On listening, stigma, AI and 'the work of connection' in medicine

What sociologists call “the work of connection,” and physicians call “the art of medicine,” is the thread running through The Physicians Foundation's research on trust, misinformation and burnout, said Foundation President Gary Price, M.D., MBA.

Physicians need time to establish trust with patients. It is critical to affect the cost, quality and safety of care, he said, even as more of that care shifts toward artificial intelligence (AI).

Price, a board-certified plastic surgeon, discussed with Medical Economics how patients view physicians' use of AI, the lingering stigma around physician mental health care, and the mentors who shaped his own approach to listening. He also is coauthor of a viewpoint published in JAMA Internal Medicine, “Rebuilding trust in the patient-physician relationship.”

This transcript has been edited for length and clarity.

There have been findings that patients are skeptical about their physicians using AI in a clinical sense. Have you heard much about that?

Gary Price, M.D., MBA: Yes, and I think this works both ways. Patients using AI to get answers to medical issues can be inefficient and lead to mistaken ideas, because the AI can only answer the questions patients pose, which reflect biases and fears a skilled physician knows about and can help cut through.

Patients' skepticism about using AI alone to make a diagnosis or recommend treatment is well founded, and physicians agree. We all get wrong or weird answers from AI sometimes, but our background knowledge lets us recognize when something's amiss. AI is a great way to rapidly surface everything recently published on an issue, much quicker than searching ourselves, but we have to be careful about its conclusions. We're trained to be skeptical even of the raw scientific papers, so questioning what the data reveals isn't new to us.

In the survey, 71% of physicians agreed that stigma remains around physicians seeking mental health care, and 36% said they feared, or knew a colleague who feared, seeking care because of potential questions on licensing, credentialing and insurance applications. How would you describe the continuing process of change around stigma and mental health care for physicians?

Gary Price, M.D., MBA: This is due in great part to the Dr. Lorna Breen Foundation. We're slowly chipping away at this problem, even though the rates of physicians feeling that stigma, and knowing colleagues who didn't seek care because of it, are still too high. Those numbers have started to come down, roughly by about 5%, which is encouraging given our well-being and stress levels are essentially the same as at the conclusion of the pandemic.

Another achievement of the All In Coalition, largely sponsored by the Dr. Lorna Breen Foundation, is that the overwhelming majority of states have eliminated licensing questions implying that mental health treatment would revoke a physician's license, replacing many with a pledge that an applicant would seek care if needed.

In fairness, this reflects a stigma our society holds toward mental health care generally. We still compartmentalize it apart from other health care, and many large institutions require physicians to seek that care within the same system where they work, which is a barrier. We've got a long way to go, but it's gratifying to see the discussion out in the open.

Related coverage: Misinformation, burnout and lost trust are 'incredibly interrelated'

Thinking back on your own career, what was a piece of good advice you got, maybe from another physician or a mentor, that helped inspire you to be an active listener for your patients?

Gary Price, M.D., MBA: There are two things I remember most. A lot of what young physicians learn about this skill comes from modeling after mentors in training. I remember several mentors as a medical student who stood out for communicating and interacting with their patients so much better than some colleagues. I had one surgical mentor who made a point of touching every patient on rounds, sitting down next to them, making eye contact and spending enough time to really listen. That was critical to making a patient feel you cared and were going to make sure they got good care.

I also took an elective on the patient interview and active listening, beyond the small required curriculum, including texts that were important parts of my education. Sociology is actively learning more about the importance of that human connection, and we need to encourage that, and stay abreast of what they learn.

With some of my younger colleagues, it's beginning to feel like there is a greater desire for personal connection and personal interaction, as opposed to looking at everything online. Do you expect that desire for real-world, in-real-life interaction to continue to grow?

Gary Price: There's an interesting question that grows out of that. Some of the skills involved in communicating, like smiling, eye-to-eye contact and active listening, I'm not entirely convinced AI couldn't learn to mimic. But the real question is whether that's the same as interacting in person with a real human being. I suspect it's not, though research on that will, I'm sure, be forthcoming. We have lots of research that shows that unless you can establish trust and connection, your results are not going to be as good as if you had.