INTRODUCTION

Access to digital health is significantly influencing the development of healthcare systems, and a change toward more patient-centric service within the healthcare ecosystem is being brought about by the reduction of the knowledge gap between patients and healthcare professionals.¹ The increasing need for healthcare services and advancements in artificial intelligence have resulted in the creation of conversational agents to aid with various health-related tasks, such as promoting behavior change, providing treatment support, monitoring health, training, triage, and screening support.² By automating these tasks, healthcare providers can shift their focus to more challenging assignments, while also making healthcare services more accessible to the general public.²

ChatGPT is a type of chatbot that was built with reinforcement and supervised learning technology. Chatbots in clinical practices can perform a wide range of tasks, including appointment scheduling and reminders, patient education and health advice, managing clinical conditions and treatments, and more.³ They use natural language processing (NLP) and machine learning algorithms to understand and respond to patient queries, making it easier for patients to access clinical services and receive the care they need.

Chiropractors are primary care clinicians who often manage patients with musculoskeletal disorders.⁴ The use of chatbot with artificial intelligence (AI) in clinical practices may have many benefits, including encouraging self-management,⁵ patient education in musculoskeletal disease,⁶ and modifying behavior in prevention of degeneration.⁷ Chatbot has the potential to revolutionize the way clinical care is delivered and make clinical services more accessible and convenient for patients.

Chatbot into the healthcare system also faces some challenges and limitations associated with, including privacy and security concerns,^2,8 a lack of human interaction,^9,10 and limitations in technology and data accuracy.⁸ Despite these challenges, the future of chatbots in clinical practices is promising, with advancements in technology and artificial intelligence offering the potential for even greater improvements in the delivery of clinical care.

DISCUSSION

The Early Days of Chatbots in Clinical Practice

Some of the first chatbots developed were designed to handle simple, frequently-asked questions from patients.¹¹ These chatbots could answer basic questions about the practice, such as office hours, location, insurance acceptance, and appointment booking procedures.¹¹ They provided an automated way to quickly respond to common inquiries and route patients to the appropriate information or staff member if needed. These initial chatbots laid the groundwork for more advanced systems that can handle more complex conversations, access patient data, and even provide some diagnosis and treatment recommendations under the supervision of chiropractors.

Early chatbots had some significant limitations and the studies reported mixed evidence for the effectiveness, and satisfaction of the chatbot.² Their knowledge bases were limited, so they could only handle simple, straightforward questions and conversations. They lacked the ability to access patient data or medical records, so they could not provide personalized responses or recommendations.² They also could not handle complex questions or conversations that required nuanced language or reasoning. As a result, these chatbots could only automate a narrow set of basic tasks and inquiries.² They could not serve as a comprehensive automated assistant for chiropractors or truly enhance the patient experience with personalized, customized interactions.

The widespread adoption of chatbots has been prompted by the recent growth in demands for effective communication and higher user learning requirements in the health sector. The evolution of chatbot technology, like ChatGPT, has improved in terms of its natural language processing capabilities, its ability to understand context, and its ability to interact with users in a conversational manner. To demonstrate a change in research priorities around the year 2016, 2148 documents were examined. More documents have been produced in the last few years than in the previous 20 years combined, and outputs could increase significantly in the future.¹² The use of chatbots in conjunction with the development of machine learning and deep learning techniques presented a research opportunity.¹² As a result, chatbots are gaining popularity in healthcare and are viewed as a beneficial tool for enhancing patient care and satisfaction.

The Benefits of Chatbot in Clinical Practice (Figure 1)

A. Improved patient-provider communication

Chatbots allow patients to easily communicate with their clinicians and receive timely responses to their questions and concerns.⁶ Patients with poor responsiveness to traditional care management modalities may demonstrate favorable engagement with asynchronous text-based chatbot interactions. The technologically-mediated patient-care manager relationship could be enhanced through chatbot-supported communication.⁸ Chatbot systems can monitor patient status and provide clinically relevant alerts to patients and providers, enabling early intervention for adverse events.⁸ By handling routine information exchange, chatbots may free up care managers to focus on high-acuity interactions requiring nuanced clinical decision-making.⁸ This improved communication can lead to better health outcomes and increased patient satisfaction.

Chatbots can enhance patient-provider communication in clinical practice by providing patients with instant and personalized support. Patients can ask questions, receive guidance on their symptoms, and schedule appointments, among other services.⁸ At the University Hospitals of Cleveland, Ohio, care management focuses on 582,000 patients with chronic disorders, chatbots were found to help patients with personalities or cultural preferences who prefer not to communicate with their care manager in person may do so using text message-based chatbots. With the help of chatbot technology, patients and physicians can gain insights from a patient’s reactions, updates, and progress in order to support earlier interventions before an incident occurs.⁸ The adoption of technology can facilitate patients in improving clinical outcomes, locating the most suitable clinicians, and a cost-effective patient journey.¹³

Figure 1.Benefits of ChatGPT in clinical practice

B. Increased accessibility to clinical services

Chatbot may make it easier for patients to access clinical services, even outside of regular office hours. Chatbots can increase accessibility to clinical services by providing patients with 24/7 support. Patients can interact with chatbots from anywhere at any time and receive immediate assistance, without having to wait for an appointment. In an observational study of chatbot utilization in women with gestational diabetes mellitus, researchers discovered that the technology facilitates quick information access and improved care.¹⁴ AI chatbot can also be used as a culturally sensitive digital health tool to prevent stigmatized diseases in certain sensitive populations such as HIV patients.¹⁵ This can be particularly beneficial for patients in remote areas, those with mobility issues, or those with time constraints. As a result, chatbots automation could liberate clinicians to focus on more comprehensive diagnosis and improve the patient’s access to their services.² This increased accessibility can lead to improved patient outcomes and increased patient satisfaction.

C. Better health outcomes

Chatbots can provide patients with personalized health advice, reminders and education, which can help improve their health outcomes and reduce the risk of injury.¹⁰ The AI-assisted health program’s short exercises decreased neck/shoulder discomfort/stiffness and lower back pain in 12 weeks, according to research.¹⁶ Participants were randomized to receive either the app-based program, which provided tailored exercise instructions daily for 12 weeks, or usual care. The majority of app users reported subjective improvement in symptoms.¹⁶ Psychotherapy offered by chatbots can be used as an alternate kind of treatment for depression and anxiety in medical facilities.¹⁷ In cases of rare serious pathology presenting in the chiropractic clinic,¹⁸ it is often unclear if clinician use treatment in that situation that may be contraindicated to the treatment.¹⁹ The usefulness and effectiveness of different therapies can be built in the database so that future AI can improve and adapt current information and give advice.² As identifying predictors of severe adverse events are important to future research,²⁰ chatbot can also plays an important role in predicting the right therapy with minimum risk. The high adherence rate suggests chatbots can help patients to stay on track with their treatment plan and achieve better health outcomes.

D. Time and cost savings for patients and clinicians

Obtaining patient health data from a patient can be time-consuming, Chatbots can automate many time-consuming tasks.²¹ It can save time and costs for patients and chiropractors by automating administrative tasks and reducing the need for face-to-face appointments.¹⁰ Patients can schedule appointments, ask questions, and receive support from chatbots, eliminating the need for phone calls or in-person visits. This can save patients time and money, particularly those with busy schedules or those who need frequent appointments. For chiropractors, chatbots can reduce administrative workload, enabling them to focus on providing quality care to patients.

E. Increased operational efficiency

Chatbots can streamline processes and reduce the number of manual tasks, increasing efficiency and freeing up time for chiropractors to focus on more important tasks.²² Chatbot uses the rules derived from data, and delivers a more sophisticated and individual history taking with virtual patients.²³ With the adoption and implementations of chatbot enhancing the acceptability of AI in healthcare, the effectiveness of therapy will improve patient outcomes and satisfaction.²⁴

F. Improved patient engagement

Chatbots can provide patients with a convenient and accessible means of receiving care and support,²⁵ leading to increased patient engagement and satisfaction.²² A study developed and validated a model to evaluate user experience and satisfaction with health care chatbots. The model considers 5 value domains: functional, epistemic, emotional, social, and conditional. A survey of 413 Chinese university students found positive user experience and satisfaction across chatbots and value domains. Functional and epistemic values were most important. Differences emerged based on gender and academic level. The findings suggest chatbots may effectively disseminate health information, especially for younger users, and imply design factors to consider.²⁶

Real-Life Examples of Chatbots in Healthcare Practice

Chatbots are increasingly being used for appointment scheduling and reminders in clinical practice. For example, Smartbot360 has a chatbot that enables patients to instantly receive help and answers from chatting with the chatbot. This chatbot also sends patients automated reminders about their home exercise program and tracks their progress, helping patients to stay on track with their treatment plan.²⁷

Chatbots can also be used for patient education and health advice in clinical practice. For instance, the HealthBuddy chatbot is an example of a chatbot offered by World Health Organization that provides patients with information on common covid conditions, treatments, and self-care tips in all different languages. This chatbot also allows patients to track their symptoms and receive personalized recommendations on home exercises and lifestyle modifications.²⁸

Chatbots can also be used for making clinical decisions and treatments. For instance, ‘FlapBot’ (ChatBot) was designed to digitally transform paper-based pathways, allowing for early recognition and escalation of free flaps with compromised vascularity.²⁹ The early adoption and use of a FlapBot to aid clinical decision-making in microvascular surgery. Use of chatbot helps the clinical decision-making since human elements in the identification process of decision-making continue to constitute a danger to timely intervention and so are a crucial determinant of success in microvascular surgery.²⁹ By automating administrative tasks, providing personalized support, and improving patient engagement, chatbots are becoming an essential tool for clinicians in managing their patients.

Challenges and Limitations of Chatbots in Clinical Practice

One of the primary challenges of using chatbots in clinical practice is the potential for ethics, privacy and security breaches.⁸ Medical publishers including Nature and Science have introduced policies that prohibit the utilization of ChatGPT, or AI technologies as authors.³⁰ Chatbots often store sensitive patient information, such as medical history and contact information, which can be compromised if the chatbot is not adequately secured. To address this concern, chatbot developers must implement robust security protocols, such as encryption, to ensure that patient data remains confidential.

Another limitation of chatbots in clinical practice is the lack of human interaction.²² While chatbots can provide instant support and assistance to patients, they cannot replace the value of face-to-face interactions with healthcare providers. Patients may feel more comfortable discussing their symptoms and concerns with a human healthcare provider, and chatbots may not be able to provide the same level of empathy and emotional support.

Finally, the accuracy of data and limitations in technology can also be a challenge for chatbots in clinical practice.⁸ Chatbots rely on algorithms and data to provide personalized recommendations and treatment plans, and inaccurate data can lead to incorrect advice and potential harm to patients. Additionally, chatbots may not be able to identify more complex health conditions that require a human healthcare provider’s expertise, leading to delayed diagnoses and treatment.

In conclusion, while chatbots have many potential benefits for clinical practice, there are also challenges and limitations that must be addressed. Privacy and security concerns, lack of human interaction, and limitations in technology and data accuracy are just a few of the challenges that must be addressed to ensure that chatbots can provide safe and effective support for patients in clinical practice.

The Future of Chatbots in Clinical Practice

The future of chatbots in clinical practice is likely to be shaped by advances in technology and artificial intelligence. As chatbot technology continues to improve, they will become more sophisticated and capable of providing patients with more personalized care. In the future, chatbots may be able to use machine learning algorithms to analyze patient data and make more accurate diagnoses and treatment recommendations.

Another area of potential growth for chatbots in clinical practice is their integration with other clinical technologies. The research of chatbot application scenarios in the Covid-19 public health shows that the scalability, wide accessibility, usability, and quick information dissemination of chatbots give public health personnel additional capability.³¹ Chatbots could be integrated with wearable devices or mobile apps to provide patients with continuous support and real-time feedback. Additionally, chatbots could be used in conjunction with telehealth technologies to provide remote support to patients in need of clinical care.

Finally, the widespread adoption of chatbots in clinical practice has the potential to improve clinical outcomes and provide patients with more accessible, efficient, and affordable care. By automating administrative tasks, providing personalized care plans, and improving patient engagement, chatbots can help to reduce the burden on healthcare providers and improve the patient experience. This could ultimately lead to improved clinical outcomes, reduced healthcare costs, and increased patient satisfaction.

The future of chatbots in clinical practice is exciting and full of potential. For example, this manuscript, generated by chatGTP and written by a grade-9 high school student in collaboration with a chiropractor, represents both an opportunity and a threat in the future of scientific writing. On the positive side, systems like chatGTP can help less experienced researchers like high-school students quickly produce a structured manuscript, synthesizing information and crafting sentences. However, it is important for the second author, me, who is the human chiropractor, to carefully evaluate and scrutinize such papers in order to ensure the credibility and accuracy of the information presented in the paper. With advancements in technology, increased integration with other clinical technologies, and the potential for widespread adoption, chatbots have the potential to revolutionize the way clinical care is delivered and improve patient outcomes.

Conclusion

Chatbots like ChatGPT, with AI integration, may have the potential to bring many benefits to clinical practice, including improved patient-provider communication, increased accessibility to healthcare services, better health outcomes, and time and cost savings for patients. However, there are also challenges and limitations to consider, such as privacy and security concerns, the lack of human interaction, and limitations in technology and data accuracy. It is essential to address these issues to ensure that chatbots can provide safe and effective support for patients in clinical practice.

The future of chatbots in clinical practice is promising, with advancements in technology, integration with other clinical technologies, and the potential for widespread adoption. As chatbots become more sophisticated and capable of providing personalized care, they have the potential to improve clinical outcomes, reduce healthcare costs, and increase patient satisfaction. However, it is essential to continue to monitor their use and address any limitations or challenges that arise.

The effectiveness of chatbots will depend on continued investment and development. By addressing challenges such as privacy and security concerns, the lack of human interaction, and limitations in technology and data accuracy, chatbots can provide safe and effective support for patients in clinical practice. Therefore, it is essential to continue investing in this area to ensure that chatbots can be integrated effectively into clinical practice and provide optimal patient outcomes.

Acknowledgments

The manuscript is written with assistance with ChatGPT

Author Contributions

EYTC drafted the report with assistance of ChatGPT. ECPC authors read and critically reviewed the manuscript, and then approved the final submitted version.