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PaperclipPerfector  2mo ago (text post)   2323 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.

Adding this to the list of things to forget before stepping into a hospital

  • the imported doctors will use new shady technology to communicate medically-relevant information, including medication
  • somehow this is still better than the alternative of relying on the regular system of poorly-trained people with even poorer technology

At some point a typo might happen... When all these horrible sci-fi predictions ('BRAIN HACKED BY CIA MICRO-CHIPS') come true we will probably be completely desensitized.

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.

I completely understand what you're saying and I agree, 999 times out of a thousand, any possible mistake in transcription / medication is probably not a big deal at all. And you don't need special technology to make a mistake as a human being.

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.

I'm not really concerned how the data is used, more about potential patient-related issues.

This is the kind of stuff that American hospitals sometimes do, and this one case is an extreme example.

18 yo patient was treated for brain aneurysm by hospital

patient and family decide that they've stayed long enough in the hospital (2 months)

hospital denies all transfers, tries legal motion to give the hospital legal guardianship of the adult patient, alleging insufficient mental condition to make own medical decisions

normal case would be to get guardianship to family + they had the adult patient sign a bunch of consent forms at the same time they were attempting that legal process

family heists the patient out of the hospital, get cell-phone tracked by the police and chased

police finally back off after seeing a 2nd hospital disagreed with the first

I've recently been made aware of a case of a family with 3 children. One child somehow received 3rd degree burns from a boiling pot of water, was taken to the hospital for treatment. Parents were locked up with a heavy bail, all children sent to foster care.

Here's one hypothetical case :

parent comes into American hospital with a child with a black eye / skull fracture / some other kind of injury that could come from something completely innocuous or from domestic abuse

staff follows the process of performing tests without telling the parent that they're looking for confirmation of domestic abuse

tests come back negative because the child was not abused

low-paid worker/ poor technology /??? introduces some kind of typo

parents get arrested for domestic abuse - kid ends up abused in foster care

This is all in normal times when there is not a powerful coalition of interests to prevent family members from visiting patients, decrease any kind of oversight over what happens inside hospitals and introduce some kind of hero worship for healthcare workers.

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.

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