Tech Titans, MRI Tales, and EHR Woes: Unraveling May’s Healthcare Insights
Written by Dr Nick on June 5, 2023
A Recap of May’s Healthcare News
This month’s episode of “News you can Use” on HealthcareNOWRadio features news from the month of May 2023
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners.
Trillion Dollar Chips
This month ChatGPT continues to be a focus and trending topic and we discuss the affirmation of this technology with the news of NVIDIA’s financial results almost catapulting them to the rarefied air of the Trillion Dollar Club. We dive into the GPU chips produced and a little of that history and context. Craig discusses in detail his experience explaining his own MRI taken as part of his challenge with back pain.
Craig dates himself as he details the book he wished he had bought which was offered as an index of the Internet (I have good news for him – an old copy of the New Rider’s Official Internet and World Wide Web Yellow Pages is available at AbeBooks).
Social Media Mayhem
We discuss the recent public Health Advisory by the Surgeon General Dr Vivek Murthy “Surgeon General Issues New Advisory About Effects Social Media Use Has on Youth Mental Health” and wonder if we need regulations to help manage these negative effects.
We touch upon an article in JAMA that discusses the impact of electronic health records (EHRs) on healthcare team communication and well-being, emphasizing the importance of reversing the trend of reduced personal interactions among clinicians. The article comes to the same conclusion most of us had already reached
The EHR has allowed or even promoted fewer person-to-person interactions among clinicians.
We should take action to reverse this trend
Listen in to hear our take on the EpicResearch papers “Opioids Plus Gabapentin Associated with Increased Risk of Opioid Use Disorder Over Opioids Alone” and “Stroke and Blood Clotting Disorders Rare After Monovalent and Bivalent COVID Vaccination” and we close by saying farewell to “Simply the Best”
You can read more about the series here and the concept of keeping up with innovation in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter by tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
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Raw Transcript
Nick van Terheyden
And today as I am each and every month, I’m joined by Dr. Craig Joseph. He’s the chief medical officer at Nordic consulting partners, Craig, thanks for joining me.
Craig Joseph
Well, thank you again for having me. As we do each and every
Nick van Terheyden
month, we take a look at the latest and greatest in terms of news and cover off some interesting insights. I think, at this point, it feels like chat GPT has taken over from COVID as the trending topic that will persist at least I hope so because it’s fun to talk about, certainly fun to use. And for me, I think the most resounding piece of data that I saw about this, aside from seeing a couple of friends who go, wow, I tried it, and it actually, you know, it’s cool, was the fact that NVIDIA announced its latest financial results and almost blew out of the water. I think the highest record for biggest and I don’t know which one it was, it really didn’t matter. But they’re almost on the verge of joining the trillion dollar club, and all of that on the back of AI. computing power that’s necessary to do all of this. So for me, just additional data that says, if you aren’t using it, what are you doing? Why? Well, what is what is right, what is wrong with you?
Craig Joseph
Yeah, so I don’t what is this chat GPT thing you’re talking about? No, I am familiar with it. And Nvidia. You know, I was reading up about this company, they started not too long ago, 20 years. So less than something Yeah, right. Something not crazy long ago, making chips for graphics, right? Or making GPUs graphical processing units. And their intent was, Hey, we should make video games better. And we can make these, you know, these little GPUs that are really not meant for doing lots of things besides graphics. And then they started making some money with Bitcoin, because it turned out that the same calculations that you needed for cool graphics and for gaming, you also needed to mine Bitcoin. And so they started making some, you know, doing even even better with that. And then as a Bitcoin kind of started to fall apart a little bit. They lost Yes, think value. The value of their stock went down, and hindsight 2020 That was the time to buy. But no one not a lot of people did and
Nick van Terheyden
oh, you’re not talking by Bitcoin? I see I’m buying in video
Craig Joseph
at a stop, because
Nick van Terheyden
I think we need to clarify this because somebody might come after you for telling them to buy bitcoin,
Craig Joseph
Bitcoin, or do so at your own risk. I know nothing about Bitcoin. I know nothing about any of this of crypto stuff. So yeah, if you’re doing that on my advice that’s, that’s on you.
Nick van Terheyden
Well, I think you know, doing anything on your advice, just I’m sorry,
Craig Joseph
Dr. Nick, I think that’s accurate. I’m not going to argue with you on this. But if we do have a listener who has a time machine, I would suggest they go back a few months and buy some invidious stock. Because I think it’s up 160%. Yeah, and based on you know, why? Because these large language models of which Chet GPT is the one we’re all familiar with. To create these AI tools, you need those kinds of, of GPUs. Again, it seems silly to talk about graphics, because they’re just doing calculations. But yeah, so I we finally have a use case, besides graphics for these for these little units. And boy, do we so you can’t, can’t get them created fast enough. So yeah, I think large language models and these new API’s light chat GPT they deserve the praise that they’re getting, right? They’re not really on the hype.
Nick van Terheyden
It is much more than what some folks say, which is, we’re just it’s a flash in the pan. It’s, you know, hype cycle on I’m, there’s no way that that’s the case at this point. There are so many interesting aspects to it. I think the GPU commentary and you’re right, I remember them launching and, you know, there was all the move, and I think it was Doom was the game that really sort of broke the mold of capacity to be interactive, and it was offloading the processing power and then people started to realize that there was all this spare processing power available. because you plugged in this card, and that was where there was this sort of inflection point, and I don’t think they even predicted it. And now we’ve got this additional use case. So I, I’m excited by that. But in terms of use cases, and you know, specifically healthcare, I believe you actually talked about this, you presented on chat GPT in healthcare just recently, right,
Craig Joseph
I did domestically, and I think you did internationally. However, I’ll tell you something that I did, I did last night, for fun with chat GPT, the 4.0, the newer one that I think cost about $20 a month, I wanted to do a little a little science experiment. And so I will now disclose that I have had an MRI, because I had a lot of back pain and sciatica and wanted to really know what was going on in my spinal canal. And so several years ago, I had an MRI, and I got the results before my doctor did or at least before my doctor called me and told me what it said. And as I think we’re clear, I am a licensed board certified physician. And I get this MRI of my own back. And I had no idea what it said. It was very complicated. And it had a lot of words, and I’m familiar with most of those words, but the way it was they were put together.
Nick van Terheyden
It was such an honest guy, I would never admit to that. But go on.
Craig Joseph
Is this a good thing? Was this a bad thing? Am I supposed to be happy with this MRI? Clearly, I still have back pain. The MRI is not going to solve that. But you know what was going on. And so what I did was, this was a pre check GPT. Several years ago, I called up my friend who’s a radiologist who happened to be the best man in my wedding. And I read him the interpretation from the MRI, and I had him I paid him exactly $0 To tell me, what does this really mean? And so he walked me through it. And then I was able to, to understand that now most of us don’t have friends who are radiologists who we can read MRIs to, so I thought this will be fun. Let me take the text of this MRI interpretation, I left my name off of it, but everything else was there, and I pasted it in to chat GPT and with the instructions of, hey, this is a MRI interpretation, please write a summary of the findings and suggested diagnostic, I’m sorry, suggested therapeutic options for the patient, and write this as if you’re writing to a primary care physician. So in other words, you know, you could use some big words, it’s a doctor talking to another doctor essentially. And and within 10 seconds, I had this exceedingly accurate almost word for word for what my friend the radiologist interpreted to me, and kind of laid out all the all the possibilities and, you know, gave me a nice summary. And then I said, Okay, that’s great. Hey, Chad, GPT, take what you just did now write it for the patient, the exact same thing, but now write it for the patient. Amazing, just, again, within seconds, it just spits out something and it, put it in patient friendly terms. And, and, you know, we talk about things that are hype, and, you know, not ready for primetime and five years in the future. This is today. And now Can we all just turn this on? No, there are legal when other kinds of ethical considerations we have to make. But the point is like, it’s really, it really is ready. And we can’t just turn it on and go forward, because it’s going to it’s wrong from time to time, and we need to put some guardrails on there. But boy, oh, boy, it’s, it’s, it’s as they call it an iPhone moment, or for me, it’s kind of like when I discovered that there was such a thing as Google. And it could really, very quickly tell, you know, point me in the right direction when it comes to, you know, websites. It’s, it’s,
Nick van Terheyden
you mean, you don’t, you don’t still have that bookmark collection that you used to organize and put into folders to keep records of all these places that were useful.
Craig Joseph
I will now age myself, and I will tell you that I remember holding and I wish I would have bought but I remember holding in my hands at a bookstore, which is again, another way of me aging myself a beadlet tensor, something like that. Some bookstore, it was called the yellow pages of the internet. And it essentially was a book with maybe 100 pages. And each page had five
Nick van Terheyden
was an index of the web. It was oh my god, I didn’t know that existed. This is priceless. I
Craig Joseph
wish I would have bought it. I didn’t buy it. I would have bought it. I probably would have thrown it away or recycled it. But yeah, so I’m old enough to remember that.
Nick van Terheyden
Oh, absolutely. I I had for the longest time I think I still have them hanging around somewhere I just don’t even pay attention to them was this bookmark collection and exporting and reading importing and then organizing and archiving did a lot, of course, completely irrelevant, you know, back to the chat GPT. And I think, you know, you’re you’re right. I mean, one of its sort of clever capabilities is to put things in terminology for different let’s call it grade levels. But you know, understanding why I’m, I’m really hesitant. I’ve seen a number of people comment on this. And I think I feel the same. I don’t want to anthropomorphize the tool, because it ain’t human. It. And it’s basic. And I know we’ve talked about this. It’s just saying I, this is word a word B, the following word is most likely to be this. I mean that and I know that super simplification. But ultimately, that’s what it’s doing. And even the folks that really understand it, or at least my experience with them, are saying, I’m not quite sure how it’s doing this. It’s a little bit magic, in terms of the capability and the way that it’s sort of creating this content. And, you know, that’s giving everybody this sort of pause for thought, you know, is this a Skynet moment and whatever? And I’m really not in that. area, don’t sort of think that I think, you know, as you rightly say, we have to watch carefully and implement. But as I said, and you know, you’re right, I got to go to Barcelona to talk about this. It was fun. Or, as we were talking buckle on as, that would be, in Fawlty Towers, for those of you that know, the classic John Cleese series, and Manuel, the long suffering waiter that worked in there, that’s where he was from, but it, I made this point, and I make it repeatedly to anybody that you know, is willing to listen to me. And to be clear, that’s you, and maybe a couple of people in my family, but it’s not my whole family to just get in, get involved, just use this stuff. Even if you have no idea what you’re doing. Because you’re learn, you can actually use the tool to learn no different to the way that we use Google for, you know, understanding how to do X or Y. I mean, I realized I’d been phased out as a parent to teach my son how to shave when he said, No, that’s alright Dad, I’ll just YouTube it. And, you know, this is a now it’s I’ll just chat GPT it. And there’s nothing wrong with that. As long as you do it in the context of at least some overarching understanding, I think you’re doing yourself a little bit of a disservice to say that you don’t understand these words. I mean, you are able to review that content and say, yeah, that clinically made sense. And it references back. And I just, I mean, I think there’s so many opportunities with this, that if you’re not playing, you truly are missing out on you know the potential of what it could or is capable of doing. It for those of you just joining, I’m Dr. Nick the incrementalist today. I’m talking to Dr. Craig, Joseph, we were just as usual talking about chat GPT. I think we’re both super fans, super geeks around this. We just both presented, talking about this and the opportunity and, you know, covered off the NVIDIA boost that I think just reaffirms that this is not just a flash in the pan. Let’s talk about some other news. I think, you know, most recently or one of the more recent things was the public health announcement from Dr. Vivek Murthy. And I certainly posted about this I’m I’m in such violent agreement. The damage that this is doing. And you know, my point was, it’s not just children, although that’s where he was sort of focused. But I think across the world, and I heard something interesting. I was talking to somebody about one of the new tools tic tock in this case, and they have taken away the gaps that you see, if you look at Instagram, and you scroll through, they’ve removed the gaps to make it even harder and more addictive. I hadn’t even understood that as a sort of element. Did you read it? What did you think? Where are you?
Craig Joseph
Well, again, let’s take it back to what he was saying. So basically, he was saying that social media is not just potentially bad for a lot of kids. It is that so we have we have ample evidence now that social media in general, I wouldn’t point you to one, one being worse than the other although that’s probably the case. Is is harmful, when, in many ways I’m trying this is me trying to be diplomatic,
Nick van Terheyden
too. And I Whoa, whoa, whoa, whoa, whoa, wait, When are you ever diplomatic? What’s what’s
Craig Joseph
diplomatic? I’m trying to be Oh, okay. All right. Never been successful at being diplomat, oh, there you go. I have not want to say that social media has no benefits. I’m on multiple social media. Every day, I generally use it professionally, I learned things. And I put other I put my learnings out onto social media. So I think social media absolutely has a place. However, there there, there’s lots of now academic research. So it’s not so much opinion is fact saying that, hey, children and teenagers have trouble emotionally, with a lot of what they see. And that the algorithms seem to either purposefully or not purposefully, often direct in a negative way. And so, you know, used to be when Facebook first came out, like you saw what your friends posted. And if you didn’t label those people, as your friends, you didn’t see what they were posting. And then to get more engagement algorithm, the Facebook’s of the world started saying, Oh, well, if you’re interested in what your friend posted about this, you might be interested in these other things. And, and the same way, you know, you watch this video on YouTube, while you might be interested in this video, and so it’s defaulting to continuing so you just have to sit there and you don’t even have to click on anything, and just keeps coming up with the next thing. And the next thing and, and the next thing and it never stops. And so, you know, I think some of the more disturbing research was done by some academicians who created some false accounts as if they were teenagers. And, you know, put in some, some search terms that were fairly innocent. And within a small amount of time, minutes, some of these algorithms were pushing self harm videos and other, you know, testimonials, which he shouldn’t be on there. And but be if they are on their heart, how are they being promoted. And so it’s a lot more than what it used to be, which was on Instagram, everyone’s like, Oh, you’re putting your best foot forward. And now I think, I’m supposed to think, Oh, my friend only does very nice things. She only goes very nice places. She only has very nice thing. You know, she has, she eats at the best places and travels are lower. Well, no, in reality, her life is just like yours, mostly. But she’s putting the highlights there. That’s the that’s that and then you’re jealous, right? You have fear of missing out and that kind of stuff. Boy, that’s kind of kids play compared to maybe you should hurt yourself, like suggestions of self that you should you should self harm suggestions that you should binge eat. And so I think the Surgeon General has come out and said, I don’t think this is what he did, and said that these things are dangerous, and we need to think about them and regulate them as we would any other public health problem, from smoking, to infectious diseases to cancer, like these are in the same these are in the same category and we need to think about them the same way. We don’t let companies make you know put out chemicals that we know cause cancer unless we think that we can mitigate that risk or at least make people aware of those
Nick van Terheyden
or if we think we can get away with it to be claimed as
Craig Joseph
Yeah, I’ll leave that out.
Nick van Terheyden
Yeah, I I’m just gonna say A plus to Dr. Vivek Murthy for you know calling this out. I’m gonna give you a B plus for your you know, appropriately navigating this cautious description. In fact be plus so good you could make a really great radiologist I cannot rule out with any certainty whether there is a possibility or not of a potential or otherwise
Craig Joseph
you’re you’re very looking you’re joking but let me go back to my chat GPT example just for a second when you were you were belittling me for saying that I didn’t understand. I’m going to give you an example if there was a there was a note in my MRI about a desiccated disc. Yes, I had. Now I know that desiccated means dried out. Right those but I don’t know what that means. Like, I know what it means it’s slightly dried out this chat. GPT told me as did my friend that radiologist that you know what that’s kind of normal for an old guy like yourself. So that’s not really worrisome, but in and of itself that shouldn’t be causing you any problems. No one would do anything about that. Right? That’s what I’m talking about Chet GPT. And my friendly radiologists came to those conclusions. And so, yeah, and I will i am ecstatic with a B plus compared to the vet Murphy.
Nick van Terheyden
Well, it’s shocking to hear you as a no, not being inflammatory. But it was, it was fun. So, a couple of other things that we should talk about, I think, the JAMA article that essentially said that the intersection of EHRs and healthcare team communications functions and well being some long winded occupational health, but you know, the, the upshot was, that it’s promoting fewer person to person interactions among clinical clinicians, and we ought to reverse this trend. I think we all knew that, right?
Craig Joseph
I don’t know if we all knew but actually,
Nick van Terheyden
I’m gonna say all clinicians knew this. Was that what you were you were going?
Craig Joseph
I actually was not, I think that there are people like you and me, and maybe some older folks who think that I think that there’s a lot of younger physicians, who that this is just how it’s always been. And these are the same people who, who don’t want to, you know, call on their generation, they’re uncomfortable with the phone. Their generation, they’ve always just sent a quick text, sent a message to someone to get information back. And the point which I agree with this, and like you and like, da, but we need research and academicians to, to give us evidence of what often we think we know for true for for certain. Yeah, it you know, in the olden days, if I was confused about a patient, I would call up a specialist and say, Hey, this is what I’ve done. This what I’m a little worried about. Maybe this is maybe I’m making a big deal out of nothing. Or maybe this is a big deal. Can you come by and take a look at the patient. And that would always happen over the phone? Or that would happen with me walking through the hospital and seeing a colleague of mine. That colleague would write up a response and would write a formal consult, as we say, but I would always get a phone call back. Hey, sorry, your patient. I wrote it all up. But really summary is this. Yeah. Don’t worry about it. It’s all cool. I’ll follow up. But I think we’re all we’re all good right. Now, that doesn’t happen. Because no,
Nick van Terheyden
we’ve learned we’ve lost that Curbside Consult, unfortunately. And, you know, to your point that I interesting that you highlight that generation that maybe doesn’t think that I think that you know, important aspect of this. And, you know, that brings us to a couple of other things came out. I mean, we’re seeing progressive additional data research done in this epic research tool. We saw the stroke and blood clotting disorders essentially rare. When, you know, looked at in the COVID vaccination for the monovalent by Verdun as compared to people that had COVID, you know, excellent data, source data from the EHR, there was also the opioids on folks taking opioids and Gabapentin shows an increase in opioid use disorder. I mean, for me, this is great stuff. I know you’re a big fan, you read these, you know, your constant study on them.
Craig Joseph
Yeah. And you’re referencing one of the major electronic health records vendors in the in the world. And they’ve pooled they’ve with their customers permission that pools the data that’s really de identified for real. And they’re able to do some of these very preliminary studies on millions and millions and millions of patients where it’s typically it would be 1000s. And so they’re able to get information out there quickly. And so yeah, no one’s saying EHRs are bad. Certainly, I’ve spent a lot of my career working with them and for some of these companies, but there are areas where we’ve made it too easy to do the wrong thing. And we want to we want to try to reverse all of that and get back that collegiality, because oftentimes, that’s where the magic happens when you tell me something, as opposed to sending me a text, that conversation is very different.
Nick van Terheyden
Yeah, so unfortunately, as we do each and every other week, we’ve run out of time. So just remains for me to say to the audience, hope you had a wonderful Memorial Day if you were in the US. If not, that’s what we were doing. And no doubt it was simply the best I’ve got to put that in. You know, we said goodbye to Tina Turner, who touched a whole whole part of the generations with all of her music. Craig, thanks for joining me.
Craig Joseph
Thank you and I think we’re all Tina fans.
