乌鸦传媒

This was an important week for me. For the first time, I can genuinely say that artificial intelligence has dramatically changed the way I practice medicine.

I don't think I'll ever go back to the way things were before my most recent clinical shift.

Nor do I want to...

Artificial Intelligence Can Now Write My Medical Charts

My hospital is piloting a program allowing some clinicians to use their smartphones to record the audio of patient encounters. An AI app called "Abridge" records and then converts the audio into well-organized, appropriately formatted medical notes for the electronic medical record. In other words, AI can now do my medical charting for me! (Yes, it is HIPAA compliant! No, it doesn't do any "thinking" for me, in terms of medical decision making.)

When I first heard about this, I was very interested. One of the most burdensome aspects of patient care is documenting everything we do. So, this felt like the first real opportunity for AI to change my day-to-day work as a clinician. (As Inside Medicine readers know, I've been exploring AI in various ways since ChatGPT first came out. Until now, I've primarily used ChatGPT in non-clinical work.)

I finally got to try the app this week. After my first patient, I knew it was an immediate game-changer. When using the app, I spent more time with my patients and less time typing or dictating to my computer afterwards.

I could barely believe it. "Now that is the promise of AI!" I thought.

Workflow: The Basics

Here's the big picture: I enter the patient's room. I get permission to record our conversation on my iPhone on Abridge. The app converts our conversation into an organized note for my medical documentation that ends up in the patient's electronic medical record. (Note: I am getting no money for using the app, nor promoting it.) Once the patient agrees, I put my phone back in my pocket and continue as normally as possible (though, as you'll read, it isn't normal, and in surprising ways). After I leave the room, I press "create note." That ends the recording and pushes the audio file to the "cloud." By the time I get back to my computer, a nicely written and formatted emergency department provider note has already appeared on my screen. I copy and paste the note into the patient's medical record, and poof, we're done.

Workflow: Details, Insights, Observations...

My first question was whether Abridge would save me time. After all, if the AI-generated note took as much time to edit as typing or dictating from scratch would have, there'd be no point.

Answer: AI-generated notes clearly saved me time, even on first use. The process is much faster than typing or using voice dictation software. And, with experience, I assume I'll get even better.

Surprise #1: Using Abridge changes the way I talk to patients. I assumed this would happen to some degree, because the app can only document what it hears. But I quickly noticed myself being far more communicative with my patients. While I pride myself on being understood by patients (i.e., explaining things simply and clearly), using Abridge made me narrate far more. (It was like an oral board exam, or those "OSCEs" -- Observed Structured Clinical Examinations -- we did in school.)

For example, to document my physical exam, I would say things like, "Your breathing looks normal. Your heart rate is also regular and a normal rate." While examining a patient's abdomen, I verbalized things in ways I almost never would have before. "It seems that I am finding tenderness in the right lower quadrant of your abdomen, but only with deep palpation."

I soon realized that I could not say everything or else it would confuse patients. So, I had to exclude some medical jargon that I wanted to include in the chart. (I quickly found a workaround, which I'll describe shortly.)

Generally, after interviewing and examining a patient, I give them a sense of my impression and my plan going forward. What conditions am I considering? Which ones are off the table? What tests are indicated? But I quickly found that when using Abridge, I was considerably more specific and direct in this. The reason was that -- as when I was narrating my physical exam -- I was essentially killing two birds with one stone: giving the patient the most information possible while giving the app enough information to make a good chart.

Surprise #2: Using Abridge changes the way patients talk to me. This was more unanticipated, but it seemed to me that patients were more concise and clear in answering my questions than normal. God bless 'em, but sometimes when I ask patients questions, I get a lot of "wind-up" -- that is, more context and background information than needed -- and answers that don't address what I asked.

Example:

Me: When did your chest pain start?

Patient: Well doc, last year I had abdominal pain and I had to come to the ED. I waited a week before I came in and by then things were bad. It was a whole big thing and I needed to be hospitalized. This pain in my chest is different, but I didn't want to wait as long this time.

Me: Okay, but when did your chest pain start?

See what I mean? This can go on for some time. (In defense of patients, remembering when a symptom started is not easy. But I find that rather than admitting they don't know, patients answer a different question, or give extraneous information. With a question like the one above, I'm after a specific day or time.)

While using Abridge, it seemed like patients were somehow more focused in their answers. Now, I hope this doesn't mean that their answers are less honest. But I found the answers to my questions to be noticeably clearer and more direct when using the app. It was an immediate change.

Surprise #3. Using Abridge changes how I use down time. Normally, after leaving a patient's room, I have to walk back to my computer. That could take 10 seconds or a minute. So, after the 2nd or 3rd patient using Abridge, I started using that time. Rather than end the recording when I exited the patient's room, I continued to speak into the app. I said something like, "Okay, I have now left the patient's room. To clarify, on exam, the patient had no rebound tenderness. The differential diagnosis is appendicitis versus diverticulitis versus viral gastroenteritis. Plan for labs and a CT scan with IV contrast."

Now, this is what I was referring to above about excluding medical jargon from the patient encounter. Rather than explain what "rebound tenderness" is (it matters to me, not the patient), or what the phrase "differential diagnosis" means (i.e., the list of conditions I'm considering), I've now started to use my time walking to the computer as an opportunity to dive into all the medical lingo that I wanted to invoke for various medical (and medicolegal) purposes, but omitted so as not to confuse the patient. So, I've already found a new workflow: I describe much more of what I am doing and thinking to the patients while in the room, and use the 10-60 seconds of walking time after the encounter to get into the weeds and add key medical jargon.

Areas for Improvement

There are things that would make the experience even better. First, I'd love the app to be integrated into our medical record directly. It would eliminate the extra copy-and-paste step. Also, it would be nice if the app automatically ordered the tests I've said I plan to order. So, if I clearly indicate that I'm worried about appendicitis, it would be "next level," for the computer to automatically have a CT scan order ready for reviewing and signing by the time I returned to my desk. I'm sure we'll get there, eventually.

Overall, the Results Are Impressive

The results are honestly amazing. Yes, I need to edit the notes that Abridge generates for me -- sometimes for clarity or further details, and I delete some things here and there. But basically, 90% of what I wanted was documented, and with gorgeous formatting. (Much nicer than my usual.)

The amount of time doctors spend documenting patient encounters is astronomical. It's a key driver of burnout. Last night, I saw a legendary and retired ED doctor at a social event. I told him about the app. The part that impressed him most? When I told him I thought that AI-generated medical charts could single-handedly add a few years to my career by staving off burnout.

If all AI ever does for my medical practice is increase the amount of time I can spend with patients (and improve our communication) while decreasing duplicative work at my computer, I'll be elated.

So, this was a good week for me. For the first time, AI technology made my work as a doctor a little more enjoyable and easier!

This story originally appeared in .

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