JMIR Publications

ABSTRACT

Artificial intelligence is already in the consulting room, whether clinicians invite it or not. OpenAI reports more than 800 million regular users of ChatGPT and over 40 million daily health-related queries,[1] yet only 16% of large language model–based mental health tools have undergone clinical efficacy testing,[3] and state-level regulation remains fragmented.[8] Major professional organizations have issued position statements; enforceable practice guidelines have not followed. Clinicians are therefore practicing in a gap between a patient reality that cannot be ignored and a professional infrastructure not yet built. This Viewpoint argues that neither enthusiastic adoption nor principled abstention is a defensible clinical posture in the current environment. The clinician who refuses to engage with AI is not preventing patient use; they are losing line of sight into a factor materially affecting the therapeutic process. The clinician who adopts AI without structured evaluation exposes patients and practice to avoidable harm. The appropriate stance is structured harm reduction within the therapeutic relationship: AI-related factors assessed at intake, integrated into case formulation, subject to informed consent, monitored across treatment, and addressed in termination planning. We propose a phased clinical framework spanning pre-intake through termination, anchored by the GUIDE mnemonic — Gather, Understand, Inform, Document, Evaluate — as an operational wrapper for daily practice. We anticipate and address counterarguments grounded in access, autonomy, and evolving evidence; restore a working ethical and legal compliance framework for AI-using practice; and conclude with what the profession now needs from regulators, professional organizations, and researchers. Supporting material — the clinical boundaries table, a survey of complementary frameworks, emerging technologies, and an AI-tool risk-mapping table — is provided in Multimedia Appendices. The patients who seek care in an AI-saturated world deserve practitioners who have engaged seriously with that reality, and the professional infrastructure required to hold innovation and patient protection in informed balance.