Directional AI Advice: Experimental Evidence from Healthcare

2026-07-09

AI Summary

This study investigates the causal impact of generative AI–delivered, biased recommendations on physician–patient interactions and clinical decision-making in real-world healthcare settings. Conducting a large-scale, preregistered randomized controlled field experiment at a hospital in China, the research randomly assigned patients to interact with an AI chatbot prior to outpatient consultations and analyzed effects using dialogue logs and structured surveys. The findings provide the first experimental evidence that AI recommendations significantly alter clinical practice—reducing prescription rates while increasing diagnostic testing—with stronger effects among physicians exhibiting high baseline prescribing tendencies or greater susceptibility to patient influence. The study further reveals that physician acceptance and prescribing habits moderate these effects and unexpectedly demonstrates that AI intervention diminishes patient adherence and satisfaction.

Abstract

Generative AI is fast becoming the first place people turn for expert advice. The advice it provides can be directional rather than neutral, shaped in part by the choices of its designers and regulators. When clients consult AI before meeting an expert, they carry this directional advice into a relationship that once rested on the expert's judgment alone. We study its consequences in healthcare through a large-scale preregistered field experiment at a Chinese hospital, where we randomize patients' access to an AI chatbot before their outpatient visit. Examination of the conversation logs shows that the chatbot routinely cautions against the use of medications, especially Traditional Chinese Medicine and antibiotics, while issuing clean recommendations for diagnostic testing, consistent with the liability-driven guardrails encoded in AI training. This directionality propagates into clinical practice. Prescription rates decline among treated patients while diagnostic testing increases, and these effects are more pronounced among physicians who are receptive to patient input and those with more intensive prescribing styles. Beyond shifting healthcare utilization, survey results show that AI access reduces patient compliance and satisfaction, shifting the balance of authority between patients and physicians.

Problem

• Generative AI
• Directional Advice
• Healthcare
• Patient-Physician Interaction
• Clinical Decision-Making

Innovation

• directional AI advice
• generative AI in healthcare
• AI-induced behavior change
• clinical decision-making
• human-AI interaction