Loneliness as a health risk, Artificial Intelligence and empathy, the impact of menopause on employers, and virtual care and emergency department visits.

May 5, 2023

Happy Friday!

Today, I’ll review the Surgeon General’s recommendations to employers to help counter loneliness, report on a study that showed that an AI chatbot offered better answers and more empathy than physicians, discuss a study of lost work time due to menopausal symptoms, and share data showing that the patients of physicians who offered more virtual care were less likely to seek emergency room care.

1.     Surgeon General promotes improved social connectedness to address loneliness

Vivek Murthy discovered that he was profoundly lonely during his first stint as Surgeon General in the Obama Administration. He wrote a book about loneliness while out of office, and he is back as Surgeon General with an advisory that includes comprehensive review of current data and recommendations for many stakeholders, including employers. This advisory was released this week, appropriate for the first week of National Mental Health Awareness Month.

Some important observations from this publication: Americans are clearly lonelier than they were in the past.  We spent 12 hours more by ourselves each month in 2019 compared to 2003 (up from 143 hours to 155 hours). This got worse still in 2020, but that could be blamed on the pandemic. Almost half of Americans (49%) reported having three or fewer close friends in 2021, up from 27% in 1990.  Marriage rates and family size are down, and only 16% reported that they felt “very attached” to their local community in 2018. Social isolation is more common in those with chronic illness including mental illness and those with lower income.

Loneliness is also bad for health. Those who suffer from loneliness have higher overall mortality rates.  The risk of heart attack in those who reported high rates of loneliness is 29% higher, and the risk of stroke is 32% higher. Those with heart failure who are lonely are more likely to have hospital admissions.

Here are Murthy’s recommendations for employers.

-        Make social connection a strategic priority

-        Train, resource and empower leaders to promote connection in the workplace

-        Leverage existing leadership and employee training and resources to educate about the importance of social connection

-        Create practices and a workplace culture to promote connections, inclusion and belonging both inside and outside of work.

-        Implement policies that protect workers’ ability to nurture relationships outside of work

-        Consider opportunities and challenges associated with flexible work hours and remote and hybrid work.

2.     AI Chatbots gave better answers and were more empathic than human physicians

Researchers in JAMA Internal Medicine sought to answer whether artificial intelligence (AI) chatbots did better or worse than human physicians in answering five standardized questions via text messages. The AI chatbots won, and it wasn’t close.

The researchers evaluated five questions that they gathered from Reddit’s r/AskDocs and compared the answers given by verified physicians on that website to answers provided by ChatGPT. Each answer was evaluated independently by three licensed health care professionals. The evaluators preferred the medical answer provided by AI in for four of the five questions, and felt the Chatbot exhibited more empathy than the physician in all answers to all five questions. 

This is a tiny study, but it’s getting substantial press attention. The physicians were answering questions on a website, not caring for patients. They had no relationship to those posing questions and received no compensation. I’m sure researchers will seek to replicate this study, hopefully with a larger range of questions and with physicians in a practice setting.

There are many problems with using AI to answer patient questions, including that AI sometimes invents answers that are unequivocally wrong. But machine learning allows AI to get better continually, so we should expect AI answers to get better over time. Artificial intelligence trained on data that includes the results of longstanding structural racism could provide answers that inadvertently increase disparities, so those developing AI programs should assess the impact of AI programs on disparities.

Why did the chatbot outperform physicians in this small study? The physicians offered short answers that directly addressed the stated question but provided little context. The physicians also didn’t validate the questioners’ concerns, and some of their answers were dismissive.  Chatbots don’t get tired or angry, and they don’t get post-traumatic stress disorder themselves from listening to what patients are facing.   

AI is already being used by the majority of HR departments as well, according to this 2022 survey. As AI becomes more sophisticated, it will be integrated into more business and health functions.

Implications for employers:

-        It’s likely that AI will allow an increase in scale and lower costs for addressing member health concerns over time, although no one should expect AI to replace physicians

-        Many vendors are building AI into their systems - and employers should be sure these programs include appropriate oversight and systematically screen for false answers and inadvertent discrimination.

3.   Menopause symptoms lead to $1.8 billion in lost working time

Researchers at Mayo Clinic reviewed survey results from about 4400 women ages 45-50 and found that many of these women reported menopausal symptoms that interfered with their lives and work. Thirteen percent reported at least one adverse work outcome due to menopause symptoms, and 11% reported missing a median of 3 days of work in the last year. Five percent said they cut back on hours in the last 6 months, and 1% said that their symptoms were so severe that they quit or were laid from their jobs. The respondents were disproportionately white (93%), married (77%) and college graduates (59%). The authors extrapolated this work absence to a loss of $1.8 billion in productivity annually. 

Implications for employers:

-        Health plans and other vendors are increasingly adding offerings specifically targeted to women in menopause.

-        Employers, and especially supervisors should be sensitive to the fact that many women who are going through menopause are reluctant to discuss their symptoms and needs and should be aware of some accommodations that can support women in menopause, ranging from fans to cool down an office to flexible work arrangements.

-        Sensitivity to these issues can help companies retain especially valuable employees, and employers must follow all applicable antidiscrimination laws.

4.     Patients of physicians who offered more virtual care had fewer emergency department visits

A cross-sectional study of 3,820 family physicians covering almost 13 million patients in Canada looked at the correlation between virtual primary care visits and ER utilization. Data was collected from February to October, 2021 during which time between 40% and 80% of care was delivered virtually. Researchers found the mean number of ED visits was highest among patients whose physicians provided only in-person care (470 per 1000 visits) and was lowest among patients of physicians who provided 80-100% of care virtually (242 per 1000 patients) and periods with high ED utilization did not correlate with periods with increased virtual care use.

This study was performed during the Omicron wave of COVID-19, and in Canada, so its results might not be exactly applicable to other locations and times.

Source: Kiran, et al JAMA Network Open, April 28, 2023 LINK

Implications for employers:

●      Virtual care grew during COVID and is here to stay so employers should make sure that their carriers and vendors can support this modality,

●      This study suggests that there's no additional ED utilization with higher virtual care, but the data is mixed on impact of virtual care on total cost of care

●      Employers should monitor the impact of virtual care on total cost of care as practice patterns re-align and the pandemic continues to recede.  

Thanks to my WTW colleague Meg Bracht, MPH who wrote #4.

Hope all have a great weekend when it comes!

Jeff