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How does the internet and AI compare with a skin doctor?

Obviously, Google—the biggest and best-known ubiquitous search engine—has revolutionized the internet. Everyone searches Google for something. Of course, now Artificial Intelligence (AI) is the new computer kid on the block, and everyone is talking about ChatGPT.  Therefore, I thought I would look at both from the context of skin diagnoses.

I was recently on a lecture tour of America. During my overseas trips, I receive daily emails or photographs (from my clinic’s online spot check/consultation service) and I tend to always clear them on the day to avoid being overwhelmed by backlogs. A fellow writer was teasing me because I was looking at a photo of a skin lesion and sending back my diagnosis to the patient in New Zealand before getting onto a waterslide in the Maldives! I explained because I received so many emails every day, such a rapid response only made my life easier.  

Google has been around for two decades and has been already studied in the context of diagnostic accuracy. According to Google itself, seven percent of all internet searches are health related.  Several years ago, researchers decided to put “Dr Google” to the test. For one year, all diagnostic cases published in the prestigious New England Journal of Medicine were analyzed. Percentage of correct diagnoses provided by Google from Google searches using the same keywords was compared with the correct diagnoses as published in the Journal. Google searches revealed the correct diagnosis in 58% percent of the cases. Therefore, Google was a little bit better than tossing a coin. The problem with Google is that companies can pay to be featured on the first page, and search engine optimization (SEO) undertaken by websites, or paid promotions, can take precedence over more authentic or accurate sources.

ChatGPT is an artificial intelligence “chatbot” developed by a company called Open AI and it was launched very recently in November 2022. ChatGPT is trained to follow instructions and prompts from the requester in a chat (message) and provides a detailed response that can be short, or even a long form essay. At the universities I am associated with, we can already see it infiltrating students’ work. ChatGPT isn’t a search engine and needs some detailing prompting. For example, if a response provided by the chatbot is too technical, you can ask it to make it simpler and so forth. 

Recently, a patient sent me a picture of a rash and an explanation about the related medical history, and I decided to put Google and ChatGPT to the test. As expected, Google did not take me to the most accurate or informative website, but to the most Googled website. It would not have been helpful to my patient at all! I asked ChatGPT for the answer. I realized that because ChatGPT essentially scrolls through every bit of information available in the public domain, it can only offer a differential diagnosis i.e., possibilities but not a particular diagnosis. It offered a few useful probabilities.

Research studies done on ChatGPT confirmed my experience. ChatGPT is pretty good at giving possibilities. A recent study showed that ChatGPT was 93% accurate in compiling a list of possible diagnoses. However, then pitted directly against doctors, the physicians beat the chatbot by 93% to 53% for final diagnostic accuracy (Phew!).

Obviously, there will be a time when these artificial intelligence programs and deep neural learning–wherein computer programs simulate the behavior of the human brain and “learn” from large amounts of data—will become better and more accurate. But for now, I still need to answer my patient queries—ones that I take very seriously much to the chagrin of family who think I am too dedicated—myself.

After having triumphed over ChatGPT, I asked my new and artificially intelligent friend to write me a poem as an admission of defeat. “Look up who Dr Sharad Paul is and write a poem about him” I prompted. It may have ended up a cringeworthy and sycophantically syrupy verse, but otherwise many humans couldn’t have written a poem like this. I showed this to a few fellow writers at the festival, and we had a good laugh, albeit a few seemed more nervous than I was because writing came easier to a chatbot than clinical diagnosis:

The Skin Doctor

In the realm where beauty seeks its light,

There dwells a doctor, skilled and bright.

With gentle touch and keen insight,

A healer of skin, a guiding knight.

Amidst the canvas of epidermal grace,

This dermatologist takes their rightful place.

With knowledge vast, their hands embrace,

The mysteries of skin, its vibrant face.

With magnified eyes, they truly see,

The tales of skin, both scars and glee.

In every pore, a story to decree,

Through scientific artistry, they set it free.

They soothe the burn of the sun’s harsh blaze,

With ointments and creams, their healing ways.

Psoriasis, rashes, they mend the maze,

Restoring confidence with each gentle phrase.

Oh, skin doctor, with your skills refined,

A vessel of compassion, one of a kind.

You restore the glow that was left behind,

Your artistry, a symphony, a precious find.

So, let us celebrate this doctor’s care,

For they shield our skin with love to bear.

Their dedication, a gift we all share,

A guardian of beauty, beyond compare.

You can decide for yourself on the technical merits or otherwise of this AI poem. Or its diagnostic accuracy!

However, given the ability of AI programs like ChatGPT in offering accurate differential diagnostic possibilities, they can be of use to a generalist doctor and reduce misdiagnoses that occur in medicine.  Maybe, as a report in the Wall Street Journal about the future of medicine noted: “Digital avatars won’t replace physicians: You will still be seeing doctors, but the relationship will ultimately be radically altered.”

THE END.