After 2 decades of practicing medicine across multiple disciplines and health systems, I’ve witnessed the dramatic transformation of patient-physician interactions, and none more dramatic than what I’m seeing in this era of artificial intelligence (AI) and its impact on cancer care. Early in my career, patients arrived for their appointment armed with questions about their cancer treatment primarily derived from conversations they had had with their family members or from the experiences of their neighbors and friends. Today, patients enter my office with reams of printouts from health-care websites, screenshots from social media platforms like Facebook and TikTok, and detailed treatment protocols generated by ChatGPT.
This shift in how patients are getting cancer information has fundamentally changed how I approach treatment discussions, especially since I work in a resource-constrained environment, in which the gap between online recommendations and available care can be overwhelming. This evolution taking place is particularly striking in oncology.
I remember when breaking the news of a cancer diagnosis meant spending most of the consultation explaining the disease, stage, prognosis, and available therapies. Now, many patients arrive for these meetings having already researched information on their cancer type, survival statistics, and treatments and question why I’m not recommending the latest therapy they read about online.
Overcoming the Challenges Created by AI in the Physician-Patient Relationship
Although we welcome patients becoming well versed in their cancer and active participants in their care, I’ve found that this easy access to AI chatbots and social media platforms does create new challenges in the physician-patient relationship. This dilemma is especially true in resource-constrained settings like Bangladesh, where I practice oncology.
In Bangladesh, the physician-to-patient ratio is extremely low—approximately 5.3 physicians per 10,000 population1—and consultation time to discuss complex and life-threatening illnesses, such as cancer, is often severely limited. In public tertiary health-care settings, with high patient loads, there is often insufficient time to establish a meaningful rapport between physicians and patients. As a result, the development of mutual trust—an essential component of effective care—is frequently compromised.
I’ve found that when patients feel heard, respected, and clearly informed, they are more likely to trust medical advice, follow treatment plans, and engage in shared decision-making.— MUHAMMAD RAFIQUAL ISLAM, MBBS, MD, MsPH, FACP
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In my early years of practice, patients rarely questioned treatment recommendations. The white coat carried inherent respect and authority, and medical advice was generally accepted without hesitation. Although not ideal—patients should be well informed and actively involved in their treatment decision-making—this traditional paternalistic practice had practical advantages in our health-care delivery system. For example, it allowed rapid consultations, enabling physicians to see more patients within limited timeframes. In low-resource settings like Bangladesh, this efficiency made the difference between providing care to many vs the few. The shortage of specialized oncology professionals in limited-resource countries—in Bangladesh, there are only 1.5 radiation oncologists for every 10,000 patients with cancer2—further exacerbates the challenge of delivering timely and quality cancer care to patients.
Building Back Trust in Medicine
The COVID-19 pandemic and the simultaneous rise in AI’s influence on health care have accelerated the erosion of trust in medicine. I have watched long-term patients who had trusted my judgment for years suddenly question my basic medical recommendations. One patient, whom I had successfully treated for breast cancer 3 years earlier, recently came to a follow-up appointment demanding to know why I hadn’t told her about corossol, also known as soursop, an antioxidant that is promoted as an alternative cancer treatment, information she had found on a social media group. The cognitive dissonance was striking, since she had trusted me enough to continue her care but had simultaneously developed suspicion about my recommendations based on online sources.
Most recently, a newly diagnosed patient with lung cancer and her family members arrived at my office with a ChatGPT-generated treatment plan that recommended targeted therapies not yet available in Bangladesh. Her family members were confused and frustrated when I explained that not only were the treatments not available, they weren’t based on the patient’s tumor type and wouldn’t be effective even if they were accessible. The conversation required extensive explanation about tumor genetics, the treatment decision-making process, and the limitations of AI in providing personalized medical advice.
Another patient, diagnosed with pancreatic cancer, had found testimonials online about alternative treatments and questioned why I was recommending chemotherapy when “natural cures” were available. She had read compelling stories about people who claimed to have cured their cancer through diet and supplements alone. Addressing these concerns required delicate navigation between respecting her autonomy and providing evidence-based guidance about a disease with limited treatment options.
These encounters have taught me that dismissing or countering patients’ self-directed research efforts, especially by trying to prove them wrong, is often counterproductive. Initially, when I responded to Internet-sourced information with skepticism or frustration, I noticed patients becoming defensive and less willing to share their concerns openly. Over time, I’ve learned that acknowledging patients’ curiosity and efforts, while gently providing accurate, evidence-based treatment context tailored to their individual medical needs, leads to more meaningful and productive conversations. This approach not only fosters trust but also encourages shared decision-making and strengthens the overall physician-patient relationship.
Developing Practical Strategies Through Experience
Through years of these challenging conversations, I’ve developed specific approaches that have proved effective in my practice. For example, when patients ask, “Why does Google say I should be getting immunotherapy, but you’re recommending chemotherapy?” I begin by thanking them for researching their condition. This acknowledgment immediately reduces defensiveness and shows that I value their engagement in their care. I then explain the concept of personalized medicine using their specific cancer type as an example. For instance, I might say, “The immunotherapy you read about works well for patients whose tumors have particular genetic markers. Your biopsy showed different characteristics, which is why chemotherapy is more likely to be effective for your cancer type.”
I’ve found that this approach educates patients while validating their research efforts and helps restore physician trust. When patients bring information that contradicts my recommendations, I’ve learned to ask open-ended questions about their concerns. For example, “What worried you most about what you read?” or “What aspects of the treatment you found online seem most appealing?” Asking these questions reveals patients’ underlying fears and helps me address specific concerns rather than providing generic reassurances.
Resource limitations in my country present additional challenges in my current practice setting. When patients find treatments unavailable locally or too expensive, I’ve developed ways to discuss these limitations without destroying hope. I explain our local treatment capabilities, discuss possible outcomes comparing the advanced treatment options, and focus on optimizing available therapies. I’ve found that patients appreciate honesty about resource constraints when it’s coupled with advocacy for their care within existing systems.
Establishing Trust in the Digital Age
Establishing effective communication is a precondition for building trust in the patient-physician relationship.3 It requires consistent demonstration of clinical competence, honesty, and genuine concern for patient welfare. I’ve found that when patients feel heard, respected, and clearly informed, they are more likely to trust medical advice, follow treatment plans, and engage in shared decision-making. This foundation of trust is especially vital in settings where patients are vulnerable and seeking both medical and emotional reassurance.
I’ve learned that admitting uncertainty, when appropriate, actually strengthens—rather than weakens—patient confidence. When a patient asks about a treatment I’m unfamiliar with, I tell her I’ll research it and follow up—then ensure that I do so. This transparency shows I am willing to learn and consider new information. Explaining my decision-making process also helps patients understand why I’m making specific recommendations. For example, rather than simply stating, “You need chemotherapy,” I explain how I arrived at that conclusion based on test results, medical history, and current evidence. This comprehensive approach helps patients become educated partners in their care rather than passive recipients of medical advice, especially in this digital era.
Developing New Skills in Digital Literacy
Working in a resource-constrained environment like Bangladesh requires continual adaptation and learning. I’ve had to develop new skills in digital literacy, especially as more patients bring health information they’ve found online, often without knowing how to judge its accuracy. I now make it a point to ask patients where they found their information and gently guide them in evaluating the credibility of different websites or social media sources.
The challenges we face, ranging from mistrust to misinformation, are too systemic for individual solutions. They need a comprehensive, context-sensitive response from policymaking authorities and service providers.— MUHAMMAD RAFIQUAL ISLAM, MBBS, MD, MsPH, FACP
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In low- and middle-income countries, where health-care systems are often overburdened and access to reliable health information is limited, professional development becomes even more critical. I actively seek out workshops on effective health communication, stay updated on emerging misinformation trends, and collaborate with colleagues to share approaches for handling complex patient interactions.
The challenges we face, ranging from mistrust to misinformation, are too systemic for individual solutions. They need a comprehensive, context-sensitive response from policymaking authorities and service providers.
Addressing the Challenges of Misinformation: A Call to Action
To address the pressing challenges of misinformation, mistrust, and health-care disparities in low-resource settings like Bangladesh, policymakers and health-care professionals must act with urgency, unity, and purpose. To accomplish this goal, a multipronged approach is essential, including the following steps:
- Strengthening communication skills by providing targeted training in health literacy, digital competency, and culturally sensitive patient engagement, enabling physicians to respond effectively to the evolving needs of informed and diverse patient populations;
- Developing accessible, evidence-based cancer awareness campaigns that are grounded in local languages and cultural contexts, ensuring communities are meaningfully engaged and empowered to make informed decisions about their health;
- Fostering collaboration across institutions and specialties to share effective strategies, build professional solidarity, advocate for stronger health policies, and work collectively to expand equitable access to cancer treatment;
- Enhancing transparency and trust by openly discussing treatment goals and limitations, acknowledging medical uncertainties, and validating patients’ emotional and spiritual concerns rather than dismissing them—laying the foundation for a more compassionate, responsive health-care system.
DISCLOSURE: Dr. Islam reported no conflicts of interest.
REFERENCES
- Mohiuddin AK: An extensive review of patient health-care service satisfaction in Bangladesh. Adesh University J Med Sci Res 2:5-16, 2020.
- World Health Organization: Cancer Bangladesh 2020 country profile. January 1, 2020. Available at www.who.int/publications/m/item/cancer-bgd-2020. Accessed August 8, 2025.
- Honavar SG: Patient-physician relationship—Communication is key. Indian J Ophthalmol 66:1527-1528, 2018.
Dr. Islam is Assistant Professor and clinical researcher in medical oncology at the National Institute of Cancer Research & Hospital in Dhaka, Bangladesh, as well as a postdoctoral scholar at the Institute for Population and Precision Health at The University of Chicago.
