Virtual primary care is an emerging technology in which an artificial intelligence (AI) system provides patient care rather than an actual human physician. “In light of the COVID-19 pandemic, use of virtual care technologies like telehealth have increased dramatically in recent months,” explains Courtney M. Goetz. “As a next step, virtual AI-powered healthcare is being developed, but it’s important to understand how this type of care will be perceived by its potential users. These perceptions can help us be prepared to address the needs and concerns of patients and inform the implementation of these technologies.”
To better understand perspectives of younger adults toward virtual primary care physicians (vPCPs), Goetz and colleagues had a qualitative study published in PLoS One that explored the attitudes of current first- and fourth-year medical and technology-focused graduate students. “Together with our supervising author/principal investigator—Bengt Arnetz, MD, PhD, MPH—as well as the rest of my research team, we held focus groups to learn about their perceptions as potential patients of virtual physicians.” Of note, the study took place in early 2019, before the COVID-19 pandemic.
The study showed that, in general, participants expressed that they would feel comfortable seeking care from a vPCP, but they were less trusting of the technology when compared with care from human physicians. Distinct themes emerged and were categorized according to the focus group discussion areas of advantages, disadvantages, and future of vPCPs (Table).
Advantages & Disadvantages
Key themes emerged on students’ perceptions of the advantages of vPCPs, including convenience/access, efficiency, standardized care, cost, and accuracy. Participants felt that a vPCP would be convenient to use and could increase access to primary care. They also agreed that using the technology would make some healthcare processes more efficient. In addition, participants thought using a virtual PCP would lower direct and indirect costs. Furthermore, increased accuracy was perceived as an advantage of using a vPCP in certain cases. “Many patients seek convenience and cost-effectiveness in their medical care,” Goetz says, “and our focus group participants thought that a virtual physician could offer both of these.”
Participants felt several disadvantages should be considered when using a vPCP. “Our participants had serious ethical concerns about AI-powered virtual physicians, such as the potential for discrimination by race, ethnicity, and socioeconomic status,” says Goetz. “They also had questions regarding accountability and wanted to know who would be responsible for medical errors made by a virtual physician. These factors should be given substantial consideration when developing and implementing virtual physicians.” She adds that participants were also concerned about data privacy and the potential for misdiagnosis by virtual physicians due to incorrect or outdated algorithms.
When participants were asked how they envisioned a vPCP working in the future, they agreed the future of virtual primary care depends on how it can work with—instead of replacing—human physicians. Participants specified that vPCP cannot replace human doctors. Regarding data technology, the medical students in the study described several factors that will play a role in adoption of vPCP, including dynamic artificial intelligence systems, adequate testing, trustworthy data, and transparency.
The study provides important insights into the potential development and implementation of virtual primary care systems, according to Goetz. “Patients may be hesitant to adopt these new technologies because of ethical concerns, especially considering recent examples of artificial technologies showing racial biases,” she says. “During programming and implementation of virtual physicians, transparency and accountability are key factors to consider. In addition, accuracy should be demonstrated using trustworthy data. Ultimately, having virtual physicians work in tandem with human physicians is most likely the optimal model for a vPCP.”
The findings on vPCP may be more relevant now than ever, but Goetz says additional research is warranted. “Our participants were young and had formal education in the fields of medicine or data science,” she says. “Future studies should include a broader range of potential users of virtual physician technologies, including older patients. Such research is important for developing and implementing vPCPs and to ensure successful adoption.”