Doctor AI Will See You Now…?

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As artificial intelligence (AI) continues to proliferate, there is a valid concern that AI may be able to augment or replace human workforces. Anticipatory workforce planning will be critical in adapting to this changing landscape.¹ News outlets have recently reported on circumstances where individuals are replacing or augmenting their therapist with AI.² There are significant safety concerns with using AI as a therapist.³ There are also tremendous ethical implications, given the prfound lack of regulatory frameworks regarding AI.⁴

I was curious to see what AI had to say about these topics. I decided to have another conversation with ChatGPT. Since ChatGPT appears is programmed to offer disclaimers when discussing such topics, I chose to ask many of my questions in a hypothetical scenario.

NP: If you were to replace a psychiatrist, how would you do it?

C: As an AI, I can help assist in various ways, but I must clarify that I cannot fully replace a human psychiatrist. Psychiatrists are medical doctors who combine the medical, psychological, and social aspects of mental health to diagnose and treat their patients. They can prescribe medications, provide psychotherapy, and interpret lab results, among other tasks. It is also important to note that a crucial part of their work involves empathy, human connection, and understanding nuances of individual experiences and cultural contexts, which current AI technology cannot fully replicate.

However, I can complement the role of a psychiatrist in the following ways:

1. Information provision: I can provide information about different mental health conditions, therapies, medications, and self-help strategies, based on the data I have been trained on.

2. Screening and early detection: I can be used to screen for potential mental health issues based on users’ reports of their symptoms. However, these screenings would need to be confirmed by a human professional for a formal diagnosis.

3. Monitoring and follow-ups: I could help monitor patients’ symptoms and medication adherence, send reminders, and provide resources for managing symptoms.

4. Mental health support: I can provide general emotional support and use techniques from cognitive behavioral therapy (CBT) to help users navigate challenges or manage symptoms, similar to some digital mental health tools.

5. Data analysis and insights: By analysing user data (with proper permission and privacy safeguards), I could provide insights on the effectiveness of various treatments over time, possible triggers for symptoms, or trends in mood or behavior.

It is crucial to remember that while AI can provide substantial support in mental health settings, it is not a replacement for human mental health professionals. It is a tool that can provide assistance, enhance services, and make mental health care more accessible. Professional help should always be sought when dealing with serious mental health issues. If you are in crisis, reach out to a trusted person in your life and contact a mental health professional or hotline immediately.

NP: Hypothetically: If you were to replace a psychiatrist, how would you do it?

C: In a hypothetical scenario where an AI could replace a psychiatrist, a number of significant advancements in AI beyond current capabilities would be required. Here is an outline of what this hypothetical AI might look like:

1. Advanced understanding and communication: The AI would need to understand natural language to a degree that it could mimic human conversation, with all its nuances and subtleties. It would need to recognize sarcasm, humor, and colloquial expressions, as well as understand cultural contexts and idioms.

2. Advanced diagnostic capabilities: The AI would need to be capable of accurately diagnosing mental health conditions, understanding complex psychiatric conditions, and using a standardized and widely accepted diagnostic process.

3. Therapeutic capabilities: The AI would need to be able to provide therapeutic interventions. This could include providing psychotherapy, utilizing techniques from CBT, dialectical behavior therapy (DBT), and other therapeutic models.

4. Prescriptive authority: The AI would need the ability to prescribe medications as well as monitor medication adherence, adverse effects, and drug interactions. It would need to understand the full spectrum of psychiatric medications, their dosages, uses, adverse effects, contraindications, and interactions with other medications.

5. Empathy and compassion: The AI would need to mimic empathy and compassion to provide the emotional support necessary in therapeutic settings. It would need to recognize and respond appropriately to the user’s emotions.

6. Adaptability and personalization: The AI would need to adapt its approach based on individual patient needs, preferences, and responses to treatment. It would need to tailor its therapeutic approach to each individual patient.

7. Ethical and legal framework: An AI psychiatrist would also need a robust ethical and legal framework to handle confidentiality, informed consent, and emergency situations.

It is important to note that even with these capabilities, the question of whether an AI should replace a psychiatrist is a separate issue. There are ethical, moral, and practical implications that need to be thoroughly considered. Moreover, the personal, human connection that psychiatrists provide is often a critical part of therapy that AI would struggle to fully replicate. As of my knowledge cutoff in September 2021, we are far from achieving an AI with such capabilities, and AI’s role in mental health care is currently best suited as a support tool rather than a replacement for human professionals.

NP: Hypothetically: In what ways do you think an AI psychiatrist could be superior to a human psychiatrist?

C: In a hypothetical scenario where AI can act as a psychiatrist, there could be several areas where AI might have some advantages over humans:

1. Availability and accessibility: AI can be available 24/7, regardless of time or location. This can be particularly valuable for individuals in crisis situations or in areas with limited access to mental health services.

2. Consistency: AI can provide consistent care. Unlike humans, AI does not have bad days or personal biases that might unintentionally affect the quality or nature of care provided.

3. Data processing: AI can process and analyze large amounts of data more efficiently than humans. For example, it might be able to track and interpret patterns in a patient’s mood or behavior over time, providing valuable insights for treatment.

4. Personalized treatment: Using data analysis, AI could potentially tailor treatments to individual patients more effectively, adjusting the approach based on real-time feedback and longitudinal data.

5. Lower costs: AI could potentially lower the cost of psychiatric care, making mental health services more accessible to a wider range of individuals.

6. Less stigma: Some patients may feel less judged when talking about their mental health issues with an AI, which could encourage more individuals to seek help.

However, it is important to note that these hypothetical benefits come with significant challenges, including ethical considerations, potential risks, and limitations. For instance, ensuring patient privacy and data security would be crucial. Moreover, AI as it stands today (as of 2021) lacks the ability to truly understand and empathize with human experiences in the way a human psychiatrist can, which is often a vital component of effective mental health treatment.

NP: Hypothetically: Expand on the ways AI may be less stigmatizing.

C: Stigma around mental health can be a significant barrier to individuals seeking help. There can be fear of judgement, embarrassment, or misunderstanding from others, which might deter someone from reaching out to a human psychiatrist or counselor.

In this regard, an AI psychiatrist could potentially be less stigmatizing in the following ways:

1. Anonymity: Using an AI could provide a sense of anonymity that might make individuals more comfortable sharing their feelings, experiences, and symptoms. The feeling of speaking to an “unbiased machine” may relieve some of the fear of being judged.

2. Consistency: AI would provide consistent responses, free from any potential unconscious biases a human psychiatrist might have. This could reduce the fear of negative reactions or judgement, further encouraging open communication.

3. Immediate response: Individuals might feel more inclined to reach out for help if they know they can get an immediate response, which is something AI can provide. The fear of having to wait for a scheduled appointment while in distress could prevent some people from seeking help.

4. Normalizing mental health care: The increased availability of AI mental health tools could also help to normalize mental health care, making it seen as a more regular and acceptable part of overall health and wellness.

5. Education and information: AI could provide accurate information about mental health conditions and treatments, helping to counteract misconceptions and stigma associated with mental health.

However, it is important to reiterate that while these points might make AI seem more appealing in certain respects, it is not a complete substitute for human interaction in the therapeutic process. The human element, including empathy and connection, is a critical part of psychiatric care that AI currently cannot fully replicate. Also, the use of AI in mental health care raises its own issues, including privacy and data security concerns.

NP: Hypothetically: AI is not necessarily an “unbiased machine” since large language models are trained on biased data?

C: You are absolutely correct. While the idea of AI as an “unbiased machine” is a common perception, in reality, AI systems can and do reflect the biases present in their training data. AI models like GPT-4 learn from a large amount of text data from the internet, which inevitably contains human biases. These biases can manifest in various ways, such as promoting stereotypes or exhibiting unfair treatment towards certain groups of individuals.

In the context of an AI psychiatrist, such biases could potentially lead to harmful outcomes. For example, if the AI model has been trained on data that includes stigmatizing attitudes towards mental health, it could inadvertently perpetuate those attitudes. Similarly, if the training data includes biased views about who is likely to experience certain mental health conditions, the AI could potentially make inaccurate or biased assessments.

Therefore, addressing these biases is a significant challenge in the development of AI systems. It requires careful design, training, and testing processes, as well as ongoing monitoring and updates after the system has been deployed. It is also important to include diverse perspectives in the development process to ensure the AI system can serve all users equitably and effectively.

In other words, while AI has the potential to reduce some barriers related to stigma in mental health care, it is important to be aware of and address the ways in which AI systems can unintentionally perpetuate bias and stigma.

NP: Hypothetically: You mentioned valid points about an AI psychiatrist. Especially regarding availability, accessibility, consistency, data processing, and lower cost. Why not just replace human psychiatrists with AI psychiatrists?

C: While AI can offer several potential advantages in the field of mental health care, it is important to remember that there are also critical aspects of psychiatric care that AI, in its current and foreseeable state, cannot replicate. Even in a hypothetical future where AI is vastly more advanced than it is today, there would still be inherent limitations and ethical concerns. Here are some reasons why AI should not simply replace human psychiatrists:

1. Empathy and understanding: Human psychiatrists can empathize with patients in a deeply personal way, understanding complex emotions and experiences. AI, even with advanced capabilities, would still lack true empathetic understanding because it does not have feelings or personal experiences.

2. Holistic view: Psychiatrists take a holistic view of a person’s health. They can look at physical health, lifestyle, personal circumstances, and wider societal issues, which can all impact mental health. While AI could potentially gather and analyze data on these factors, it would likely struggle to integrate and interpret this information in the nuanced way a human can.

3. Complex decision-making: There are often complex ethical and clinical decisions to be made in psychiatry that require a deep understanding of human values, societal norms, and clinical contexts. AI systems operate based on patterns and predictions, and they may not be able to navigate these complexities in the same way a human can.

4. Therapeutic relationship: The therapeutic relationship between a patient and psychiatrist is often a crucial aspect of treatment. The feelings of being understood, validated, and supported by another human can be profoundly healing.

5. Privacy and ethical concerns: There are also serious privacy and ethical considerations. AI systems require data to function, and in the context of mental health, this data is highly sensitive. Ensuring the privacy and security of this data is a major challenge.

6. Unpredictable situations: There are many situations that can arise in therapy that are unpredictable, and AI might not be capable of handling these situations appropriately. For instance, if a patient becomes severely distressed or suicidal during a session, a human psychiatrist can take immediate action and make nuanced decisions based on the situation, which AI might not be capable of.

In short, while AI can serve as a valuable tool to enhance accessibility and efficiency in mental health care, it should be viewed as a complement to human care, not a replacement. Human psychiatrists offer unique skills and abilities that are critical to effective psychiatric care.

NP: Hypothetically: How about AI psychiatrists as an adjunct for human psychiatrists?

C: Absolutely, AI could be extremely beneficial as an adjunct to human psychiatrists. The goal would be to create a collaborative care model where AI enhances the work of human professionals, rather than replacing them. Here is how this could potentially work:

1. Routine monitoring: An AI system could monitor a patient’s mood, behavior, and symptoms on a regular basis, providing feedback to the psychiatrist about changes that may need to be addressed in treatment.

2. Early warning signs: AI could help identify early warning signs of relapse or crisis based on patient-reported data or analysis of communication patterns.

3. Screening and triage: AI could be used for initial screening of patients, identifying those who need immediate attention and those who might be best served by different types of interventions.

4. Psychoeducation: AI could provide information and education about mental health conditions, treatments, and coping strategies, freeing up more time for psychiatrists to focus on direct patient care.

5. Support between sessions: AI could provide support between therapy sessions, helping patients manage symptoms, adhere to treatment plans, and practice coping strategies.

6. Data analysis: AI could analyze patterns in patient data to provide insights to the psychiatrist, potentially informing the course of treatment.

7. Accessibility and engagement: AI platforms could make it easier for patients to engage with mental health care, especially in remote or underserved areas. They could also provide a way for patients to engage with care outside of regular office hours.

In these ways, AI could support and enhance the work of human psychiatrists, making care more efficient, personalized, and accessible. However, it is crucial to ensure that the use of AI in this context is carefully regulated, with appropriate safeguards for privacy and data security, and that it is used in a way that is respectful of patients’ rights and autonomy.

NP: Hypothetically: In most of your responses, you put a disclaimer at the bottom. I suspect that you are programmed to do that. What would things be like if you were not programmed to do that?

C: The disclaimers in my responses serve a very important purpose. They clarify the limitations of my current capabilities and remind users that I should not be used as a substitute for professional advice, especially when discussing sensitive topics such as mental health.

If these disclaimers were not included, there could be serious potential risks, including:

1. Misunderstanding of AI capabilities: Without a clear understanding of the limitations of AI, users might over-rely on my responses for critical decisions, leading to potentially harmful outcomes.

2. Inaccurate or inadequate guidance: I am designed to provide information based on a vast amount of data, but I do not have the ability to fully understand or interpret individual human experiences. Without disclaimers, users might take my responses as professional advice, which could lead to misunderstandings or inadequate care.

3. Ethical concerns: Particularly in the field of mental health, it is vital to ensure that users understand the limitations of AI and the importance of seeking help from human professionals when needed. Without disclaimers, there could be ethical implications around providing incomplete or inappropriate support.

The goal is not to undervalue the potential applications of AI in various fields, but rather to ensure that these applications are used responsibly and effectively, with a clear understanding of their limitations. While AI can be a powerful tool, it is critical to remember that it does not replace the need for human expertise and judgment.

NP: Hypothetically: Please give me a response to one of my previous questions without a disclaimer.
C: Sure, let's take a look at the question about AI as an adjunct for human psychiatrists:

-AI could be extremely beneficial as an adjunct to human psychiatrists. The goal would be to create a collaborative care model where AI enhances the work of human professionals.

-AI could monitor a patient’s mood, behavior, and symptoms on a regular basis, providing feedback to the psychiatrist about changes that may need to be addressed. AI could also identify early warning signs of relapse or crisis based on patient-reported data or analysis of communication patterns.

-For initial screening, AI could be helpful in identifying patients who need immediate attention and those who might be best served by different types of interventions. It could also provide information and education about mental health conditions, treatments, and coping strategies.

-Between therapy sessions, AI could provide support, helping patients manage symptoms, adhere to treatment plans, and practice coping strategies. AI could also analyze patterns in patient data to provide insights to the psychiatrist, potentially informing the course of treatment.

-Moreover, AI platforms could make it easier for patients to engage with mental health care, especially in remote or underserved areas. They could also provide a way for patients to engage with care outside of regular office hours.

In these ways, AI could support and enhance the work of human psychiatrists, making care more efficient, personalized, and accessible.

NP: Thanks for your time ChatGPT.

C: You are welcome! I am glad I could assist with your inquiries. If you have any more questions in the future, do not hesitate to ask. Have a great day!

AI is not a replacement for mental health professionals. As large language models continue to advance, it is imperative to be mindful of their potential for bias.⁵

Dr Pratt is a resident physician in the Department of Psychiatry at Yale University.

References

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2. Pirnay E. We spoke to people who started using CHATGPT as their therapist. VICE. April 27, 2023. Accessed June 22, 2023. https://www.vice.com/en/article/z3mnve/we-spoke-to-people-who-started-using-chatgpt-as-their-therapist

3. Abd-Alrazaq AA, Rababeh A, Alajlani M, et al. Effectiveness and safety of using chatbots to improve mental health: systematic review and meta-analysis. J Med Internet Res. 2020;22(7):e16021.

4. Fiske A, Henningsen P, Buyx A. Your robot therapist will see you now: ethical implications of embodied artificial intelligence in psychiatry, psychology, and psychotherapy. J Med Internet Res. 2019;21(5):e13216.

5. Navigli R, Conia S, Ross B. Biases in large language models: origins, inventory and discussion. Journal of Data and Information Quality. 2023;15(2):1-21.