While AI Tools Improve, Caution Remains
OpenAI plans to release its upgraded ChatGPT tool in the next few weeks based on the newer GPT-4 platform. While its capabilities exceed those of its application based upon GPT-3.5, limitations remain. The latest version delivers more focused and succinct responses and describes images well. But every AI tool is limited by the data available for the AI model to ingest.
For physicians and nurses to safely utilize these tools, their institutions must rigorously test them before deployment. Solely using AI output to direct patient care without clinician intervention presents the most significant risk to patients.
Source: 10 Ways GPT-4 Is Impressive but Still Flawed – NY Times March 15, 2023
Physician + AI = Better Healthcare
Yes, artificial intelligence can improve healthcare now. Here’s why. Computers do not tire, their eyes do not get strained, and they never get distracted. According to a recent NY Times article, Hungary is leading the way in using AI to screen for breast cancer. What makes the approach so promising is the combination of AI software screening images that identify potential areas of concern and a trained radiologist’s review of the scans. This two-pronged review helps focus the radiologist on the most significant parts of the image requiring further evaluation.
Although this may increase the radiologist’s efficiency by decreasing the time devoted to reviewing a scan, it focuses the radiologist on areas of concern. Therefore, it increases the likelihood of identifying cancers earlier.
Collecting clinical data from each scan and adding it to the AI model dataset increases the model’s reliability in identifying cancer lesions. The proper use of AI in clinical care is to enhance the work of caregivers and not replace them. While AI may be able to help physicians diagnose cancer, it never will replace the human touch required to inform patients of a life-threatening diagnosis and the frightening treatment road ahead.
Source: Using A.I. to Detect Breast Cancer That Doctors Miss – NY Times March 5, 2023
The Chronic Illness Phase of the Pandemic Remains
More than 35 million Americans have experienced long Covid symptoms. Studies put the overall share of long Covid symptoms at 6.2% at three months and 0.9% after 12 months. A more severe illness increases the likelihood of long Covid.
While we may think the healthcare burden of the pandemic is behind us, there appears to be a long tail of Covid illness that we will need to treat for many years. We need to do more research on treating long Covid while accelerating our vaccine research to prevent another pandemic anytime soon. Congress cut funding for coronavirus vaccine research, but fortunately, Europe continues its investment, a topic I reviewed in an earlier post.
What leadership role should the U.S. take in preventing the next pandemic?
Living Longer. Can Our Economies Adjust
February 21, 2023, LinkedIn Post
Statistica’s latest report on life expectancy offers good news. The gap between highly developed regions and the rest of the world is decreasing. The global progress in ensuring access to healthcare, clean water, education, and food security continues to make a difference. Africa lags behind other regions, but it is closing the gap. But what does this mean for our economies? Long lifespans put a burden on governments to provide social services. Will we have enough workers to support more citizens in their 70s, 80s, and beyond? Thinking that increasing the population is the only way to sustain growth while supporting longer lifespans seems illogical. How many billions more people can the resources of the Earth support? I do not know the answers to these questions, but we need to think differently about how our economies are structured and the role of each of us in supporting them. How do you think our economies should change to support longer lifespans?
Source: https://www.statista.com/chart/2266/life-expectancy-by-world-region/
Are Clinicians Reacting to Bloated EHRs as We do to Online Ads?
As humans, our ability to devote attention to something is limited. Fortunately, our brains are very good at weeding out unimportant stimuli so we can focus our minds on the essential task. Without this ability, every sight, sound, touch, and smell would paralyze our actions.
In a recent Ezra Klein NY Times podcast, Tim Hwang discussed the impact of the avalanche of targeted online ads described in his book titled “Subprime Attention Crisis.” Ezra and Tim reviewed the problems facing companies that advertise online or sell online ads. They emphasized how the online ad market is changing due to consumers “tuning out” the ads. The overwhelming number of ads has trained consumer brains over time to ignore the ads due to a maxed-out attention quota.
Our consumer experience with ads differs significantly from our work with EHRs. Do EHRs have too much information recorded in them? Do copying and pasting notes bloat the EHR to such an extent that clinicians need help identifying what is important and worth reviewing? Do medical errors happen due to this documentation bloat? And is AI a tool that can help focus the clinicians on what is essential? Clinicians now struggle with too much patient data, not too little. And in turn, their patients suffer. As we further expand patient data collection, we must figure out a way to effectively manage this information. If we have not surpassed the ability of clinicians to ingest the patient information currently in the EHR, it is not long before that day will come.
(The podcast and its transcript are available using this link. https://www.nytimes.com/2023/02/14/opinion/ezra-klein-podcast-tim-hwang.html)
Who Can Afford Life-Saving Drugs?
February 7, 2023, LinkedIn Post
The past decade delivered highly effective treatments for cancer, autoimmune syndromes, and many rare diseases. But to be effective, patients need to access those miracle drugs. Whether insured by private insurance or a government program, out-of-pocket costs are often a barrier to obtaining those medications, even for middle and upper-middle-class families. Over the past seven years, the number of drugs covered by Medicare Part D costing $70,000 or more per year rose from 40 in 2013 to more than 150 in 2020. Many patients choose less expensive treatments that are less effective and bring more side effects due to costs, while others avoid treatment altogether.
While we must continue to fund pharmaceutical firms so they can develop more miracle drugs, we also need to figure out a balance between the cost of development and the price to patients and the government. Continued delivery of miracle cures that few can afford works against health equity, and it misappropriates the government funding that underpins much of the research that leads to these treatments.
Source – https://www.nytimes.com/2023/02/07/health/medicine-insurance-payments.html
Should We Pay Physicians to Respond to Patient Emails?
February 1, 2023, LinkedIn Post
As the medical impact of the pandemic recedes, the digital effects remain. While clinics and physician offices were closed, we learned to use telemedicine, patient portals, and secure email to interface with our clinicians. And we continue to use these digital tools. But how is this impacting the physician? We know physicians are leaving practice due to burnout. Are the use of these tools contributing to this problem?
One study suggests that patient emails have increased by 50% over the last three years. Many physicians report spending hours during “pajama time” before bed responding to emails.
These email messages are a form of patient care, yet payers rarely reimburse physicians for their time. Failing to respond is poor quality care and could lead to unnecessary patient visits to already overbooked clinics and physician offices. Physician responses to emails lead to cost savings and a better patient experience. It is time to devise a standard method to reimburse physicians for this work. Everyone would benefit.
Source – https://www.nytimes.com/2023/01/24/health/emails-billing-doctors-patients.html
COVID’s Impact on Healthcare Continues Worldwide
January 16, 2023, LinkedIn Post
While the pandemic horrors of early 2020 diminish due to vaccines and treatments, the negative impact on patients and healthcare providers continues. Reduced access to routine services over the past three years led to delayed cancer diagnoses, elective surgeries, and routine disease screening. And changes in care protocols decreased hospital productivity while expenditures rose. These changes are evident in both the U.S. and across all high-income countries.
A research article in the December issue of Mayo Clinic Proceedings documented clinician burnout due to the pandemic. (https://www.mayoclinicproceedings.org/article/S0025-6196(22)00515-8/fulltext ) We must change how we deliver, organize, and pay for care.
Aging Workforce: Will They Be There for Us
January 12, 2023, LinkedIn Post
The recent nursing strikes in NYC highlight the workforce challenges facing hospitals. Are there enough nurses to deliver high-quality, safe care? What does providing a working environment that protects staff and patients mean? How should our healthcare workforce be compensated?
These are all important issues to discuss and debate to arrive at reasonable solutions. No matter what we decide, we face a future shortage of nurses. While Millenials embraced the profession, the same cannot be said for the generations that followed. We need to take steps to make entry into the nursing profession easier. More training programs and access to financial support are required. By taking care of them, they will be there to take care of us.
Source – https://www.healthaffairs.org/do/10.1377/forefront.20220412.311784/
Does Healthcare Have a Southwest Airlines Problem?
January 9, 2023, LinkedIn Post
The recent Southwest Airlines travel fiasco can be traced to its failure to upgrade its information technology systems. Due to antiquated systems and poor interoperability, the airline needed to know where its crews were stranded to reallocate staff to flights efficiently. Its systems did not offer that capability.
In describing the situation, Zeynep Tufekci wrote in the NY Times, “Well, if you are a corporate executive whose compensation is tied to stock prices and earnings statements released every three months, there are strong incentives to address any immediate problem by essentially adding a bit of duct tape and wire to what you already have, rather than spending a large amount of money — updating software is costly and difficult — to address the root problem.”
Do you see similarities in how some healthcare business managers lead their organizations? Could some of the problems of staff shortages, quality of care, and patient experience be related?
Source – https://www.nytimes.com/2022/12/31/opinion/southwest-airlines-computers.html
We Need to Take Care of Them……
So They Can Take Care of Us
January 4, 2023, LinkedIn Post
For almost three years, they have been there. Out doctors and nurses and therapists and administrative staff, accepting the unknown personal risk to their health to be sure we got the care we needed. Now faced with the triple threat of COVID, RSV, and flu, they show up every day to do what they can to treat and comfort us.
Yes, American healthcare has problems. And many people have great suggestions on how to fix it. But unless we figure out how to take care of them, no matter what solutions we implement, there will not be enough of them to take care of us.
Source – https://www.nytimes.com/2022/12/26/health/icu-nurse-pandemic.html