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self_made_human

Interesting Times Correspondence Club

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joined 2022 September 05 05:31:00 UTC

I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.

At any rate, I intend to live forever or die trying. See you at Heat Death!


				

User ID: 454

self_made_human

Interesting Times Correspondence Club

10 followers   follows 0 users   joined 2022 September 05 05:31:00 UTC

					

I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.

At any rate, I intend to live forever or die trying. See you at Heat Death!


					

User ID: 454

Can't get arrested for malpractice if they can't prove it was my signature!

But surgeons, by far, have the worst handwriting. I guess the fine motor skills were all used up. And there's a neuro consultant who makes me question if he's cottoned on to his own Parkinsons. And our medical oncology boss, who thinks writing BIG is a substitute for legibility (it isn't), but man's dying of cirrhosis and his wife and kids left him, so I'll give him a pass.

That is not remotely anywhere near the issues I covered.

A discharge summary is precisely that. It's written up when a patient is being sent out of the hospital (and still alive, thankfully, death certificates are a pain), and exists solely to summarize events and therapies, as well as ongoing medical care and planned follow up. They are both medicolegal documents, as well as necessary for continuity of care (if you're a doctor relying on patient memory to cover everything they have or had done to them, better have good malpractice insurance).

There is no universe in which a transcription error or misspelled drug leads to a hospital getting into a tussle with the family over a patient being discharged or criminal charges being brought against them. That does not happen, or, if it's happened, it's so vanishingly rare as to not be worth worrying about. Those are issues of hospital policy, legality and overpolicing, not anything related to "imported doctors" using "shady technology". I invite you to show me the relevance.

Further, this is simply an evolution of existing techniques, such as human transcriptionists (who may or may not be licensed for medical transcription, for what that's worth), and voice dictation software. Whisper is just more advanced in terms of functionality, and Dragon VTT is probably old enough to predate modern ML/DL, though some of that might have been folded in. It's also free and open-source, I just happen to have found a way to get it for "free", using the ChatGPT app, without relying on the otherwise unreliable 3.5 model for handling patient data. Hence all the rambling about me reviewing the text, copying it over and editing it for errors. It's not 3.5 doing anything of note, it exists as a dumb receptacle for a far more contextually useful service, the Whisper service, in much the way someone can use an AI Waifu or Twitter bot to learn how the Navier-Stokes equation works (real example from a meme). Your objections make no sense in that regard, and I would hope that Western hospitals have more robust systems (who am I kidding? It's another junior doctor pulling their hair out), but it saves me time, and does a better job for the poor bastards who are waiting for discharge paperwork and insurance to clear before they get to leave.

You have summoned a crankier doctor than the one I think you are looking for but I'm sure he will chime in at some point.

My general sunny disposition has been severely tarnished of late. The schadenfreude from seeing the nurses being chewed out after a patient lodged a formal complaint when they woke him up for his sleeping pills has yet to outweigh the far more numerous times I've been woken up to prescribe them to someone enjoying a far more restful night than I have.*

Personal anecdote: I've run into a "date rape" drug level alcohol response in settings where I know nobodies shit is tampered with, so I'm certain this class of thing exists, including one time where it was me and my own bottle of rum (and I later connected the dots that I recently had diarrhea and that may have been responsible for my bad time...).

I can handle an ungodly amount of liquor (a terrible thing for my bank balance if I were to indulge it), but I remember accepting a single shot of local moonshine at a girl's birthday party and then poof, total anterograde amnesia, with me waking up next morning with a pounding hangover in my knickers.

In her bed.

I'm told that I was uh, talked into crossdressing, and someone has a video of it, which I must figure out a way to delete. Then again, if I ever become cancel-worthy for my many online crimespeeches, it offers a convenient retreat into Protected Characteristic territory. I'm just grateful I didn't go blind, the fucking thing smelled like hand sanitizer and tasted like coconut.

*Urine output on an intensive care unit: case-control study :

Objective To compare urine output between junior doctors in an intensive care unit and the patients for whom they are responsible.

Design Case-control study.

Setting General intensive care unit in a tertiary referral hospital.

Participants 18 junior doctors responsible for clerking patients on weekday day shifts in the unit from 23 March to 23 April 2009 volunteered as “cases.” Controls were the patients in the unit clerked by those doctors. Exclusion criteria (for both groups) were pregnancy, baseline estimated glomerular filtration rate <15 ml/min/1.73 m2, and renal replacement therapy.

Main outcome measures Oliguria (defined as mean urine output <0.5 ml/kg/hour over six or more hours of measurement) and urine output (in ml/kg/hour) as a continuous variable.

Results Doctors were classed as oliguric and “at risk” of acute kidney injury on 19 (22%) of 87 shifts in which urine output was measured, and oliguric to the point of being “in injury” on one (1%) further shift. Data were available for 208 of 209 controls matched to cases in the data collection period; 13 of these were excluded because the control was receiving renal replacement therapy. Doctors were more likely to be oliguric than their patients (odds ratio 1.99, 95% confidence interval 1.08 to 3.68, P=0.03). For each additional 1 ml/kg/hour mean urine output, the odds ratio for being a case rather than a control was 0.27 (0.12 to 0.58, P=0.001). Mortality among doctors was astonishingly low, at 0% (0% to 18%).

Conclusions Managing our own fluid balance is more difficult than managing it in our patients. We should drink more water. Modifications to the criteria for acute kidney injury could be needed for the assessment of junior doctors in an intensive care unit.

(This is why I avoid ICU work like the plague, and if you think medical oncology discharges are bad..)

I'm sure your prescription of:

Tab Paracetamol 500 mg PO TDS and SOS

Miscellaneous antacids/PPIs

Tab (Random Multivitamins)

and so on and so forth are eminently unique and precious bits of personal data, laundered through "new shady technology". Or that you're now on 50 mcg of thyroxine instead of 25 post resection is super important to nebulous entities. Huh, which of the seven (hundred) patients with near identical procedures was that again?

By all means, such paranoia is heartening and helpful, I hope you shred all your old mail before putting it in the garbage, wouldn't want hobos going through it.

Oh, and try to forget too, while you're at it, that anonymized patient case reports are regularly published in medical journals, because doctors have to learn things as well.

There are far more senior and qualified doctors here, but if you want cheap free medical advice and random bullshit, I'm always on call heh. Anyone is free to ping me, it beats the nurses waking me up at 1 am to write a prescription for Xanax to a patient who is already asleep (this is not a joke, it legitimately happened to me on multiple occasions).

On the topic of MAOIs, can't recall seeing one prescribed recently but I'm not working in pscyh or neuro. My understanding is that, in India at least, they're used far more for Parkinsons than depression, and that seems to be true in the UK.

I have had plenty of drinks while on SSRIs, and I can't say it made a difference.

From what I'm aware of in the literature, the risk is minimal, and primarily due to alcohol worsening symptoms of depression rather than a significant interaction.

I do, however, lean towards it being hysteria that so many women confuse being "blackout drunk" with being roofied. Like, drink enough alcohol and that just happens, including waking up in an unfamiliar place feeling like shit. It's just not probably due to SSRIs making it worse, women have a lower alcohol tolerance in the first place.

I don't look forward to the novel length discharges in psychiatry, I'll tell you that much.

I wonder if avoiding patient names lets you get around the PII issues with using unsecured/public services, though that is entirely a theoretical concern in India. There's the option to turn off chat history in ChatGPT, though I don't know how happy Western regulators would be with it. Nobody cares here, I'm keeping my trick a secret because I don't want the regs to get ideas about making me write even more discharges even faster haha.

Something made inhouse, which is an abomination made by the one of the infinite monkeys that was so blackout drunk it submitted the lowest bid.

Horrendously unintuitive, slow, has a distressing tendency to eat multiple paragraphs if you don't scrupulously save, or make the mistake of leaving it unattended.

https://radiopaedia.org/articles/lymph-node-levels-of-the-neck

The lymph nodes in the neck have historically been divided into at least six anatomic neck lymph node levels for the purpose of head and neck cancer staging and therapy planning.

Some say there are are seven, so the different groups are numbered in (rough) height order from Group I to Group VI/VII.

So you can imagine it's going to take a very long crane to operate on a XXXXXX level node, assuming that was a valid roman numeral at all. Someone fucked up, and the doctor responsible for checking the final draft didn't do a good job.

Eh, I can't imagine it's on par with Whisper, which, if no longer quite SOTA (by like 3 months, the field moves fast), is really goddamn good and fast. Plus Dragon doesn't seem to have an Android app. I have to shuffle between whichever sorry excuse for a PC is free on the multiple wards I cover, so it's not like I have a place to call my own. And I don't even own a laptop.

  1. I'm cheap. And $20 a month is, well, not exactly nothing by my standards.

  2. I have a pretty nice mechanical keyboard, but I sure as fuck won't be lugging it to the hospital, maybe if I end up running the psych ward and need something to batter uppity people with.

Mundane life hack:

Writing discharge summaries for patients is a pain in the ass.

I've got a few options:

  1. Hand write it on paper and send it over to the transcriptionists, who are not medically trained, and will likely mangle it beyond recognition. Like, I know my handwriting is reflecting my sanity, but it's not that bad, and yet they manage to do things that leave me in awe.

(@throwaway05 I caught my consultants guffawing over the previous discharge for a post op thyroid carcinoma case, apparently the XXXXXX level LNs were involved, which is either a typist fuckup, or they needed a crane to operate on a giraffe)

  1. Type it out myself, using gummy keyboards that swallow letters, and EMR software that makes me want to pull my hair out.

  2. Type it out, but using something less likely to make me want to self-discharge into purgatory, such as writing it on my phone and mailing it over to the transcriptionists to copy-paste (far harder for them to fuck it up). But still a PITA, fighting autocorrect and RSI to output the 25 drugs my geriatric soon to be ex-patient is on.

  3. Apparently, there's a verbal medical transcription service, where all you need to do is mutter into the mic for some low wage worker to do the dirty work (one that isn't me), but my investigations show that this is a service only offered to actual consultants, in a sub-basement with a Beware of Leopard sign covering up the computer. Limited licenses, HR approval, yada yada. And why would said senior doctors bother when they can get their juniors to bother me at 5 pm to absolutely urgently prepare a discharge by 7 pm for a patient I know for a fact won't be discharged till next afternoon, after being reviewed by said doctor.

Well fuck all of the above, it's the last thing I want to be doing at either 9 pm, when I'm bone tired, or 7 am, when I'm being woken up to handle incessant early morning bullshittery. So, as someone who believes in better living through technology, I wondered if I could use OpenAIs Whisper voice transcription service to save me a lot of writing.

Short answer? Yes.

However, there's no free and easy way to do so, and I can't be arsed to drag a laptop out and install an offline version. There are apps out there, but they're the usual trial and nagware shit.

But wait!

ChatGPT uses Whisper for voice transcription when you use the voice input option. I don't pay for GPT-4, so I don't trust it to do the whole job correctly, but simply transcribing what I'm saying to text verbatim? Hell yeah it can do that.

Cue me opening up the app, entering a prompt that amounts to STFU till I tell you otherwise, then I unload my stream of thought, terribly written surgical notes, and the other forms of torment undergone by my ward. Even the drugs, it does a really good job of handling even the weirdest generics and brand names.

I then copy and paste that, or have ChatGPT lightly format it when relevant, move it around and edit it myself till it fits the format, and then email it off.

I estimate this saves at least half an hour per discharge, what with me not having to write by hand, or undo the errors introduced by the typists.

Thank god nobody gives a shit about HIPAA here, but there you have it, my most useful use case for ChatGPT Free is just to hack into the Whisper API. For anything more important, please use either the paid version or Bing, but this saves me a great deal of real pain.

I still need to give it a once over and fix minor errors but by Allah it does a fantastic job right out of the gate.

If there's one thing that Jim and co got right most of all, it's that sex differences are very great. Completely different mindset.

I'm going to tattoo this on my forehead for the next time my girlfriend suggests we watch a Victorian period drama jfc

I look forward to these threads, and your contributions to them, even if I rarely have much to add! I don't follow Indian news, largely for my own mental health, so it pains me to have to passively consume most of the time, but consider me another one of the many people who would be sad to see you not continue, even if all we do is upvote and go hmm.

My ADHD is mild, as in I could convince others (including my parents and tutors) that I was a perfectly normal kid, and as for myself, why would I have reason to assume otherwise?

Then high school hit, and my usual habit of cramming for subjects the last couple nights before an exam ceased to cope. Turns out enormous amounts of stress and caffeine (all the pharmaceutical therapy I had access to then) only goes so far, and it only got worse when I crawled into med school.

I realized I had ADHD, badgered my parents to take me to a psychiatrist, and they refused for ages, mostly because they simply couldn't accept that their darling son could have such a disease, as well as the general stigma/ignorance around it in India. It took a complete nervous breakdown for them to finally take me over, and what did you know, I got diagnosed, got meds, and while hardly perfect, am far more capable of handling professional and academic pressures.

For a long time, I thought it was preposterous that people studied until right before exams. Like, can't you just cram dawg? Turns out that, no, most neurotypical people don't need do or die levels of stress or constant micromanagement to do so, even if some leave it off longer than they ought to.

At any rate, ADHD meds work, both on people with "actual" ADHD, depending on where you draw a line on the curve, and even those with above average executive function or conscientiousness. You can't take a happy person and give them antidepressants to make them super duper happy. I'm not inclined to gatekeep, I'd be utterly fucked without meds, so presuming I ever become an actual psychiatrist, I'm inclined to be far less anal than the ones who the blog author encountered.

And my case is mild. It's not obvious at all in normal conversation, nor did it reflect on my grades till the burden simply become too much to cope. My brother is worse struck, and my little nephew is a flagrant example, and I consider them lucky that my suffering will make my/their parents take the issue more seriously. Once again, I complain about methylphenidate/Ritalin. Shit drug, at least in terms of how it makes you feel. I look forward to trying Adderall when I can, since it's not available here. But given that Ritalin still makes me a functional doctor (academically, I can work just fine without it in an actual job), I can't complain too hard.

Hang in there for Grey Zone Warfare, you can think of it as Wildlands and Tarkov having a FPS baby, and with far less PVP than the latter.

I'm holding out for it, and I've almost completed everything worth doing in Tarkov two months in, with four to go of fucking about, so I expect GZW will take over.

Yeah, if you're not getting any benefit from a formal positive diagnosis, you're doing much the same as with a regular cold or flu, lying in bed and trying not to spread it to anyone you care about. More serious if you're ailing or old, at which point paxlovid is a good shout, but for anyone outside that, just wait it out with a cup of something hot.

In my case, I am all too familiar with COVID and I could swear blindly this was a bout, but either the lab fucked up, or it's the flu. The complete anosmia was only for half a day, whereas with COVID it lasts at least one or two for me personally.

As best as I could tell, yes, couldn't smell perfume or taste food. That increases the odds the COVID test was a false negative, for what it's worth, but I couldn't bother with the nasal rape of a new swab.

It's standard for the cancer patients, but gone are the days when most Indian hospitals provided PCR tests to their staff for free when suspected. At least I managed to get my money's worth when I worked in a (COVID) ICU during the peak of the pandemic here, and two weeks off certainly eased the very real pain. I was looking forward to the sick leave than anything else, my boss is an asshole who wouldn't approve it if it wasn't COVID, or at least he'd make a fuss about it.

Oh well, I'm alive and not at any risk, and thankfully today wasn't the worst day at work. Just a pretty bad one.

Fentanyl hasn't been a problem in India from my anecdotal experience. Opioid overdoses were pretty rare, I can't recall one from my intern days, though I make it a point to stay as far from the ER as possible now. When it happens, it's usually plain old heroin.

If I had to guess why that's the case, well, heroin was enshrined and fentanyl dealers probably couldn't break in, or found selling precursors/smuggling it into wealthier nations more lucrative.

I thought I caught COVID for the 8th time, but no, the PCR came back negative and it's likely just the bloody flu.

I was fervently hoping for a positive result (and confident in it, since I'd expect I'd know what the disease feels like by now), but it was not to be. No sick leave for me. You'd think being in contact with thirty or so immunocompromised people might make them care, but alas. Anosmia, the works, maybe I'll bother with the flu vaccine next time.

Compatibility issues aside (which are ridiculous because the format is more than a decade old), .webp is actually a good format on its own merits. Far better compression and quality than JPEG, and quite close to PNG in terms of the latter.

It's funny/sad the creator actively participates in Twitter threads trying to clear his name when it's being maligned, but it's not really his fault that software devs are too lazy to implement it. It makes for massive savings in image size for hosts, and for little loss in quality, you'd hope they'd have picked up on that by now.

Now consider the difference between Pygmy populations in Africa and Nordics. There's nothing you can feed the former, barring Human Growth Hormone, that will make them reach similar average heights.

Understandable, have a nice day!

(How many kids did it take? Was the short term rental worth it? Did you have to lose your deposit because of the stains?)

My bad. I didn't think it was that Ben Franklin quote, which I can see after I bothered to open it.

Don't mind me, just dying of my 8th bout of COVID here.