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Before and after: See how ChatGPT helped local doctors make medical forms easier to understand

Dr. Rohaid Ali, neurosurgery resident at Brown University, conducted a study on how GPT-4 can effectively simplify medical consent forms for the average American.Matthew J. Lee/Globe Staff

It’s something all future doctors learn in medical school: how to communicate informed consent to patients. Yet medical forms are littered with impenetrable jargon, making it hard for lay people to understand exactly what they’re signing up for.

Dr. Rohaid Ali, a neurosurgery resident at Brown University in Providence grew fed up with the forms and enlisted ChatGPT, a language model-based chatbot developed by OpenAI, to help translate them into regular English.

Working with colleagues at Brown, Massachusetts General Hospital, Brigham and Women’s Hospital, and others, Ali collected medical consent forms from hospitals across the country, pasted them into GPT-4, the latest public version of the program, and prompted it to create simplified versions. Fellow medical professionals and medical malpractice attorneys reviewed the results to judge whether the content remained legally and medically accurate. The researchers posted their results, which are under peer review at a medical journal, to the medical preprint database MedRxiv.org.

“Our hope is that this makes it so that consent forms read less like terms and conditions statements and more like how they should read for someone who is entrusting their lives in doctors’ hands,” Ali said.

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Original: "I agree to have additional procedures if, during the Procedure, my Surgeon decides they are needed for reasons not known before the Procedure. I also authorize my Surgeon to provide or arrange for the provision of additional services, as necessary or advisable, including but not limited to, pathology and radiology services."

GPT-4: If the Doctor thinks I need more procedures during the Treatment, I agree to have them. I also let the Doctor get other services for me if needed, like tests and imaging.

Source: Bridging the Literacy Gap for Surgical Consents: An AI-Human Expert Collaborative Approach," by Rohaid Ali, MD, et al

Most Americans read at an eighth-grade level according to a study published in the New England Journal of Medicine. However, Ali and his colleagues found that medical consent forms created by doctors are often tailored to fellow medical professionals and college freshman-level readers.

In 1980, the New England Journal of Medicine published a call to action for improving the readability of surgical consent forms. “Thousands of persons may be undergoing surgery each year on the basis of inadequate consent,” the piece argued. More than 40 years later, incomprehensible forms persist across medical specialties.

James Zou, an assistant professor of biomedical data science at Stanford University who was not involved in the research, said that Ali’s study is the first he’s seen that uses ChatGPT to make medical consent forms more accessible. He said it was an effective demonstration of how to leverage ChatGPT to help patients.

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“This would broadly benefit the patient population, especially patients who may not have the technical knowledge to fully understand all the jargon in consent forms,” Zou said.

To conduct his research, Ali collected standard surgical consent forms from 15 teaching hospitals across the country. Some of these were generic and some detailed surgical treatments for specific operations such as appendectomies.


Original: "If procedural sedation will be used during this procedure, I understand that this sedation has risks. My physician has discussed the use of procedural sedation."

GPT-4: "If I need medicine to make me sleepy during the procedure, I know that there are risks. My doctor talked to me about using this medicine."

Source: Bridging the Literacy Gap for Surgical Consents: An AI-Human Expert Collaborative Approach," by Rohaid Ali, MD, et al

The original forms were word-heavy, and the words were character-heavy. For example, one original consent form reads: “I agree to have additional procedures if, during the Procedure, my Surgeon decides they are needed for reasons not known before the Procedure. I also authorize my Surgeon to provide or arrange for the provision of additional services, as necessary or advisable, including but not limited to, pathology and radiology services.”

ChatGPT translated that to: “If the Doctor thinks I need more procedures during the Treatment, I agree to have them. I also let the Doctor get other services for me if needed, like tests and imaging.”

Compared to the original consent forms, Ali found the GPT-4-generated forms used significantly fewer characters and words, decreased reading time from 3.26 minutes to 2.42, and had fewer sentences written in the passive voice — indicating more clear, direct language.

The AI-produced forms were reviewed by medical authors and malpractice defense attorneys, who unanimously found that their content was comparable to that of the originals and met the same legal standard.

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Ali instructed GPT-4 using the prompt, “While still preserving the same content and meaning, please convert to the average American reading level.”


Original: "I also consent to the administration of anesthesia, (including but not limited to general anesthesia, spinal anesthesia, and/or major regional anesthesia), intravenous procedural sedation, and/or the intravenous or intraductal injection (or administration by any other route) of a contrast material, as determined by my physician/surgeon or his/her qualified designee"

GPT-4: "I also agree to receive anesthesia, sedation, and/or contrast material as decided by my doctor or their qualified helper"

Source: Bridging the Literacy Gap for Surgical Consents: An AI-Human Expert Collaborative Approach," by Rohaid Ali, MD, et al

Humans would still be ultimately responsible for the forms’ accuracy.

Ian Connolly, a neurosurgery resident physician at Massachusetts General Hospital who worked with Ali on the study, said that sometimes AI can “hallucinate” and produce information that is incorrect but sounds true because it is written with such conviction.

“You need pretty close human oversight, because the models can hallucinate and it’s quite frightening,” Connolly said.


Original: Material risks of the procedure include, but are not limited to: DEATH, RESPIRATORY ARREST, CARDIAC ARREST, BRAIN DAMAGE, DISFIGURING SCAR, PARAPLEGIA OR QUADRIPLEGIA, PARALYSIS OR PARTIAL PARALYSIS, LOSS OR LOSS OF FUNCTION OF ANY LIMB OR ORGAN, SEVERE LOSS OF BLOOD, ALLERGIC REACTION AND INFECTION

GPT-4: The main risks of the procedure can include, but are not limited to: DEATH, BREATHING STOPPAGE, HEART STOPPAGE, BRAIN DAMAGE, UGLY SCARS, PARALYSIS OF HALF OR ALL BODY, LOSS OF USE OF A LIMB OR ORGAN, HEAVY BLOOD LOSS, ALLERGIC REACTION, AND INFECTION.

Source: Bridging the Literacy Gap for Surgical Consents: An AI-Human Expert Collaborative Approach," by Rohaid Ali, MD, et al

Informed consent is a process, and Ali said the form is just one part of it. Even if AI-generated consent forms are implemented industry-wide, physicians will still need to verbally ensure their patients understand their care.

“A truly informed consent process will still include a conversation,” Ali said. “It’s up to the physician to ensure that their patient understands and can articulate back the risks of a procedure.”

Ultimately, Connolly said he envisions a world where patients can use AI chatbots to receive medical information in plain English, and physicians could use it to generate diagrams that visually communicate medical information to patients.

“The study represents the tip of the iceberg because there is a lot of important content that needs to be explained in the form of consent,” Connolly said. “But as a resident, we rely on face-to-face conversations, and I don’t think this will replace that.”

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Ali is now working with various health care systems to deploy these simplified consent forms and has received a lot of interest from hospitals. And beyond consent forms, Ali said that he hopes this study can inspire professionals across the health care industry to use GPT-4 to create readable copy that is accessible to the average American.

“We know from years of research on this concept in health literacy that the less that a patient is informed, there is a greater chance that there will be poor outcomes associated with those patients,” Ali said. “The more we can empower patients to make their own health decisions, the less of a burden there will be, and they will be inspired to make more informed decisions in their life.”


Maggie Scales can be reached at maggie.scales@globe.com. Follow her @scales_maggie.