Eight common AI-informed encounters with ready-to-use scripts. The pattern throughout: acknowledge the AI, show what you found, explain the gap, teach for next time.
1. Costochondritis confirmation
Patient: 25M, athletic, left chest pain worse with movement. AI said: costochondritis vs anxiety (correct). AI missed: family history (father MI at 52). Your exam: reproducible point tenderness at the costochondral junction, normal cardiac exam.
Script: "ChatGPT got the diagnosis right. Here is what my exam confirms: I can reproduce your pain exactly by pressing here, and your heart sounds perfect. AI for information, me for confirmation." Outcome: reassured, anxiety addressed, appropriate use validated.
2. Pediatric sepsis
Patient: 9-month-old, 102°F fever, mother says "something feels off." AI said: viral illness, antipyretic, fluids, monitor (reasonable). AI missed: lethargy, poor eye contact, subtle distress. Your exam: HR 180, cap refill 3 sec, decreased turgor, lost consolability.
Script: "AI gave reasonable general advice, but your instinct was right. I am seeing signs AI could not: his heart rate is too fast and he is not responding normally. Parental instinct is real data. Never let an algorithm override that." Outcome: admitted, cultures positive for S. pneumoniae, IV antibiotics, full recovery.
3. DKA emergency
Patient: 28F, T1DM, excessive thirst, fatigue, "feeling weird." AI said: adjust insulin, monitor 24 to 48 hours. AI missed: Kussmaul respirations, fruity breath, mental status change. Your exam: deep rapid breathing, acetone breath, mild confusion, glucose 450.
Script: "AI could not smell your breath or see how you are breathing. Those signs, the deep breathing and the fruity smell, tell me this is DKA, not just high sugar. You need IV fluids and insulin now, not an adjustment at home." Outcome: ICU, pH 7.15, treated for DKA, full recovery.
4. Medication interaction: warfarin + turmeric
Patient: 72F on warfarin (INR 2.8), CKD 3b, wants a turmeric supplement. AI said: no significant interactions documented. AI missed: her specific INR, kidney function, individual risk. Your data: already near the upper INR range, reduced clearance.
Script: "AI knows general rules; medicine is individual. Your INR is already high and your kidneys clear things more slowly. Population advice can be dangerous for you specifically. Always check medication questions with us first." Outcome: supplement avoided, alternative pain plan discussed.
5. POTS dismissed as "just anxiety"
Patient: 24F, 4 weeks of palpitations, breathlessness, lightheadedness, 6 weeks post-COVID. AI said: panic attacks (common in young women). AI missed: orthostatic intolerance, post-viral syndrome. Your exam: HR 95 supine to 145 standing, no anxiety on exam.
Script: "When you said this feels different from anxiety, that was important data. AI pattern-matched to anxiety in a young woman. I measured something AI could not: your heart rate jumps 50 points when you stand. That is POTS, not panic." Outcome: POTS diagnosed, salt, fluids, compression started, significant improvement.
6. Melanoma miss
Patient: 45M, changing mole on the back, photo sent to a chatbot. AI said: appears benign, monitor. AI missed: asymmetry, irregular borders, color variation, evolution over 6 months. Your exam: 8mm asymmetric lesion, irregular borders, multiple colors with pink regression.
Script: "Never trust AI for visual diagnosis; photos lose information. Your wife noticed change over months, that is the E in ABCDE. What I see in person is a concerning lesion that needs a biopsy today." Outcome: melanoma in situ confirmed, wide excision, clear margins.
7. Atypical appendicitis
Patient: 22F, 18 hours of RLQ pain, temp 99.1°F. AI said: atypical for appendicitis (no fever), consider ovarian cyst or constipation. AI missed: exam findings and progression. Your exam: positive rebound, guarding, Rovsing and psoas signs.
Script: "AI said atypical because there was no fever, but about 30% of appendicitis has no early fever. What I am feeling, rebound and guarding, tells me your appendix is inflamed regardless of temperature. CT now." Outcome: CT confirmed, laparoscopic appendectomy, uncomplicated.
8. Gabapentin toxicity
Patient: 68F, CKD 4 (eGFR 22), followed an AI dose escalation for neuropathy. AI said: standard 300mg three times daily target. AI missed: severe kidney dysfunction requiring dose reduction. Your exam: somnolent, ataxic, slurred speech, gabapentin level 3x therapeutic.
Script: "AI gave standard dosing, but standard is for average kidneys, and yours are at 22% function. The drug accumulated because it could not clear. Never dose medications based on AI; we need your specific organ function." Outcome: drug held, supportive care, recovered, restarted at a renal-adjusted dose.