Practice Tips and Efficacy
ChatGPT – Should I Worry or Should I Use It?
By Mariam Mafee, MD, FACMS
I began my journey writing this article by first signing up for ChatGPT, and then asking the program to “write an article on why ChatGPT could help a Mohs surgeon.” It came up with 10 points, which were valid, but somewhat vague and not good enough to call it quits. Needless to say, I am not worried at this point in time. However, as a first-time user, I was intrigued.
ChatGPT, which stands for Chat Generative Pre-trained Transformer, was developed by OpenAI and launched in November 2022. It is an online chatbot, which is a program that simulates conversation with human users and generates responses to users’ questions in plain language using artificial intelligence.1 It is free to everyone that signs up and is useful for a wide range of tasks.
ChatGPT uses data input from the internet written by humans, including conversations, which is why it can sound human-like. With vast amounts of information, it will generate a response within seconds. The user can critique it to revise its responses and correct its mistakes, and then provide feedback to OpenAI by using the “thumbs down” button. Interestingly, it is not directly connected to the internet in real-time and has limited knowledge of events after 2021, which can lead to inaccuracies.2 It can even make up details called “artificial hallucination,” while sounding realistic. In fact, I asked it to provide the CPT code for a tangential biopsy and it gave me the following incorrect response:
“11104- Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion.”
Therefore, it is far from perfect, but it is one of many AI models and they will undoubtedly improve over time.
Although it can be used for a variety of tasks, ChatGPT has a disclaimer that it is not meant for medical use. Patients and clinicians can ask questions about a series of symptoms or a specific diagnosis, and it will provide a response with a disclaimer at the end — for example:
“It's crucial to emphasize that while ChatGPT can be a valuable tool, it should not replace the expertise and judgment of trained medical professionals. Dermatologists should use their clinical knowledge and experience in conjunction with the information provided by ChatGPT to deliver the best possible care to their patients.”
Outside of clinical and diagnostic purposes, ChatGPT has been reported to be used to draft prior authorizations and in-basket responses.3 Additionally, it has been used for clinical documentation. Although speedy, one study in an orthopedic clinic found errors in 36% of the documents.4 Another article discusses its value in perioperative planning, patient education, patient communication, and clinical documentation specifically in Mohs surgery.5 Although promising, use of ChatGPT in direct patient encounters seems complicated due to high risk of error. However, I think one area it currently can be useful to Mohs surgeons is within the realm of clinical operations.
Training staff is one aspect of our job that can be tedious, especially when formulating written materials. ChatGPT can be used to jumpstart the process in creating scripts, protocols, training manuals and patient hand-outs. When I typed in “script for a dermatology nurse for phone calls,” ChatGPT generated a polite script including confirmation of the patient name/DOB, then scripts for scheduling an appointment, refilling a prescription, and general inquiries. I encourage you to play around, but here are some other examples I tried:
“Script for dermatology nurse phone call about bleeding wound”
“Script for dermatology nurse phone call about concern for infection”
“Script for dermatology nurse to discuss Mohs surgery”
I then typed “help create a training manual for a dermatology nurse.” Within secondsan outline of 15 topics including dermatology basics (common conditions, medications), documentation, procedures, patient education, etc. was created. Of course, some further work needed to be done, but at least a decent foundation was set.
When I inquired about a “handout for patient on basal cell carcinoma,” ChatGPT responded with a professional looking document titled “Understanding Basal Cell Carcinoma: A Patient's Guide.” One thing that was impressive is that it included a section for “patient resources” which listed the website for the AAD and Skin Cancer Foundation. This highlights that the chatbot pulls from other sources, including those handouts already available on the internet.
The same applies for post-operative instructions. “Wound care instructions after Mohs surgery” generated a basic handout. Albeit it did need some edits as it instructed the patient to apply antibiotic ointment, and this may not be every surgeon’s preference. This highlights that the key to ChatGPT is that it is a collaboration between the user and the chatbot. Let it do the work up front for you. It can give you an outline or bare bones and then you can edit and add to it as needed.
This type of AI is likely here to stay and evolve over time, so it would be prudent to experiment with the program to further understand it and maybe even use it to your advantage. In the end, ChatGPT won’t replace us (yet), but we could at least use it to save us time.
References:
- E Mollick. ChatGPT Is a Tipping Point for AI. Harvard business review. Published Dec 14, 2022. Accessed Dec 8, 2022. https://hbr.org/2022/12/chatgpt-is-a-tipping-point-for-ai
- What is ChatGPT? OpenAI Help Center. Accessed Dec 8, 2022. https://help.openai.com/en/articles/6783457-what-is-chatgpt
- Jin J, Dobry A. ChatGPT for healthcare providers and patients: Practical implications within dermatology. J Am Acad Dermatol. 2023 Oct;89(4):870-871.
- Baker H, Dwyer E, Kalidoss S, et al. ChatGPT's Ability to Assist with Clinical Documentation: A Randomized Controlled Trial. J Am Acad Orthop Surg. 2023 Nov 17.
- Jeha G.M. Qiblawi S. Jairath N. et al. ChatGPT and generative artificial intelligence in Mohs surgery: a new frontier of innovation. J Invest Dermatol. 2023; 143: 2105-2107.