. Still, this patient was thanking me for an act of empathy I had not actually undertaken. The AI gave her a different impression of me in that moment. Is that a moral use of AI?
Rostand understood this unease when he wrote his play. After the balcony, Christian, who was loved for words that were not his own, felt less loved because he knew those words were not his words, albeit they meant what he was feeling.
So what do we owe our patients? A 2025 Duke study in JAMA Network Open offers a partial answer. Patients slightly preferred AI-drafted messages when they did not know the author. Their satisfaction dipped modestly when told AI was involved, yet more than three-quarters remained satisfied regardless. The authors concluded that disclosure should be maintained to respect patient autonomy, and participants preferred the simplest statement: The message was written by the physician with the support of automated tools.
This study highlights something important. Being honest with patients costs little, but hiding the truth can be costly if they find out on their own. Disclosure doesn’t have to be an apology. It can be a reassurance: I read your message, I reviewed this reply, and I stand behind every recommendation.
AI itself isn’t the real problem. A tired doctor who uses AI to better express what he already believes may actually provide better care than someone who fires off three rushed lines at midnight. The real risk is letting the message lose its connection to the person responsible for it.
Christian wanted what every physician should want: to be appreciated and trusted for who he really is. Our patients deserve to know who is speaking to them. Our job is to make sure they trust the real person.
Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness.
Dr. Torres was born in Spain and grew up in Puerto Rico. He graduated from the University of Puerto Rico School of Medicine. Dr. Torres performed his physical medicine and rehabilitation residency at the Veterans Administration Hospital in San Juan before completing a musculoskeletal fellowship at Louisiana State University Medical Center in New Orleans. He served three years as a clinical instructor of medicine and assistant professor at LSU before joining Florida Spine Institute in Clearwater, Florida, where he is the medical director of the Wellness Program.
Dr. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine. He is a prolific writer and primarily interested in preventative medicine. He works with all of his patients to promote overall wellness.
