Robert Pearl, M.D.

Generative AI tools have made remarkable strides in medicine since the launch of ChatGPT in late 2022. Research has shown that AI, with expert clinician oversight, can significantly enhance diagnostic accuracy , treatment recommendations , and patient monitoring and analysis .

And yet, despite its impressive capabilities and buzz, generative AI is still in the early stages of adoption—both in U.S. healthcare and society.

While almost everyone has heard of genAI , less than a quarter of Americans use it regularly in their personal or professional lives. OpenAI’s newest update, GPT-4o, aims to change that.

In demos released during its spring update , OpenAI showed users engaged in natural, human-like conversations with GPT-4o. The AI interacted with people on their smartphones across video, audio and text, offering real-time spoken responses that sounded eerily human.

In the demo above, AI’s instant answers and friendly voice closely mimic the pace and inflection of normal dialogue. Not coincidently , GPT-4o’s voice sounded remarkably like Scarlett Johansson’s AI character in the movie Her (a decision OpenAI later walked back “ out of respect ”).

Regardless of the voice coming out of it, GPT-4o is at once awe-inspiring and unsettling. It also represents a significant departure from tech-industry norms. Most tech companies have long avoided creating AI “ companions ” because of ethical concerns , fearing people could form addictions that exacerbate isolation and loneliness.

What Will GPT-4o’s Rule-Breaking Mean For Medicine? Critics point out that OpenAI and its peers have yet to resolve a host of major “trust” issues. These include accuracy, privacy, security, bias and misinformation. Of course, these will need to be resolved.

But by creating an AI experience that feels more like talking to a friend, or potentially a doctor, OpenAI has already leapt the tallest hurdle to mass acceptance and adoption. The company understands that humanizing GPT-4o—making it easier and more enjoyable to use—is essential for attracting a wide array of users, including the “late majority” and “laggards” described in Geoffrey Moore’s seminal 1991 book Crossing the Chasm .

Today, 70% of genAI’s non-users are Gen X (ages 44-59) and Baby Boomers (60-78). These generations, which comprise 136 million people, strongly prefer voice and video technologies to typing or touchscreens, and greatly prefer “conversational” AI apps to text-only ones.

They also make up the overwhelming majority of Americans with chronic diseases like diabetes, heart failure and cancer.

GenAI: From Mass Adoption To Mass Empowerment Once consumers in their 50s, 60s and 70s become comfortable using GPT-4o for everyday tasks, they will then start to rely on it for medical inquiries, too. In a healthcare context, using GPT-4o will closely resemble a video visit or a phone call with a medical professional—two modalities that satisfy the majority of older patients . In fact, 93% of adults over age 70 say they value having telehealth as an option.

With broad adoption, GPT-4o (which will be embedded in next generations of ChatGPT) will empower the sickest Americans to take greater control of their own health, preventing up to hundreds of thousands of premature deaths each year from the complications of chronic disease: heart attacks, strokes, cancer and kidney failure. According to the Centers for Disease Control and Prevention , the effective management of chronic illness would reduce these complications by 30% to 50%, with a similar reduction in mortality.

Generative AI technology contains both the knowledge and ability to help accomplish this:

Knowledge. ChatGPT houses an extensive corpus of scientific literature, which includes a diverse and extensive dataset of clinical studies, guidelines from professional medical organizations and research published in top-tier medical journals. In the future, it will be updated with real-time data from medical conferences, health records and up-to-the-minute research, ensuring the AI’s knowledgebase remains both comprehensive and current.

Ability. To assist overburdened clinicians, genAI can provide patients with round-the-clock monitoring, insights and advice—empowering them to better diagnose and manage their own health problems. Future generations of these tools will connect with monitoring devices, informing patients about their health status and suggesting medication adjustments or lifestyle changes in clear and friendly terms. These tools will also remind people about preventive screenings and even facilitate testing appointments and transportation. These proactive approaches can reduce complications and improve health outcomes for the 130 million Americans living with chronic diseases.

Combatting Chronic Disease With GPT-4o To dive deeper into genAI’s difference-making potential, let’s look at two major gaps in chronic disease management: diabetes and hypertension.

Diabetes is the leading cause of kidney failure, a major contributor to heart attacks and responsible for 80% of lower limb amputations. Effective management is possible for nearly all patients and would prevent many of these complications. Yet diabetes is well controlled in only 30% of cases across the United States.

Similarly, effective control of high blood pressure—the leading cause of strokes and a major contributor to kidney failure and heart attacks—is achieved only 55% to 60% of the time. Although some health systems achieve control levels above 90% , the best-available tools and approaches are inconsistently deployed throughout medical practices.

Medical monitoring devices plus AI could play a crucial role in managing hypertension. Imagine a scenario in which a doctor prescribes medication for hypertension and sends the patient home with a wearable device to monitor progress. After a month, the patient has 100 readings—90 normal and 10 elevated. The patient is unsure whether the 90 normal readings indicate all is well or if the 10 elevated ones signal a major problem. The doctor doesn’t have time to review all 100 readings and prefers not to clutter the electronic health record with this data. Instead of the patient waiting four months for the next visit to find out if all is well or not, a generative AI tool could quickly analyze the data (using the doctor’s instructions) and advise whether a medication adjustment is needed or to continue as is.

Today’s generative AI tools aren’t ready to transform medical monitoring or care delivery, but their time is coming. With the technology doubling in power each year, these tools will be 32 times more capable in five years.

Overcoming Barriers To Mass Adoption Concerns about AI privacy, security and misinformation need to be solved before the majority of Americans will buy in to an AI-empowered future. Progress is being made on those fronts. For example, the leap from GPT-3.5 to GPT-4 saw an 82% reduction in hallucinations , a larger context window and better safety mechanisms.

In addition, clinicians worry about potential income loss if AI leads to healthier patients and reduced demand for medical services. The best solution is to shift from the current fee-for-service reimbursement model (which rewards the volume of medical services) to a value-based, capitated model. This system rewards doctors for preventing chronic diseases and avoiding their most serious complications, rather than simply treating life-threatening medical problems when they arise. By adopting a pay-for-value approach, medical professionals will embrace genAI as a tool to help prevent and manage diseases (rather than seeing it as a threat to their livelihoods).

The release of GPT-4o shattered the industry norm against creating human-like AI, introducing ethical risks that must be carefully managed. However, the potential for genAI to save thousands of lives each year makes this risk worth taking.

Dr. Robert Pearl is the author of a new book on the future of generative AI in medicine titled " ChatGPT, MD ," available on Amazon now in ebook and hardcover editions. All profits from the book go to Doctors Without Borders.

Robert Pearl, M.D.

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