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PaperclipPerfector  2mo ago (text post)   2328 thread views

Friday Fun Thread for February 23, 2024

Be advised: this thread is not for serious in-depth discussion of weighty topics (we have a link for that), this thread is not for anything Culture War related. This thread is for Fun. You got jokes? Share 'em. You got silly questions? Ask 'em.

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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.

Dragon Naturally Speaking has worked in medical environments for a while, and I was able to find a pirated copy at some point.

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.

Yeah most of my coworkers swear by Dragon or some other licensed or free/cobbled together replacement.

Whatever works though.

I know a lot of people subscribe the "you are slow OR you are fast" approach to medical care and documentation, and I'm partially on that train....but if you want to focus on getting faster you will. It'll take awhile (and if you don't have exceptional insight you likely won't notice it's happening until you look back) but you can get faster at typing/writing/dictating.

Figure out what is fat and trim it.*

*Okay I have no fucking clue what the regulatory environment and documentation burden is in India but this is a good skill to get started on now to prep for psych.

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.

No way I'm doing that in the US because "regulation" jazz hands. We'll catch up eventually though, and I know some are doing it. A good EMR and/or dictation fixes a lot of these issues, even for Psych you can automate a note pretty well in Epic. OP notes a bit tricker depending on your style (but dictation works great). IM discharge notes are a shit show if you want them to be not worthless though.

Most long notes that people are write in psych (less so in other specialties) are a nervous habit, or driven by "training." Regulatory/legal/billing/admin stuff is less than you think it is, filling up the whole thing with subjective info is avoidable if you are willing to condense it - use dem writing skills you got.

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