New AI app could hold key to better older patient-doctor communication

A new app developed by a second-year medical student could hold the key to helping doctors and other health professionals communicate better with older patients.

Various studies have shown that physicians often find it difficult to converse with older people, leading to many over-65s avoiding seeking medical care.

Research published in the Journal of Applied Gerontology in 2020 looking at Medical Care Avoidance Among Older Adults in the US found that one-fourth of people aged 65 and older had side-stepped remedial help.

The findings based on 2,155 participants from the 2008 Health Information National Trends Survey, revealed that while feeling uncomfortable about having their bodies examined and fearing being diagnosed with a serious illness were major factors in medical care avoidance amongst older people, lower confidence in obtaining health information and less trust in doctors and patient-centred communication, also played a part.

Meanwhile, a National Health and Retirement study published in 2015 found that one in five adults over 50 in the US, claimed to have experienced age-related discrimination in healthcare settings, with one in 17 saying they were subjected to it often.

Other studies have found that compared to younger patients, older adults were less involved in their own healthcare decisions, with doctors cited as being less tolerant, respectful, and optimistic.

Age-based discrimination was found to be common when it came to diagnostic procedures and the types of treatment offered, most especially regarding stroke and cardiological and oncological conditions.

But the new app which uses artificial intelligence to give unique rather than pre-prescribed responses to help medical students develop empathy with patients, could in the future play a vital role in facilitating better communication, diagnosis, and treatment for older people.

It is the brainchild of Eddie Guo, a second-year medical student at the University of Calgary’s Cummings School of Medicine in Canada.

The 23-year-old who is hoping to specialise in neurosurgery, was prompted to develop the platform after realising he needed more practice talking to patients.

The result is OSCE-GPT, a free-to-use objective structured clinical examination program where the computer is the patient.

Users choose whether the patient is male or female and either select a specific scenario or allow the computer to pick a random one for them, letting them practice inquiry-based conversations.

Believed to be the first app of its kind to use one-off replies every time, it is already being used by healthcare professionals in 35 countries, including Canada, the US, Japan, Australia, India, and the UK.

Powered by Whisper, GPT-4, and Google text-to-speech, users speak any language they want, and the app translates it into English.

Developed with the support of the Canadian Federation of Medical Students, scenarios currently include everything from dealing with a patient presenting with a brain bleed, chest pain, or spine trauma, to how to break bad news.

But Guo – who was inspired to become a medic after a neurosurgeon visited his school resulting in an invitation to sit in on a Parkinson’s disease consultation – said within the next few months he hoped to have included scenarios dealing with geriatric care and how to talk to older patients.

He told Agetech World: “It’s certainly an area that needs looking at. I remember we had a geriatric session, and I was just mind-blown by the amount of various complex medical issues that are present in that patient population. Certainly, some cases can be added.

“The reason why there aren’t any cases currently is because I personally haven’t come across them in the clinic. But some things I can think of off the top of my head, are issues such as polypharmacy.

“Oftentimes, older individuals are on quite a few drugs for various medical conditions, and sometimes those drugs can add up, and they each have side effects. Sometimes with these side effects, patients are prescribed more drugs to fix the secondary issue, and it’s just a perpetual cycle.

“That is one major area that could be easily added to the scenarios for someone to manage. Just having that conversation about what drugs an older patient is taking, what doses they are taking, and how can we best manage this with you.

“Other scenarios that could be added in the future are with multiple people all speaking in different voices, such as a provider, an older individual, as well as their primary care giver if they have one, or their children.

“That way it could simulate the sort of conversations you’re likely to have to face, so medical students will have the opportunity to practice with it.

“There is a lot of opportunity to add these sorts of cases involving older people. The way the program is structured is such that if anyone has an idea of a case they want to share, it is quite easy to add it.”

Medical students practice their communication skills in what are known as Objective Structured Clinical Examination (OSCE) stations. However, these require a room, a preceptor, an actor, and a student.

The chance to take part in additional practice opportunities are usually few and far between.

Mehul Gupta, left, and Eddie Guo. Credit: Nada Hassanin, University of Calgary

As Guo said: “It’s really hard to practice communication skills with friends as it’s difficult to replicate what a professional actor can do. Also, when you’re in a clinic, or shadowing someone, patients don’t give feedback on a person’s communication skills.”

It’s not just medical students that could benefit from the platform. Seasoned professionals could too. Guo said: “As you go through medical school, residency, and practice, there is often a trend that physicians become less empathetic.

“There was a study on this a while ago that showed that when you first enter medical school is when you have the most empathy. That slowly declined over the years of training. You’re also working crazy hours and if you can imagine having to go through that for a decade, two decades, then you become worn down.

“It doesn’t make up for the loss of empathy, but it perhaps explains why practicing physicians who are older, may show less empathy with their communication skills compared to their younger counterparts.”

It’s never been more important, however, that those skills are honed when dealing with older patients – especially as we’re living with an ageing planet. The populations of many countries will soon have significantly higher proportions of older people than young adults.

Globally, one-fifth of the population is predicted to be over the age of 60 by 2050.

This demographic timebomb brings with it a host of serious health implications with diabetes, certain types of cancer, dementia, cardiovascular diseases, stroke, mental health issues, and age-related hearing and sight loss and mobility problems, all becoming more prevalent.

Yet despite the health issues facing many older people, they are less likely to seek out medical help because of an assumption that pain, tiredness, dependency, and depression are all part of the ‘ageing process’ – a belief shared by many physicians.

And as research has shown, those who do seek medical help often find themselves undertreated because of factors like hearing loss, mobility problems, or cognitive decline, which may make it difficult to communicate and be mistakenly seen as non-cooperation.

Studies from the American Society on Aging have revealed that healthcare professionals also communicate differently with older people than with younger ones, often being less patient and engaged, and providing less information.

Guo said around three weeks had been given over to geriatrics as part of an ageing, neurosciences and special senses course, and added: “Geriatrics was emphasised during our small group cases as being an area to really consider and focus on, especially with the ageing population.

“As the population ages, the more patients you will be seeing that are of an older age and oftentimes they will be sicker patients, simply because they gather so many medical issues.

Mehul Gupta, left, and Eddie Guo discuss how an AI tool will work to help students develop empathy. Credit: Nada Hassanin, University of Calgary

“Currently, the way we are trained, the model is you have an issue and either we go in and fix it or we investigate and we come up with a plan and we try to tackle it.

“However, if you have multiple issues, for example, heart failure, liver failure, or perhaps multi-system organ failure, or even just disease of multiple organs, that is something that is a little trickier to deal with, because the way we are taught is system by system currently.

“I think medical schools should begin transitioning into more of these complex patient presentations, especially towards the end of medical training as you gain foundational knowledge.”

It is in situations such as this that Guo’s app could come into its own.

“Having that set base of this is actually the general direction you want to take this conversation before going in and seeing the patient, is likely going to be a positive experience for both the patient and the provider,” he said.

Currently medical students the world over use the Calgary-Cambridge guides for interviewing patients. These were developed by a team based at the University of Calgary and the University of Cambridge in the UK.

The first publication was in 1998 and the model which is based on 71 skills and techniques to improve patient interviews, has since been adapted for veterinarians.

Guo was helped in the creation of OSCE-GPT by University of Calgary alumini, Dr Mehul Gupta.

He said of his decision to become involved: “As a resident, I see what a critical skill communication is. How you phrase things and approach situations matters. Communicating effectively requires practice. This system has the promise to really change the way health professionals interact with patients.”

Guo maintains the interaction with the computer is surprisingly human-like.

He explained: “Developing empathy is a critical skill for health professionals and the real world can be intimidating. The platform offers a safe environment so someone can practice and fumble and learn from mistakes so they can be more confident when they do see a real patient.

“As you can imagine, it might not be the best idea to go see a real patient to learn to communicate with them, especially if they are coming in with an issue and you don’t know how to approach it.

“That decreases the care for both the patient and provider. But by having extra practice with this app, providers and trainees get the opportunity to have seen a case, to have seen a general approach, and to have seen what does and doesn’t work, and what does and doesn’t come naturally to them.”