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Breast Cancer ScreeningWalz’s MisstepsMental Health Support for Schoolchildren
To the Editor:
Re “ChatGPT’s Bedside Manner Is Better Than Mine,” by Jonathan Reisman (Opinion guest essay, Oct. 9):
Dr. Reisman notes that ChatGPT’s answers to patient questions have been rated as more empathetic than those written by actual doctors. This should not be a call for doctors to surrender our human role to A.I. To the contrary, we need to continue to improve our communication skills.
For the past 25 years, I have been facilitating seminars in doctor-patient communication. The skills to communicate bad news listed by Dr. Reisman are exactly the techniques that we suggest to our medical students. However, doctors can avoid the temptation to surrender their “humanity to a script” as if it were “just another day at work.”
Techniques are a valuable guide, but the real work consists of carefully listening to the responses and their emotional content, and crafting new words and phrases that speak to the unique patient’s confusion, fear and distress.
In my experience, patients know when we are reciting a script, and when we are paying attention to their thoughts and feelings. Unlike A.I., and especially when conversations are matters of life and death, we can reach into the depths of our humanity to feel and communicate empathy and compassion toward our patients.
Neil S. ProseDurham, N.C.
To the Editor:
Mention the words “A.I.” and “doctoring” to most physicians in the same sentence, and the immediate reaction is often skepticism or fear.
As Dr. Jonathan Reisman noted in his essay, A.I. has shown a remarkable ability to mimic human empathy in encounters with patients. This is one reason many practicing physicians worry that A.I. may replace doctors eventually.
At the Geisel School of Medicine at Dartmouth, we feel differently. We believe that A.I. can assist and improve, not replace, essential doctoring skills.
Medicine has always been an apprenticeship, but with busy clinicians having less time to mentor, innovative technology can be leveraged to bridge this gap. Our medical students can practice their communication skills with an A.I. Patient Actor, even for difficult conversations like breaking bad news.
A.I. allows them to rehearse these sensitive scenarios in a safe environment, while receiving immediate, personalized feedback to help them improve before they engage in real-life patient interactions.
We believe that A.I. can never replace the empathy of a human. The therapeutic effects of empathy arise only from human connection, trust and shared emotions. Therefore, the human element remains essential to sustaining the healing benefits of empathy in medicine.
Roshini Pinto-PowellThomas ThesenHanover, N.H.The writers are professors of medical education at the Geisel School of Medicine at Dartmouth.
To the Editor:
I rarely have a more visceral response to an Opinion piece than I did to this one. I am a hospice chaplain with 30 years of experience. The notion that one can just find the right words to say and immediately fulfill one’s responsibilities to a patient is a sad result of scientific positivism and its mechanistic view of what it means to be fully human.
I was taught to examine everything about the encounter with the patient and their family from how I entered the room, to how I prepared my state of mind, to my tone of voice, to my posture, to where I stood or sat in the room, to whether I touched them, etc. There is much more going on in a medical meeting than just an exchange of information from one frontal lobe to another.
A robot cannot hold my hand or give me, when it is helpful, a hug. Patients have little desire for the alienation of encountering another medical machine in an environment already filled with dehumanizing medical machines. It might be helpful for the doctor to risk bringing his head and his heart more fully to stressful situations with patients.
(Rev.) Keith A. RaseyToledo, Ohio
Breast Cancer Screening
To the Editor:
Re “The Legacy of Betty Ford’s Breast Cancer” by Barron H. Lerner (Opinion guest essay, Oct. 5):
Dr. Lerner brings needed attention to annual breast cancer screenings, though he downplays their lifesaving potential. “One must screen 750 to 1,000 women throughout their 40s to save just one life from breast cancer,” he writes, without citing the extrapolated benefit at a larger national scale. Using Dr. Lerner’s most conservative estimate (1,000 screens to save one life), screening our 20.8 million American women in their 40s saves over 20,000 lives, a major accomplishment.
Annual breast cancer screening is critical to save lives and improve quality of life for women diagnosed (early or late) with breast cancer. Continued investment in innovation, as well as more accurate and available screening, is proven to save lives. We need to do more!
Fred WalkerWyndmoor, Pa.The writer was a founding member of Curing Women’s Cancer, a nonprofit.
Walz’s Missteps
To the Editor:
Re “Walz Prefers Popular Vote for Electing a President” (news article, Oct. 10):
It looks as if Gov. Tim “Coach” Walz could use some coaching himself about being a helpful running mate. He seems not to realize that since he is a candidate for vice president, his every public statement should be calibrated so as to assist and not hinder the candidacy of Vice President Kamala Harris at the top of the ticket.
Mr. Walz’s unvetted preference for eliminating the Electoral College has been disavowed by the Harris campaign as a counterproductive distraction. This follows soon after his peculiar and unhelpful decision to treat his vice-presidential debate opponent, Senator JD Vance, with gentle civility instead of vigorous criticism for Mr. Vance’s harsh public denunciations of childless women and his inflammatory accusations against legal Haitian residents in his home state.
Add this to Mr. Walz’s careless earlier misstatements about his combat record and being at Tiananmen Square, and one must hope that the Harris campaign will more strongly censor her V.P. pick going forward.
Stanley SpiegelBrookline, Mass.
Mental Health Support for Schoolchildren
To the Editor:
Re “School Absences Rise as Special Education Fails Students, Suit Says” (nytimes.com, Oct. 8):
The article paints an accurate picture of the growing crisis facing our young people. While there are no quick fixes, there are real solutions to the mental health challenges faced by students with disabilities and their families.
The first: Embed robust mental health support in all schools for students and the professionals working with them. The New York Foundling runs several such school-based programs, and we can testify that working with lower-income families means solving problems by leveling the playing field and providing access to care.
Second, all stakeholders, led by the city’s school system and the Administration for Children’s Services, must come together and build a toolbox of practical solutions for families, who should never be left to fend for themselves. A great example of where innovation can take us is A School Without Walls, the city’s first and only truly hybrid school program.
Taking children out of school for home or all-remote schooling should never be a first resort. We can do a better job ensuring that no child’s disability keeps them away from a supportive school environment.
Akeem MarshNew YorkThe writer is the medical director of The New York Foundling’s Home of Integrated Behavioral Health and the vice president of the Vincent J. Fontana Center for Child Protection.
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