Advancing AMIE towards expert-level audio-visual clinical consultations

When a physician meets a patient, the consultation extends far beyond the words exchanged. The physician observes the patient's gait, registers visible signs of discomfort, notes their breathing, and guides the patient through physical examination maneuvers. This continuous stream of visual and auditory information is seamlessly integrated with the spoken clinical history. These non-verbal visual and auditory cues are central to effective diagnosis, patient trust, and clinical communication.AI systems capable of clinical reasoning and dialogue have the potential to dramatically increase access to medical expertise and care, fostering a future where physicians can focus their time on the most meaningful aspects of patient interactions. In early work, the Articulate Medical Intelligence Explorer (AMIE), our research AI system for clinical reasoning and dialogue, demonstrated expert-level performance in text-based diagnostic dialogue and proved effective as a differential diagnosis aid for clinicians. Recently, we advanced AMIE’s capabilities beyond diagnosis towards treating and managing disease over time.We have also extended AMIE's capabilities towards specialist-level evaluations in oncology, cardiology and ophthalmology, and multimodal diagnostic reasoning over images and clinical documents, in simulated settings with patient actors. In parallel, we have begun translating these research advances towards clinical practice, through a framework for physician-centered oversight, as well as our first real-world clinical studies including a clinical feasibility study with Beth Israel Deaconess Medical Center, and an ongoing nationwide randomized study in partnership with Included Health.Despite these advances, a fundamental constraint in our research remained that text-based interfaces discard the visual and auditory dimensions of clinical practice. Patients must translate complex physical symptoms into written descriptions, a process that discards diagnostic information and can negatively affect patients with limited digital or health literacy. Text-only systems cannot independently observe the visual and auditory cues that inform clinical reasoning, nor can they guide patients through the physical examination maneuvers that shape differential diagnosis.Today, in “Towards expert-level medical AI for real-time video consultations”, we present AMIE in a real-time video configuration, AMIE (Video), that addresses these limitations. Built on Gemini and Project Astra, AMIE (Video) conducts synchronous clinical video consultations, perceiving non-verbal clinical cues, guiding patient actors through virtual physical examinations, and reasoning diagnostically, all in real time. In a multi-arm randomized study with 100 scenarios, 300 live consultations, and a group of 30 board-certified primary care physicians (PCPs), we present the first demonstration of an AI system exhibiting expert-level performance in real-time clinical video consultations.

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