Medical Practice andArtificial Intelligence~How Should We Prepare?~Hirotaka Onishi MD, MHPE, PhD
Dept of Medical Education for Int’l Cooperation
Int’l Research Center for Medical Education
Graduate School of Medicine, The University of TokyoFuture Direction of AI UseGenomic medicine
Drug discoveryCancer Institute Hospital starts collection of cancer
genome information in the core center for genome
analysis to develop better diagnosis and therapy.
AI related research is done for targeting,compound, pharmacodynamics, and toxicity test.

Surgical operation support
Integration of images, navigation system, androbots with previous data and logs.

AI Use for Visual Information


Pathological diagnosisRadiographical diagnosis

X-ray, CT scan, MRI…

Endoscopic images


Tissues of stomach, colon, and gynecology

Upper GI, Capsule endoscopy…

Other images
Retina, Pharynx…
 AI’s Accuracy is as good as human Dr.

AI Support for
Medical Interview
Preliminary interview
Ask questions to a patient for reflecting her/hissymptoms with medical meaning.
 Relating questions to ask more questions.
 Such dialogues are converted to text for electronic
medical chart.
 Information on the medication note and referral letter isconverted to text by OCR (optical character reader)Transcribing dialogues
Patient-physician (nurse) dialogues are converted totext file with summary.

AI Support for
Differential Diagnoses
After signs/symptoms are entered differential
diagnoses are listed by the order of plausibility.
 IssuesSeveral approaches are used – Gestalt, exhaustiveenquiry, multiple branching, hypotheticodeductive…
 Information source – (1) Dr’s interpreted information mightbe biased, (2) Pt’s entry may include Pt’s misunderstanding,(3) Other data sources: Images, Continuous monitoring ofpatients’ vital signs etc.

Goals – Diagnosis, Symptom improvement…
 Improvement decision – Pt’s subjective information orDr’s objective measurement…


Does ChatGPT Work asDecision Support System?
Healthcare DSS assist Drs in improving Dx accuracy,
treatment efficacy, patient safety, etc.
 Example case: If a senior person has fever, shoulder
pain, low back pain and fatigue for more than amonth what would be differential diagnoses?
 Go to ChatGPT!

Six Principles to Ensure AI
Works for the Public Interest
Protecting human autonomy
 Promoting human well-being and safety and thepublic interest.
 Ensuring transparency, explainability andintelligibility.
 Fostering responsibility and accountability.
 Ensuring inclusiveness and equity.
 Promoting AI that is responsive and sustainable.
WHO (2021), Global report on Artificial Intelligence

Concerns for Large
Language Models (LLMs)








Bias in AI training data, which can lead to misleading or inaccurate
information that poses risks to health, equity, and inclusiveness.
LLMs generating responses that may seem authoritative and plausible
but can be completely incorrect or contain serious errors, particularly inhealth-related contexts.
LLMs being trained on data without prior consent and not adequately
protecting sensitive data, including health data, provided by users.
Misuse of LLMs to create and spread highly convincing disinformation,such as text, audio, or video content that is difficult to distinguish fromreliable health information.
The World Health Organization (WHO) supports the use of newtechnologies, including AI and digital health, for improving humanhealth but recommends that policy-makers prioritize patient safety andprotection while technology companies work to commercialize LLMs.
WHO (16 May 2023) WHO calls for safe and ethical AI for healthhttps://www.who.int/news/item/16-05-2023-who-calls-for-safe-and-ethical-ai-for-healthGeneral Concerns for AI
Copyright of the answer/ Right of AI’s portrait
publicity Accuracy of information (input/output)
 Personal information/ Privacy protection
 Invasion of privacyA physician considered introducing AI to simplify his
medical practice. He collected information fromseveral companies, but none of them indicated thatthey would not use patient information to improvetheir future AI programs.

Competencies for the Use of Artificial
Intelligence in Primary Care
1. Foundational knowledge – what is this tool?
2. Critical appraisal – should I use this tool?
3. Medical decision making – when should I use thistool?
4. Technical use – how do I use this tool?
5. Patient communication – how should I communicate
with patients regarding the use of this tool?
6. Awareness of unintended consequences –what are
the “side effects” of this tool?

Wrap Up
Please make good use of AI. Not used by AIcreators!
 Learn strengths, weaknesses, possible
concerns first. Make AI your smart servant!
 Don’t be too scared!! If you are a
professional, don’t rely on it too much!
