Heart-to-heart with ChatGPT: the impact of patients consulting AI for cardiovascular health advice.

OBJECTIVES: The advent of conversational artificial intelligence (AI) systems employing large language models such as ChatGPT has sparked public, professional and academic debates on the capabilities of such technologies. This mixed-methods study sets out to review and systematically explore the capabilities of ChatGPT to adequately provide health advice to patients when prompted regarding four topics from the field of cardiovascular diseases. METHODS: As of 30 May 2023, 528 items on PubMed contained the term ChatGPT in their title and/or abstract, with 258 being classified as journal articles and included in our thematic state-of-the-art review. For the experimental part, we systematically developed and assessed 123 prompts across the four topics based on three classes of users and two languages. Medical and communications experts scored ChatGPT's responses according to the 4Cs of language model evaluation proposed in this article: correct, concise, comprehensive and comprehensible. RESULTS: The articles reviewed were fairly evenly distributed across discussing how ChatGPT could be used for medical publishing, in clinical practice and for education of medical personnel and/or patients. Quantitatively and qualitatively assessing the capability of ChatGPT on the 123 prompts demonstrated that, while the responses generally received above-average scores, they occupy a spectrum from the concise and correct via the absurd to what only can be described as hazardously incorrect and incomplete. Prompts formulated at higher levels of health literacy generally yielded higher-quality answers. Counterintuitively, responses in a lower-resource language were often of higher quality. CONCLUSIONS: The results emphasise the relationship between prompt and response quality and hint at potentially concerning futures in personalised medicine. The widespread use of large language models for health advice might amplify existing health inequalities and will increase the pressure on healthcare systems by providing easy access to many seemingly likely differential diagnoses and recommendations for seeing a doctor for even harmless ailments.

Interrogating the pill: Rising distrust and the reshaping of health risk perceptions in the social media age.

Since its introduction in 1960, the combined oral contraceptive pill has become the dominant reversible contraceptive technology for controlling female fertility in spite of early and ongoing ethical, critical medical, and societal disapproval. Over the last decade, prescription rates among young women in Western Europe have declined alongside the rise of social media use. This article investigates the mechanisms underlying this change in contraceptive choices and the role played by social media in this trend. Via exploratory online observation and an in-depth interview study with 19 informants in Germany and Denmark, we find social media consolidates the social construction of hazards associated with the contraceptive pill by reshaping young women's risk perception from questions around drug reliability and safety to those of individual physical, mental, and social well-being. We shed light on how social media contributes to the delegitimation of health professionals such as gynaecologists and general practitioners and adds to wider debates on the erosion of medical authority and the attendant rise of peer influencers. We condense our findings into a framework for health-related attitude formation and decision-making in the social media age, which elucidates how social media amplifies and reshapes societal discourses regarding health-related technologies, choices, and risks.

Patientology revisited: Toward tailored care pathways.

BACKGROUND: Concepts such as patient-centred care, patient empowerment and patient participation have challenged our understanding of what it means to be a patient and what role patients play in care pathways. Consequently, patientology as the medical sociological and anthropological study of patients is currently being reconceptualized through perspectives of health as individualized and privatized capital. AIMS: This article explores the potential of such a patientological perspective to enhance our understanding of and tailor care pathways. Particularly, we aim to investigate how such a perspective can contribute to tailoring care pathways to the capacities of individual patients and their relatives. MATERIALS & METHODS: We elaborate on an emerging health capital-theoretic model for patientology and study its potential for optimizing care pathways through two distinct cases of care contexts: communicative challenges in the context of integrative primary care for vulnerable chronically ill multi-morbid patients and the potential of parent involvement in the acute hospitalization of children suspected to be affected by multisystem inflammatory syndrome in children. RESULTS: Our results shed light on the importance of cultural and social capital of patients and their relatives in the design of effective tailored care pathways. We find that a lack of cultural and social capital presents a significant barrier to effective communication between patients and the healthcare professionals involved in their care pathways. We also find that understanding the cultural and social capital of relatives provides an entry point to their effective involvement in the care pathways of their children. DISCUSSION & CONCLUSION: The implications of these findings extend beyond the concrete care contexts studied. This article contributes to our understanding of care pathways through a perspective of health inequalities being based on differences in health capital and demonstrates how the health capital-theoretic patientology model facilitates the systematic development of guidelines for healthcare professionals to assess patients' resources and tailor their care pathways accordingly.

COVID-19 Vaccine Hesitancy in Denmark and Russia: A qualitative typology at the nexus of agency and health capital.

Vaccination of the world population is being embraced by 184 countries as the main strategy to end the COVID-19 pandemic; vaccination rates are stalling even in countries with high vaccine availability, though. This article investigates the phenomenon of vaccine hesitancy in two such countries, the Kingdom of Denmark and the Russian Federation, through a qualitative study of the different types of hesitancy to COVID-19 vaccination programs and their underlying mechanisms. The analysis reveals a typology along the dimensions of agency and health capital: resisting hesitancy based on mistrust of authority, paralyzed hesitancy based on personal fear, informed hesitancy based on informed choice, and empowered hesitancy based on empowered choice. While the mechanisms underlying vaccine hesitancy are to a great extent comparable between the two countries, differences in population size, societal cohesion, and political culture seem to impact the prevalence and severity of types and, thereby, the outcomes of national COVID-19 vaccination programs and national campaigns for mitigating COVID-19 vaccine hesitancy. The implications of these findings extend beyond the particular context of COVID-19 and the countries studied, supporting and nuancing existing models for vaccine hesitancy, as well as providing a starting point for tailored campaigns for mitigating vaccine hesitancy.

Detached co-involvement in interactional care: Transcending temporality and spatiality through mHealth in a social psychiatry out-patient setting.

This article explores how the integration of digital technology into healthcare processes of social psychiatry impacts the healthcare professional-patient relation. To this end, it adopts a new materialist perspective, viewing the context of social psychiatry as an assemblage of human and technological components and their relations. We draw on a qualitative study of the introduction of an mHealth platform including shared calendars, messaging, and video calls into the care processes of a social psychiatry out-patient setting in Denmark. The study demonstrates how technology acceptance is facilitated by familiarity and relational trust, how the platform streamlines routine care tasks by providing shared structures, and how the platform allows for a multi-channel approach to interactional care. The analysis reveals an emerging type of care interaction, detached co-involvement, which appears to strengthen the healthcare professional-patient relation and concomitantly increase patient autonomy by facilitating temporally and spatially detached albeit more frequent interactions. The implications of these findings extend beyond the context of social psychiatry. First, they demonstrate that the careful integration of digital technology into care processes has the potential to increase the involvement of and even empower mentally vulnerable patients. Second, they demonstrate how adding such technology can extend an assemblage temporally and spatially and, consequently, allow components to remain attached to it while they attach to and detach from other assemblages.

The Potential of AI in Care Optimization: Insights from the User-Driven Co-Development of a Care Integration System.

Transitions from one level of care to another are complex processes that pose medical and organizational risks and depend on care integration between different providers. This qualitative study investigated user experiences with an existing digital system for care integration between hospitals and nursing homes, and the potential of artificial intelligence to contribute to its optimization. The findings reveal challenges regarding (a) untimely information, (b) irrelevant information, (c) confusing information, (d) missing information, (e) information overload, and (f) information multiplicity. Artificial intelligence could address these by (i) identifying and verifying low-quality information, (ii) targeting information for different user groups, (iii) visually summarizing relevant information, and (iv) jointly presenting multiple versions. The implications of these findings extend beyond the context of care integration, presenting empirical evidence for the importance of qualitative health research in, and a model for, determining the scope and design of future artificial intelligence solutions to optimize (health)care processes.

Health capital: toward a conceptual framework for understanding the construction of individual health.

Emerging perspectives of health as individualized and privatized capital seem promising to shed light on the construction of individual health in the face of the growing individualization of healthcare. This article reviews extant perspectives of health as capital, reflecting upon how a conceptualization of health capital might be conceived by two of the main contrasting traditions: human capital theory affiliated with the Chicago School of Economics and Bourdieusian concepts of social field and capital. Arguing that a Bourdieusian perspective is potentially more fruitful to capture the importance of social and cultural dimensions in the construction of individual health, this article arrives at a conceptualization of health capital as the aggregate of the actual or potential resources possessed by a given agent that have the capacity to affect the position of agents in the social field of health. Drawing on Bourdieu's conceptualization of forms of capital, this article discusses the efficacy, the legitimation, and the positioning of health capital, uncovering its potential for understanding contemporary trends in health practices and health discourse.

Putting patients into the centre: Patient empowerment in everyday health practices.

Patient empowerment is a key topic in public health, medical sociology and in public debates on the modernisation of healthcare. This article joins the on-going discussion on public and patient involvement by offering a patient-centred perspective on patient empowerment outside the usual institutionalised context of chronic disease management. We present results from a qualitative study on individuals' practices of dealing with acute non-life-threatening medical conditions conducted from 2012 to 2017 in Denmark. Based on 34 home visits including in-depth interviews and participant observations with a sample of 28 informants, we uncover a spectrum of four patient tactics governing these practices: delegating, informing, consuming and resisting. The findings suggest disruptive changes to the role of the patient-physician relationship as well as the existence of practices indicative of patient empowerment outside the context of patient empowerment initiatives. Some patients are found to take over responsibility for their health, employing tactics where the role of general practitioners is severely demoted. These empirical contributions lead to the two theoretical contributions of the article: an extension of an existing model of patient empowerment and a conceptual reconsideration of patient empowerment, advocating viewing it as emerging from a bricolage of tactical interactions with social environments rather than as the consequence of an external strategic process.