Application and ethical exploration of ChatGPT in medical clinical practice_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PAN Gaojian ¹ , YE Guanzhi ² , FANG Shaohan ² , ZHU Xiaolei ² , LIU Hongming ² , LI Ning ² ,  GENG Guojun ² ,  JIANG Jie ²

1. School of Medicine, Xiamen University, Xiamen, 361003, Fujian, P. R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, Fujian, P. R. China;

Corresponding author：

GENG Guojun, Email: ggj622@126.com; JIANG Jie, Email: jiangjie06@126.com

Keywords：

ChatGPT; artificial intelligence; clinical practice

DOI：

10.7507/1007-4848.202402032

Video：

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Following the rapid advancement of artificial intelligence technologies, especially the development of large language models like ChatGPT, the field of medical clinical practice is undergoing an unprecedented technological revolution. These advanced technologies, through efficient processing and analysis of large datasets, not only provide medical professionals with auxiliary diagnoses and treatment suggestions but also significantly enhance the quality and efficiency of medical education. This study conducts a comprehensive analysis and review of the applications of large language models in various aspects, including clinical inquiry, history collection, medical literature writing, clinical decision support, optimization of medical portal websites, patient health management, medical education, academic research, and scientific writing. However, the application of these technologies is not without flaws and presents several limitations and ethical challenges. This paper focuses on challenges related to technological errors, academic dishonesty, abuse risks, over-reliance, possibilities of misdiagnosis and treatment errors, and issues of accountability. In conclusion, large language models demonstrate tremendous potential in the integration and advancement of medical practices. Nevertheless, while fully harnessing the benefits brought by ChatGPT, it is essential to acknowledge and address these ethical challenges to ensure that the application of ChatGPT in the medical field is responsible and effective.

Citation： PAN Gaojian, YE Guanzhi, FANG Shaohan, ZHU Xiaolei, LIU Hongming, LI Ning, GENG Guojun, JIANG Jie. Application and ethical exploration of ChatGPT in medical clinical practice. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(6): 910-914. doi: 10.7507/1007-4848.202402032 Copy

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2.	林泽玉, 徐林. 痛风致骨破坏机制的研究与进展. 中国组织工程研究, 2024, 28(8): 1295-1300.
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12.	Dave T, Athaluri SA, Singh S. ChatGPT in medicine: An overview of its applications, advantages, limitations, future prospects, and ethical considerations. Front Artif Intell, 2023, 6: 1169595.
13.	Khan RA, Jawaid M, Khan AR, et al. ChatGPT-reshaping medical education and clinical management. Pak J Med Sci, 2023, 39(2): 605-607.
14.	Eggmann F, Weiger R, Zitzmann NU, et al. Implications of large language models such as ChatGPT for dental medicine. J Esthet Restor Dent, 2023, 35(7): 1098-1102.
15.	Han JW, Park J, Lee H. Analysis of the effect of an artificial intelligence chatbot educational program on non-face-to-face classes: A quasi-experimental study. BMC Med Educ, 2022, 22(1): 830.
16.	Mokmin NAM, Ibrahim NA. The evaluation of chatbot as a tool for health literacy education among undergraduate students. Educ Inf Technol (Dordr), 2021, 26(5): 6033-6049.
17.	瞿星, 杨金铭, 陈滔, 等. ChatGPT对医学教育模式改变的思考. 四川大学学报(医学版), 2023, 54(5): 937-940.
18.	Ruksakulpiwat S, Kumar A, Ajibade A. Using ChatGPT in medical research: Current status and future directions. J Multidiscip Healthc, 2023, 16: 1513-1520.
19.	No authors listed. Tools such as ChatGPT threaten transparent science; here are our ground rules for their use. Nature, 2023, 613(7945): 612.
20.	van Dis EAM, Bollen J, Zuidema W, et al. ChatGPT: Five priorities for research. Nature, 2023, 614(7947): 224-226.
21.	Tan D. Using artificial intelligence to help write code. URL: https://DlabBerkeleyEdu/News/Using-Artificial-Intelligence-Help-Write-Code n.d. Accessed on 2024-02-25.
22.	Lopez K, Fodeh SJ, Allam A, et al. Reducing annotation burden through multimodal learning. Front Big Data, 2020, 3: 19.
23.	Dash S, Shakyawa SK, Sharma M, et al. Big data in healthcare: Management, analysis and future prospects. J Big Data, 2019, 6(1): 1-25.
24.	Sun TQ, Medaglia R. Mapping the challenges of artificial intelligence in the public sector: Evidence from public healthcare. Government Information Quarterly, 2019, 36(2): 368-383.
25.	Sallam M. ChatGPT utility in healthcare education, research, and practice: Systematic review on the promising perspectives and valid concerns. Healthcare (Basel), 2023, 11(6): 887.
26.	Alawida M, Mejri S, Mehmood A, et al. A comprehensive study of ChatGPT: Advancements, limitations, and ethical considerations in natural language processing and cybersecurity. Information, 2023, 14: 462.
27.	Wilson A, Saeed H, Pringle C, et al. Artificial intelligence projects in healthcare: 10 practical tips for success in a clinical environment. BMJ Health Care Inform, 2021, 28(1): e100323.
28.	Stokel-Walker C, Van Noorden R. What ChatGPT and generative AI mean for science. Nature, 2023, 614(7947): 214-216.
29.	Gordijn B, Have HT. ChatGPT: Evolution or revolution? Med Health Care Philos, 2023, 26(1): 1-2.
30.	马武仁, 弓孟春, 戴辉, 等. 以ChatGPT为代表的大语言模型在临床医学中的应用综述. 医学信息学杂志, 2023, 44(7): 9-17.
31.	Cohen IG. What should ChatGPT mean for bioethics? Am J Bioeth, 2023, 23(10): 8-16.
32.	Sheriff K. Defining autonomy in the context of tort liability: Is machine learning indicative of robotic responsibility? SSRN Electron J, 2016, DOI:10.2139/ssrn.2735945.
33.	Hajian S, Bonchi F, Castillo C. Algorithmic bias: From discrimination discovery to fairness-aware data mining. In Proceedings of the 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining. Association for Computing Machinery, New York, NY, USA, 2125-2126.
34.	Vaishya R, Misra A, Vaish A. ChatGPT: Is this version good for healthcare and research? Diabetes Metab Syndr, 2023, 17(4): 102744.

1. King MR. The future of AI in medicine: A perspective from a Chatbot. Ann Biomed Eng, 2023, 51(2): 291-295.
2. 林泽玉, 徐林. 痛风致骨破坏机制的研究与进展. 中国组织工程研究, 2024, 28(8): 1295-1300.
3. Korngiebel DM, Mooney SD. Considering the possibilities and pitfalls of Generative Pre-trained Transformer 3 (GPT-3) in healthcare delivery. NPJ Digit Med, 2021, 4(1): 93.
4. Issom DZ, Hardy-Dessources MD, Romana M, et al. Toward a conversational agent to support the self-management of adults and young adults with sickle cell disease: Usability and usefulness study. Front Digit Health, 2021, 3: 600333.
5. Betzler BK, Chen H, Cheng CY, et al. Large language models and their impact in ophthalmology. Lancet Digit Health, 2023, 5(12): e917-e924.
6. Xiao D, Meyers P, Upperman JS, et al. Revolutionizing healthcare with ChatGPT: An early exploration of an AI language model's impact on medicine at large and its role in pediatric surgery. J Pediatr Surg, 2023, 58(12): 2410-2415.
7. Chlorogiannis DD, Apostolos A, Chlorogiannis A, et al. The role of ChatGPT in the advancement of diagnosis, management, and prognosis of cardiovascular and cerebrovascular disease. Healthcare (Basel), 2023, 11(21): 2906.
8. Chee J, Kwa ED, Goh X. "Vertigo, likely peripheral": The dizzying rise of ChatGPT. Eur Arch Otorhinolaryngol, 2023, 280(10): 4687-4689.
9. Rao A, Pang M, Kim J, et al. Assessing the utility of chatGPT throughout the entire clinical workflow: Development and usability study. J Med Internet Res, 202, 25: e48659.
10. Robinson RJ,Davis SE,Cronin RM et al. Use of a patient portal during hospital admissions to surgical services. AMIA Annu Symp Proc, 2017, 2016: 1967-1976.
11. Robinson JR, Valentine A, Carney C, et al. Complexity of medical decision-making in care provided by surgeons through patient portals. J Surg Res, 2017, 214: 93-101.
12. Dave T, Athaluri SA, Singh S. ChatGPT in medicine: An overview of its applications, advantages, limitations, future prospects, and ethical considerations. Front Artif Intell, 2023, 6: 1169595.
13. Khan RA, Jawaid M, Khan AR, et al. ChatGPT-reshaping medical education and clinical management. Pak J Med Sci, 2023, 39(2): 605-607.
14. Eggmann F, Weiger R, Zitzmann NU, et al. Implications of large language models such as ChatGPT for dental medicine. J Esthet Restor Dent, 2023, 35(7): 1098-1102.
15. Han JW, Park J, Lee H. Analysis of the effect of an artificial intelligence chatbot educational program on non-face-to-face classes: A quasi-experimental study. BMC Med Educ, 2022, 22(1): 830.
16. Mokmin NAM, Ibrahim NA. The evaluation of chatbot as a tool for health literacy education among undergraduate students. Educ Inf Technol (Dordr), 2021, 26(5): 6033-6049.
17. 瞿星, 杨金铭, 陈滔, 等. ChatGPT对医学教育模式改变的思考. 四川大学学报(医学版), 2023, 54(5): 937-940.
18. Ruksakulpiwat S, Kumar A, Ajibade A. Using ChatGPT in medical research: Current status and future directions. J Multidiscip Healthc, 2023, 16: 1513-1520.
19. No authors listed. Tools such as ChatGPT threaten transparent science; here are our ground rules for their use. Nature, 2023, 613(7945): 612.
20. van Dis EAM, Bollen J, Zuidema W, et al. ChatGPT: Five priorities for research. Nature, 2023, 614(7947): 224-226.
21. Tan D. Using artificial intelligence to help write code. URL: https://DlabBerkeleyEdu/News/Using-Artificial-Intelligence-Help-Write-Code n.d. Accessed on 2024-02-25.
22. Lopez K, Fodeh SJ, Allam A, et al. Reducing annotation burden through multimodal learning. Front Big Data, 2020, 3: 19.
23. Dash S, Shakyawa SK, Sharma M, et al. Big data in healthcare: Management, analysis and future prospects. J Big Data, 2019, 6(1): 1-25.
24. Sun TQ, Medaglia R. Mapping the challenges of artificial intelligence in the public sector: Evidence from public healthcare. Government Information Quarterly, 2019, 36(2): 368-383.
25. Sallam M. ChatGPT utility in healthcare education, research, and practice: Systematic review on the promising perspectives and valid concerns. Healthcare (Basel), 2023, 11(6): 887.
26. Alawida M, Mejri S, Mehmood A, et al. A comprehensive study of ChatGPT: Advancements, limitations, and ethical considerations in natural language processing and cybersecurity. Information, 2023, 14: 462.
27. Wilson A, Saeed H, Pringle C, et al. Artificial intelligence projects in healthcare: 10 practical tips for success in a clinical environment. BMJ Health Care Inform, 2021, 28(1): e100323.
28. Stokel-Walker C, Van Noorden R. What ChatGPT and generative AI mean for science. Nature, 2023, 614(7947): 214-216.
29. Gordijn B, Have HT. ChatGPT: Evolution or revolution? Med Health Care Philos, 2023, 26(1): 1-2.
30. 马武仁, 弓孟春, 戴辉, 等. 以ChatGPT为代表的大语言模型在临床医学中的应用综述. 医学信息学杂志, 2023, 44(7): 9-17.
31. Cohen IG. What should ChatGPT mean for bioethics? Am J Bioeth, 2023, 23(10): 8-16.
32. Sheriff K. Defining autonomy in the context of tort liability: Is machine learning indicative of robotic responsibility? SSRN Electron J, 2016, DOI:10.2139/ssrn.2735945.
33. Hajian S, Bonchi F, Castillo C. Algorithmic bias: From discrimination discovery to fairness-aware data mining. In Proceedings of the 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining. Association for Computing Machinery, New York, NY, USA, 2125-2126.
34. Vaishya R, Misra A, Vaish A. ChatGPT: Is this version good for healthcare and research? Diabetes Metab Syndr, 2023, 17(4): 102744.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application and ethical exploration of ChatGPT in medical clinical practice

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