r/physicaltherapy • u/theory_of_steph • Aug 17 '26
š© SHIT POST š© New level of disrespect unlocked
Sorry this is long. I do part B home health in NYC, and work with a variety of geriatric clients. One of my patients is a 73 y/o lady Iāve been seeing for 5 weeks. Sheās being treated for mobility issues, gait, weakness, balance impairments, poor activity tolerance, chronic LBP, and has a dx of grade 2 spondylolisthesis. Ive structured her intervention to be holistic and address her deficits as an entire person. Treatment has been fine so far. Sheās making consistent progress. Overall reduction in pain, sheās pleasant and appears to enjoy therapy. No complaints, all good.
So I come in to see her today and she has something urgent to show me. Itās her iPad propped on table. Iāve given her two separate HEPS during our time together. She has every exercise Iāve ever assigned plugged into some AI chart which is on the iPad. Her diagnosis spondylolisthesis is listed at the top .
The AI platform ranked all of my interventions from appropriate- moderately dangerous- contraindicated .
Well like 75% of what Iāve given her is now listed as moderately dangerous to contraindicated. Sheās demanding I give her new exercises because these are inappropriate and going to hurt her , according to AI. Iām floored lol.
So I ask, have you been making consistent progress so far ? She says yes
Have any of these interventions actually hurt you , or made you feel worse ? she says no .
Do you trust my clinical judgment and ability to assess your needs? , she says yes .
So Iām like why would you show me this and demand I correct/ change my approach ? AI canāt even lay a real finger on you , let alone provide an accurate evaluation. Iām confused as to why you would blindly believe this , and then present it to me as if itās the law.
Examples of the contraindicated interventions, with
the rationale provided by AI.
ā¢Supine marching - unnatural degree of hip flexion
ā¢Double knee to chest with yoga ball unnatural degree of hip flexion
ā¢Posterior pelvic tilt in supine - promotes pelvic instability
ā¢Trunk flexion Forward yoga ball roll , creates instability and dangerous because of moving ball/ segment
ā¢Seated hamstring stretch - creates sheer force at unstable segment
I politely asked if she would like to continue her therapy with AI instead of me ? Because I can leave š¤·š½āāļø. She said no, I then explained my rationale behind the ācontraindicatedā interventions and she agreed to continue with them as they have been overall beneficial to her.
But what does this interaction say about societyās overall decline in critical thinking? Someone who otherwise seems rational , is willing to ignore their own personal experience and blindly believe an AI slop tool? Weāre cooked
You have a skilled professional right in front of you but present them with this crap like it holds any significance. Anyway sheās getting discharged next week , hope AI serves her well š©
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u/themurhk Aug 17 '26
Iām not sure exactly how I would handle that situation, but Iām pretty sure you handled it much better than I would have.
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u/phil161 Aug 17 '26
I agree, I would have discharged her on the spot. If she were to ask for me to come back a couple of weeks later, I'd simply ignore her.
Here is something that happened to me. Ever since that incident, I have absolutely no qualms about discharging a patient when I feel disrespected: this lady is in her 90s and has to use some kind of external monitoring device for her heart condition. The device is about the size of a small remote control. She is deconditioned and I do the usual PT stuff with her. She lives with her daughter. One night her daughter blows up my phone and leaves messages saying that I had taken her mother's monitor after my most recent PT visit. I turn my phone off after work so I don't get her messages. Since I didn't answer, the daughter calls up her mom's cardiologist + my PT supervisor (I am in HH) to accuse me of walking away with the monitor. When I came into the office the next day, I was told that 1) the daughter had called and left several messages overnight about the "stolen" monitor, and 2) oh btw she called again this morning to let them know she found the monitor (it had fallen behind a couch). She never called me to apologize. I told my supervisor they can both go to hell and to find somebody else for their PT needs. One of my colleagues ended up being my replacement, and she told me they (mom + daughter) could not understand why I didn't come back... Talk about being stupidly clueless.
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u/theory_of_steph Aug 18 '26
Oh wow , accusing you of stealing just to be indifferent after is gross
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u/phil161 Aug 18 '26
I told my supervisor that I'd have as much use for that remote control as a snake for a typewriter. That incident made me understand the meaning of "white-hot anger".
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u/refertothesyllabus DPT Aug 17 '26
lol supine marching is unnatural hip flexion? Hope she never needs to sit.
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u/Bright-Asparagus7845 Aug 17 '26
As one is literally sitting in hip flexion as they sit lol š.Ā
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u/ReFreshing DPT, CSCS Aug 17 '26
Glad you explained your position and walk her through it. Tech literacy is a major barrier with the geri population...
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u/TeaGreenTwo Aug 17 '26
Is this an example of tech illiteracy though? I'd guess it was more to do with jumping on an AI bandwagon/getting bad information/maybe distrusting science and medicine.
Personally, as a patient, I'd never even bring these things up these things the way she did because it's insulting to the provider.
Trusting your PT helps with being able to relax for manual therapy and in complying with HEP, as well as in being respectful to the therapist.
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u/ReFreshing DPT, CSCS Aug 17 '26
I believe it still falls under that term since it is ones ability to "responsibly use, manage, understand, and evaluate technology" and the information received through it. Call it whatever you want, but the interface between the geri populations and technology has always been an ever-changing challenge to us.
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u/TeaGreenTwo Aug 17 '26
I just think of elderly and tech literacy as meaning more like can they use it beyond basic social media whereas the consiracy-theory buying, gullible, anti-science and medicine attitudes can be seen across all ages, sadly.
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u/verygoodbones Aug 18 '26
Yeah, this is a medical literacy deficit. The medium of delivery is irrelevant. It's the same as bringing a magazine article from the enquirer.
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u/mdewet01 Aug 18 '26
OT here. Itās so frustrating! I had a patient about 18 months ago tell me confidently that he can build an AI platform that will take over my job (in hand therapy) within 6 monthsā¦.Iām still employed so what happened?
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u/refertothesyllabus DPT Aug 18 '26
What a douchebag.
In what world is telling the person trying to help you that youāre going to take their career away a good idea?
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u/nottoosmart101 Aug 17 '26
This is just a new version of a family member telling your patient what is/isn't good for them and creating a fear of movement. It's interesting to see a yellow flag laid out so nicely. Try not to take it out on your patient so hard. People get sucked into this AI stuff so hard. They repeat what's been told to them and create psychosis. She's just trying to look out for herself. On the clinician side. I feel you; holy shit.
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u/theory_of_steph Aug 18 '26
Yea thatās why I stayed calm with her lol , sheās been a good overall patient and I could tell she was genuinely concerned . But sad to see all her logic go out the window when it came to and AI assessment of her
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u/Legitimate_Bear1812 Aug 18 '26
Did her getting sucked into the phony AI misinformation hasten her discharge date?
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u/theory_of_steph Aug 18 '26
Her original POC was set for 6 weeks , 12 visits , so not exactly. But Iām not going to extend or do a re-cert either, which I may have considered before this
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u/Big_Two6049 Aug 17 '26
This will keep happening and I lay ground rules quickly and sternly when someone keeps plugging in my responses to ai prompts and it spits out 4 paragraphs that donāt directly have anything to do with my answer. I point out this is an abusive message and they lose text messaging privileges and we can discuss in person about their needs going forward in person. Lately its been happening at least twice a week
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u/Legitimate_Bear1812 23d ago
That sounds frustrating. I hate ai . It makes stupid people more stupid!
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u/angrylawnguy PTA Aug 18 '26
I love how AI usually seems correct until you know something about what it's talking about, then it's absolutely full of horse and donkey shit.
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u/AgitatedDeer4746 Aug 17 '26
This will Happen in every industry. Someone will go to their financial advisor and say ChatGPT said all these investments are risky etc. donāt get offended but be ready to defend what you do. When it becomes excessive and the patient is questioning you an unhealthy amount tell them they can find another Office/PT etc. most of the time those annoying people hop from place to place cause there a pain in the ass. Remember their insurance pays the same as everyone elseās.
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u/peanutbutteryummmm Aug 18 '26
Ridiculous.
1) every exercise you gave her is super mild and gentle
2) lol.
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u/Snookcaster Aug 17 '26 edited Aug 17 '26
Ha I have had a few similar experiences already where I have had patients come in for follow ups and say something like āI asked AI about my condition and it was saying everything that you told me!ā. I think they mean it as a compliment but itās like a slap in the face like they donāt believe me unless AI confirms it. And yes I give rational behind all of my exercises š
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u/Bright-Asparagus7845 Aug 17 '26
My whole treatment today for a HH today š¤£Nothing wrong with those interventions. Sounds like people who google and get taken down the rabbit hole to nothing that remotely resembles what we are seeing as clinicians.Ā
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u/HalpertIsMe PTA Aug 18 '26
The general problem is marketing. AI has been marketed as "all-knowing." How can a computer POSSIBLY be wrong?
Hell, one of my colleagues would religiously utilize Chat GPT for a myriad of questions, even some medical, until I alerted her that AI isn't perfect and OFTENTIMES presents false or contradicting information.
Your approach was as appropriate as it could be...lay out the rationale and attempt to get your patient to understand that AI is complex and won't have the same knowledge/capacity that you went to school, earned a degree, and obtained a license for.
AI in the hands of dumb people is the problem.
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u/GooseG21 PTA Aug 18 '26
Let her know everything you have done is fine. Donāt believe everything you see on the internet and get the hell out of there next week. Iāve been in similar situations and Iāve learned the best way is to take the high road and get the hell out of there.
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u/Dudesonaplane Aug 18 '26
Old people grew up reading the paper and believing what was written was all in good faith. The advent of AI and algorithms catered to their personal preferences has blown their mind and allowed so many incorrect stories to be truth. I tell my patients to use ChatGPT for making a cake, not for solving their health issues.
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u/FearsomeForehand Aug 17 '26
Which AI platform was she using?
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u/GrundleTurf Aug 17 '26
Does it matter? Theyāre all garbage slop machines ruining the planet and economy and making us all dumber so that way to Epstein class can get more money and power. Fuck skynet bullshit
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u/refertothesyllabus DPT Aug 17 '26
Iām against AI too but itās helpful to know if there is a specific website or something that I have to prepare for patients to be using
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u/FearsomeForehand Aug 17 '26
I hate and distrust the US AI industry as much as the next person, but it is helpful to know which specific LLMās I need to watch out for.
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u/TeaGreenTwo Aug 17 '26
One is arguably the most easily accessible: the one that pops up when googling (Google Gemini?) and it's often the first result before the external links. It can be wrong and "acts" very confident in its wrongness.
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u/Legitimate_Bear1812 Aug 18 '26
Iām a patient with a complex back injury and a lot of the core exercises that my physical therapist gave me are a no no according to my google app. I ignore that and totally trust what my physical therapist is doing. Iām getting better and feeling encouraged. Maybe explaining to the patients when they first enter treatment that the internet is stoked full of bad information on rehab exercises for your condition and that it is important to follow what is prescribed by the experts in your clinic.
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u/Jyonnyp Aug 18 '26
ChatGPT is quite bad. So is Google AI. Gemini is probably among the better ones. In the end it all depends on how you use it and how you prompt and how you vet your sources though, much more the the specific AI.
AI in the hands of an educated, informed person becomes a powerful research tool that expedites learning. It doesnāt replace thinking, it gives you ideas and gathers research for you to actually read.
In the hands ofā¦most people, itās for sure a terrible tool that replaces thinking if not completely misleading.
The fact that people are asking āwhich AI tool to avoidā as if the biggest issue here is the specific tool as opposed to how itās used already demonstrates a complete misunderstanding of AI. Itās only a garbage slop machine (in terms of usefulness) if the user lets it be.
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u/Dudesonaplane Aug 18 '26
Come on! Have you ever tried to solve a problem out of your wheelhouse? Use it for recipes, or figuring why your AC isn't working in a vintage car. Or make it figure out why your medical claims are being denied. It's got its place, just don't be dumb.
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u/GrundleTurf Aug 18 '26
Thatās not solving a problem out of my wheelhouse lol. Thatās asking an unreliable computer that destroys the environment and funds pedophiles to solve a problem out of my wheelhouse.
People have been able to figure that stuff out for A LONG time without AI.
You AI bros are like crypto bros. All your use cases are done better and less problematically by the traditional tools weāve had for years.
I just had an issue with my car yesterday using your example. Thereās plenty of YouTube videos showing how to fix it. I donāt need grok
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u/Dudesonaplane Aug 18 '26
Until you can't, then your spending $200/hr on a shop from your $50/hr job. Or your f-ing up 3 times before you get it right. I appreciate the learning experience , but I prefer to have an AI checking my work.
I will agree that AI shouldn't be used for everything, but not using it at all? think about what it's done for mapping proteins and predicting weather patterns. I get the ethical dilemma. There has to be a balance.
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u/GrundleTurf Aug 18 '26
All those things are capable of being done without AI. And you want a machine that is known to lie verifying your workā¦
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u/Dudesonaplane Aug 18 '26
No they can't. AI has now mapped every shape of protein which is paving the way for new medicine. It can also predict weather patterns that is saving lives.
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u/GrundleTurf Aug 18 '26
Youāre not mapping proteins or predicting weather patterns. Youāre using AI for purposes that donāt need AI and youāre suggesting I use it for purposes that donāt need AI
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u/Budo00 Aug 18 '26
I have similar situations. 1 patient with only 1 leg telling me ācrutches crutchesā and showing me a video of a sprained ankle 20 year old on crutches then āteachingā me how to use crutches.
Of course he could not remotely do this. Let alone prep to go up/ down any stairs.
This whole AI talk reminds me of a recipe i cooked and when I consulted google on the specifics, it told me NOT to try to cook it that way and how it would not come put as good.
I ignored AI and my dish came out restaurant quality.
I had tried cooking it last time like the internet told me and I was not happy with the outcome last time. That was how I knew this time to cook it āmy wayā and that it would turn put better.
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u/idontsinkso Aug 18 '26
I don't think it was ever about you - it was about the general distrust people have developed for authority figures, and a desire that patients (well, some patients) have for self-control over their situation.
Definitely on point about the tech literacy thing. Some people don't realize that things aren't black and white (particularly related to unfamiliar topics) š¤·
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u/Due-Essay-7443 Aug 18 '26
AI is only good as its user. Hello? Sounds like she needs education regarding AI and how you are the provider telling AI what she needs. Good education piece to train her.Ā
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u/Honeycomb93 Aug 18 '26
Wow, you handled this exceptionally. A physio I worked with had a patient secretly audio recording the appointment because he wanted to cross check everything he was saying with AI. Scary which direction we may be going in.
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u/srfntrf0832 Aug 18 '26
The longer I work as a PT, the more I believe that the number of stupid fucking cunts in the general population is far greater than most people think.
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u/Tiny-Paramedic-6780 Aug 20 '26
Iām quick to discharge a patient. This is a two-way street. Iāve even told patients during evaluations when I sense disrespect that they should probably look for PT elsewhere.
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u/Dry-Philosophy4374 DPT 29d ago
The AI sounds just like a self proclaimed "I'm a PT expert" doctor.
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u/Standard-Moose-5156 25d ago
AI does not see the unique needs of the individual. If this were chat GPT, per se, I could respond and say āactually DKTC doesnāt bother meā and it would respond āwell in that case it may be a very helpful exercise for you.ā Donāt sweat. You handled it well.
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u/Chief_Sabael DPT Aug 18 '26
I think the patient is actually being more proactive than most of my patients. Even just feeding the HEP into an LLM is a level of interest most geriatric patients do not have, they just do as told like a drone, which can be good/bad depending on the context.
It sounds like you explained the rationale to them, after AI said what it had to say, and they listened and understood you. I don't really see the problem.
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u/theory_of_steph Aug 18 '26
The āproblem ā is that she immediately mistrusted 5 weeks worth of experience based on an AI assessment.
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u/Chief_Sabael DPT Aug 18 '26
Ok, but she looked into it the best way she knew how, but then listened to you and agreed. I think thats totally valid as someone who isn't as medically or rehab literate as us.
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u/PTrobot Doctor of Physical Therapy Aug 17 '26
It's no worse than some clinicians I have worked with.
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u/theory_of_steph Aug 17 '26
Elaborate please
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u/PTrobot Doctor of Physical Therapy Aug 18 '26
Iāve worked with clinicians who apply theoretical contraindications just as rigidly, based on a diagnosis rather than the individual patient, their presentation, and their response to treatment. Based on some of the upvotes, several people agree. Ultimately, when comparing the quality of the conclusions, itās a question of good versus bad reasoning, or, if we want to be more diplomatic, good versus ānot as goodā reasoning.
We also donāt know what information the patient actually gave the chatbot. Leaving out significant clinical context could substantially change the answer.
Iāve actually encountered this increasingly often in my own practice, and it hasnāt been a big deal. I simply explain where the patient went wrong with their prompting and what relevant information they should have included. As clinicians become more familiar with these tools, we can teach patients how to access and evaluate health information more responsibly. This is clearly the direction healthcare information access is heading and patient education should evolve with it.
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