Trisha and Cooper Fishbein, witnesses to Dr. Fishbein’s vertigo experience that led her to ChatGPT. Photo courtesy of Dr. Fishbein.
By Bethany Fishbein, OD
March 5, 2026
I was in bed ready to fall asleep a few weeks ago when the mattress suddenly fell off the bed frame—or maybe the whole frame broke—or maybe there was an earthquake. It happened too quickly to tell.
But something major was definitely happening because I was suddenly thrown to one side of the mattress and had to grab on to whatever I could to avoid falling off the bed completely. As my brain struggled to figure out what was happening, the bed continued to rock, like a small boat in suddenly rough waters.
Interestingly enough, the pillows were all in place and nothing else seemed out of order. The dogs were happily snoozing at my feet and seemed completely unaffected by the bed’s movement (they’re old, but not so old that they wouldn’t notice the bed falling out from under them).
As the rocking began to subside, I started to realize that nothing was actually moving. What I was experiencing must have been the thing I had heard so many patients describe over the years: vertigo.
TURNING TO TECHNOLOGY
I was home alone and did what seemed natural in the moment—I grabbed my phone and started a conversation with ChatGPT.
It was very reassuring. After hearing my symptoms (and making sure to clarify that it wasn’t actually a doctor and couldn’t diagnose me), it suggested the most likely diagnosis of BPPV, benign paroxysmal positional vertigo. It assured me this was probably fine. There was advice on what symptoms and red flags to look for to know if I needed urgent medical care.
One red flag was difficulty walking after symptoms subsided, so as I stumbled to the bathroom I got concerned. I reconsulted ChatGPT, and with its stern reminder that although things are probably fine, there was enough risk to make it worth getting checked out… I headed to the ER.
Fifteen hours and $70,000 of tests later ($4,500 after insurance adjustments), I was fine. But the experience gave me a new appreciation for the patient side of a medical issue and how ChatGPT and other AI tools are shaping a patient’s expectations for their medical care and the people who provide it.
Patients today have access to tools that interpret symptoms, suggest diagnoses and even walk them through clinical reasoning. By the time they walk into your office, they probably already have a theory about what’s happening and what needs to be ruled out.
This shift changes what patients expect from us as providers.
THE PATIENT JOURNEY STARTS BEFORE YOU
Whether they tell you this or not, more and more patients arrive with a working diagnosis. Acknowledging this starting point lets patients know that you have at least as much information as they do—and lets them relax as you begin your exam.
I came into the ER knowing what I likely had and what needed to be ruled out. As I saw one provider after another and had test after test, no one ever acknowledged the possibility of a diagnosis or told me what they thought was going on. That left me wondering if maybe they didn’t actually know or if there was something much worse they were concerned about.
For us as OD’s, a simple acknowledgement early in the visit can go a long way. After a patient presents their symptoms, something as straightforward as “It sounds like it’s most likely this, but I’m going to do some tests to make sure and to rule out anything more serious” can let the patient know that you understand the problem and have a plan. That goes a long way toward building patient confidence in you and the entire experience.
Photo Credit: Getty Images
PATIENTS EXPECT EXPLANATIONS
One thing that ChatGPT does very well (better than Google or even consulting family and friends) is explaining its reasoning.
It didn’t just say “BPPV” and give me links to information. It explained in very understandable language why this diagnosis best fit my symptoms, what else it had considered (and why those were less likely) AND what signs would suggest that perhaps it was something different.
This was a far cry from the ER where the only information I was getting was what test would be done next. I’m sure the doctors probably had a whole decision making process in their heads. But as a patient, I had no idea what they were thinking.
As patients gain access to not only information, but the structured thinking that goes with it, they will increasingly expect the same from their clinicians. They will expect their doctor to walk them through what their diagnosis is, how the testing they did led to that conclusion, what their expectations are for treatment, and what responses might change the course of action.
PERSONAL CARE IS STILL IMPORTANT
Although AI can offer information and likely probabilities, it can’t run tests. I was confident in the information I had, but still needed certainty, reassurance and a plan.
Interestingly, after 15 hours in the hospital, I was discharged without anyone ever saying the words BPPV. They told me the tests were fine and that I could go home. But when I asked what it might have been, they didn’t answer.
Two weeks later, the symptoms returned and were even worse and longer lasting. I was able to get an appointment with an ENT within a few hours. He asked about my kids and expressed disbelief that they were both in college, with one graduating in a few months. Then, he proposed BPPV in the first few minutes. He explained which of my symptoms aligned well with the diagnosis and which made him question it. After a few additional tests, he explained how the results fit into his diagnostic picture. With reassurance, he reminded me to breathe. He let me grab his arm when these “additional tests” made me feel like I was falling off his exam table!
The ENT shared a personal story of his own vertigo experience. He talked about the treatment he pursued for himself and recommended the same path for me. He made a personal referral to a vestibular physical therapist and was open to referring elsewhere when that PT was booked for weeks.
I left feeling physically worse, but mentally so much better.
The receptionist at the physical therapy office was exceptionally kind and reassuring. She “moved some things around” and got me an appointment for that evening. The therapist performed a treatment (shoutout to the Epley maneuver!). I was one of the lucky patients who got near-immediate relief. Forty eight hours later, I was back to normal.
DIFFERENT EXPERIENCES
Looking back, what stayed with me most wasn’t the diagnosis itself, but the contrast between the experiences along the way.
ChatGPT helped me understand what might be happening and what questions to ask. The treatment in the ER made me question the reliability and knowledge of the providers there. The ENT, the physical therapist and even his receptionist made me feel understood, reassured and cared for.
Patients may arrive with information. What they need from you is someone who will listen, explain what they’re thinking and guide the next steps. And, occasionally, let them grab your arm if the room starts spinning!
Read more insights from Dr. Fishbein here.
Read more on AI in eye care in our sister publication here.
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Bethany Fishbein, OD, is a practice owner, practice management consultant and certified executive coach. She can be reached at bethany@leadersofvision.com |
