Doctors are drowning in paperwork. Some companies claim AI can help

Geoff Brumfiel

NPR.org - Health Shots

Originally posted 5 APR 23

Here are two excerpts:

But Paul kept getting pinged from younger doctors and medical students. They were using ChatGPT, and saying it was pretty good at answering clinical questions. Then the users of his software started asking about it.

In general, doctors should not be using ChatGPT by itself to practice medicine, warns Marc Succi, a doctor at Massachusetts General Hospital who has conducted evaluations of how the chatbot performs at diagnosing patients. When presented with hypothetical cases, he says, ChatGPT could produce a correct diagnosis accurately at close to the level of a third- or fourth-year medical student. Still, he adds, the program can also hallucinate findings and fabricate sources.

"I would express considerable caution using this in a clinical scenario for any reason, at the current stage," he says.

But Paul believed the underlying technology can be turned into a powerful engine for medicine. Paul and his colleagues have created a program called "Glass AI" based off of ChatGPT. A doctor tells the Glass AI chatbot about a patient, and it can suggest a list of possible diagnoses and a treatment plan. Rather than working from the raw ChatGPT information base, the Glass AI system uses a virtual medical textbook written by humans as its main source of facts – something Paul says makes the system safer and more reliable.

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Nabla, which he co-founded, is now testing a system that can, in real time, listen to a conversation between a doctor and a patient and provide a summary of what the two said to one another. Doctors inform their patients that the system is being used in advance, and as a privacy measure, it doesn't actually record the conversation.

"It shows a report, and then the doctor will validate with one click, and 99% of the time it's right and it works," he says.

The summary can be uploaded to a hospital records system, saving the doctor valuable time.

Other companies are pursuing a similar approach. In late March, Nuance Communications, a subsidiary of Microsoft, announced that it would be rolling out its own AI service designed to streamline note-taking using the latest version of ChatGPT, GPT-4. The company says it will showcase its software later this month.

The info is here.

Discerning bias in forensic psychological reports in insanity cases

Tess M. S. Neal
Behavioral Sciences & the Law, (2018).

Abstract

This project began as an attempt to develop systematic, measurable indicators of bias in written forensic mental health evaluations focused on the issue of insanity. Although forensic clinicians observed in this study did vary systematically in their report‐writing behaviors on several of the indicators of interest, the data are most useful in demonstrating how and why bias is hard to ferret out. Naturalistic data were used in this project (i.e., 122 real forensic insanity reports), which in some ways is a strength. However, given the nature of bias and the problem of inferring whether a particular judgment is biased, naturalistic data also made arriving at conclusions about bias difficult. This paper describes the nature of bias – including why it is a special problem in insanity evaluations – and why it is hard to study and document. It details the efforts made in an attempt to find systematic indicators of potential bias, and how this effort was successful in part, but also how and why it failed. The lessons these efforts yield for future research are described. We close with a discussion of the limitations of this study and future directions for work in this area.

The research is here.

Cultivating Humility and Diagnostic Openness in Clinical Judgment

John R. Stone
AMA Journal of Ethics. October 2017, Volume 19, Number 10: 970-977.

Abstract
In this case, a physician rejects a patient’s concerns that tainted water is harming the patient and her community. Stereotypes and biases regarding socioeconomic class and race/ethnicity, constraining diagnostic frameworks, and fixed first impressions could skew the physician’s judgment. This paper narratively illustrates how cultivating humility could help the physician truly hear the patient’s suggestions. The discussion builds on the multifaceted concept of cultural humility as a lifelong journey that addresses not only stereotypes and biases but also power inequalities and community inequities. Insurgent multiculturalism is a complementary concept. Through epistemic humility—which includes both intellectual and emotional components—and admitting uncertainty, physicians can enhance patients’ and families’ epistemic authority and health agency.

The article is here.

Professional Intuition Is Under Assault, Wachter Says

By Marcia Frellick
Medscape.com
Originally published November 24, 2015

Profession intuition — the gut feeling doctors get with experience and instinct that something just isn't right — is under assault, Robert Wachter, MD, professor of clinical medicine at the University of California, San Francisco, told the audience at TEDMED 2015.

"It's suspicious, it's soft, it's squishy," said Dr Wachter, the physician who, along with Lee Goldman, MD, coined the word "hospitalist" in 1996 (N Engl J Med. 1996;335:514-517).

"There's not an algorithm for it, it's not evidence-based," he explained. And "it's antidemocratic, it's paternalistic."

The entire article is here.

Doctors, Patients, and Nudging in the Clinical Context-Four Views on Nudging and Informed Consent

Ploug T and Holm S
Am J Bioeth. 2015 Oct;15(10):28-38.

Abstract

In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.

The entire article is here.

Dilemma 33: Breaking Bad (or Good)

Dr. Jesse Pinkman has been working with a 26-year-old professional for about a year, Ms. Skyler White. They have been working on managing her symptoms of depression and anxiety.  The patient smokes marijuana regularly, which has been a concern for Dr. Pinkman.

Skyler arrives late to her appointment, looking frazzled.  She explained her friend overdosed on heroin the prior evening.  She has been in the ER for the past 12 hours.  Her friend will likely survive, but she may have residual cognitive problems.

Skyler reported feeling horribly guilty because she introduced her friend to her next door neighbor, who is the drug dealer.  Her friend always stops by to see Skyler first, before purchasing drugs. Skyler purchases her marijuana from the same dealer.

After processing the events of the previous evening, Skyler stated she will move away from the drug dealer.  She no longer wants to be this close or indirectly cause harm to someone else.  The police are actively investigating, but Skyler does not want to divulge any information.  She does not want to get involved.  Skyler makes an appointment for next week, and then leaves feeling somewhat better.

Dr. Pinkman becomes preoccupied about what Skyler reported.  Dr. Pinkman knows the dealer’s name from previous sessions and can figure out the address of dealer, based on his patient’s address.

Dr. Pinkman is contemplating calling in an anonymous tip to the police.  Dr. Pinkman is aware of the increase in heroin use in his community.  He also recognizes his struggle with moral outrage and sense of injustice in this situation.  Struggling with the emotions to report or not report anonymously, Dr. Pinkman calls you for a consultation.

What are the competing ethical principles in this situation?

How would you feel if you were Dr. Pinkman?

What are some of the positive and negative consequences about Dr. Pinkman making the anonymous report?

How do your own professional values and personal morals influence how you would respond to Dr. Pinkman?

How would you respond to Dr. Pinkman’s moral outrage?

Would your answers differ if the friend died?

Would your answers differ if the patient was of low socio-economic status?

Would your answers differ if Skyler were a teenager?

Biological Biases Can Be Detrimental to Effective Treatment

By John Gavazzi
Originally published in The Pennsylvania Psychologist

During workshops on ethical decision-making, I typically take time to highlight cognitive and emotional factors that adversely affect clinical judgment and impede high quality psychotherapy.  In terms of cognitive heuristics that hamper effective treatment, the list includes the Fundamental Attribution Error, Trait Negativity Bias, the Availability Heuristic, and the Dunning-Krueger Effect.  Emotionally, a psychologist’s fear, anxiety, or disgust (also known as countertransference) can obstruct competent clinical judgment.  A PowerPoint presentation providing more details on these topics is on my SlideShare account found here.

Research from cognitive science and moral psychology demonstrates many of these heuristics and emotional reactions are automatic, intuitive, and unconscious.  The cognitive heuristics and emotional responses are shortcuts intended to evaluate and respond to environmental demands quickly and efficiently, which is not always conducive for optimal clinical judgment and ethical decision-making.  For better or worse, these cognitive and affective strategies are part of what makes us human.  It is incumbent upon psychologists to be aware of these limitations and work hard to remediate them in our professional roles.

Recent research by Lebowitz and Ahn (2014) provides insight into another cognitive bias that leads to potentially detrimental emotional responses.  Their research illustrates how a clinician’s perception as to the causes of mental health problems can undesirably influence his or her perceptions of patients.  The authors chose to investigate clinicians’ perceptions of patients when using a biological model of mental disorders.  The biological model supports the belief that genetics play an important role in the creation of mental distress; that central nervous system dysfunction is the most important component of the mental health disorder; and, because of these biological origins, a patient’s thoughts and behaviors are largely outside of the patient’s control.

The entire article is here.