Virtual humans could improve conversations at the doctor's office

You sit down to talk with your doctor, but you sense he's in a rush to get to the next patient. Add to this the lack of training many physicians have had in effective patient communication, and it becomes nearly impossible to have an engaging conversation about your health.

But virtual humans might help to change that.

Simulations using virtual patients are training health care professionals to be more empathetic and to tackle important conversations on topics like mental health and substance abuse.

One health simulation company, Kognito, uses gaming technology and virtual patients to create mock clinical scenarios in which real-life physicians, nurses and other practitioners test out different conversation paths to see how virtual patients respond. They're then given real-time feedback on how to have more effective and meaningful conversations.

"Simulations and gaming technology can help create a safe environment for people to learn through practice," said Kognito co-founder and CEO Ron Goldman. "It's risk-free. I can try to do things in a simulated environment that if I try to do them in real life can have bad consequences on people's health."

Virtual humans are being implemented in other areas of health care, from boosting patient honesty with doctors to potentially becoming a testing ground for new heart drugs. A study last year found that virtual humans can help teach medical students empathy in order to improve how they interact with patients and share bad news.

Mental health assessment is another critical area that could use a boost from technology. A growing number of Americans are seeking mental health services as the US grapples with a severe shortage of psychiatrists. Many patients are turning to primary care physicians because they're easier to access than mental health providers, says Dr. Asim Shah, professor of psychiatry at Baylor College of Medicine.

But many primary care doctors don't get much exposure to mental health or psychiatry during their training, and often aren't prepared to diagnose things like anxiety, depression and insomnia. In one study, US primary care providers only discussed suicide in 11 percent of encounters with patients who, unbeknownst to them, had suicidal thoughts. In addition, just 36 percent of the doctors explored suicide with patients who exhibited major depression, adjustment disorder or who sought antidepressants.

"A lot of medical providers sometimes don't feel comfortable with the subject matter [of mental health], and just aren't sure how to best phrase the questions," said Melissa Frick, a nurse practitioner at Loyola University Chicago's Wellness Center.

The center started using Kognito in January to improve medical staff training on behavioral health. Other services like i-Human Patients and Simtabs also let students and providers practice patient dialogue, assessment and diagnosis.

"The simulation provides a good opportunity for providers to learn from actually trialing it and watching the sessions, and feeling like they could have this similar experience in person," Frick said.

Trial and error

Kognito's primary care simulation, which costs around $50 per user, starts by offering general advice: sit at eye level with patients to put them at ease, ask open-ended questions to get more information and to save time, and restate patients' statements in your own words to show that you're listening and that you care.

The participant then sees the virtual patient's history and the conversation begins. A patient may come in with severe low back pain and ask for more meds, for example. A bubble that says "talk" appears in the upper left-hand corner, which opens up a menu of things you can say or do, like discuss the complaint, talk about medication or give an exam.

If you say something that prompts the patient to shut down or become defensive, a virtual psychiatrist will offer advice on how to have a more engaging and helpful conversation. According to the simulation, you should be able to gather enough information to see if a patient has a mental health disorder within three to five minutes.

The company says its simulations are proven to work. Three-month follow-up studies of its simulation showed a 51 percent increase in identifying patients with substance use or mental health disorders. There was also a 62 percent increase in patient screening and a 60 percent increase in discussions of treatment options.

"It's not something you're going to learn by reading a PDF or watching a movie," Goldman said. "You really have to practice it."

Improving team communication

Virtual humans could also help in another key area of medicine: team training.

Getting a group of busy people together to practice team communication can be nearly impossible. So Benjamin Lok, a computer science professor at the University of Florida, developed a system that integrates AI-powered virtual humans on 40-inch TV screens who represent medical professionals such as surgeons, anesthesiologists and nurses. These avatars communicate with real-life participants to help them learn skills like administering drugs and managing conflict.

"You can create these simulations where people have a chance to fail in communicating with another human, and that's useful for training," Lok said.

Lok is also the co-founder of software company Shadow Health, which uses clinical simulations to augment nursing students' health courses. Participants can communicate with virtual patients, give physical exams and practice health assessment. Students pay $99 for each course.

Discussions around AI and virtual humans often raise concerns about tech taking over "real" people's jobs. Lok says those fears are unfounded; they're merely trying to create opportunities for people to practice communication.

Of course, virtual humans can't fix everything. A greater investment in teaching communication skills is still necessary, said Jonathan Gratch, director for virtual humans research at the University of Southern California's Institute for Creative Technologies.

"There's a big crisis not just in medicine, but across all kinds of disciplines, that we're lacking as a society the ability to be human," Gratch said. "But there's some evidence [virtual humans] can play an important role in interpersonal skills training."

In that regard, virtual humans could be just what we need to be better people.

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