What happens when AI flips the script of paternalism in healthcare?

For generations, ailing patients have entered the clinic, donned their gowns, submitted to examinations, and dutifully followed their doctor’s command to take two pills and call him in the morning. 

Most of the time, patients were not encouraged to argue.  Information they provided was often dismissed as a distraction to the diagnostic process – or worse, a sign of hypochondria and hysteria that needed to be stamped out immediately with a show of clinical authority and benevolent paternalism. 

Depending on who you are, that scenario doesn’t play out the same way quite so often these days.  The digital age has brought in a new set of concepts that promote the patient as a partner in, not just a recipient of, the care process.   

Patient-centered care, shared decision-making and consumer empowerment are all well-worn buzzwords by now – and in many cases, they have been embedded into the ecosystem in a meaningful way.  It’s taken a long time, and the cultural inertia has been extremely difficult to combat. 

But healthcare leaders now say they want empowered, informed patients.  Shared decision-making lowers costs, they say, especially when patients and their providers are culturally aligned.  And patient-centered relationships can reduce avoidable resource use for the entire healthcare system. 

We have reached a point where providers have become comfortable with the degree to which patients are participating, even if patients themselves still want more. 

However, everything is about to change again now that artificial intelligence is entering the equation. 

One in three patients are already using AI chatbots to get healthcare information before they ever speak to a provider.  And 58% are then following up with their care teams, meaning they’re no longer entering the healthcare relationship as blank slates whose only source of guidance is the clinician in the room.  

The pendulum of patient empowerment is swinging, and healthcare organizations need to start taking a very hard look at themselves before it happens. 

What happens when the comfortably knowledgeable-but-compliant consumer starts to expect to become the main driver of their own care?  Will the health system revert to exasperated paternalism again if providers feel that AI has gone too far?  How can health systems help their clinicians understand the new role that AI is carving out for them without eroding their own sense of autonomy, purpose, and connection with their patients?  

The patient participation paradox

The patient-provider relationship is continually being redefined.  Technology has always played a part in doing so.  In many cases, some degree of resistance from clinicians has accompanied these changes. 

When WebMD launched its public-facing resources, anxious patients with stacks of printouts have long been the butt of (unfunny) jokes about how consumers think they’re better diagnosticians than their clinicians.    

And when Open Notes debuted in the early 2010s, some providers were swift to condemn the concept over fears that patients would be able to read their private observations, which would lead to more questions, longer appointment times, and more contentious relationships.  

Now that AI chatbots are giving patients access to even more advanced tools that can return highly personalized, contextualized insights, the boundaries of the clinical relationship are shifting once again. 

This time, there’s no clinging on to the past.  However, healthcare organizations are probably not prepared for exactly how much AI will change the traditional dynamic. 

The unvarnished truth is that the healthcare system has always liked informed patients until they arrive with their own conclusions.  It applauds engagement until it starts to disrupt established workflows. It encourages shared decision-making until patients start to shape the diagnostic frame itself. 

Patient use of AI resources is challenging the basic assumptions of this status quo and rewriting the rules of the clinical encounter.   

Healthcare organizations can either respond by doubling down on exerting their authority, or they can adapt to evolving expectations and find ways to make patient AI use a feature instead of a bug. 

Redefining the clinical conversation in the age of AI

Healthcare organizations need a new conversational framework that recognizes that clinicians might not always be the ones generating the initial theory about what a patient needs.    

They need to accept the fact that AI can (sometimes) be a useful ally in pointing the patient in the right direction, and develop mechanisms to build that concept into the care process. 

 As AI continues to influence patients before the first encounter, the health system will need to transition away from a machine that extracts information and spits out answers into an ecosystem that can receive, interpret, and leverage AI-shaped narratives with the appropriate blend of respect, curiosity, and healthy skepticism.  

It starts with a culture of openness to greater degrees of patient participation.  Right now, one in five patients actively hide their AI use from their clinicians for fear of being criticized or dismissed.  This builds on an established trend of anxiety and trepidation over feeling judged during clinical encounters, with more than a third of patients in a 2024 poll saying they’re afraid of how their providers might perceive them. 

About half of patients in that survey also expressed a desire to be able to describe their symptoms and conditions more clearly before they spoke with their providers, and that they would like more information and advice on how to talk to their provider about their concerns. 

AI can often provide the education, clarity, and framework for asking questions that patients so strongly desire. But not if patients are afraid to share their AI use in the first place. 

Healthcare organizations need to offer clear guidelines and boundaries to both patients and care providers around when AI-informed participation is useful, when it might become unsafe, and how to communicate those factors in a mutually respectful manner.  

Putting a robust conversational framework in place can encourage appropriate AI use while dissuading overreliance or excessive enthusiasm that might make both patients and providers feel disrespected.   

Aligning expectations and creating a space for respectful discussion can reduce the likelihood that either the patient or the provider feels like their role and autonomy are being challenged.  That’s where trust starts to crystalize and AI can become an asset to the conversation, not a liability.  

Accepting the renegotiation of authority in the patient-provider relationship

The answer to patient AI use isn’t to stamp it out completely, nor is it for providers to throw up their hands and let patients outsource all their clinical decisions to chatbots. 

It’s to accept that the underlying notion of authority in the patient-provider relationship is due for a rethink.  Information is no longer flowing in just one direction, which means decision-making can’t happen unidirectionally, either.   

Health systems simply have to ask themselves how much participation and informational independence they are truly prepared to accept from patients, and how they are going to recalibrate the clinical conversation accordingly. 

After spending decades systematically expanding the boundaries of acceptable patient participation, it doesn’t make sense to put a hard stop on that progress now that AI is becoming the force that’s pushing those limits. 

Organizations that react to the acceleration of AI-driven patient empowerment by reverting to rigid paternalism will find themselves reinforcing distrust and disengagement without doing much to halt the momentum of the industry as a whole. It’s an easy way for health systems to lose the authority they’re trying to preserve, and damage their reputation in the process. 

The bottom line is that the patient-provider relationship is actually more important than ever.  It just has to incorporate the patient in a more equitable and participatory way than ever before.  The organizations that take a structured, collaborative approach to balancing clinical expertise with increasingly informed patients will be better positioned to succeed in an AI-infused environment. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at [email protected].