This month’s episode of “News You Can Use” on HealthcareNOWRadio features news from the month of October 2023
News You Can Use with your Hosts Dr Craig Joseph and Dr Nick van Terheyden
The show that gives you a quick insight into the latest news, twists, turns and debacles going on in healthcare with my friend and co-host Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners and myself, where every diagnosis comes with a side of humor. We hope you stay curious, stay engaged, and keep seeking the truth in healthcare in a world that thrives on information.
Buckle up as we dive into the ER of excitement, the ICU of irrationality, and the waiting room of wacky wisdom in this month’s show that features a review of:
- ChatGPT getting its Voice
- New Blood tests for diagnosing Children with Fever
- Healthcare is Hard – a New Conference Idea
- Rural Hospitals – buy out or going bust?
AI, Candy, and Cigarettes
In recent news, ChatGPT now comes with a speech-enabled interface. We discuss several aspects of this and what it might mean going forward. With the addition of images more capability and even more weirdness as demonstrated by this Recursive loop GPT-4V “Describe this image” over to Dall-E 3 “Generate this image”
https://twitter.com/conradgodfrey/status/1712564282167300226
Hopefully, the voice options will be customizable perhaps even with your own voice as an option!
We talk about the new blood test unlike many prior approaches with genomics and epigenetics in mind offering some potential early warnings of disease in children (maybe keeping Craig’s shoes vomit-free) and then move to review “Healthcare is Hard” – the new conference proposed by Chrissy Farr. We know the healthcare system is complex and are wondering if perhaps what we need is a solutions for many of the points laid out in the panel suggestions.
Listen in to hear our thoughts on rural hospital takeovers and the dilemmas surrounding the acquisition of these hospitals by larger healthcare systems, the potential impact on communities, and the challenges of maintaining promises made during acquisitions.
We hope you enjoy our take on the latest news and developments in healthcare and want to help you keep untangling the web of information, dodging the sensational pitfalls, and emerging victorious, albeit a little dizzy, on the other side. In the end, the stories we uncover, and the discussions we ignite, all shape the narrative of our shared future. We want to hear from you especially if you have topics covered or questions you’d like answered. You can reach out directly via the contact form on my website, or send a message on LinkedIn to Craig or me.
Until next month keep solving healthcare’s mysteries before they become your emergencies
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
So first off this week, Craig, we’re talking about chat GPT for a change. And it turns out that they’ve added voice recognition. So now you can talk to your AI system and that large language model that is streaming, a sense of streaming consciousness. Have you tried it?
Craig Joseph
I have not tried it. But I have a colleague who did try it and sent me an audio recording of it. And it was it was scary. It’s not instantaneous, I will say you have to give it a few seconds to ponder what you’ve said and to respond. And the the, the user experiences that you can kind of see it thinking because it makes a little, it’s got a little circle, and it kind of gets bigger and smaller.
Nick van Terheyden
You can see chat GPT thinking, how does it look like?
It’s it’s a
Nick van Terheyden
circle there with the fist of the
Craig Joseph
know the hell? It’s simply a circle? Obviously, you don’t know anything about computers. But when a computer thinks it’s a circle, and it gets big when it’s thinking big thoughts and small wins, thinking small thoughts. We all know this. Dr. Nic, I’m not sure why you’re asking these questions. But it has Yeah, I suspect you can change the voice. You definitely
Nick van Terheyden
can please let that be the case. Just to be clear, if nobody has found this, in case you haven’t, and it’s not there at the moment, they took it away again, but Waze comes with an opportunity to customize the directions with Arnold Schwarzenegger as the Terminator. Okay, that’s awesome. It is like the best thing. I actually like going for a drive and calm right there. The speed drop ahead, speeding would be ill advised.
Craig Joseph
That says,
Nick van Terheyden
No, that’s good. That’s not bad, right?
Craig Joseph
I’ve configured my map as a a woman with a British accent. And based because it’s been 100%, based on my work with you, because you’re always giving me directions. And so I thought, let’s just complete the whole thing. And just have this person give me directions with a British accent yet. I digress. We were talking about interacting with chat, chat GPT. And so, you know, you can ask it a question, and it thinks about it for a second. And then it gives you an answer. And it can talk quickly, or it can talk slowly. And just like with the chat GPT on the computer or the app, you can continue to the conversation back and forth asking it to be more specific or less specific.
Nick van Terheyden
It’s, it’s got to speed things up. I mean, you know, we’ve already got speech. I mean, I spent my almost a big part of my career, let’s be clear on this speech and speech enablement. And, you know, despite that, I have to say that I forced my kids to learn touch typing, and it was probably the best thing that I ever did for them, because I don’t think we’re ever going to reply, what maybe we will, but I always struggle with the idea of this sort of, you know, keeping it private, when you wanted to have a, an interaction with technology, you couldn’t do that with speech, because, you know, potentially people are listening. But there are solutions to that, including a little microphone you can put next to your tooth, and then you can talk very quietly, you can still pick it up. But it I guess I’m a little bit disappointed to hear that there’s this delay, because for me, that’s it’s just adding to the pain and agony of this if you gotta wait for things, if there’s a spinning ball or whatever it is, in this instance,
Craig Joseph
there was at least in the in the initial version that I saw, and I do want to correct you. We don’t call it typing, we call it keyboarding.
Nick van Terheyden
Oh, another one of those phrases. Yeah,
Craig Joseph
I mean, these are things you old people such as yourself seem to have, I’m not really sure what typing is. Because I am young, and a, and whatever the youngest generation is that’s the generation
Nick van Terheyden
gave me this youngest generation that was that’s exactly what your British guide would tell you on your map service that’s typing. That’s what we do in England. It’s the same as I go to physio, I don’t go to pt. And I got dinged for that this morning when I went to physio, and they said, What’s that?
Craig Joseph
Yeah, and this is why your country’s number two to America but I but I digress.
Nick van Terheyden
Number two to South Africa in the rugby but that’s a whole other story. That’s been I’ve been moaning about. We’ve really gotten out in the finals. We’ve really digressed. Here
Craig Joseph
digressed? Yeah, talking about jet chat GPT you can interact with it. And now you can be sent pictures to it and ask questions. So I was just looking at that too. You could say hey, how helped me fix my bike and and it will give you a some guidance about that. And, hey, here’s a picture of the manual. And here’s a picture of my tools. Do I have everything that I need? It’s scary smart.
Nick van Terheyden
Yeah, I think one of the things that I saw that was kind of interesting was, there was somebody that decided to send it into a massive loop. That was essentially, can we ask it to look at an image, describe the image, then pass that off to dally II. And then it just went into this never ending spinning set of constant? You know, refining going back and forwards, you know, creates all sense of these wonderful opportunities, I think, you know, continuing expansion, very exciting. I think the more that we add to this, the more that we sort of enabled this, the more people can experiment. And I have regular conversations with people who are saying they try it for this feature, in a particular example I heard earlier was, can you take a very complex, challenging physics paper, and describe it in layman’s terms, and it does a really effective job. And I hadn’t thought about that. But you know, there are sometimes I read things and I think, Gosh, I don’t fully understand that it’d be nice if somebody could explain it to me. Like, I used to have people that were able to do that. And, you know, so there’s all these opportunities. So I think, again, I’ve got to say, if you’re not trying it, just go and mess around play with this stuff. It’s imperfect, but it does some amazing things. Moving on, let’s talk a little bit about this new blood test that I think we saw being pushed out as a potential diagnostic test for children with fever. Now, you’re a pediatrician, you’ve seen one or two kids with fever. In fact, I imagine that’s probably the primary challenge for any pediatrician. When you see a kid with fever. What do you do?
Craig Joseph
Well, you know, the first thing that that we’re trying to do is try to figure out how sick the patient is. Curiously, it’s not what many people would think, which is, what does the patient have? But how sick Are you? Do you look ill like you need to go to the hospital? Or are you running around? If you’re a kid, or you’re running around the exam room, getting into trouble because parents may not like kids running around the exam room at the pediatricians. But the pediatricians actually love to write. We love that because that means that is someone who is not that sick. But at some point, you got to figure out okay, is this something that I can? So now we figured out, maybe they’re not that sick, that they have to go to the emergency room? But there’s still, you know, can we do something for them? And then we’re breaking it down into two big categories, generally of infectious disease? Is it a bacterium? Or is it a virus and bacterium we can often fix think about strep throat and antibiotics and a virus, we cannot think about colds and even the flu. And so sometimes we have some medicines that can help for viruses. But that’s the big kind of category is, hey, is this something that’s bacterial? Or is it viral? Now, of course, you can get fever for reasons that are not based on infection. I’m gonna put that aside for now and just kind of worry about the things that are caused by, by, by viruses and bacteria. And so to have a test, and certainly have blood tests, we’ve had blood tests for decades and decades that push us in a direction. So I can order a complete blood count, I can look at your white blood cells, your total count, and then look at what kind of white blood cells are there? Do you have more of the white blood cells that fight viruses or more that fight generally bacteria, and that will give us a clue, it will push us in a direction, but it doesn’t definitively tell us what you have. And so a blood test that could help much more quickly with much higher probability would be very, would be great, right? Because if you have, if you have a virus, and if I don’t have anything, if a that virus is generally self limited, meaning you’re gonna get over it without without my help and be I don’t have anything anyway, that just fixes that virus, then it’s really not that big of a deal. And we’re just going to treat it with some some fever, medicine and time, tincture of time. And so if there’s a blood test, which now there is, well at least there’s some research around that can point us in the right direction, faster with higher probability of being correct. That is a that’s a game changer.
Nick van Terheyden
I just have to say I couldn’t shake the image from my head of Dr. Craig Joseph sitting in his surgery delighted with kids, causing total and utter chaos around him because he’s sitting there go Oh, they’re okay. They’re not really sick. I don’t mind that they tear my office.
Craig Joseph
I, I had a I’ll tell you this one. This one quick story. This mom brought in her I don’t know how maybe three or four year old child and she was clearly very, very worried about this child and he hadn’t been feeling well and had some kind of diffuse, you know, not great didn’t tell us exactly what was what was going on. And I said to her, you know, this seems to me, I think this is a stomach flu. I don’t think it’s it’s daint she was thinking the child was very sick. I thought, well, you know, stomach flu is going around. I’ve been seeing a lot of stomach flu. I think this is probably stomach flu. And she said, Well, it can’t be stomach flu. And I said, Well, why is that? And she said, Well, he’s had some loose stools, but he hasn’t thrown up. So it’s, it can’t be stomach flu. And as I was telling her like, well, you don’t, you don’t have to have throwing up and diarrhea to have somebody flew. The child just started throwing up all over the place. And the middle, right, yeah, in the middle of my conversation, and, you know, got all over her got all over the table even got, he got me on my shoes, I think some issues. And and she was of course, not, of course, but she was horrified and kept apologizing. And I kept like almost jumping up and down. I said See, was right. I was right. And I think she thought I was trying to be nice, but I was not trying to be nice. I was absolutely ecstatic that I called stomach flu. And she didn’t believe me. And then proof came from this child.
Nick van Terheyden
So as the three year old leaves the office, you give him my five nice, buddy. Absolutely,
Craig Joseph
absolutely make Dr. Joseph look smart.
Nick van Terheyden
Hold it up for me. I have sorry. Very cool. So anyway, that the good news is that, you know, potentially you can add some additional data, I think, you know, we’re always looking for definitive as opposed to hey, I think this I’m, you know, let’s wait for this child to vomit on my shoes to be sure that they, you know, actually confirm conditions. So I think, you know, some good news in developments of tests, not that we need more and more testing, but you know, it just adds to the conference.
Craig Joseph
Well, what’s but what’s really fascinating about this, this is actually not looking for the virus or the bacteria, right? It’s it’s actually looking at genes to try and saying, well, well, we’ve tested enough, you know, patients that we know that when you have strep throat, these genes seem to be turned on and these genes seem not to be turned on. And if they can get you know, so basically, we’re like, well, we don’t see we don’t even aren’t, weren’t even really looking for, for the bacterium that causes strep throat, we’re looking at gene expression that seems to be associated with the bacteria that causes strep throat, it’s a very different way of, of trying to figure out what’s going on.
Nick van Terheyden
Yeah, and, you know, side note of a little bit of science here, that whole epigenetics is absolutely fascinating. Because, you know, at one point, certainly in my career, we, you are a product of your genes, this is how life will unfold, you know, we it was a bit of this Gattaca kind of world that we lived in, and then, you know, slowly, this sort of emergence of no 95% of the genome that we’ve sequenced isn’t actually junk as it used to be called, but actually does something and it turns out, it’s all this epigenetics or the expression and, you know, I just, I think, much like the brain, we’re only scraping the surface of what’s possible here, and we’re gonna find more and more of these biomarkers. You know, that come? And I hope we don’t sort of descend into Gattaca, right? If you’re familiar with that movie with the, you know, test your blood, this is where you end up. It’s, you know, a bit of Brave New World type of approach. I don’t think that’s where we’re going. I think it’s you aren’t a product of your genes, you can change it, but it can inform thing. So I think pretty cool. So that’s good news. Moving on, alternative healthcare conference. That was suggested by Chrissy Farr, who I think many listeners might know, she was longtime reporter now, I think she’s a venture investor of sorts. And interestingly, she was at one of the conferences I was that she, you know, continues to post and, you know, obviously, her publication routes still play out, she posts a lot of material and is struggling with the healthcare system. And you know, not to, to laugh at that sort of unfortunate experience. But, you know, it’s one of the points that I make on a regular basis. I wish people would understand, you know, keep trying to fix the business of healthcare as if your life depended on it because one day soon it will and she was struggling with the healthcare system and struggled with this whole healthcare conference and actually came up with a big list of potential panels and content for a an alternative healthcare Samak summit or conference called Health is hard. H IH, she called it with a bunch of panels. Did you take a look? What did you think?
Craig Joseph
I thought that she’s right, that that health is hard? And, you know, I think it is, it’s actually, you know, we’ve talked about it, and others talk about it, how it’s almost, it’s almost unbelievable. How difficult and how broken the healthcare system in air quotes is in the United States. And, and oftentimes people, they can’t appreciate it until they live it. And, and young people often don’t live it until either something happens with them or potentially with their parents. And so I think, yeah, as as we age and start meeting services, and then discovering that, yeah, it’s one thing if I think I have strep throat, or mono or sinus infection, you know, that’s one thing. But now, I’m delivering a baby. Or I diagnosed with a, you know, heart problem. And that’s a completely different thing and trying to, you know, work through the system that we have with the, with the various insurance companies and various healthcare systems and how they all interact. It’s, it’s, it’s awe inspiring, and and awe in a bad way. Not a good way. So yeah, she very quickly, seemingly came up with a long list of things of most of the sentences begin with why, you know, why? Why is prior authors, their very first one, why is prior authorization still a thing when everyone hates it? And I agree, Chrissie, why is that? I mean, I think I know the answer. But I think there are solutions, but we’re moving slowly towards some of them. But yeah, some of these things, we understand why they are some of them made complete sense in the 50s and 60s when they were set up, yet they’re still with us. And a lot of the craziness has to do with money. Shockingly, shockingly, are you sitting down?
Nick van Terheyden
Thankfully, no. Carefully sat down. Considering that less than, you know, obviously, the money and and to be clear, even in systems that normally are free to be clear, it’s never free. You know, take one of the extremes, which you know, was the system that I grew up in the NHS, and I always bristled when people said, oh, it’s free. It isn’t. It’s free at the point of service, but you are paying for it. Somebody is paying for it, it comes out and even in that system, you know, I’m I’m watching it carefully at the moment, because it seems to be just unfolding in a terrible, terrible way over there. So they certainly don’t have the answers. You know, I’ve heard people I’ve certainly had pushback, because obviously I open my mouth, they hear English, British accent, oh, my God, He wants the NHS here. That’s what you know, that’s my sole purpose in life, and it really wasn’t. But even if it was, that wouldn’t be the answer, because you only have to look over there to see that it’s actually not working. And in fact, it seems to have declined significantly, causing major problems. So I’d like to see that conference. I think my only pushback against it is I don’t know that we need another conference, what we actually need is a group of people to actually fix these things. And some of them feel relatively easy. You know, why are retail pharmacies still selling candy and cigarettes? Good question. And I think it was, I want to call out CDs, I think I’m right in saying when they’re the ones that stood up against cigarettes, to be clear, I mean, that that just seemed easier than any of the other things. Candy might be a little bit difficult, because you know, a lot of kids and whatever, but cigarettes just seemed really easy. And they did they stood up and you know, and I don’t think they’ve suffered for it. I don’t recall. But that seemed like a anytime I say there’s a brave decision that always seemed like it was a it, it wasn’t so good. But I think it was a brave decision. And you know, all credit to them. I’m sure I beaten up on CVS at some point. But you know, hey, they did the right thing there. And that’s just one of the things rather than using this as a conference news, this is a to do list. Who could we hand it over to?
Craig Joseph
Well, it gets the right people in the room. Right. Yeah. And then everything has to be feasible, right. So, CVS, I think you’re right, it was CVS who said we’re not going to have cigarettes, and they didn’t go out of business, and they seem to still be making some money. And so that’s economically feasible. But other things may not be and I think you gave Candy and I think you blame chill Run. As a pediatrician, I’m going to fight against that. I
Nick van Terheyden
thought there was no blame involved.
Craig Joseph
I wanted candy and I’m gonna Darn it. I’m not gonna have you say bad things about children and candy.
Nick van Terheyden
I am a cat. I am an addict. I No question. I’m a sugar addict. It’s awful.
Craig Joseph
There you go. Now I feel Do you feel better saying
Nick van Terheyden
out? Unfortunately not because I’m gonna reach for some in a short, short, hot second right here. So no. All right. That’s fair. All right. Well, so all good. So let’s quickly cover off this set of hospitals, the Appalachia hospitals that were featured, there was a piece that talked about this, you know, they were purchased. And, you know, there was some offer of actually delivering on care, there seems to be a lot of pushback, there was a piece about this. It’s not quite as simple as that. Right?
Craig Joseph
Yeah. Well, it’s, it’s, um, there’s no easy answers, right. So what was happening and what’s happened in multiple states is that smaller, typically rural, but not always, hospitals, per our previous conversation, can’t make money. They just can’t deal with the healthcare system. And so they are at risk of, of closing, just closing their doors. And what can happen is, is larger healthcare systems say, well, we’ll buy that hospital at but typically the state or the federal government would say, No, you can’t buy that you’ve already got a bunch of hospitals in the area. If you if you buy these two hospitals that are at risk of failing, then you’ll you’ll be the only game in town, you’ll have absolutely no competition, we can’t allow that. And so then the question is, well, which is better to have competition? Or I’m sorry, to have no competition? Or to close these hospitals? And and if you believe that would happen, and it certainly happened enough, so that to me, it’s believable. And I don’t think I don’t think there’s a right answer. So what some would have would have happened in some states is they’ve given permission for hospitals for health care systems to buy hospitals acknowledging that now they have created a monopoly essentially, and and said, well, we’ll allow you to buy this hospital, if you promise to do a bunch of things, maintain, you know, the health of the community, give charitable care, you know, don’t price gouge those kinds of things. And, and some people are calling them on it and saying, Well, you promised to do these things, you haven’t done some of these things. And and that’s an that’s an issue. And I I don’t I don’t I see both sides. I don’t know what the right answer is. There is no right answer. It’s really which less bad option do you want? And I think typically, if I were just if all else was equal, the bad option I would want is the hospital to stay open, but become part of a monopoly. That seems to me better than shutting the hospital down.
Nick van Terheyden
Yeah, there’s another good reason for that. I mean, not only in terms of delivering the healthcare services, but quite often, it’s one of the biggest employers in some of these communities, and, you know, it shuts down. And that’s not just the death of the hospital, that’s the death of the community, everything that the whole place just sort of withers on the vine, and you know, they’re a central tenant to these things, maybe it can’t exist in quite the same space, I agree with you, these things are just generally hard to decide on. I mean, it’s just like delivering healthcare and you have a cancer diagnosis. It’s not as simple as Oh, hey, we’ll just do X or Y, we have to weigh up all the pros and cons. We’re not always very good at sort of weighing up the risk reward elements of this. And, you know, it’s individualized in many cases. And unfortunately, in the case of a rural hospital, it’s not individualized, it’s for the community. And then there’s different competing interests, and people have different views. And but I think, you know, thinking about this in a balanced way is absolutely essential. So, good points. And so unfortunately, we find ourselves at the end of another episode exploring Healthcare’s mysteries before they become your emergencies. Until next time, I’m Dr. Nick.
Craig Joseph
And I’m Dr. Craig.
