Latest / Morning Medical with Dr. Chow / AI in Healthcare, Deprescribing, and 2024 Paris Olympics Health Precautions

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AI in Healthcare, Deprescribing, and 2024 Paris Olympics Health Precautions · Morning Medical with Dr. Chow

• 0:00
  Welcome to another episode of Morning Medical with Dr.
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  Chow.
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  I am your host, Dr.
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  Chi-Ming Chow, and today we have an intriguing topic to discuss.
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  We're diving into the world of artificial intelligence in healthcare and exploring a
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  novel perspective: thinking of AI as a medical student.
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  Since the development of artificial intelligence solutions in healthcare, a
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  compelling question looms: 'Will AI eventually replace your doctor?' Artificial intelligence
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  can often outperform physicians in diagnostic accuracy, bedside manner, and test-taking.
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  However, it faces significant barriers in trust, human-relational aspects, and oversight
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  that, at least for now, categorize this technology as more of a companion solution.
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  So, what should the AI-physician partnership actually look like?
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  Eric Shan, a medical student with experience in healthcare AI, and Dr.
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  Jeffrey Millstein, an attending physician, propose that we should think of AI as a medical
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  student in training.
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  While working with actual medical students can be rewarding, it can also be burdensome for
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  attending physicians in our busy clinical environments.
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  The AI medical student will require preparation and ongoing iterative adaptations, but it
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  learns so quickly that it can meaningfully lighten the physician's workload.
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  With a growing wealth of medical knowledge, artificial intelligence can help complete
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  tasks, gather information, and tailor communications.
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  Since it can still make mistakes, miss the full picture, and have gaps in its clinical
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  thinking, there should be a fully licensed attending physician supervising the work.
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  Moreover, as in actual teacher-student collaborations, learning can be bidirectional.
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  In the case of AI, the 'student' can point out their mentor's errors without the constraint of
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  hierarchy.
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  Shan and Dr.
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  Millstein hope that this framework for thinking about medical AI will shift the conversation
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  and development efforts away from approximating the tasks of human physicians and towards
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  improving physician excellence.
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  While there is so much excitement about AI in healthcare, we also need to recognize that
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  these solutions are still early in their application, and like medical students, they
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  need time to grow and prove themselves.
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  What would this look like in practice?
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  Imagine the start of a future clinic visit or hospitalization: AI takes over the medical
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  student's task of digging through a patient's chart to understand their prior medical course,
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  focusing on how their health has changed since they were last seen.
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  It is the first 'provider' on the care team to engage directly with the patient, gather
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  preliminary information, and help the supervising physician get a sense of what is
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  going on before they enter the patient's room.
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  Because many patients come in with extensive medical histories, and physicians only have so
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  much time to see each patient, the AI medical student helps focus the visit and make the most
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  of the time the physician spends with the patient.
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  The AI medical student will also: perform a review of all home medications; summarize the
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  patient's case; craft a succinct consult question for another specialty when needed; put
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  together a condensed discharge summary; query prior notes to answer ad hoc questions about
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  the patient's history; and engage the patient's family with updates.
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  In addition, it will perform literature searches to help broaden the clinical team's
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  list of possible diagnoses and ground each care plan with an evidence-based approach.
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  As a result, physicians can reprioritize tasks more directly relevant to improving quality of
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  care while giving more complete attention to the patient.
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  After the clinic visit or hospitalization, the AI student will take a first pass at writing a
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  documentation note that the supervising physician reviews and co-signs with relevant
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  edits.
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  It also provides tailored information to all the stakeholders in the patient's care, from a
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  set of discharge instructions written at the patient's level of understanding to relevant
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  updates for all their outpatient providers.
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  Finally, AI continues to follow the patient in a low-touch manner.
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  For instance, a patient presenting with poorly controlled hypertension will receive automated
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  post-visit communication asking about their blood pressure, and any concerning updates
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  could be flagged to human doctors.
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  In this setting, AI can help create seamless transitions of care while making sure patients
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  continue to be supported beyond the acute care setting.
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  Throughout these examples, the AI medical student is responsible for important but
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  low-stakes tasks.
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  These drive better care, but they are also easy to double-check, and mistakes can quickly be
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  corrected.
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  The current capabilities of AI are well-suited to these needs.
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  AI tools have already been built to understand and generate natural human language, parse and
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  connect massive amounts of information, and scale across a sizable panel of patients.
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  Thinking of AI as a medical student can help healthcare leaders and physicians better
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  understand how to cohesively integrate these solutions into the workflow of a typical
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  clinical encounter.
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  This can encourage us to temper our expectations with these innovations.
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  Instead of talking about whether a technology is going to replace human cognitive
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  capabilities, we should instead be talking about finding the most helpful way to
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  collaborate with it -- in the best interest of physicians and patients.
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  As AI increasingly takes on tasks that medical students currently have, we envision a
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  concurrent shift in what medical training will look like.
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  We anticipate a greater emphasis on engaging with AI tools and on refining core clinical
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  decision-making skills.
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  Additionally, prompt engineering -- determining the best way to ask AI a question so that it
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  outputs the most helpful clinical information -- will be a core component of medical
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  training.
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  All of this begs the ultimate question: medical students eventually learn enough to become
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  fully-fledged doctors -- will this also hold true for AI?
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  Shan and Dr.
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  Millstein remain open to this possibility.
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  But just like medical training, we should slowly advance AI in healthcare by giving it
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  increasing clinical responsibilities and subsequently evaluating how it performs at each
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  step.
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  Swallowing a handful of pills is a daily ritual for many people, from young adults coping with
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  anxiety to older adults managing chronic conditions.
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  Overall, thirteen percent of people in the United States take five or more prescription
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  drugs.
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  For those sixty-five and older, that number is forty-two percent.
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  If you are taking multiple medications, it is smart to be aware of potential problems.
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  One pill can lead to a side effect, leading to another pill and another side effect in what
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  experts call a “prescribing cascade.” Some drugs can cause harm if taken for years.
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  Others stop working or interact badly with a new drug.
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  A drug tolerated well at first can cause side effects later, leading to cognitive decline and
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  injuries from falls.
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  “Our metabolism changes as we get older,” said Dr.
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  Elizabeth Bayliss, who studies deprescribing at Kaiser Permanente’s Institute for Health
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  Research in Aurora, Colorado.
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  “Everyone’s ability to metabolize the medications they’ve been taking for a long time
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  may change.” The nonprofit Lown Institute calls the whole situation a medication overload that
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  will cause four point six million hospital visits this decade.
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  If your daily pill routine is getting out of hand, ask for a medication review.
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  Here is how to get started with a process called “deprescribing.”
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  Start with a professional you trust, like a doctor or pharmacist, said Lisa McCarthy, a
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  pharmacist and deprescribing expert at the University of Toronto.
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  If you are asking your doctor, do not wait until the end of a fifteen-minute visit.
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  Instead, make a dedicated appointment and tell them when booking you want to talk about your
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  medicines, McCarthy said.
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  Your doctor may not have the full picture of what you are taking if other prescribers are
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  involved, and some doctors hesitate to manage drugs prescribed by others.
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  That is when a pharmacist can help by reviewing everything and writing up suggestions you can
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  share with your doctors, said pharmacist Bradley Phillips of the University of Florida
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  College of Pharmacy.
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  “We are considered the medication experts,” Phillips said.
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  Swelling, incontinence, restlessness, insomnia — all are side effects caused by common
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  medications that sometimes get treated with new drugs.
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  McCarthy wants people to ask their doctors a simple question: Could this symptom be related
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  to one of my medications?
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  “If we could teach the public to ask that question it would be very powerful,” McCarthy
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  said.
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  And for a follow-up question, she suggested: Do I still need this medicine?
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  Pharmacist Barbara Farrell sees dramatic changes in many people she helps at an
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  outpatient geriatric center in Ottawa, Ontario.
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  Some have emerged from a drug-induced dementia after their medications are reduced.
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  A seventy-seven-year-old woman was able to leave her wheelchair and walk with a cane after
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  cutting her daily pills from thirty-two to seventeen.
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  She had arrived sedated and unable to communicate, and a few months later, she was
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  back to her hobby of knitting.
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  Some medications can be stopped abruptly but others require a slow taper to prevent
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  uncomfortable withdrawal symptoms — or even life-threatening seizures.
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  Tapering to progressively lower doses is particularly important with drugs for
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  depression, insomnia, and anxiety.
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  After two decades on various pills for these conditions, therapist Molly Bernardi of
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  Spokane, Washington, began tapering down her doses.
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  The forty-five-year-old suspected the pills were the cause of her worsening problems with
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  digestion, balance, memory, stiff muscles, and flickering dots across her field of vision.
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  When scans ruled out other illnesses, she gradually stopped each of four medications.
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  “It’s been by far the hardest thing I have ever done,” Bernardi said.
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  One of the final drugs she stopped was the toughest: a benzodiazepine, a class of
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  sedatives that can be harmful if taken long term.
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  Over the course of three months, she used a kitchen knife and a nail file to cut her one
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  milligram daily pill into ever-smaller pieces.
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  She listened to her body, found support groups on Facebook, and used breathwork and prayer to
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  get through withdrawal symptoms.
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  “Now when I have a good day, a good hour, a good moment, it is peace and presence like I
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  have never known since before I was medicated,” Bernardi said.
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  “I am just experiencing a little bit of great.
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  And a little bit of great is so great that it keeps me going.”
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  Even in the best-connected health care systems, McCarthy said, information about prescriptions
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  is not always shared among doctors.
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  And they will not know about your over-the-counter drugs, vitamins, or nightly
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  cannabidiol gummy.
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  The only person who knows everything you take is you, McCarthy said.
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  So keep a current list of what you take, why it was prescribed, and when you started taking it.
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  For an example of a medication list, which McCarthy called a “tremendously powerful” tool,
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  look at the workshop materials she and her colleagues designed.
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  As sports fans from all over the world prepare for the 2024 Paris Olympics, health officials
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  and experts are urging caution and vigilance.
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  With the Olympics officially starting on Friday, and more than 10,000 athletes
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  participating, an estimated 15 million spectators are expected to attend, including 2
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  million visitors.
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  This mass gathering creates potential health risks that everyone should be aware of.
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  The World Health Organization recently published new guidance for spectators traveling
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  to the Olympic and Paralympic Games.
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  Developed jointly by WHO Europe, the French Ministry of Health and Prevention, Santé
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  Publique France, and the European Centre for Disease Prevention and Control, the guide
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  covers vaccinations, respiratory infections, heat risks, and alcohol consumption, among
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  other advice.
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  “The thing about an Olympics or any kind of large event is you have maximum population
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  mixing,” said Colin Furness, associate professor at the University of Toronto’s
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  faculty of information.
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  “You have people coming from all over the globe and converging.
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  That is a lot more dangerous than a bunch of locals getting together at the local stadium
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  where you all come from the same population.”
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  Furness highlighted that the biggest risk comes from crowds, especially indoors, and these
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  risks can start as early as the airport.
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  He highly recommends wearing a face mask.
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  Given the current rates of COVID-19, he said, “boarding a plane is actually particularly
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  risky.”
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  The WHO guide emphasizes that before traveling to Paris, spectators should ensure they are up
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  to date on their vaccinations, particularly for measles.
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  “Cases of measles are on the rise worldwide, including in Europe and in France,” the guide
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  said.
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  “Anyone is at risk of measles if they have not been fully vaccinated or have not had measles
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  in the past.”
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  Furness added, “It would be foolish to get on an airplane and travel anywhere without being
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  up to date with measles shots, which are incredibly effective.”
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  Before making the trip, other diseases to be vaccinated against may include whooping cough,
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  tetanus, diphtheria, polio, and COVID-19, according to the WHO guide.
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  Masking on the plane and in big indoor crowds can keep Olympic attendees safe.
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  Furness advised, “The more time you can spend outdoors, the better.”
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  To further protect yourself from respiratory infections while attending the Summer Games,
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  the WHO recommends avoiding close contact with sick people, washing or cleaning your hands
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  frequently, and avoiding touching your eyes, nose, or mouth.
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  “If you have symptoms, such as a cough, fever, or sore throat, stay at home or in your hotel
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  if possible and consider wearing a mask when you leave your hotel or home,” the guide
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  advises.
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  Temperatures are expected to soar again in the European summer, after setting records in 2023.
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  A recent report by U.K.
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  researchers highlighted the heat risks at the 2024 Paris Olympics, warning that “the threat
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  of a devastating hot spell is a very real one.” The WHO also warned about “serious health
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  risks” due to high temperatures.
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  “Without proper precautions, heat stress can develop into heat stroke, which can be fatal if
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  untreated,” it said.
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  To minimize risks from the sun and heat, fans are urged to stay hydrated, carry a fan, apply
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  sunscreen, stay in the shade, and wear long, airy, light-colored clothing as well as a hat.
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  Travellers should also take precautions for mosquito- and tick-borne diseases by using
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  approved repellents and wearing light, breathable clothing that covers most of the
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  body.
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  “Tiger mosquitoes, which can transmit several diseases, are widely present in France and are
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  mainly active during the day,” the WHO guide noted.
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  Smoking and vaping are banned in most indoor public spaces in France, and doing so outside
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  of designated areas is punishable by a fine of up to 450 Euros or 673 dollars.
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  The guide also recommends limiting alcohol consumption, as large amounts can lead to
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  accidental poisoning and disturbances in perception and attention.
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  Furness said, “Moderation is key when it comes to drinking.
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  Recent research suggests that there really is no safe level of alcohol.”
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  Paris officials are beefing up security measures for the Olympics opening ceremony,
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  which will take place along the River Seine and not in a stadium for the first time.
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  Roughly 45,000 police, including members of France’s elite special intervention forces
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  trained in counterterrorism, will be present during the opening ceremony on Friday.
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  Although French officials have stated that there are no specific terrorism threats for the
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  ceremony, they have backup plans should specific concerns arise.
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  The Canadian government updated its travel advisory for France last week, warning of an
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  increased presence of security forces, major traffic disruptions, large crowds, and public
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  gatherings during the Olympic Games.
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  It also cautioned against an increase of petty crime, including theft and pickpocketing.
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  That wraps up today's episode of Morning Medical with Dr.
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  Chow.
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  I hope you found our discussion on AI in healthcare, the importance of medication
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  reviews, and health precautions for the Paris Olympics informative.
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  Stay safe and healthy, and join us next time for more updates on the latest in medical and
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  health news.
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  Goodbye!