FHC #230: Flashback to healthcare skimping and AI-powered patients

Fixing Healthcare is revisiting a Diving Deep episode that feels even more important today than when it first aired in November 2023.

At the time, ChatGPT had been available to the public for just one year. Generative AI was still widely viewed as a fascinating but unreliable tool, impressive in some settings and error-prone in others. Many clinicians saw it as a novelty. Some saw it as a threat. Few fully grasped how quickly the technology would advance or how profoundly it might reshape the relationship between doctors and patients.

Nearly three years later, that early vision already feels outdated. We’ve already surpassed the vision of generative AI helping patients prepare for office visits and ask better questions. The next generation of AI agents are proving capable of helping provide care between visits: monitoring chronic disease, identifying early signs of heart failure, flagging postoperative wound infections, answering medication questions and alerting doctors when a patient’s condition begins to worsen. Instead of centering care almost entirely around the doctor’s office, these tools could extend medical expertise into the home, 24/7.

When the episode was released, many people worried that generative AI was not powerful enough to solve clinical problems. Now, some worry that it has become too powerful and may pose existential risks. Across the nation, health systems, technology companies and policymakers are debating how far these tools should go, how quickly they should be adopted and who should guide their use.

That makes this replay especially timely. In this episode, co-hosts Dr. Robert Pearl and Jeremy Corr return to two connected problems: the high cost of American healthcare and the potential for generative AI to give patients more knowledge, agency and control.

The first half of the conversation focuses on “skimping,” a term Pearl uses for the many ways healthcare organizations constrain costs by giving patients less care, less access or fewer resources while still charging more. He compares it to buying a box of cereal at the same price, only to discover there are fewer flakes inside. In healthcare, however, the consequences are far more serious.

The second half of the episode turns to generative AI and the future of the doctor-patient relationship. Pearl argues that, when used correctly, generative AI could make medicine more collaborative. Instead of relying entirely on brief office visits, patients could use AI to better under