Healthcare ChatGPT
Chu and Chu
THE POTENTIAL OF CHATBOT IN
CHIROPRACTIC PRACTICE
Eden Yi Tian Chu1, Eric Chun-Pu Chu, DC, PhD, FRCC 2
sophisticated assistance of clinical procedures.
Although chatbots cannot replace human practitioners,
they can free up providers to focus on more complex
issues and improve patient access to and satisfaction
with care. (J Contemporary Chiropr 2023;6:72-78)
ABSTRACT
Developments in artificial intelligence and natural
language processing have permitted the creation of
conversational agents, or chatbots, to assist with a
variety of healthcare activities. Chatbots, such as
ChatGPT, can boost patient access to care and allow
physicians to focus on more complicated concerns by
automating basic questions and requests. Chatbots
can provide health advice and information, organize
appointments, and monitor symptoms, among other
functions. The increasing need for health services and
advancements in AI have prompted the development of
chatbots to assist with behavior modification, treatment
support, screening, training, and triage. Chatbots
have the ability to support self-management, educate
patients, and avoid degeneration for chiropractors
and other professionals who treat musculoskeletal
disorders. Overall, chatbots could transform therapeutic
delivery and improve patient access and convenience.
Key Indexing Terms: ChatGPT; Healthcare Chatbot;
Rehabilitation Business; AI Clinic
INTRODUCTION
Access to digital health is significantly influencing the
development of healthcare systems, and a change
toward more patient-centric service within the
healthcare ecosystem is being brought about by the
reduction of the knowledge gap between patients
and healthcare professionals. [1] The increasing
need for healthcare services and advancements in
artificial intelligence have resulted in the creation of
conversational agents to aid with various health-related
tasks, such as promoting behavior change, providing
treatment support, monitoring health, training, triage,
and screening support. [2] By automating these tasks,
healthcare providers can shift their focus to more
challenging assignments, while also making healthcare
services more accessible to the general public. [2]
However, the introduction of chatbots faces
considerable obstacles, including privacy and
security concerns, a lack of human engagement, and
technological and data accuracy limits. While effort is
being made to remove these obstacles, clinicians are
still indispensable. The future of chatbots in healthcare
is bright, since advances in articial intelligence and
natural language processing will allow for increasingly
1
2
ChatGPT is a type of chatbot that was built with
reinforcement and supervised learning technology.
Chatbots in clinical practices can perform a wide
range of tasks, including appointment scheduling
and reminders, patient education and health advice,
managing clinical conditions and treatments, and more.
[3] They use natural language processing (NLP) and
machine learning algorithms to understand and respond
Victoria Shanghai Academy, Hong Kong SAR, China
New York Chiropractic and Physiotherapy Centre,
EC Healthcare, Hong Kong SAR, China
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to patient queries, making it easier for patients to
access clinical services and receive the care they need.
basic tasks and inquiries. [2] They could not serve as a
comprehensive automated assistant for chiropractors
or truly enhance the patient experience with
personalized, customized interactions.
Chiropractors are primary care clinicians who often
manage patients with musculoskeletal disorders. [4]
The use of chatbot with artificial intelligence (AI) in
clinical practices may have many benefits, including
encouraging self-management [5], patient education in
musculoskeletal disease [6], and modifying behavior in
prevention of degeneration. [7] Chatbot has the potential
to revolutionize the way clinical care is delivered and
make clinical services more accessible and convenient
for patients.
Chatbot into the healthcare system also faces some
challenges and limitations associated with, including
privacy and security concerns [2,8], a lack of human
interaction [9,10], and limitations in technology and
data accuracy. [8] Despite these challenges, the future
of chatbots in clinical practices is promising, with
advancements in technology and artificial intelligence
offering the potential for even greater improvements in
the delivery of clinical care.
The widespread adoption of chatbots has been
prompted by the recent growth in demands for
effective communication and higher user learning
requirements in the health sector. The evolution of
chatbot technology, like ChatGPT, has improved in
terms of its natural language processing capabilities, its
ability to understand context, and its ability to interact
with users in a conversational manner. To demonstrate
a change in research priorities around the year 2016,
2148 documents were examined. More documents
have been produced in the last few years than in the
previous 20 years combined, and outputs could increase
significantly in the future. [12] The use of chatbots in
conjunction with the development of machine learning
and deep learning techniques presented a research
opportunity. [12] As a result, chatbots are gaining
popularity in healthcare and are viewed as a beneficial
tool for enhancing patient care and satisfaction.
DISCUSSION
The Benefits of Chatbot in Clinical Practice (Figure 1)
The Early Days of Chatbots in Clinical Practice
A. Improved patient-provider communication
Some of the first chatbots developed were designed
to handle simple, frequently-asked questions from
patients. [11] These chatbots could answer basic
questions about the practice, such as office hours,
location, insurance acceptance, and appointment
booking procedures. [11] They provided an automated
way to quickly respond to common inquiries and route
patients to the appropriate information or staff member
if needed. These initial chatbots laid the groundwork for
more advanced systems that can handle more complex
conversations, access patient data, and even provide
some diagnosis and treatment recommendations under
the supervision of chiropractors.
Chatbots allow patients to easily communicate with
their clinicians and receive timely responses to
their questions and concerns. [6] Patients with poor
responsiveness to traditional care management
modalities may demonstrate favorable engagement
with asynchronous text-based chatbot interactions.
The technologically-mediated patient-care manager
relationship could be enhanced through chatbotsupported communication. [8] Chatbot systems can
monitor patient status and provide clinically relevant
alerts to patients and providers, enabling early
intervention for adverse events. [8] By handling routine
information exchange, chatbots may free up care
managers to focus on high-acuity interactions requiring
nuanced clinical decision-making. [8] This improved
communication can lead to better health outcomes and
increased patient satisfaction.
Early chatbots had some significant limitations and the
studies reported mixed evidence for the effectiveness,
and satisfaction of the chatbot. [2] Their knowledge
bases were limited, so they could only handle simple,
straightforward questions and conversations. They
lacked the ability to access patient data or medical
records, so they could not provide personalized
responses or recommendations. [2] They also could
not handle complex questions or conversations that
required nuanced language or reasoning. As a result,
these chatbots could only automate a narrow set of
Chatbots can enhance patient-provider communication
in clinical practice by providing patients with
instant and personalized support. Patients can ask
questions, receive guidance on their symptoms, and
schedule appointments, among other services. [8]
At the University Hospitals of Cleveland, Ohio, care
management focuses on 582,000 patients with chronic
disorders, chatbots were found to help patients with
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personalities or cultural preferences who prefer not to
communicate with their care manager in person may
do so using text message-based chatbots. With the
help of chatbot technology, patients and physicians can
gain insights from a patient's reactions, updates, and
progress in order to support earlier interventions before
an incident occurs. [8] The adoption of technology can
facilitate patients in improving clinical outcomes,
locating the most suitable clinicians, and a costeffective patient journey. [13]
B. Increased accessibility to clinical services
Chatbot may make it easier for patients to access
clinical services, even outside of regular office hours.
Chatbots can increase accessibility to clinical services
by providing patients with 24/7 support. Patients can
interact with chatbots from anywhere at any time and
receive immediate assistance, without having to wait
for an appointment. In an observational study of chatbot
utilization in women with gestational diabetes mellitus,
researchers discovered that the technology facilitates
quick information access and improved care. [14] AI
chatbot can also be used as a culturally sensitive digital
health tool to prevent stigmatized diseases in certain
sensitive populations such as HIV patients. [15] This
can be particularly beneficial for patients in remote
areas, those with mobility issues, or those with time
constraints. As a result, chatbots automation could
liberate clinicians to focus on more comprehensive
diagnosis and improve the patient’s access to their
services. [2] This increased accessibility can lead to
improved patient outcomes and increased patient
satisfaction.
C. Better health outcomes
Chatbots can provide patients with personalized
health advice, reminders and education, which can
help improve their health outcomes and reduce the
risk of injury. [10] The AI-assisted health program's
short exercises decreased neck/shoulder discomfort/
stiffness and lower back pain in 12 weeks, according
to research. [16] Participants were randomized to
receive either the app-based program, which provided
tailored exercise instructions daily for 12 weeks, or usual
care. The majority of app users reported subjective
improvement in symptoms. [16] Psychotherapy
offered by chatbots can be used as an alternate kind
of treatment for depression and anxiety in medical
facilities. [17] In cases of rare serious pathology
presenting in the chiropractic clinic [18], it is often
unclear if clinician use treatment in that situation
that may be contraindicated to the treatment. [19] The
usefulness and effectiveness of different therapies can
be built in the database so that future AI can improve
and adapt current information and give advice. [2] As
identifying predictors of severe adverse events are
important to future research [20], chatbot can also
plays an important role in predicting the right therapy
with minimum risk. The high adherence rate suggests
Figure 1. Benefits of ChatGPT in clinical practice
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chatbots can help patients to stay on track with their
treatment plan and achieve better health outcomes.
example, Smartbot360 has a chatbot that enables
patients to instantly receive help and answers from
chatting with the chatbot. This chatbot also sends
patients automated reminders about their home
exercise program and tracks their progress, helping
patients to stay on track with their treatment plan. [27]
D. Time and cost savings for patients and clinicians
Obtaining patient health data from a patient can be
time-consuming, Chatbots can automate many timeconsuming tasks. [21] It can save time and costs for
patients and chiropractors by automating administrative
tasks and reducing the need for face-to-face
appointments. [10] Patients can schedule appointments,
ask questions, and receive support from chatbots,
eliminating the need for phone calls or in-person visits.
This can save patients time and money, particularly
those with busy schedules or those who need frequent
appointments. For chiropractors, chatbots can reduce
administrative workload, enabling them to focus on
providing quality care to patients.
Chatbots can also be used for patient education and
health advice in clinical practice. For instance, the
HealthBuddy chatbot is an example of a chatbot offered
by World Health Organization that provides patients with
information on common covid conditions, treatments,
and self-care tips in all different languages. This chatbot
also allows patients to track their symptoms and receive
personalized recommendations on home exercises and
lifestyle modifications. [28]
Chatbots can also be used for making clinical decisions
and treatments. For instance, 'FlapBot' (ChatBot) was
designed to digitally transform paper-based pathways,
allowing for early recognition and escalation of free
flaps with compromised vascularity. [29] The early
adoption and use of a FlapBot to aid clinical decisionmaking in microvascular surgery. Use of chatbot helps
the clinical decision-making since human elements in
the identification process of decision-making continue
to constitute a danger to timely intervention and so
are a crucial determinant of success in microvascular
surgery. [29] By automating administrative tasks,
providing personalized support, and improving patient
engagement, chatbots are becoming an essential tool
for clinicians in managing their patients.
E. Increased operational efficiency
Chatbots can streamline processes and reduce the
number of manual tasks, increasing efficiency and
freeing up time for chiropractors to focus on more
important tasks. [22] Chatbot uses the rules derived
from data, and delivers a more sophisticated and
individual history taking with virtual patients. [23]
With the adoption and implementations of chatbot
enhancing the acceptability of AI in healthcare, the
effectiveness of therapy will improve patient outcomes
and satisfaction. [24]
F. Improved patient engagement
Chatbots can provide patients with a convenient
and accessible means of receiving care and support
[25], leading to increased patient engagement and
satisfaction. [22] A study developed and validated a
model to evaluate user experience and satisfaction
with health care chatbots. The model considers 5 value
domains: functional, epistemic, emotional, social, and
conditional. A survey of 413 Chinese university students
found positive user experience and satisfaction across
chatbots and value domains. Functional and epistemic
values were most important. Differences emerged
based on gender and academic level. The findings
suggest chatbots may effectively disseminate health
information, especially for younger users, and imply
design factors to consider. [26]
Challenges and Limitations of Chatbots in Clinical
Practice
One of the primary challenges of using chatbots in
clinical practice is the potential for ethics, privacy and
security breaches. [8] Medical publishers including
Nature and Science have introduced policies that
prohibit the utilization of ChatGPT, or AI technologies
as authors. [30] Chatbots often store sensitive patient
information, such as medical history and contact
information, which can be compromised if the chatbot
is not adequately secured. To address this concern,
chatbot developers must implement robust security
protocols, such as encryption, to ensure that patient
data remains confidential.
Another limitation of chatbots in clinical practice is
the lack of human interaction. [22] While chatbots can
provide instant support and assistance to patients, they
cannot replace the value of face-to-face interactions
with healthcare providers. Patients may feel more
Real-Life Examples of Chatbots in Healthcare Practice
Chatbots are increasingly being used for appointment
scheduling and reminders in clinical practice. For
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comfortable discussing their symptoms and concerns
with a human healthcare provider, and chatbots may
not be able to provide the same level of empathy and
emotional support.
tasks, providing personalized care plans, and improving
patient engagement, chatbots can help to reduce the
burden on healthcare providers and improve the patient
experience. This could ultimately lead to improved
clinical outcomes, reduced healthcare costs, and
increased patient satisfaction.
Finally, the accuracy of data and limitations in
technology can also be a challenge for chatbots in
clinical practice. [8] Chatbots rely on algorithms
and data to provide personalized recommendations
and treatment plans, and inaccurate data can lead
to incorrect advice and potential harm to patients.
Additionally, chatbots may not be able to identify
more complex health conditions that require a human
healthcare provider's expertise, leading to delayed
diagnoses and treatment.
The future of chatbots in clinical practice is exciting and
full of potential. For example, this manuscript, generated
by chatGTP and written by a grade-9 high school student
in collaboration with a chiropractor, represents both
an opportunity and a threat in the future of scientific
writing. On the positive side, systems like chatGTP can
help less experienced researchers like high-school
students quickly produce a structured manuscript,
synthesizing information and crafting sentences.
However, it is important for the second author, me, who
is the human chiropractor, to carefully evaluate and
scrutinize such papers in order to ensure the credibility
and accuracy of the information presented in the paper.
With advancements in technology, increased integration
with other clinical technologies, and the potential for
widespread adoption, chatbots have the potential to
revolutionize the way clinical care is delivered and
improve patient outcomes.
In conclusion, while chatbots have many potential
benefits for clinical practice, there are also challenges
and limitations that must be addressed. Privacy and
security concerns, lack of human interaction, and
limitations in technology and data accuracy are just a
few of the challenges that must be addressed to ensure
that chatbots can provide safe and effective support for
patients in clinical practice.
The Future of Chatbots in Clinical Practice
CONCLUSION
The future of chatbots in clinical practice is likely to
be shaped by advances in technology and artificial
intelligence. As chatbot technology continues to
improve, they will become more sophisticated and
capable of providing patients with more personalized
care. In the future, chatbots may be able to use
machine learning algorithms to analyze patient data
and make more accurate diagnoses and treatment
recommendations.
Chatbots like ChatGPT, with AI integration, may have
the potential to bring many benefits to clinical practice,
including improved patient-provider communication,
increased accessibility to healthcare services, better
health outcomes, and time and cost savings for patients.
However, there are also challenges and limitations to
consider, such as privacy and security concerns, the
lack of human interaction, and limitations in technology
and data accuracy. It is essential to address these issues
to ensure that chatbots can provide safe and effective
support for patients in clinical practice.
Another area of potential growth for chatbots in
clinical practice is their integration with other clinical
technologies. The research of chatbot application
scenarios in the Covid-19 public health shows that
the scalability, wide accessibility, usability, and quick
information dissemination of chatbots give public health
personnel additional capability. [31] Chatbots could
be integrated with wearable devices or mobile apps
to provide patients with continuous support and realtime feedback. Additionally, chatbots could be used
in conjunction with telehealth technologies to provide
remote support to patients in need of clinical care.
The future of chatbots in clinical practice is promising,
with advancements in technology, integration with other
clinical technologies, and the potential for widespread
adoption. As chatbots become more sophisticated
and capable of providing personalized care, they have
the potential to improve clinical outcomes, reduce
healthcare costs, and increase patient satisfaction.
However, it is essential to continue to monitor their use
and address any limitations or challenges that arise.
Finally, the widespread adoption of chatbots in clinical
practice has the potential to improve clinical outcomes
and provide patients with more accessible, efficient,
and affordable care. By automating administrative
J Contemp Chiropr 2023, Volume 6
The effectiveness of chatbots will depend on continued
investment and development. By addressing challenges
such as privacy and security concerns, the lack of
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Chu and Chu
human interaction, and limitations in technology and
data accuracy, chatbots can provide safe and effective
support for patients in clinical practice. Therefore, it
is essential to continue investing in this area to ensure
that chatbots can be integrated effectively into clinical
practice and provide optimal patient outcomes.
9.
10. Xu L, Sanders L, Li K, Chow JCL. Chatbot for
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systematic review. JMIR Cancer 2021;7(4):e27850
ACKNOWLEDGMENTS
The manuscript is written with assistance with ChatGPT
11.
AUTHOR CONTRIBUTIONS
EYTC drafted the report with assistance of ChatGPT.
ECPC authors read and critically reviewed the
manuscript, and then approved the final submitted
version.
Chun-Pu Chu E. Chiropractic and future of
healthcare in Asia. J Contemp Chiro, 2021;4(1):138–
141.
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Chu E, Trager R J, Lee W et al. Lung cancer with
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