00:00:07 Dr Samantha Black

Welcome to this episode of Anaesthesia On Air, the podcast from the Royal College of Anaesthetists.

00:00:12 Dr Samantha Black

My name is Dr.

00:00:13 Dr Samantha Black

Samantha Black and I'm A consultant anaesthetist in Medway in Kent and I'm also the patient information lead at the Royal College of Anaesthetists.

00:00:20 Dr Samantha Black

Today we'll be talking about the use and growth of artificial intelligence and its role in the patient clinical conversation.

00:00:26 Dr Samantha Black

which comes with many risks, but also many opportunities.

00:00:33 Dr Samantha Black

I'm joined today by Doctor Maya Sussman.

00:00:36 Dr Samantha Black

Maya, did you want to introduce yourself?

00:00:37 Dr Maya Sussman

Hello, my name is Maya.

00:00:39 Dr Maya Sussman

I'm one of the anaesthetic registrars in London, and I'm the former Patient and Public Involvement Fellow at the Royal College of Anaesthetists.

00:00:46 Dr Maya Sussman

I've been working with Sam and Jenny and other members of the patient information team on trying to engage both members of the public and our expert patients and patient voices to try and understand how artificial intelligence might impact the patient.

00:01:04 Dr Maya Sussman

patient journey in the perioperative period and specifically how it might affect their discussion with clinicians when they do come into hospital.

00:01:13 Dr Samantha Black

We're also joined by Jenny Westaway.

00:01:16 Dr Samantha Black

Jenny, did you want to introduce yourself?

00:01:17 Jenny Westaway

Hi, Sam.

00:01:18 Jenny Westaway

I chair patient voices at RCOA.

00:01:21 Jenny Westaway

So we're the group of patients who help the college consider patient perspectives on all they do.

00:01:26 Dr Samantha Black

Fantastic.

00:01:27 Dr Samantha Black

It's really great to have you both here today.

00:01:29 Dr Samantha Black

So Maya, I think it'd be really helpful to explain to our listeners what we mean

00:01:34 Dr Samantha Black

by AI chatbots and large language models.

00:01:38 Dr Maya Sussman

So generative artificial intelligence describes a technology that can create new content, whether that's text or images or audio.

00:01:46 Dr Maya Sussman

And large language models are types of generative AI models that are trained on these huge amounts of data and they employ natural language processing.

00:01:56 Dr Maya Sussman

So it's designed to mimic human language and communication.

00:02:00 Dr Maya Sussman

The most famous of those is ChatGPT.

00:02:03 Dr Samantha Black

Maya, the latest technology, I suppose, then being used within healthcare anaesthesia, do you think you could tell us a little bit more about that?

00:02:10 Dr Maya Sussman

The top usage of models like ChatGPT is asking questions and people are using these models to ask health questions as well.

00:02:20 Dr Maya Sussman

And we know that from public surveys, even though it's not licensed to give medical advice, but the model will never turn people away.

00:02:28 Dr Maya Sussman

It doesn't say, sorry, I'm not allowed to answer that.

00:02:31 Dr Maya Sussman

it will usually give an answer.

00:02:32 Dr Samantha Black

Jenny, as a patient yourself, how can you see AI chatbots being beneficial to patients who try to find information about their preoperative care and their preoperative journey and their anaesthetic, for example, obviously using this in a positive way.

00:02:48 Jenny Westaway

That's something that we've been talking about with the Patient Voices Group.

00:02:52 Jenny Westaway

We had a really good discussion that Maya helped facilitate where

00:02:56 Jenny Westaway

we were thinking about some of these questions about how might we use AI.

00:03:00 Jenny Westaway

So in terms of the beneficial aspect, our patient voices said it could be really useful in that a time is unlimited.

00:03:11 Jenny Westaway

So you know that if you've got an appointment with your anaesthetist, if you're lucky before your operation or in a pre-op clinic or something,

00:03:19 Jenny Westaway

You've got a limited amount of time.

00:03:21 Jenny Westaway

But if you're using ChatGPT or another tool, you can ask all the questions you want.

00:03:28 Jenny Westaway

You can dive into some of the detail.

00:03:30 Jenny Westaway

You don't feel under pressure.

00:03:32 Jenny Westaway

And I guess in particular, I mean, there's problems with that.

00:03:35 Jenny Westaway

And we'll probably come on to some of the problems as well, won't we?

00:03:38 Jenny Westaway

But in particular, we were talking about it being really useful to help you

00:03:43 Jenny Westaway

get a set of questions ready to prepare for that really pressurised session that you might have with a clinician to talk about, you know, with somebody really expert to talk about yourself, just helps you kind of maybe you can put aside some of the really obvious points that AI might help you answer and you can really focus on the things that are going to be important to you.

00:04:03 Jenny Westaway

So it was particularly in preparing, we thought, for a session with a clinician that we thought it might be really, really helpful.

00:04:11 Dr Samantha Black

So Maya, with the research that you've done,

00:04:13 Dr Samantha Black

What's the current landscape that you found that patients are using AI to inform themselves about their health care going into consultation with their anaesthetist?

00:04:23 Dr Maya Sussman

The engagement that we've done is focused on a small number of patients.

00:04:28 Dr Maya Sussman

Some of them have been our own expert patients who consult with us on the lay perspective and opinion.

00:04:35 Dr Maya Sussman

These discussions have been very much theoretical, not necessarily from experience.

00:04:40 Dr Maya Sussman

I've then spoken to a group of patients who have recently been through pre-operative assessment and surgery and have been users of our website with some discussion of how they use artificial intelligence in their own lives and whether they do use it in relation to health and how that might change things for them if they were preparing for surgery.

00:05:05 Dr Maya Sussman

And interestingly, none of them have actually used artificial intelligence to look specifically for health information around surgery.

00:05:14 Dr Maya Sussman

But there is a lot of theoretical discussion and we've been reaching out and trying to understand where the members of the public are using it.

00:05:21 Dr Maya Sussman

That said, all of our data is caveated by the fact that there's biases there in terms of who we are asking.

00:05:30 Dr Maya Sussman

For example, we are recruiting a lot of patients from our own website so that they are intrinsically a group of people who've ended up on our website rather than searching on Google AI, Gemini and ChatGPT, for example.

00:05:43 Dr Samantha Black

Jenny, have you got anything to add there about what might be patients' sort of hopes and fears with artificial intelligence going forwards and using that to help inform their conversations with anaesthetists?

00:05:55 Jenny Westaway

I guess on the side of the hopes,

00:05:58 Jenny Westaway

the discussions that we've had, that the hopes have really been around enabling patients to kind of engage in shared decision making because they're better informed when they go to those appointments.

00:06:10 Jenny Westaway

I guess the fears are like sort of almost the diametric opposite in that there are worries around the trustworthiness.

00:06:18 Jenny Westaway

So maybe patients might think they're better informed, but can we really trust what the AI is telling us?

00:06:26 Jenny Westaway

And

00:06:27 Jenny Westaway

We've mentioned, haven't we, that it feels like there's been a real change in the amount that we're all using this now.

00:06:33 Jenny Westaway

So maybe we've all kind of known for a number of years that AI is coming and we all need to adapt.

00:06:39 Jenny Westaway

But suddenly in the last, I don't know, year, people are using ChatGPT, you get those AI summaries.

00:06:48 Jenny Westaway

I think

00:06:49 Jenny Westaway

we as patients and all members of the public are maybe seeing that it's not infallible.

00:06:55 Jenny Westaway

So, if you kind of put in, you search for something that you actually know about, quite often the AI summary includes something that you know is wrong.

00:07:05 Jenny Westaway

They've mangled something.

00:07:07 Jenny Westaway

So if I search something about my kind of area that I actually know about, I can see it's got things wrong.

00:07:13 Jenny Westaway

So if I was using it to search for my risk factors,

00:07:19 Jenny Westaway

for my own characteristics for undergoing an anaesthetic, my worry would be it's going to mangle something and get it wrong.

00:07:28 Jenny Westaway

And I think Maya also mentioned that it will give you an answer, even if it doesn't know, almost like predictive text, give you an answer of what could possibly be there or could be the answer, which again, you wouldn't go to a doctor.

00:07:43 Jenny Westaway

And if they don't know the answer, they just make something up on the spot.

00:07:45 Jenny Westaway

But that's what you're getting with AI.

00:07:47 Jenny Westaway

Because I guess the more we talked about it, I think the more worried people got about the patient safety aspect of it.

00:07:54 Dr Samantha Black

Yeah, and I suppose there's a real concern if you're using something like ChatGPT, where is it putting all that information from?

00:08:02 Dr Samantha Black

I suppose we don't know it's putting it from trusted resources like us at the Royal College, whereby we have followed an accreditation process to create all our resources.

00:08:11 Dr Samantha Black

I suppose out there we just don't know, is it coming from America?

00:08:14 Dr Samantha Black

Is it coming from a different country?

00:08:16 Dr Samantha Black

Or as you said, is it just pulling an answer together to almost please us, I suppose, isn't it?

00:08:22 Jenny Westaway

Yeah, and we talked a little bit about that kind of...

00:08:25 Jenny Westaway

the sicker fancy problem that it will tell you that it will kind of make you feel sort of say things like, that's a great question.

00:08:31 Jenny Westaway

You're really on the right lines, even if you're not.

00:08:34 Jenny Westaway

Again, it might be nice if the doctor said that to you, but you really, you want your doctor, you want somebody who's giving you advice to be honest and say, you're not on the right lines at all.

00:08:43 Jenny Westaway

You've got that totally wrong in a nice way.

00:08:46 Jenny Westaway

But AI is not going to do that.

00:08:47 Dr Samantha Black

No, not at all.

00:08:48 Dr Samantha Black

So, Maya, quite a few of our patients that will see us in a high-risk clinic in pre-assessment or CPEC clinic, for example, will be of a frailer.

00:08:58 Dr Samantha Black

population.

00:08:59 Dr Samantha Black

How do you see artificial intelligence and chatbots being used in that population?

00:09:05 Dr Samantha Black

Or do you think there's going to be some form of discrepancy between the age ranges of patients that we see?

00:09:10 Dr Maya Sussman

Yeah, so that's a really interesting question.

00:09:13 Dr Maya Sussman

And I guess from my engagement work, I don't feel like we've had a

00:09:18 Dr Maya Sussman

good enough range in age ranges with the people that we've spoken to.

00:09:22 Dr Maya Sussman

In particular, we haven't spoken to younger populations who might be a lot more accepting with this technology.

00:09:29 Dr Maya Sussman

Interestingly, we have spoken predominantly in my semi-structured interviews to older adults, all over the age of 65.

00:09:39 Dr Maya Sussman

And there was significant acceptance of this technology.

00:09:42 Dr Maya Sussman

But I don't think that's going to be the case in all patient populations.

00:09:47 Dr Maya Sussman

And there's definitely a concern around digital poverty.

00:09:51 Dr Maya Sussman

And digital poverty might not just be related to age.

00:09:55 Dr Maya Sussman

It can just be related to access to the internet, for example.

00:09:59 Dr Maya Sussman

So, you know, do you have the handset or the laptop, the computer?

00:10:04 Dr Maya Sussman

And then can you actually access the internet?

00:10:08 Dr Maya Sussman

And this is a huge concern, not only from an artificial

00:10:13 Dr Maya Sussman

intelligence perspective, but also from the fact that there is massive digitalization of NHS resources, whether that's how to book an appointment, how to access information about your health care.

00:10:28 Dr Maya Sussman

And that's been flagged up as a red flag by lots of GPs in terms of the 10 year future NHS plan.

00:10:38 Dr Maya Sussman

And where there's increasing disparity in outcomes related to deprivation, there is a real risk here of worsening those disparities if we push and move everything to online and digital.

00:10:55 Dr Samantha Black

So potentially in the future, as the NHS and other reputable health organisations like the Royal College, for example, start,

00:11:03 Dr Samantha Black

potentially hosting their own chatbots.

00:11:05 Dr Samantha Black

Members of the public might well turn to these instead of ChatGPT or Gemini.

00:11:11 Dr Samantha Black

But until that happens, Maya, what do you think are the possible implications of patients gaining information from these wider and probably less controlled resources?

00:11:20 Dr Maya Sussman

Yeah, so I think as Jenny has mentioned already, there's a lot of concern out there about misinformation and where is this information coming from?

00:11:30 Dr Maya Sussman

A lot of us have experienced this

00:11:34 Dr Maya Sussman

phenomena of hallucinations, instead of saying, sorry, I don't know, go find this information somewhere else, or I can't reliably give you an answer for that, it tends to make something up.

00:11:45 Dr Maya Sussman

When it's been rigorously researched, for example, it has made-up.

00:11:50 Dr Maya Sussman

references to scientific articles that don't exist, for example.

00:11:56 Dr Maya Sussman

And there's multiple, multiple examples of hallucinations.

00:11:59 Dr Maya Sussman

So that is one concern that we have as clinicians, but also members of the public have, both in the patient voices and participants in the semi-structured interviews that we've carried out.

00:12:11 Dr Maya Sussman

And in that sort of line of thought, it is really felt like at the moment, you still really have to be using the chatbots with a lot of critical thinking, scrutiny, and some members of the public have specifically said they'll only use it to look into something that they already know about.

00:12:28 Dr Maya Sussman

So if they're not an expert in health, that is not where they're going to be getting their health information from.

00:12:34 Dr Maya Sussman

The patients that we've spoken to time and time again have highlighted how important it is for them to get health information from reputable organizations.

00:12:43 Dr Maya Sussman

There's also other concerns.

00:12:45 Dr Maya Sussman

So for example, there's this idea that you can really build a bond with a chatbot.

00:12:51 Dr Maya Sussman

Because of the fact that it's non-judgmental and accepting and reassuring, it's almost empathetic.

00:12:59 Dr Maya Sussman

And

00:13:01 Dr Maya Sussman

What happens, for example, if a member of the public goes away, speaks to a chatbot week on week because they're worried about this operation that they've got coming up?

00:13:10 Dr Maya Sussman

They've got a bond now with the chatbot.

00:13:12 Dr Maya Sussman

And then you go and meet your anaesthetist the morning of surgery and actually the anaesthetist is saying something different.

00:13:18 Dr Maya Sussman

And how is that going to affect the patient-clinician relationship?

00:13:23 Dr Maya Sussman

So that's something interesting that has also come up.

00:13:25 Dr Maya Sussman

There's also a lot of worries about what happens if the wrong information is given to patients and that leads patients to come to harm.

00:13:32 Dr Maya Sussman

Who's then responsible for that?

00:13:35 Dr Maya Sussman

I mean, the owners of the current chatbots are not going to take the responsibility for the harm to that patient.

00:13:41 Dr Maya Sussman

So there's sort of ethical and legal questions in this area as well.

00:13:45 Dr Samantha Black

A bit of a tricky subject, particularly if you are a anaesthetist that does, for example, a pre-assessment clinic.

00:13:51 Dr Samantha Black

and you have a patient that has done their research, inverted commas, with ChatGPT, that conversation is going to be really hard sometimes to steer into potentially the correct information that you want to give to lead that shared decision-making discussion.

00:14:07 Jenny Westaway

I think that kind of relationship of trust was really on patients' minds as well.

00:14:13 Jenny Westaway

I was looking at some other kind of research this week also that the Health Foundation did.

00:14:18 Jenny Westaway

I had done a survey with both clinicians and with patients and that worry of a sort of a distancing between the patient and the clinician came up from both patients and staff, NHS staff.

00:14:31 Jenny Westaway

And the idea that your trust would be undermined by a machine is really quite worrying, isn't it?

00:14:39 Dr Samantha Black

Absolutely.

00:14:39 Dr Samantha Black

I agree with you.

00:14:41 Dr Samantha Black

Jane, just to continue with public attitudes towards the use of AI, is there any more wider research out there that maybe other health organisations have done that we could use as the college to help steer those conversations at pre-assessment?

00:14:55 Jenny Westaway

Yeah, I've been looking for a different role also that I do this week.

00:14:59 Jenny Westaway

And there's actually loads out there.

00:15:02 Jenny Westaway

But one of the things that I was quite interested in seeing, in particular, the surveys that have kind of been repeated and tracked over time, is that there is an increasing level of understanding.

00:15:13 Jenny Westaway

And some of the surveys seem to show, one that the NHS AI lab did, that there's worries starting to creep in about bias.

00:15:21 Jenny Westaway

And I think whilst it's true to say, most members of the public will know a lot less than Newmire and then many of the collisions that we're talking to, I think there is this increasing understanding of some of the problems with AI.

00:15:33 Jenny Westaway

And I think maybe the college

00:15:35 Jenny Westaway

can trust that it's dealing with a more informed public, or at least some parts of the public are becoming more informed about these things.

00:15:42 Jenny Westaway

And so in presenting our college resources and saying these are rigorously tested based on representative data, I think people, I would hope that at least some people are going to see why that is so important.

00:15:58 Dr Samantha Black

Definitely the hope, isn't it?

00:15:59 Dr Samantha Black

And something that we as clinicians will have to deal with potentially on a daily basis as

00:16:05 Dr Samantha Black

AI keeps developing and more people keep using it.

00:16:08 Dr Samantha Black

Mai, do you, through all the research that you've done, have any concerns with the NHS and its adoption of apps or AI technologies?

00:16:15 Dr Maya Sussman

The thing is, that we're going to have an increasing usage in all walks of life in AI-powered tools, whether that is now being integrated into our actual browser, thanks to Google,

00:16:31 Dr Maya Sussman

or whether it's related to our shopping, banking, or healthcare.

00:16:36 Dr Maya Sussman

Like other organizations, the NHS is wanting to adopt AI technology.

00:16:42 Dr Maya Sussman

And that's not only what we're doing in hospitals, but how we're communicating with the patients as well.

00:16:48 Dr Maya Sussman

So there's several examples where the NHS is already producing AI patient-facing chatbots.

00:16:55 Dr Maya Sussman

Fit for the Future is the government's new 10-year health plan for England.

00:17:01 Dr Maya Sussman

and it was published in July of this year.

00:17:03 Dr Maya Sussman

Digitisation of the NHS is one of three big shifts planned alongside the prevention and community-based care.

00:17:11 Dr Maya Sussman

And there is a plan to build an AI-powered chatbot.

00:17:13 Dr Maya Sussman

And the idea would be that it's something within called My Companion.

00:17:19 Dr Maya Sussman

It will be on the NHS app.

00:17:21 Dr Maya Sussman

And

00:17:22 Dr Maya Sussman

it would be a place where patients could get information instead, I guess, or alongside the NHS choices.

00:17:28 Dr Maya Sussman

And then we've already got apps that are in use, for example, Coventry and Warwickshire.

00:17:33 Dr Maya Sussman

They've got a talking therapist services mental health app, and within there, users can chat to an AI bot and also get referrals into the service itself.

00:17:44 Dr Maya Sussman

And I think there's a lot of learning that we can do from other services to try and understand how these technologies

00:17:51 Dr Maya Sussman

work when they do interact with patients.

00:17:55 Dr Maya Sussman

We are, in our context, we're thinking more about the patient information side of things because it's a huge piece of work that the Royal College actually does.

00:18:04 Dr Maya Sussman

It produces and curates a huge number of resources.

00:18:08 Dr Maya Sussman

They're all approved, accredited by the Patient Information Forum.

00:18:12 Dr Maya Sussman

They're co-produced, so they take clinicians and patients.

00:18:17 Dr Maya Sussman

and they go through rigorous rounds of making sure that they are readable and accessible and all of those things.

00:18:26 Dr Maya Sussman

And the question is, if we keep them as they are, and actually every other way of informing yourself has become far more interactive, then are we at the risk of

00:18:40 Dr Maya Sussman

falling behind, we're not keeping with the times.

00:18:42 Dr Maya Sussman

Interestingly, there is one example that we found of a chatbot that's being built within a reputable environment and co-produced with patients, and that's Lupus GPT on the Lupus Europe website.

00:18:58 Dr Maya Sussman

So it'd be interesting to learn how they've done things.

00:19:01 Dr Maya Sussman

When we've gone and asked members of the public, what would they think about

00:19:06 Dr Maya Sussman

a chatbot if it was hosted by a reputable website.

00:19:10 Dr Maya Sussman

Their ideas of whether or not they would accept that kind of technology is very much mirrored by their concerns.

00:19:16 Dr Maya Sussman

So concerns about accuracy, reliability, precision,

00:19:21 Dr Maya Sussman

People have told us they want assurance that the information is correct and that it won't take them down tangents because that's what they feel that the internet brings them sometimes, too much information, feeling overwhelmed.

00:19:32 Dr Maya Sussman

And there's real concerns about threat, you know, safety.

00:19:36 Dr Maya Sussman

And so they want a chatbot to be accountable and to be well governed, essentially.

00:19:42 Dr Maya Sussman

So there is this real concern that if we are hosting a chatbot and we don't know exactly how the chatbot works and it comes up with a piece of advice that we wouldn't have given normally and a patient comes to harm, then instead of ChatGPT's fault, it's now our fault.

00:19:58 Dr Maya Sussman

So there's these questions about what would happen around there.

00:20:00 Dr Maya Sussman

And I'm sure that the NHS will be thinking about these questions too when they're employing their patient-facing chatbots.

00:20:09 Dr Maya Sussman

I think one other thing that I've heard several times is that patients are fearful of loss of human contact.

00:20:16 Dr Maya Sussman

Because as much as this additional technology can help, you know, when you've got no one to talk to, when you can't get a GP appointment, when you're not going to see your anaesthetist for another four weeks, it's great to have something else there to inform yourself.

00:20:34 Dr Maya Sussman

But the safeguard that people want is that it's not going to then take your time away from an anaesthetist.

00:20:39 Dr Maya Sussman

So instead of saying, yeah, you know, five years ago you would have had 30 minutes to talk to your anaesthetist, but now we've provided you with this online anaesthetic sort of helper and instead of talking to your anaesthetist for 30 minutes, now you only get to speak to your anaesthetist for 5 minutes.

00:20:56 Dr Maya Sussman

And that's a real concern, even if it is a reliable chatbot.

00:21:00 Dr Samantha Black

Yeah, thanks, Maya.

00:21:01 Dr Samantha Black

And I think we can all share experience.

00:21:03 Dr Samantha Black

When we try to, for example, contact a bank or try and contact Amazon to return something, for example, the human aspect has been really removed, hasn't it?

00:21:13 Dr Samantha Black

And you're then with a chatbot and you've got to ask it several questions.

00:21:17 Dr Samantha Black

And eventually we all end up going to that one bit at the end where it says, do you want to speak to an assistant or a person?

00:21:24 Dr Samantha Black

And most of us are clicking yes.

00:21:26 Dr Samantha Black

So I think that real fear of losing that human contact is there in every aspect of our lives at the moment as this technology is advancing in every area that we are dealing with.

00:21:38 Dr Samantha Black

Jenny, did you want to add anything to that final question I just asked, Maya?

00:21:42 Jenny Westaway

I guess I just really heartily agree with that point around

00:21:47 Jenny Westaway

human contact.

00:21:48 Jenny Westaway

I think as you were talking, Maya, about the potential different tools that different parts of the NHS or different services or organisations might develop, that was in my mind.

00:21:59 Jenny Westaway

I was thinking, oh, that might be quite good.

00:22:00 Jenny Westaway

I thought I would quite lose that, but I still feel like I would never ever want to lose the, I would use them if I thought they're reputable, but I wouldn't want that to be my only contact.

00:22:12 Jenny Westaway

That would be a really worrying thought.

00:22:14 Jenny Westaway

And I guess there could be the temptation for some organisations to say, well, this is creating us opportunities for efficiency.

00:22:25 Jenny Westaway

And AI does create huge opportunities for efficiency, but you would hope that those efficiency gains could be to free up time for those face-to-face conversations rather than to take them away.

00:22:37 Dr Maya Sussman

I think that's huge, Jenny.

00:22:39 Dr Maya Sussman

But equally, I've had one patient tell me that

00:22:44 Dr Maya Sussman

Several years ago, they've had to make a really big decision, and he felt really unsupported by clinicians at the time because enough information was given to him, and he actually felt that.

00:22:55 Dr Maya Sussman

if he'd had that access to a chatbot, at least he could have better informed himself.

00:23:01 Dr Maya Sussman

And I think there is that flip side where you think, well, it can really empower patients to have the conversation with the clinician, but it's the balance of not taking away the actual interaction with the clinician itself.

00:23:13 Jenny Westaway

Yeah, supporting the conversation rather than it being the only part.

00:23:16 Jenny Westaway

Yeah.

00:23:18 Dr Maya Sussman

Definitely.

00:23:19 Dr Maya Sussman

And I think that's kind of what we've tried to understand in our lines of engagement is,

00:23:24 Dr Maya Sussman

we don't want to think about only the risks.

00:23:28 Dr Maya Sussman

It's so easy to think, this is a new technology and it's terrible and it's unsafe.

00:23:34 Dr Maya Sussman

But there are the other sides, like why is it useful and how can it be adopted in a useful, safe way that will benefit patients in the future?

00:23:45 Dr Maya Sussman

And I think that it's really worthwhile having those conversations and thoughts.

00:23:51 Dr Maya Sussman

not to take away, for example, the leaflets that we already have and give away in hospitals and videos and other modalities of information, because that's another thing that we've been told time and time again, please don't take away your other resources.

00:24:06 Dr Maya Sussman

We like these resources, you know, they help us understand what is going to happen next.

00:24:12 Dr Maya Sussman

They help us prepare for surgery.

00:24:13 Dr Samantha Black

I think one of the key bits though is how can patients use AI to, as we said at the very start, to

00:24:20 Dr Samantha Black

prepare them for that conversation they're going to have with their clinician, with their anaesthetist?

00:24:25 Dr Samantha Black

Can it help them develop a set of questions they want answered on that day and also support them therefore with that risk discussion and the benefits before they go in so they feel more informed in that shed skin making process?

00:24:40 Dr Maya Sussman

Yeah, absolutely.

00:24:41 Dr Samantha Black

So Jelly, I've got one more final question to ask you to end this brilliant discussion we've had around AI.

00:24:47 Dr Samantha Black

As some of our listeners might know, we've got a chatbot for our GPAS guidance that sits within our Royal College of Anesthetists website.

00:24:55 Dr Samantha Black

How do you think patients might feel if they knew that there could be some resources on our website that are accredited that they could search using a chatbot, for example, that only looks at those accredited resources?

00:25:09 Jenny Westaway

Yeah, I think it's a really interesting and potentially promising idea.

00:25:14 Jenny Westaway

I mean, as I understand the GPAS tool, it is only searching on the GPAS information and guidelines produced by the college.

00:25:22 Jenny Westaway

So you know when you search it and it gives you an answer, it's not going to be drawing on a whole load of, let's say, potential rubbish on the internet, that idea of rubbish in, rubbish out with these tools.

00:25:36 Jenny Westaway

And that's the kind of worry that we've discussed around asking ChatGPT a question.

00:25:42 Jenny Westaway

Who knows what data it's drawing on?

00:25:44 Jenny Westaway

So the idea, I do think it's a promising idea, a chatbot that would only draw on the high quality patient information that is

00:25:54 Jenny Westaway

has been so carefully produced and we have our patient information forum tick to say this is really good quality stuff.

00:26:03 Jenny Westaway

So I think it would really help reassure and lower those levels of anxiety about can I rely on the answer that I'm getting out of this.

00:26:12 Dr Samantha Black

Yes, I think that sounds very reassuring.

00:26:14 Dr Samantha Black

Any reflection from you, Maya, about that?

00:26:16 Dr Maya Sussman

We've done lots of thinking about these issues and I think it's such a fast moving area.

00:26:23 Dr Maya Sussman

and public perception and opinion is going to change, the technology is going to change, and the adoption of the technology is going to change.

00:26:32 Dr Maya Sussman

Some people are saying, is it the same as Google?

00:26:35 Dr Maya Sussman

Is it like a couple of years ago when GPs were like, oh, all these people coming in and saying, I've Googled this, I've Googled this symptom, I think I've got this wrong with me.

00:26:44 Dr Maya Sussman

Is that going to be amplified?

00:26:46 Dr Maya Sussman

I think it is probably something slightly different.

00:26:49 Dr Maya Sussman

And the difference is just the level of interaction and ease of use that you can have with it.

00:26:54 Dr Maya Sussman

And I think the balance here is how do we...

00:26:59 Dr Maya Sussman

take a piece of technology that has risks related to it, concerns related to it, and think about putting in the correct safeguards so that we can use it for good.

00:27:11 Dr Samantha Black

Yeah, I think I agree with you there, Maya.

00:27:13 Dr Samantha Black

I'd just like to say thank you so much, Maya and Jenny, for today's conversation.

00:27:17 Dr Samantha Black

If you could give our listeners one takeaway each,

00:27:21 Dr Samantha Black

What would that be from this conversation, Maya?

00:27:23 Dr Maya Sussman

For me, it's exactly that.

00:27:25 Dr Maya Sussman

Just to say that, you know, this technology is here to stay at the moment, just like other things that we've seen before and we weren't really sure what the social implication of it would be.

00:27:35 Dr Maya Sussman

For example, social media and other things that we come across, this is just another one of those things.

00:27:41 Dr Maya Sussman

And if as clinicians, we're having patients coming in saying, I've been talking to ChatGPT about what anesthetic I'm going to have and

00:27:50 Dr Maya Sussman

this sort of conversation, I guess it's useful not to just shut it down because this is, a patient taking initiative and trying to take control over a stress provoking and anxiety provoking time.

00:28:06 Dr Maya Sussman

Just keep on having the conversations that we're having with patients and try to bring the best information that we can to the consultations if there are elements and aspects of misinformation.

00:28:20 Dr Maya Sussman

We also have to be increasingly aware that these conversations might be happening in the background before patients come and talk to us.

00:28:27 Dr Samantha Black

Thank you for that, Maya.

00:28:28 Dr Samantha Black

Jenny, do you have a takeaway for our listeners today from a patient perspective?

00:28:34 Jenny Westaway

I would imagine that as a clinician, maybe it's frustrating sometimes if a patient comes to you and has got some false information from somewhere, but

00:28:43 Jenny Westaway

I think just understanding and having from the patient perspective why that might have happened, I think, it's a marker of maybe anxiety, maybe worry, and hopefully it can be used to kind of open up a more positive conversation with the patient because,

00:29:02 Jenny Westaway

Yeah, it's a sign that they want to talk and hopefully they want to talk to you.

00:29:05 Dr Samantha Black

Absolutely that.

00:29:06 Dr Samantha Black

And I suppose if AI and these technologies can be used really responsibly, it can be about educating and empowering and to actively partake in that shared decision-making discussion with their anaesthetist.

00:29:19 Dr Samantha Black

So thank you, Maya and Jenny.

00:29:20 Dr Samantha Black

It's been an absolute provisional delight to talk to you both today about such a topical subject within the NHS and Alegre.

00:29:28 Dr Samantha Black

And thank you to our listeners for listening.

00:29:30 Dr Samantha Black

We have more information and useful links in the episode description.

00:29:35 Dr Samantha Black

And for more podcasts like this, make sure you subscribe to Anesthesia On Air and review us while you're there.

00:29:40 Dr Samantha Black

Thank you very much.