Urologist Uses AI to Really Show His Stuff
The above image is from a note he received. It was from a urologist seeing the patient they share. I will let him do his own rant:
I haven’t used AI scribes or ChatGPT in my patient notes yet. But for those of you who are using or planning to, please proofread and edit them, so we don’t have this kind of b#llshit.
Here’s the A/P from a UROLOGY consult note on my patient who’s been on Lupron for high-grade prostate cancer, now zero PSA no detectable disease for 2 years. Went to his urologist to discuss severe Lupron side effects (weakness, sarcopenia, loss of virility and life feels almost not worth living.) This is the recent consult note *from the urologist who prescribed and administered the Lupron shots the last 18 months, and who diagnosed and treats the patient’s prostate cancer.*
Their number 1 recommendation:
1) Consider a urology consult. What the actual f#ck?!? This is embarrassing.
Every single recommendation in this is equally inane and worthless. You couldn’t possibly parody this, it’s too unbelievable.
2) says “If the patient was taking Lupron for cancer, consider consulting an oncologist.” This is the note from the urologist who diagnosed and treated his prostate cancer. What the actual f%ck? It’s really pathetic.
Are they even reading their own fucking notes? There was a little narrative about the patient’s symptoms and Lupron side effects (as if a human listened to him a bit), but this was the entire assessment and plan/recommendations section. It’s farcical.
Maybe AI isn’t ready for primetime. Or, maybe, some doctors just get lazy. This is not good.
EVERYTHING IS A BUSINESS MODEL. WITH BRILLIANT AI NOTES WE CAN NOW JUSTIFY EVERYTHING AND TREAT NOTHING….GLORIOUS REVOLUTIONARY THOUGHT COMRADE…
Where is my SOAP note. Subjective, Objective, Analysis, Plan. Simple Concise,direct to the point. Same as History, Physical Exam,Labs, Imaging, Analysis/differential ,and Plan of Treatment.. More progress like this and we will advance to Primative Medicine Man..
So It Goes… Good Luck. dinosaurs……
Indeed. Read the tea leaves, then let Nature take its course. Barefoot medicine arises again.
There are long traditions for developing knowledge in the various arenas of life. These should not be cast aside under the contemptuous insult of “old fashioned” and “not modern.” That arrogant predilection drives us towards haughty ignorance of what we should be trying to describe and bring to the processes of rational understanding.
Dialectical thinking was demonstrated in writing in the remembrance of the philosophical discussions of Socrates. It became enervated in philosophy by German idealism in the 19th century, and met a woeful end under the Marxists, who have effectively canceled its meaning for a century.
Medicine is fundamentally a profession which exists through the dialectic, and cannot be pursued in any other way. From Wikipedia,
dialectic (is the) dialogue between people holding different points of view about a subject, but wishing to arrive at the truth through reasoned argumentation. Dialectic resembles debate, but the concept excludes subjective elements such as emotional appeal and rhetoric.
The dialectic is what happens between patient and doctor. The chart is the receptacle of written notes which can facilitate the recounting of the encounter. Medical notes were never an attempt to offer photorealism about some encounter or thing or whatever object comes to mind; rather, they were instruments to jog the memory of the physician, and the patient.
It connects with the principle of tacit understanding, that a particular means of thinking, developed by interest and training such as during residencies, allows one to gain a tacit understanding of health and disease in a particular patient.
Dialectical medicine is dead. We allow ChatGPT to write with a dead hand all sorts of dead-ends and blind associations, carefully packaged in exquisitely perfect grammer. “Colorless green ideas sleep furiously,” offered Noam Chomsky, in an example that rules of grammar, the heart of IT translation, is a mechanism for grammatical construction which can perfectly offer nonsense in a perfect – and billable – manner. G47.9, that’s how I’d encode Chomsky’s observation.
The fall of the branch of medicine is hardly the greatest fall of our civilization in the presence of IT.
I disagree with the criticism of the note, for it is perfect. ChatText is merely gibberish conforming to a set of rules, and need not be informative, but correct. An infinite number of monkeys at an infinite number of typewriters might produce the works of Shakespeare. However, if one frees them from the constraint that the content be meaningful, than EACH monkey produces a work of art. The medical note can readily be produced by AI, and that is evidence that the medical note is dead. It is dead as to its purpose, a rapid and efficient display of thoughts which advance the care of a patient in diagnosis, treatment and through time. The medical note began dying fifty years before Chat GPT lent its hand to the mix. Medicine itself, as prey for IT, has been suffering from the attack for decades. Medical notes serve now to fill a billing purpose, to document a billable encounter, and IT does great at this. Everything comes here – as to a landfill. Nobody trusts what is published in a note, in the same way that nobody read Pravda in the old Soviet Union expecting to be given the truth. This note does exemplify the collapse of medicine and of our future society in general, by reducing what could be recorded human thought into formulaic verbigeration devoid of meaning. Don’t blame the Urologist. He has a gun to his head.