How Does Generative AI Reshape Chinese Patients’ Perceptions of Medical Authority?

Employing a sequential mixed-methods design combining survey (N = 607), interviews (N = 30), and digital ethnography, the study traces pathways from technology adoption to clinical interaction and introduces the concept of “algorithm-mediated negotiated authority.” Findings indicate that trust in generative AI arises from both perceived technical capability and socially conferred legitimacy, mediated by cognitive load. Health literacy and technology anxiety moderate this process, resulting in unequal empowerment. Authority is dynamically co-constructed as patients strategically introduce AI advice and physicians respond with explanatory, reassertive, or reserved strategies. Theoretically, the study bridges macro-level power critique with micro-behavioral analysis, advancing the “medical gaze” into a “negotiated gaze.” It extends technology acceptance models by emphasizing legitimacy construction and cognitive internalization, framing generative AI as a reconstructive force that reshapes clinical communication.