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Medscape
21-05-2025
- Health
- Medscape
AI Tool to Answer Patient Queries Has Mixed Performance
A novel generative artificial intelligence (genAI) tool for drafting physician responses to patients' online questions showed mixed results, according to a poster presented recently at the Society of General Internal Medicine (SGIM) 2025 Annual Meeting in Hollywood, Florida. Researchers led by Natalie Lee, MD, MPH, assistant professor of internal medicine at The Ohio State University College of Medicine in Columbus, Ohio, conducted a thematic analysis of 201 genAI responses to real online questions from patients. The AI generator, an Epic draft tool based on GPT-3.5, was trained with four to five rounds of revisions to build the model. The team grouped responses into five categories: Building rapport, gathering information, delivering information accurately and professionally, facilitating next steps and patient decisions, and responding to emotion. Primary care provider reviewers developed a coding system to define strengths and limitations for each domain. '73% of Drafts Had Limitations' 'We observed both strengths and limitations across all communication domains,' Lee told Medscape Medical News. The data show that 60% of drafts were deemed 'usable,' and 73% had limitations. In the category of information delivery, for instance, the model performed well in providing accurate information about what to expect with a medical test but gave information about blood donation when the patient's question was about kidney donation. The researchers reported that 65% of AI information delivery responses made incorrect assumptions about clinical context, 36% made incorrect assumptions about workflow, and 24% of the responses were 'simply wrong.' In responding to emotion, an example limitation was seen when a patient expressed long-standing emotional suffering related to a condition and the reply did not acknowledge patient emotion. Overall, the researchers wrote, 'While GenAI drafts often contain usable portions, net value added may be limited by inadequacies in more cognitively demanding, critical domains like providing accurate information, asking key questions, and responding to patient emotions. Further optimization is needed to genuinely enhance patient care and provider experience.' This work provides more data about the usefulness of AI as the need for assistance in fielding patients' questions has intensified with unprecedented volume. 'How do we integrate generative AI technology so that we uphold communication and care quality while also reducing provider burden? It's not clear we have that figured out,' she said. Framework Adds Novel Assessment Owais Durrani, DO, an emergency medicine physician with Memorial Hermann Health System in Houston, told Medscape Medical News that the authors' use of a novel framework to assess the quality of medical communications made this study particularly significant. 'Too often, we judge AI tools on surface-level efficiency metrics — how many clicks saved, how many seconds shaved off. But this study looked at deeper clinical domains. The finding that AI performed better in low-risk areas like enabling next steps or basic rapport-building but struggled in areas like delivering accurate information or responding to emotion really highlights where the gaps are. It's a reminder that AI can support the clinical process but shouldn't replace human judgment, especially in patient interactions that require empathy, nuance, or clinical reasoning.' He said he's open to AI communications, but with caution. 'Many of the drafts are overly verbose, vague, or miss the clinical nuance required to answer a patient's real question,' he said. 'Physicians then have to sift through the noise and rework the content, which in many cases takes as much — or more — time than writing it ourselves. For now, I view AI-generated messages more as a starting point than a solution.' Lee and Durrani reported having no relevant financial relationships.
Medscape
20-05-2025
- Health
- Medscape
Improving End Organ Checks in Outpatient Hypertension
Providers should evaluate all patients with new-onset hypertension for evidence of end organ damage, guidelines say, but researchers have found gaps in that process. Researchers at Indiana University School of Medicine's Southwest Internal Medicine Residency Program, including Mark Georgy, MB BCh, presenting author, noted that new-onset hypertension is commonly diagnosed in the outpatient setting by primary care providers. Organ dysfunction secondary to hypertension was not being monitored appropriately at their own outpatient residency clinic, so they suspected that may be the case elsewhere. The team set out to find a way to improve the evaluation of end organ damage and presented their findings in a poster at Society of General Internal Medicine (SGIM) 2025 Annual Meeting in Hollywood, Florida. First, they looked at why the end organ evaluations weren't being done and found that unfamiliarity with the most recent guidelines was a significant factor, followed by lack of resources in the clinic that providers could easily reference. A lack of streamlined order sets within the electronic medical record (EMR) was also an issue. Multipronged Intervention The researchers developed 30-minute interactive seminars for small groups of residents and created and printed posters detailing algorithms and made them readily available in multiple areas of the resident clinic work area. They also developed an order set for the EMR that included all the workup required to evaluate end organ damage according to guidelines. Their measures of success were increases in evaluating end organ damage and, through survey responses, how the resources were received by residents and attending physicians. While the qualitative results were not available by the poster deadline, the authors wrote, the survey responses show the intervention was well received. They added that their approach was designed to allow other programs to easily replicate the steps. 'Most complimented have been the interactive seminars, with most noting the wealth of useful knowledge gained in an engaging yet efficient format. Posters were deemed easy to interpret and a useful tool to reinforce knowledge,' the authors reported. 'The order sets were found to make workflow more streamlined.' Complex Guidelines May Feed Problem Donald DiPette, MD, clinical professor of internal medicine at University of South Carolina School of Medicine Columbia, told Medscape Medical News the lack of end organ damage evaluation in hypertension is a common gap in care far beyond the group studied here. He said the number and length of guidelines may well contribute to the gap and make it difficult for primary care physicians to easily access guidance on best practices. Additionally, he said, it's also common to not act on the signs of end organ damage even after it is identified. Reasons for that are that the guidelines 'are overly comprehensive and that makes them overly complicated,' he said. 'Even the executive summaries are overly complicated. Most guidelines are written by subspecialists and not necessarily aimed at the primary care physician.' What's Missed Without the Evaluation DiPette explained the need for the end organ evaluation. The elevated pressure damages primarily the heart, the brain, and the kidneys. It's a vicious cycle, DiPette said, because 'if you develop the end organ damage either from the hypertension or another disease that causes the end organ damage, that damage can further elevate the blood pressure. One of the reasons the evaluation is so important is to break that cycle.' Finding the end organ damage may also change the level of blood pressure physicians treat. 'In most of the guidelines now, if you have end organ damage like heart disease or kidney disease or diabetes, you would treat patients at a lower blood pressure level,' he explained. That, in turn, changes the target blood pressure you want to achieve. It also might influence the medications you choose, DiPette said. 'Some of the blood pressure medicines can lower blood pressure and help the organ,' he said. 'There also may be medications you want to add to further treat the patient's organ damage at the same time you're lowering the blood pressure.' He said these researchers are 'likely onto something' with their intervention. 'I like their idea of utilizing the electronic medical records,' DiPette said. 'We often are pretty critical of electronic medical records as physicians, but there's really some positive benefits of an EMR and this is one of them.' 'Any positive acknowledgment of the problem and ways to address it brings the issue to light.' Then professionals are more likely to not only investigate for the presence of end organ damage but also act upon it, he said. DiPette declared having no relevant financial relationships. He was part of a leadership team that developed World Health Organization guidelines on hypertension. Authors reported having no relevant financial relationships.
