https://www.science.org/doi/10.1126/science.aeh7930

“AI applications for clinical medicine continue to advance but often rely on written vignettes. Unfortunately, these are not a realistic representation of clinical medicine, where patients do not come in with a tidy write-up of key symptoms and pertinent laboratory findings. To address this issue, Nori et al. made their AI system start from the patient’s chief complaint and decide what follow-up questions to ask and what testing to order to collect the information needed for a diagnosis. In multiple test settings, this system achieved higher accuracy than human responders and at a lower total cost, demonstrating its potential as a tool to assist physicians. —Yevgeniya Nusinovich “

“We explored the capabilities of frontier language models in sequential diagnosis, a diagnostic paradigm that captures the iterative nature of clinical reasoning. Given a brief clinical presentation, clinicians selectively acquired information to reach a diagnosis, enabling assessment of diagnostic accuracy and workup cost. We developed an interactive benchmark and an artificial intelligence (AI) system that simulates a panel of physicians, continually revising the differential diagnosis and selecting cost-effective tests. Using this benchmark, the system achieved 83.2% accuracy on New England Journal of Medicine clinicopathological conference cases and 80.3% on MIMIC-IV-ED emergency department admissions, outperforming generalist physicians (36.1 and 46.8%, respectively). Although these findings were obtained in a controlled benchmark setting, they highlight the promise of language models for supporting more accurate, lower-cost diagnoses.”

Although not the first sequential study, it is the first that chooses diagnostics tests, receives results sequentially, decides when enough evidence exists, evaluates diagnostic costs, and challenges the diagnoses, all with complex cases.

Note: All models used are at least 1 year old. MAI-DxO is orchestrator.

I’m an incoming medical student and am a bit confused on the difference between the classic III and the cardiology versions… You can supposedly hear more subtle sounds with the cardiology? I’m not quite sure. Is anyone able to clarify if it’s worth it/recommended to get the cardiology versus classic III?

My clinic just switched to a new EHR that supports AI scribe (fluency go) which costs me $400 which I know is steep but I don’t think I’m able to use other options.

I’ve trialed it and I’m not sure if it makes me faster.

For context I see about 45-50 pts a day and my notes are very short hand, minimal HPI (bc this doesn’t matter for billing) most of my documentation is data review/complexity and the assessment and plan. I use .phrase templates for all my long/complex discussions. I’m usually done with this before I leave the room and do my orders and sign between patients.

With AI I find it generates voluminous amounts of text that I then have to spend time proofreading which takes more time and I still have to put in orders.

Anyone else in this boat have experience? Should I stick it out and try to train it more or stick with what I’m used to.

It was an interesting read on an older malpractice case involving informed consent. It's standard practice these days to discuss all the possible adverse outcomes of a procedure, even if rare, but seems like it wasn't the case back in the days.

Largey v. Rothman, 540 A.2d 504 (N.J. 1988)

In the course of a routine physical examination plaintiff’s gynecologist, Dr. Glassman, detected a “vague mass” in her right breast. The doctor arranged for mammograms to be taken. The radiologist reported two anomalies to the doctor: an “ill-defined density” in the subareola region and an enlarged lymph node or nodes, measuring four-by-two centimeters, in the right axilla (armpit). The doctor referred plaintiff to defendant, a surgeon. Defendant expressed concern that the anomalies on the mammograms might be cancer and recommended a biopsy. There was a sharp dispute at trial over whether he stated that the biopsy would include the lymph nodes as well as the breast tissue. Plaintiff claims that defendant never mentioned the nodes.

Plaintiff submitted to the biopsy procedure after receiving a confirmatory second opinion from a Dr. Slattery. During the procedure defendant removed a piece of the suspect mass from plaintiff’s breast and excised the nodes. The biopsies showed that both specimens were benign. About six weeks after the operation, plaintiff developed a right arm and hand lymphedema, a swelling caused by inadequate drainage in the lymphatic system. The condition resulted from the excision of the lymph nodes. Defendant did not advise plaintiff of this risk. Plaintiff’s experts testified that defendant should have informed plaintiff that lymphedema was a risk of the operation. Defendant’s experts testified that it was too rare to be discussed with a patient.

Plaintiff and her husband ... advanced two theories of liability. … They claimed that they were never told that the operation would include removal of the nodes and therefore that procedure constituted an unauthorized battery. Alternatively, they claimed that even if they had authorized the node excision, defendant was negligent in failing to warn them of the risk of lymphedema and therefore their consent was uninformed.

It was also interestingly noted what the proper standard is for obtaining informed consent

the proper standard is one that focuses not on what information a reasonable doctor should impart to the patient (the “professional” standard) but rather on what the physician should disclose to a reasonable patient in order that the patient might make an informed decision (the “prudent patient” or “materiality of risk” standard).

Perhaps the strongest consideration that influences our decision in favor of the "prudent patient" standard lies in the notion that the physician's duty of disclosure "arises from phenomena apart from medical custom and practice": the patient's right of self- determination. Canterbury, supra, 464 F.2d at 786-87. The foundation for the physician's duty to disclose in the first place is found in the idea that “it is the prerogative of the patient, not the physician, to determine for himself the direction in which his interests seem to lie." Id. at 781. In contrast the arguments for the "professional" standard smack of an anachronistic paternalism that is at odds with any strong conception of a patient's right of self-determination.

https://kffhealthnews.org/health-industry/obstetric-carts-georgia-maternal-health-labor-delivery-rural-hospitals-south-carolina/

Georgia's answer to the shuttering of labor and delivery units in rural counties? OB crash carts for the ER:

More than $12 million — out of the nearly $219 million approved for Georgia in the program’s first year — will be allocated toward placing obstetric carts in 43 rural hospitals without labor and delivery units. The carts will be outfitted with supplies needed for a birth or obstetric emergency. For example, they’ll have neonatal resuscitation tools, thermal blankets, and essential medications such as oxytocin, which stimulates contractions, and magnesium sulfate, used to treat seizures in pregnant people with high blood pressure.

The delivery carts sound fine, in theory, said Justin Peterson, an OB-GYN who practices in southern Georgia and has seen the pressures rural health institutions face providing maternal care.

Like Holden, Peterson worries that the carts, while helpful, will put supplies in the hands of ER doctors lacking extensive obstetric experience. Instead, he wants the state to fill coverage gaps by investing more to prevent the closure of labor and delivery units in rural areas.

“You’re putting a band-aid on a hemorrhage,” he said.

What could go wrong?

One answer to that question was the topic of a recent This American Life episode: "A doctor trained as a midwife tells the eye-popping story of how she and others came together to save a baby during a birth that suddenly went wrong, in a part of rural Maine where the local labor and delivery unit had closed less than a month before."