{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T22:21:16Z","timestamp":1768515676232,"version":"3.49.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:p>Through a series of case studies, we have pretested the capabilities and reliability of the Large Language Models (LLM), Generative Pre-trained Transformer 4 (GPT-4) and OpenAI o3 reasoning model (o3) in educational and healthcare contexts. Based on this knowledge, we took a step further by testing these technologies in an authentic patient case set in a fictitious location. The context for this brief case report relates to the fact that, in the first quarter of 2025, fewer patients lacked an assigned GP compared to previous years\u2014a positive trend. However, this offers little relief to those cut off from GP care due to their rural location or because of landslides and extreme weather. This case highlights the need for knowledge-based preparedness and alternative health empowerment pathways in rural Norway. This brief case report describes a single 16-year-old boy (<jats:italic>N<\/jats:italic>\u2009=\u20091) with no significant past medical history or chronic conditions. Although he lived in an urban area, we reframed the encounter as a simulated rural, avalanche-isolated scenario to test the feasibility of AI-supported care under extreme access constraints. Specifically, the case models how a patient in an avalanche-prone mountain valley\u2014where seasonal road closures routinely sever access to healthcare facilities\u2014could receive rapid, guideline-concordant treatment for severe tonsillitis during a period of general-practitioner (GP) unavailability. Repeated attempts to secure a same-day appointment were thwarted by workforce shortages and impassable roads, resulting in the earliest available appointment being five days away. The family leveraged point-of-care technologies (fingerstick C-reactive protein analysis, wearable sensors, blood pressure device, digital fever device, mobile ECG) and an o3 language model[1] to evaluate disease severity. A peak CRP of 130\u2005mg\/L, combined with otherwise stable vital signs, prompted a remote consultation with a trusted physician in their social network, who confirmed the diagnosis of bacterial tonsillitis and initiated treatment with phenoxymethylpenicillin (Apocillin). Within 72\u2005h, CRP fell to 23\u202fmg\/L and symptoms were resolved. The patient case and the events described in this pilot study are authentic, but the location is fictitious. The waiting time to see a general practitioner was five days in both the actual urban setting and the simulated rural scenario; however, unlike in urban contexts\u2014where patients can often access immediate care through emergency clinics or private GPs\u2014such options are typically unavailable in sparsely populated rural areas. This case illustrates how AI and health technology can serve as a \u201cvirtual waiting room\u201d for individuals in rural or landslide- and avalanche-isolated areas, especially when GP access is limited and the condition is low-risk, such as mild sore throat symptoms. The case illustrates how inexpensive diagnostics and AI-supported reasoning can strengthen health empowerment and temporarily bridge care gaps for residents of geographically isolated Norwegian communities\u2014provided that human clinical oversight and robust digital health governance remain in place. Therefore, all LLM recommendations and technology support were reviewed during an in-person physician examination in a family network, and the final antibiotic prescription came from the clinician, underscoring that AI functioned solely as decision support rather than autonomous care.<\/jats:p>","DOI":"10.3389\/fdgth.2025.1655154","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T04:13:25Z","timestamp":1756181605000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Artificial intelligence and health empowerment in rural communities and landslide- or avalanche-isolated contexts: real case at a fictitious location"],"prefix":"10.3389","volume":"7","author":[{"given":"Rune Johan","family":"Krumsvik","sequence":"first","affiliation":[]},{"given":"Vegard","family":"Slettvoll","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"B1","volume-title":"Health at a Glance 2021: OECD Indicators","year":"2021"},{"key":"B2","volume-title":"Statistikk om Tettsteders Befolkning og Areal","year":"2024"},{"key":"B3","volume-title":"Gjennomgang av Allmennlegetjenesten: Ekspertutvalgets Rapport","year":"2023"},{"key":"B4","volume-title":"Allmennlegetjenesten\u2014\u00e5rsrapport 2023, Inklusive Status per Mai 2024","year":"2024"},{"key":"B5","volume-title":"Innbyggere Uten Fast Lege. Indikatoren Viser Antall og Andel Listeinnbyggere Uten Fast Lege. Kvalitetsindikatorer","year":"2025"},{"key":"B6","doi-asserted-by":"publisher","first-page":"855506","DOI":"10.3389\/feart.2022.855506","article-title":"Landslide risk reduction through close partnership between research, industry, and public entities in Norway: pilots and case studies","volume":"10","author":"Solheim","year":"2022","journal-title":"Front. Earth Sci"},{"key":"B7","volume-title":"Skredhendelser. Nasjonal Database for Grunn- og Flomskred (NSDB)","year":"2024"},{"key":"B8","volume-title":"Hva er Digital Learning Communities Artificial Intelligence Centre (DLCAIC)?","author":"Krumsvik","year":"2025"},{"key":"B9","volume-title":"Fylkesros for Troms og Finmark","year":"2022"},{"key":"B10","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1080\/00291951.2016.1238847","article-title":"Natural hazard experiences and adaptations: a study of winter climate induced road closures in Norway","volume":"70","author":"Jacobsen","year":"2016","journal-title":"Nor J Geography"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1080\/23311886.2018.1460899","article-title":"Prepared and flexible: local adaptation strategies for avalanche risk","volume":"4","author":"Hovelsrud","year":"2018","journal-title":"Cogent Soc Sci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1093\/fampra\/cmab064","article-title":"Rural general practice staff experiences of patient safety incidents and low quality of care in Norway: an interview study","volume":"39","author":"Harbitz","year":"2022","journal-title":"Fam Pract"},{"key":"B13","volume-title":"Evaluation of Digital Triage Solution in General Practice","year":"2025"},{"key":"B14","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/s12875-025-02785-2","article-title":"Opportunities, challenges, and requirements for artificial intelligence (AI) implementation in primary health care (PHC): a systematic review","volume":"26","author":"Yousefi","year":"2025","journal-title":"BMC Prim Care"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1186\/s12909-024-05944-8","article-title":"Performance of ChatGPT-3.5 and GPT-4 in national licensing examinations for medicine, pharmacy, dentistry, and nursing: a systematic review and meta-analysis","volume":"24","author":"Jin","year":"2024","journal-title":"BMC Med Educ"},{"key":"B16","volume-title":"Capabilities of GPT-4 on Medical Challenge Problems","author":"Nori","year":"2023"},{"key":"B17","doi-asserted-by":"publisher","first-page":"16492","DOI":"10.1038\/s41598-023-43436-9","article-title":"Comparing ChatGPT and GPT-4 performance in USMLE soft skill assessments","volume":"13","author":"Brin","year":"2023","journal-title":"Sci Rep"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e2440969","DOI":"10.1001\/jamanetworkopen.2024.40969","article-title":"Large language model influence on diagnostic reasoning: a randomized clinical trial","volume":"7","author":"Goh","year":"2024","journal-title":"JAMA Netw Open"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e60807","DOI":"10.2196\/60807","article-title":"Performance of ChatGPT across different versions in medical licensing examinations worldwide: systematic review and meta-analysis","volume":"26","author":"Liu","year":"2024","journal-title":"J Med Internet Res"},{"key":"B20","article-title":"Superhuman performance of a large language model on the reasoning tasks of a physician","author":"Brodeur","year":"2025"},{"key":"B21","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1186\/s13690-024-01414-1","article-title":"Artificial intelligence in healthcare: a scoping review of perceived threats to patient rights and safety","volume":"82","author":"Botha","year":"2024","journal-title":"Arch Public Health"},{"key":"B22","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s44247-024-00091-y","article-title":"Artificial intelligent tools: evidence-mapping on the perceived positive effects on patient-care and confidentiality","volume":"2","author":"Botha","year":"2024","journal-title":"BMC Digit Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1109\/THFE2.1960.4503259","article-title":"Man-computer symbiosis","volume":"1","author":"Licklider","year":"1960","journal-title":"IRE Trans Hum Factors Electron HFE"},{"key":"B24","volume-title":"Toward an Emergent Symbiotic Intelligence: A Study of Five AI Case-studies","author":"Krumsvik","year":"2026"},{"key":"B25","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1177\/2327857921101138","article-title":"Symbiotic design application in healthcare: preventing hospital acquired infections","volume":"10","author":"Li","year":"2021","journal-title":"Proc Int Symp Hum Factors Ergon Healthc"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1016\/j.fmre.2025.01.009","article-title":"Symbiopersonal intelligence towards symbiotic and personalized digital medicine","volume":"5","author":"Mensah","year":"2025","journal-title":"Fundamental Res"},{"key":"B27","volume-title":"Bredb\u00e5ndsdekning","year":"2025"},{"key":"B28","volume-title":"Arbeidet med Allmennlegetjenesten [Rapport]","year":"2025"},{"key":"B29","volume-title":"2025 Digital Decade Ehealth Indicator Study\u2014final Report","author":"Page","year":"2025"},{"key":"B30","volume-title":"Digital Competence in AI Society: A look at how Artificial Intelligence Shapes our Lives [in Norwegian]","author":"Krumsvik","year":"2023"},{"key":"B31","doi-asserted-by":"publisher","first-page":"5","DOI":"10.18261\/njdl.19.3.5","article-title":"Artificial intelligence in nurse education\u2014a new sparring partner?","volume":"19","author":"Krumsvik","year":"","journal-title":"Nordic J Digit Lit (NJDL)"},{"key":"B32","doi-asserted-by":"publisher","first-page":"9427","DOI":"10.1007\/s10639-024-13177-x","article-title":"Chatbots and academic writing for doctoral students","volume":"30","author":"Krumsvik","year":"","journal-title":"Educ Inf Technol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1441747","DOI":"10.3389\/fmed.2025.1441747","article-title":"GPT 4\u2019s Capabilities for formative and summative assessments in Norwegian medicine exams\u2014an intrinsic case study in the early phase of intervention","volume":"12","author":"Krumsvik","year":"","journal-title":"Front Med (Lausanne)"},{"key":"B34","volume-title":"Hverdagshelseteknologi og Kunstig Intelligens: Kan vi Avlaste Prim\u00e6rhelsetjenesten?","author":"Krumsvik","year":"2025"},{"key":"B35","doi-asserted-by":"publisher","first-page":"20552076251365006","DOI":"10.1177\/20552076251365006","article-title":"Artificial intelligence, health empowerment, and the general practitioner scheme","volume":"11","author":"Krumsvik","year":"2025","journal-title":"Digit Health"},{"key":"B36","volume-title":"Symbiotisk Intelligens I Tanntraumediagnostikk\u2014en Eksplorativ Casestudie av Spr\u00e5kmodellen o3 som Simulert \u00abSparringpartner\u00bb for Tannlegestudenter","author":"Krumsvik","year":"2025"},{"key":"B37","volume-title":"o3\u2019s Response, Part 1, 2 and 3","year":"2025"},{"key":"B38","volume-title":"o3\u2019-Model","year":"2025"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e56930","DOI":"10.2196\/56930","article-title":"Roles, users, benefits, and limitations of chatbots in health care: rapid review","volume":"26","author":"Laymouna","year":"2024","journal-title":"J Med Internet Res"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-023-02245-9","article-title":"The use and usefulness of point of care tests in patients with pharyngotonsillitis: an observational study in primary health care","volume":"25","author":"Pallon","year":"2024","journal-title":"BMC Primary Care"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1186\/s12879-021-06878-y","article-title":"C-reactive protein velocity discriminates between acute viral and bacterial infections in patients who present with relatively low CRP concentrations","volume":"21","author":"Bernstein","year":"2021","journal-title":"BMC Infect Dis"},{"key":"B42","volume-title":"AI Act Enters into Force [Press Release]","year":"2024"},{"key":"B43","volume-title":"Regulation (EU) 2016\/679 of the European Parliament and of the Council of 27\u202fApril\u202f2016 on the Protection of Natural Persons with Regard to the Processing of Personal Data (General Data Protection Regulation)","year":"2016"},{"key":"B44","volume-title":"Proposal for a Regulation of the European Parliament and of the Council Laying Down Harmonised Rules on Artificial Intelligence (Artificial Intelligence Act): Provisional Political Agreement","year":"2024"},{"key":"B45","volume-title":"EU sticks with Timeline for AI Rules [Press Statement]","year":"2025"},{"key":"B46","volume-title":"Regulation (EU) 2017\/745 of the European Parliament and of the Council of 5\u202fApril\u202f2017 on Medical Devices","year":"2017"},{"key":"B47","volume-title":"MDCG\u202f2021-24: Guidance on Classification of Medical Devices","year":"2021"},{"key":"B48","volume-title":"National e Health Strategy 2023\u20132030","year":"2022"},{"key":"B49","volume-title":"OpenAI o3 Breakthrough High Score on ARC-AGI-Pub","author":"Chollet","year":"2024"},{"key":"B50","volume-title":"Regulation (EU) 2024\/1689 of the European Parliament and of the Council of 13\u202fJune\u202f2024 Laying Down Harmonised Rules on Artificial Intelligence (Artificial Intelligence Act)","year":"2024"},{"key":"B51","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1016\/j.cmi.2024.05.014","article-title":"European Society of clinical microbiology and infectious diseases guidelines for antimicrobial stewardship in emergency departments (ESCMID)","volume":"30","author":"Schoffelen","year":"2024","journal-title":"Clin Microbiol Infect"},{"key":"B52","doi-asserted-by":"publisher","first-page":"263.e1","DOI":"10.1016\/j.cmi.2014.08.020","article-title":"The aetiology of pharyngotonsillitis in adolescents and adults\u2014fusobacterium necrophorum is commonly found","volume":"21","author":"Hedin","year":"2015","journal-title":"Clin Microbiol Infect"},{"key":"B53","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1080\/13510002.2016.1173328","article-title":"Alteration of thiol-disulphide homeostasis in acute tonsillopharyngitis","volume":"22","author":"Kara","year":"2017","journal-title":"Redox Rep."}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1655154\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T04:13:30Z","timestamp":1756181610000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1655154\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,26]]},"references-count":53,"alternative-id":["10.3389\/fdgth.2025.1655154"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2025.1655154","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,26]]},"article-number":"1655154"}}