Dedicated, personalized patient care; inquiry aimed at improving medical practice; training the next generation so that medicine will continue to improve.
Thanks, Adam! This describes much of emergency medicine. Personally, I don’t find integrated AI useful yet. The first order of business- EHR integration across the country- is still missing. Sure “EPIC everywhere” is an improvement but when the “everywhere” doesn’t include the hospital down the road that patients bounce between, AI can’t solve access to full patient information.
Also, #8- remind physicians that they need to get paid for training LLMs.
And when The Pulse hits, our value goes up ! We continue dehumanizing humanity. We are doing more, but, are we achieving relevant outcomes? Instead of mandatory corporate compliance courses, why not review how to pick up a phone and arrange for a consult or call in a critical prescription? Go to the radiologist office and review images in person? Review how to change a flat tire. Table manners. Genuine respect and civility. True teamwork instead of the “ come and get it “ mentality, if you know someone else needs it now, don’t just report it and contact the person directly. Review and update drug interactions and notify on the clinically relevant ones. Same with lab panic values. Way too much background noise. But, the patient died in electrolyte balance.
Regarding #3 - document your thinking. Amen! May we let the medical record serve again as an effective means of communication - both to our future selves, and to our colleagues. If you are talking to my 82-year-old patient about whether or not to go forward with a TAVR, if you are giving my patient a choice between BCG treatment in the bladder vs cystectomy, if you don't think this patient needs to get a coronary angiogram, if you are concerned that the redo hernia repair is going to be complicated due to the mesh.... let me know your thoughts! In your words! I don't need the pages of CYA/billing boilerplate (include at the bottom if you must), I need the thinking behind the decision. That way I can have confidence in (or question) the plan and help counsel the patient on their next course of action.
Good article - I like the positive spin. My only concern would be AI calling with test results. As a nurse in a Free Clinic, many times when I call patients with their results, they have other unrelated questions or ask questions about making an appointment, etc.
As a patient, I hate talking to AI. I'd rather a message in the portal/email - if that comes from AI, I am fine with that.
I would also add, if you have the time, and if you don’t make it to ask the patient who they are. A patient I’d seen for years came in wearing his World War II hat. I sat down that day and asked him to explain and heard about the 29th infantry that landed in D-Day + 3. First unit into Berlin, sometimes only going 50 yards in a day. Survives that nightmare and they put them on a ship eventually, where they’re quarantined in New Jersey because they have too much PTSD, I assume, to be out in public for three months. Gets drafted again for Korea, and when they see that he was infantry in World War II, make him a cook in the Navy. At 93, we put a couple stents in the circumflex and his main problem was his prostate. Next guy was 90 very hearing impaired , and when I asked what he did, he yelled out “secret service” . His wife confirmed it, and he showed me his Timex, a Timex, no joke, that had an inscription on the back that says to so-and-so from “LBJ”. Point is the joy and the privilege of medicine is getting to know people as people, and we haven’t been able to because we’ve been buried doing other ridiculous things. If AI does give time back and we use it not to see even more patients in the day and get back to the same craziness, please use it and teach, use it and teach the younger doctors to use it to really understand who they are treating. I promise it will increase the joy and job satisfaction that they have and improve patient care. You might actually get some answers you don’t expect!
Good post. Love AI subscribe by Oracle. But as a woman find number 2 on your list mildly irritating and maybe number one. Like most female positions I spend more time in the EHR than male mds do and because I’m a woman and I have to appear more empathetic than a male md, patients are willing to abuse my time where they would never do that for a very busy male doctor. Doubt me, ask your female colleagues. Keep up the good work. I would tell you to get more female MDS on sensible medicine, but there is no time – we have to go home, clean the house and do all the mental preparation for everything else.
Cheer up ! The next generation is thinking differently! My junior partners are already decreasing their hours and dividing childcare responsibilities. My son who just finished his palliative fellowship has opted for a lower stress position to spend more time with his family.
Thanks, Adam! This describes much of emergency medicine. Personally, I don’t find integrated AI useful yet. The first order of business- EHR integration across the country- is still missing. Sure “EPIC everywhere” is an improvement but when the “everywhere” doesn’t include the hospital down the road that patients bounce between, AI can’t solve access to full patient information.
Also, #8- remind physicians that they need to get paid for training LLMs.
And when The Pulse hits, our value goes up ! We continue dehumanizing humanity. We are doing more, but, are we achieving relevant outcomes? Instead of mandatory corporate compliance courses, why not review how to pick up a phone and arrange for a consult or call in a critical prescription? Go to the radiologist office and review images in person? Review how to change a flat tire. Table manners. Genuine respect and civility. True teamwork instead of the “ come and get it “ mentality, if you know someone else needs it now, don’t just report it and contact the person directly. Review and update drug interactions and notify on the clinically relevant ones. Same with lab panic values. Way too much background noise. But, the patient died in electrolyte balance.
Agree with all Dr. Cifu!
Regarding #3 - document your thinking. Amen! May we let the medical record serve again as an effective means of communication - both to our future selves, and to our colleagues. If you are talking to my 82-year-old patient about whether or not to go forward with a TAVR, if you are giving my patient a choice between BCG treatment in the bladder vs cystectomy, if you don't think this patient needs to get a coronary angiogram, if you are concerned that the redo hernia repair is going to be complicated due to the mesh.... let me know your thoughts! In your words! I don't need the pages of CYA/billing boilerplate (include at the bottom if you must), I need the thinking behind the decision. That way I can have confidence in (or question) the plan and help counsel the patient on their next course of action.
Good article - I like the positive spin. My only concern would be AI calling with test results. As a nurse in a Free Clinic, many times when I call patients with their results, they have other unrelated questions or ask questions about making an appointment, etc.
As a patient, I hate talking to AI. I'd rather a message in the portal/email - if that comes from AI, I am fine with that.
Totally agree. I use AI to write 1st drafts of replies. If pt has further question, time to pick up the phone.
I would also add, if you have the time, and if you don’t make it to ask the patient who they are. A patient I’d seen for years came in wearing his World War II hat. I sat down that day and asked him to explain and heard about the 29th infantry that landed in D-Day + 3. First unit into Berlin, sometimes only going 50 yards in a day. Survives that nightmare and they put them on a ship eventually, where they’re quarantined in New Jersey because they have too much PTSD, I assume, to be out in public for three months. Gets drafted again for Korea, and when they see that he was infantry in World War II, make him a cook in the Navy. At 93, we put a couple stents in the circumflex and his main problem was his prostate. Next guy was 90 very hearing impaired , and when I asked what he did, he yelled out “secret service” . His wife confirmed it, and he showed me his Timex, a Timex, no joke, that had an inscription on the back that says to so-and-so from “LBJ”. Point is the joy and the privilege of medicine is getting to know people as people, and we haven’t been able to because we’ve been buried doing other ridiculous things. If AI does give time back and we use it not to see even more patients in the day and get back to the same craziness, please use it and teach, use it and teach the younger doctors to use it to really understand who they are treating. I promise it will increase the joy and job satisfaction that they have and improve patient care. You might actually get some answers you don’t expect!
The day AI asks “ how’s yo’ Momma n them “ is near ….
Good post. Love AI subscribe by Oracle. But as a woman find number 2 on your list mildly irritating and maybe number one. Like most female positions I spend more time in the EHR than male mds do and because I’m a woman and I have to appear more empathetic than a male md, patients are willing to abuse my time where they would never do that for a very busy male doctor. Doubt me, ask your female colleagues. Keep up the good work. I would tell you to get more female MDS on sensible medicine, but there is no time – we have to go home, clean the house and do all the mental preparation for everything else.
Agree, we need more women writing here. Our submissions are overwhelmingly from men.
Cheer up ! The next generation is thinking differently! My junior partners are already decreasing their hours and dividing childcare responsibilities. My son who just finished his palliative fellowship has opted for a lower stress position to spend more time with his family.
Love it
If AI is as time saving as the EMR we’re all effed.
Yes but think of all the paper it will save!
And decrease the incidence of carpal tunnel syndrome…