Transcription
So, ChatGPT continues to take the world by storm. It's being used in so many different ways in healthcare today. In today's video, I want to show you how you can actually use it in your day-to-day activities as a doctor or as a resident. The first three prompts I'm going to cover are actually all focused on patient care directly, looking at drug interactions and how to use ChatGPT as a curbside consult, for example. The last three will focus more on medical documentation to boost your productivity.
A quick disclaimer about ChatGPT: whenever using it for medical care, you should really be using it out of an abundance of caution and at your own discretion. What I'm showing here are just examples of how you can leverage this technology, but I think a lot needs to be done to ensure that this is safe and accurate. Always fact-check anything that comes out of ChatGPT to make sure it's correct, and also ensure that you're not inputting patient-sensitive data that could potentially violate HIPAA, for example.
The first use case I want to show of ChatGPT is to use it as a medical consultant. This is basically whenever you're wanting to do a curbside consult. For example, if you're a physician in the ER wanting to consult infectious disease about a question, or if you're a surgeon trying to consult internal medicine about a question, ChatGPT actually does a pretty good job serving as a basic curbside consultant.
In the first example, I asked ChatGPT to please assume the role of an experienced interventional cardiologist with over 20 years of experience in treating chest pain, heart attacks, and heart arrhythmias. I am an emergency room physician and would like to discuss the case of a 65-year-old male patient with a history of strokes who presented with severe chest pain in his right arm with radiation to the fingers. I asked what lab tests I should get, what medication I should start, and what other diagnoses I should consider.
ChatGPT responded by stating that, as an AI language model, it is not a medical professional, but it could provide some basic information. It reiterated the case and pointed out the importance of ruling out life-threatening causes first, which is great because that's what you should be doing in the emergency room. It provided a differential diagnosis that includes acute coronary syndrome, including myocardial infarctions or heart attacks, pulmonary embolisms, aortic dissections, PVD, cervical radiculopathy, and musculoskeletal causes. It also provided a list of labs and tests to use: CBC, BMP, troponins, BNP, EKG, and chest X-rays, along with a list of applicable medications.
Now, let's say I want to dive deeper. If the patient has a pulmonary embolism, what signs, symptoms, labs, and treatments should I consider? ChatGPT indicated that if you suspect a PE, you should look for signs and symptoms such as sudden onset shortness of breath, tachycardia, hypoxia, and cyanosis. It also suggested some labs to order and noted that the gold standard for diagnosing a PE is CT pulmonary angiography. It provided treatment options as well.
Overall, this is a really good way to approach and think about your differential diagnosis. You can ask ChatGPT for things to follow up on, such as, "I think it might be a PE; what else should I be doing?" We can also go further and say, "I am concerned that the patient may have a pulmonary embolism or a heart attack. Can you please provide a table indicating the lab values that would distinguish these two conditions?" ChatGPT then provided the lab tests for PE versus myocardial infarctions, including D-dimer, troponin levels, BMP, CK-MB, EKG, and ABG changes. It did a great job summarizing this information quickly, which can be very helpful if you have a condition you're not super familiar with.
Now, let's move on to the next prompt. Sometimes we have patients who come in with a laundry list of medications, and it's really important to understand which medications may be interacting with each other. This may influence the medications you're prescribing or a medication that may need to be taken off the list due to potential drug interactions.
In this case, I asked ChatGPT about a patient who is on isotretinoin, which is basically high vitamin A for their acne, and I'm thinking about adding doxycycline. I asked if there are any potential medication interactions I should be aware of. From my own experience, I've learned that isotretinoin and doxycycline can cause a higher risk of intracranial hypertension. ChatGPT responded that combining isotretinoin and doxycycline may not be recommended, as both can increase the risk of intracranial hypertension or pseudotumor cerebri. It also provided some symptoms and signs of increased intracranial hypertension, which is always good to know.
I wanted to do another example. In this case, I asked ChatGPT to take on the role of a doctor with several decades of experience. I provided a list of medications, including Tylenol, lisinopril, hydrochlorothiazide, aspirin, warfarin, and furosemide, and asked if there are any concerning medication interactions I should be aware of. ChatGPT provided potential drug-to-drug interactions for the medications the patient is already on, such as aspirin and warfarin, and also discussed hydrochlorothiazide, furosemide, and spironolactone. It noted that hydrochlorothiazide and furosemide are diuretics that help reduce fluid retention, and adding spironolactone, another diuretic, could potentially exacerbate the diuretic effect, leading to excessive fluid loss, dehydration, or electrolyte imbalances, particularly low potassium or sodium levels.
That's really good to know. Then, I asked ChatGPT to help with the prescription itself in terms of how frequently to do lab checks and what labs to check at baseline and for the frequency of screening labs moving forward. I decided to move forward with prescribing spironolactone and asked what labs I should order and how frequently. ChatGPT indicated that when prescribing spironolactone, it's essential to monitor electrolytes, renal function, and blood pressure. It provided the important fact that spironolactone can affect electrolyte levels, particularly potassium, so monitoring serum potassium and managing any hyperkalemia is crucial.
The next prompt I wanted to focus on was using ChatGPT to help you connect with patients better, providing better support and comfort whenever they're in a time of need. In this example, I mentioned the patient above and expressed concern that they may also be suffering from anorexia nervosa. I asked how I should best approach this as a doctor. ChatGPT responded that addressing concerns about anorexia nervosa requires a compassionate, sensitive, and multidisciplinary approach. It provided different tips and suggestions, including building rapport, choosing the right moment to open up, and verbatim questions you can directly use. For example, it suggested asking, "How do you feel about your habits?" or "Can you tell me more about your relationship with food and your body?"
It also mentioned that you can share your observations and express your concerns about the patient's health by sharing observations without judgment or blame. For instance, you might say, "I've noticed you've lost a lot of weight recently, and I'm concerned about how this may be affecting your health." I think this is really helpful, especially if you haven't dealt with anorexia nervosa for a long time or if you haven't encountered a particular condition in a while. You can always think about how to approach that from a compassionate care standpoint.
Let's take this another step further. You can actually use ChatGPT to think about what the patient may be feeling. I see this as really useful in medical education, especially when medical students are just starting to learn about how to handle difficult and challenging conversations. You can ask ChatGPT, "Can you tell me a little bit about the emotions and feelings that someone with anorexia nervosa may have, particularly about their condition?" It goes on to say that some common emotions individuals with this condition may experience include fear, control, anxiety, guilt or shame, low self-esteem, perfectionism, depression, and isolation.
I think this is really nice because whenever you're reading it before you go into the patient's room, for example, you're able to put yourself in their shoes and think about what they may be experiencing. This really equips you to be a more compassionate doctor when talking with them about their challenges and care. I find this application of ChatGPT interesting as it helps us connect with patients on an individual and emotional level by understanding what they may be experiencing.
Now, let's jump to the medical documentation prompts. The first prompt I wanted to demonstrate in this category was using ChatGPT to summarize text at a reading level that may be more appropriate for your patient, such as a fifth-grade reading level, a high school reading level, or a college reading level. For example, I asked, "Can you please provide an explanation for how spironolactone can be used to treat hormonal acne, explained at a fifth-grade level and provide an analogy?" Initially, it provided something that I thought wasn't the greatest in terms of an analogy, so I subsequently removed it.
After I asked for a simpler explanation for a third-grade level and to remove the analogy, ChatGPT responded: "Spironolactone is a medication that helps with hormonal acne. Hormonal acne happens when there are too many hormones in your body, like androgens. These hormones make your skin produce extra oil, which causes pimples. So, spironolactone, the medication we're going to be prescribing, works by blocking these hormones. When the hormones are blocked, the skin doesn't make as much oil, and you get fewer pimples. This helps your skin stay cleaner and clearer."
I thought this was a really good synopsis of how spironolactone works. It's simple and could easily be included in the after-visit summary. Here's an example of me using it to write that after-visit summary. In this prompt, I said, "I am planning to start spironolactone for a patient, starting with 50 milligrams daily, then increasing it to 100 milligrams daily. Please write an after-visit summary about this, explaining that it is being used to treat her acne, and tell her what potential side effects to notify us about, keeping the explanation to a fifth-grade level and succinct."
ChatGPT responded: "Dear Patient, thank you for your visit today. We discussed your acne and wanted to start you on a medication called spironolactone." It then explained the methodology or pathophysiology of why it works and listed the concerning side effects. It concluded with, "Remember to keep all your appointments and let us know if you have any questions or concerns." So, that's basically the after-visit summary already. I don't necessarily need to be in the room typing this all out if I wanted to write this after-visit summary.
The next prompt I wanted to cover in this section was also using ChatGPT to translate text. For example, if we wanted to translate one of those after-visit summaries, I can ask ChatGPT, "Can you please translate the following explanation to Spanish, Chinese, Vietnamese, and Arabic?" It actually did a pretty good job, and I copied and pasted this into Google Translate to verify its accuracy.
Next, let's use ChatGPT to write a letter of medical necessity for an orthopedic surgeon trying to get an MRI for his patient. The prompt states, "I am an orthopedic surgeon that specializes in joints. A patient has been declined an MRI for his shoulder, and I would like to get a letter of medical necessity for him to get his MRI." I provided a brief summary about the patient: he's a 60-year-old male with a history of right shoulder pain that has been progressively worsening despite physical therapy and other conservative management strategies, including rest, compression, and ice.
ChatGPT did a great job generating a letter of medical necessity. One of the best lines in the letter states, "In light of these facts, I respectfully request you reconsider the decision to deny coverage for an MRI of my patient's right shoulder. The MRI is medically necessary to provide a definitive diagnosis, guide treatment decisions, and ultimately improve the patient's quality of life." Overall, this is a really good letter of medical necessity written by ChatGPT, and it only took a few minutes. I can also ask for citations as well, as I did above.
That's it for this video, guys! I hope you liked it. There will be a part two and probably a part three, just because there are so many different ways that ChatGPT can be used in day-to-day activities as a doctor. If you liked this video, go ahead and hit that like and subscribe button below. I'll also be coming out with a book about ChatGPT in healthcare, which will be more of a practical guide for doctors on how to leverage this technology. If you want to hear more about the upcoming book, go down to the description below, where there's a newsletter button. You can join that to receive exclusive updates or deals that are coming out.
Alright, see you guys! Bye!