EPtalk by Dr. Jayne 8/7/25

One of the hot topics around the virtual physician lounge this week was the opening of the Alice L. Walton School of Medicine in Bentonville, Arkansas. The school is named after its founder, who is an heir to the Walmart fortune.

The initial class of 48 students will be trained in a curriculum that is based on preventive care and a whole-health philosophy. The school is located on Walton family property and borders the Crystal Bridges Museum of American Art, which should provide an excellent diversion when students need time away from studying. Apparently the curriculum also includes a course that incorporates art appreciation as a way of encouraging observational skills and empathy.

Students are expected to perform community service as a way of better understanding those in their care. Other ways the curriculum differs from the standard include a focus on nutrition education, including cooking classes with teach-back sessions to patients, and time spent gardening and working on a teaching farm.

Tuition for the first five graduating classes will be covered by Mrs. Walton, who hopes that graduates will consider practicing in underserved areas. There are certainly some opportunities for service in Arkansas, which has some of the poorest health outcomes in the US.

The lure of free tuition is strong, but students are taking a bit of a gamble attending a school that does not yet have a track record for residency placements or a broad alumni network. Still, the school received over 2,000 applications for the class. Best wishes to these new students, and I look forward to seeing how the curriculum is implemented as the inaugural class progresses.

Another hot topic was a recent JAMA op-ed piece that is titled “When Patients Arrive With Answers.” It covers the evolution from patients arriving with newspaper clippings to bringing in printed results of internet searches and now arriving with AI-generated materials to discuss with their physicians.

One of my colleagues focused on a line in the piece about tools like ChatGPT: “Their confidence implies confidence.” This led to a discussion hallucinations that we have encountered using AI solutions, even in situations where simple fact-based questions are being posed. The author notes that they are now “explaining concepts like overdiagnosis, false positives, or other risks of unnecessary testing.” 

That comment resonated with my colleagues. One noted that she feels that AI is worsening the burnout problem in her primary care practice. She must regularly defend her recommendations against AI-generated suggestions, as well as misinformation that is being provided by TikTok influencers. The author recognizes this, and notes that explaining evidence-based recommendations in contrast with patient requests isn’t a new phenomenon and encourages physicians to “meet them with patience and curiosity.” Given the tight schedules that most physicians face, I’m not sure that’s realistic.

Keeping with the theme of AI, I enjoyed this JAMA Editor’s Note on “Can AI Improve the Cost-Effectiveness of 3D Total-Body Photography?” As someone who has had entirely too many skin biopsies, this immediately caught my attention.

The authors specifically address the idea of photography for patients who are at high risk for melanoma, citing a recent randomized clinical trial published in JAMA Dermatology. The study found that although the intervention resulted in more biopsies, it didn’t increase the number of melanomas that were identified.

Another study that was also published in JAMA Dermatology looked specifically at whether 3D total-body photography is cost-effective. It found that it wasn’t, but posed the idea that with AI enhancements, it could become more financially feasible. For patients who need regular monitoring, however, I guess we’ll just have to stick with “usual care.”

I used a non-medical AI tool this week to help address a question that a family friend posed. When you’re a primary care physician, everyone assumes you know about all facets of medicine. I’m constantly getting questions about radiology reports or lab results because people “don’t want to bother the doctor.” I still find it strange that they’d rather expose their protected health information to someone they don’t know well, who is merely the daughter of a friend, but that’s often how it goes.

I was curious what the patient would have seen had they decided to just use Google or any of the AI tools out there. In this case, both Google and Copilot did a great job explaining “what does pleural based opacity” mean, giving answers that were similar to my own.

The primary difference between the human answer and the AI generated one was in the follow up. Where I said that the patient should follow up with the ordering physician to understand what the term means in context of their clinical picture, both sources recommended further investigation, which most patients would interpret as needing additional testing.

I wasn’t as patient with another person who reached out for medical advice. Someone who I hadn’t seen since high school decided it was a great time to message me via Facebook and ask about various medications versus injections versus surgery for back pain. I have to admit that I took the easy way out by saying “so many factors play into the choice of treatments and it really depends on the patient,” which was as empathetic as I could get at the time.

A few days later, I plugged it into Google to see what it would provide. It did an exhaustive review of the different options and closed with this: “Important note: The choice of treatment depends on the specific nature and severity of the herniated disc, as well as individual patient factors and preferences. It’s crucial to consult with a doctor or pain specialist to determine the most appropriate course of action for your situation.” At least in this situation, I agree 100% with the Google. 

Are you a clinician who has to field medical questions from people who are not your patients? Have you considered outsourcing your advice to AI, especially if it’s outside of your typical scope of practice? Leave a comment or email me.

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