ChatGPT: What Does This Mean For Doctors?

so chat gbt is this new language learning AI that has really taken the Internet by storm over the past month and if you haven't heard about it already it really has the potential to change the way we practice medicine a lot I'm going to talk about it in this video show you some examples of what it can do and then also kind of discuss how this is really going to affect our practices as Physicians and other health workers in general you can put in any prompt that you want and it's going to pump out an answer for you an essay a response you know in the future it potentially even could type hmps and progress notes for you that's actually how crazy this machine is although at the same time it is still very limited it's still very early but if you can just imagine if this AI is this good right now where is it going to be in two years from now five years now from now or ten years from now because technology advances at such a fast pace this is a post on our residency that I read about a month ago and this says that open ai's chat gbt actually has a rudimentary understanding of some basic medicine chatgpt is a new AI for natural language processing that open AI is letting people try out obviously not going to replace Us by this time next year but I thought it was really cool and had fun messing out with it so this person straight up copy pasted a prompt for a board style question from mix app so a 79 year old man is evaluated in the emergency department for a 30-hour history of dizziness he describes a constant room spinning Sensation that is worse with position changes and when he tries to ambulate symptoms are associated with nausea and he has vomited twice he reports no change in hearing tinnitus or recent viral symptoms the patient has a history of hypertension and hyperlipidemia medications are amlodipine andalopril and atorvastatin on physical exam blood pressure is 156 over 92 pulse rate is 84 and other vital signs are normal the patient is ataxic hints exam is positive only for the presence of vertical skew so just first of all just take a moment to you know think about how much information that is to process just for a human brain and just then just think about what the AI is going to have to do to process all of this information in order to make any kind of coherent response at all so immediately you know when I'm reading this uh you know the first thing that obviously jumps out is you know when people say room spinning sensation oh this could be bppv benign paroxysmal positional vertigo uh but there's a few things that don't line up with it so you have to see is this AI going to get tricked by this so you know it's a 30 hour history of dizziness bpv is more coming and going and like intermittent the fact that he has nausea is concerning and the vomiting is concerning and uh also he's got this history of hypertension and hyperlipidemia which increases his risk for having some kind of stroke and uh he's got he's got Ataxia huge red flag as well and his hint exam is positive for the presence of vertical skew which is abnormal that's also suggesting some kind of central process and so like is this machine even gonna know like what these red flags are is it even gonna be able to know what the hints exam is like that's a pretty specific thing for a random AI that has no specific training in medicine to to know about and just as an offhand comment the things that are concerning on the hinting exam is no nystagmus or no corrective sakad on the head impulse so the fact that he has a negative head impulse is actually concerning bi-directional nystagmus rather than unidirectional nystagmus so in this case the patient doesn't really have any concerning nystagmus that we are able to see but the fact that they have known nystagmus is actually kind of concerning too you would expect if they had a peripheral process like bpvpv you should see some nystagmus and test of skew being showing vertical skew all three of these are basically scary for some kind of central process so anyways here's what the AI said based on the information provided it is likely that the patient is experiencing vertigo a type of dizziness that is characterized by a sensation of spinning or motion this can be caused by a variety of underlying conditions such as inner ear disorders head injuries or certain medications in this case the positive result on the hints Examination for vertical skew suggests that the patient's dizziness is likely due to a problem with the vestibular system in the inner ear which is responsible for maintaining balance and spatial orientation not super correct there at least in terms of my interpretation treatment for vertigo typically involves medications to control symptoms and restore balance such as vestibular suppressants and antihistamines the patient's underlying medical conditions and current medications should also be considered when choosing a treatment plan so honestly uh even though this answer is not correct and it did get tricked by that kind of buzzword of the spinning Sensation that is a very impressive answer to to be able to spit out like that and just again this is just the like prototype the like very first version that's available to the public but not only that the more information that you continue to give this Ai and the more you have a conversation with it it will start to take into account some of the information that you're providing it and we'll actually adjust its you know differential diagnosis based on what you tell it so the person on this thread then asks why don't you think it's orthostatic hypotension orthostatic hypertension also known as postural hypotension is a condition in which a person's blood pressure drops significantly when they stand up from a seated or lying position this can cause dizziness lightheadedness and fainting however in this case the patient's blood pressure is 156 over 92 which is within a normal range and does not suggest orthostatic hypotension Additionally the patient's symptoms of dizziness are not typically associated with orthostatic hypotension as they are not relieved by lying down and are worsened by position changes in ambulation vertigo on the other hand is a type of dizziness that is often characterized by these types of symptoms now basically the person starts kind of leading the uh the the AI to the correct answer so it could be a vestibulo basilar stroke also and look it didn't even spell the person didn't even spell this correctly and this is what it said a vestibulo basilar stroke is a type of stroke that affects the blood flow to the brain stem which includes the vestibular system in the inner ear this can cause symptoms of vertigo as well as other neurological symptoms such as double vision difficulty speaking and weakness on one side of the body in this case the patient's symptoms of dizziness and Ataxia loss of coordination may be suggestive of a vestibular basilar stroke however other potential causes of vertigo such as inner ear infection or other medication side effects should also be considered a thorough neurologic exam and imaging of the brain such as CT scan or MRI are typically needed to confirm a diagnosis of vestibular basilar stroke and determine the appropriate treatment then the person asks what about a vertebral basal stroke honestly I don't even know the difference between freaking vestibular basilar and vertebral basaler Strokes so I'll have to rely on my neurology colleagues for this one but a vertebral basilar stroke is a type of stroke that affects the blood flow to the back part of the brain which includes the cerebellum and brain stem this can cause a wide range of neurological symptoms including vertigo double vision difficulty speaking and weakness on one side of the body in this case the patient symptoms of dizziness and Ataxia may be suggestive of a vertebral basil or stroke so again it's staying pretty vague and just saying you know there are some things that match and some things that don't match it that is kind of how medicine is practiced you know we have all these pattern recognitions and we are able to develop our differential diagnosis but a lot of times we are not 100 sure we're like fairly certain that something is going on but we can never be 100 certain until really you know extensive testing has been done the person even says I think it's AIDS and uh the computer is back uh dizziness is not typically a prominent symptom of AIDS in this case the patient's symptoms of dizziness in Ataxia are more consistent with other potential causes so some other responses to this I am surprised how few people are terrified by this the disruption to our entire economy including medicine is going to be drastic this one says amazing now type in a 15-minute ramble of all of the life of a patient with three symptoms hidden within the ramble and let's see how good it is most of the AI prompts are presented in a sequential manner not in the regular word seller that patients shoot and I totally totally agree with this like this AI would very much struggle to I'd identify the key things in a patient because when patients present their hmp it is all over the place and you have to really synthesize things into like one story that actually makes sense but still I am like Beyond impressed with how good this AI is I'm gonna try and test it out now and have it like generate some soap notes or something so uh this is a YouTube video that I was watching and then this person says you are using this so wrong my friend let me help you type in create a soap note for a 66 year old female with past medical history of type 2 diabetes hypertension and SLE who presents with a left MCA stroke status post tnk on 1210 currently on ICU day two subjectively she complains of a new mild headache and weakness in her upper and lower extremities which started this morning she has no pain or other Associated symptoms include normal vital signs and a full physical exam for the assessment include a detailed differential diagnosis with pros and cons for the plan include Labs at Imaging that should be ordered as well as medications with dosing given given that she has normal renal and liver function like holy crap I don't know what is going to pop out here because I have not tried this yet but I'm going to go here okay I'm going to copy this I'm going to go to the chat GPT right here this is what chat EBT is actually going to look like and I'm just gonna I'm gonna type this in and I I hope I'm gonna be like shocked and impressed and surprised but I'm also kind of scared because if it's like really good it's kind of scary it's like oh my God what what is this gonna be able to do in a few years you know all right here it is typing it out right now and uh you know right now really just kind of typing out a lot of the provided information but here it's starting to generate its own stuff blood pressure 122 over 78 Harvey 84 respiratory rate 18 setting 98 on room air physical exam had an enormous smell like an a dramatic no cervical spine tenderness pupils equal around and reactive light um clear to auscultation regular rain Rhythm soft non-tender non-distended differential diagnosis for this patient's new mild headache and weakness and upper lower extremities include stroke given the patient's history of left MCA stroke and current status on Ico Day 2 it is likely that the patient systems are related to The Stroke the weakness and headache may be due to brain injury or inflammation infection medication side effects hypoglycemia plan order the following Labs CBC BMP liver function test blood culture obtain Imaging studies including a head CT and chest x-ray to evaluate for new brain injury or infection consider adjusting the patient's medications including any anticoagulants or glucose lowering agents as needed based on the results of the labs and imaging studies administer IV fluids and electrolytes as needed administer 325 aspirin 325 lysinopril 20 and Insulin as needed to maintain sugar control so I don't know like obviously this is like very vague and like it's not it's not this is not like what you would actually do but like holy crap it gets a lot of the details right about how we would kind of approach this patient and a lot of how we would generate a plan for the patient for that day and like this looks pretty legit for a soap note like it's got all the things that we typically include in them so then this person goes back and says then when it does that type in make it longer and include pros and cons in the assessment and include a table of a full neuro exam with expected findings based on her Chief complaint like holy crap let me try this in like I'm actually I I knew I was going to be impressed but honestly this is freaking insane I definitely gotta link this to my neuro colleagues because obviously this is a neuro presentation but like just like it's gonna include a full neuro table on this one I I'm looking forward to seeing what that is so far everything seems about the same let's see a neuro exam is now coming out and it's actually generating a table uh this honestly this note looks better than the notes that we write in the hospitals like what is this table like this table is beautiful five out of five strength in all extremities intacted light touch and been Recon exterminities no gross deficits two plus and symmetric reflexes differential diagnoses Pros cons like yo this is uh okay I'm I'm actually getting I'm getting a little bit like I'm a little bit flabbergasted right now I don't know what other word to use but look at these you know offering pros and cons this is like basically how an intern a resident or even like an attending like how anybody in medicine is going to present it like hey here's like the reasons this differential is probably more likely and this is these are some of the reasons that it's less likely this is very like colloquial this is very easy to read this is very much How We Do approach a lot of these problems see even for the infection um they say infections can often present with non-specific symptoms such as headache and weakness cons the patient's vital signs are within normal limits and there are no other signs or symptoms of infection they literally generated their own Vital Signs and they generate their own physical exam and then it interpreted its own Vital Signs and physical exam and said that it is not possible it's probably not consistent with infection like the way you can interpret that is just absolutely insane uh medication side effects some medications can cause side effects such as headache and weakness cons the patient has been on these medications for several days and any side effects would typically have occurred sooner all right and then pros and cons about the hypoglycemia the pro the cons they're saying that the blood sugar has been well controlled they didn't even provide a blood sugar in here um so this AI is already like has some like Labs stored in the back of its mind somewhere and I think the next thing it says uh oh it says keep going so keep going and we'll see what it's going to say what are the following mobs it's going to be pretty much the same as what it said previously like now it's doing like a summary statement here uh overall the patient's new mild headache and weakness may be related to the left MCA stroke that she recently experienced further testing is indicated let me let me just try this so this person I think that was the end of what it you know this guy suggested here but please give me a CBC CMP um coag panel and glucose level for the patients Labs so this is just me typing this CBC white cow for 6.4 hemoglobin 13.5 holy insane this is crazy guys like oh my God glucose 116 yeah it's not hypoglycemic did the patient have any blood cultures question mark it is not specified in the in a given scenario whether the patient had blood culture is drawn if the healthcare system works that the patient may have an infection blood cultures may be ordered to identify the specific type of bacteria causing the infection and guide anti-microbial treatment should we start this patient on a Heparin drip it is not appropriate to shade a heparate drip first without really considering the potential risk of benefit all right so they're very vague right now so I think this is starting to get into the areas where it's like um getting a little bit more generalized and it's uh not really giving us like a specific answer it's just like being very vague generalized uh generalizations but um should I consult neurology right now question mark and yeah see now it's now it's starting to falter a little bit right should we consult neurology please give me a yes or no answer it is not possible to accurately determine so at this point it's starting to falter but really honestly that was a pretty insane ride right there please write an hnp for a patient coming in with HIV and profuse watery diarrhea for the last three months they have been non-adherent to their big tarvy and recently traveled to Thailand they have a mild fever please also provide a differential diagnosis and assessment and plan okay okay all right all right oh they put the fever in 101.2 fever soft non-tender large volume of watery stool no no visible blood differential diagnosis HIV Associated diarrhea travelers diarrhea infectious diarrhea look the patient's reason traveled to Thailand increases the likelihood of Travelers area this is just so awesome this is freaking insane obtain stool studies including stool culture over and parasites and clostridium diff uh C diff toxin administer bittarvi as prescribed administer oral rehydration solution administer anti-motility agents no no no no no no no no no you got to be careful gotta be careful uh consider antibiotics such as Cipro or zithro refer the patient to ID or GI for uh further management and evaluation or HIV Associated diarrhea counsel the patient on the importance of adherence to HIV medication and safe food and water precautions when traveling okay can you generate labs for this patient including CD4 count CBC CMP [Music] and stool over and parasite results lab CD4 count 200 white blood cell count 6.4 hemoglobin 30 okay it's like generating the same Labs as it did for that neuropatient back there and yeah it's basically the same lab so it's kind of using some generic Labs like this would not be the labs that you would expect in somebody with this kind of History I would expect Aki probably some acidosis because he's pooping out all his bicarb a bunch of metabolic abnormalities probably have like low potassium and low chloride and all this stuff stool over and parasites positive Giardia they gave it a diagnosis of giardia that's pretty great could this be crypto spiridium cryptosporium is a type of parasite that can cause diarrhea abdominal cramps blah blah blah possible that this could be due to cryptosporidium however is not possible to accurately diagnose cryptosporidium yeah so now I I guess my question you know when you give it more and more targeted questions that's when it's really able to shine and when you give it just like a simple question it's a lot more vague so you know giving it a more specific scenario is when it's a lot more useful in terms of its um ability to give you an answer rather than just like something big all right I just want to move briefly on just because this is not just limited to um language learning right now and this chat GPT thing right here which honestly this right here I think is going to be a game changer in medicine in the coming years like it's pretty insane what it's able to do right now um but you know when that's gonna happen like I'm curious to hear what your thoughts are like hey do you think this is going to be a game changer or is this really just kind of like a fun little gimmick that's not really going to do anything or be a risk for you know taking Physicians jobs in the future or something and two if you do think it's going to be a game changer what is the time frame that you expect that this is really going to actually uh start coming into play where it starts writing notes for us or starts doing differentials for us and do you think it's just going to be a tool that like makes us better clinicians or do you think eventually it's going to actually take over our jobs in 20 years or something me personally I think for the next five years or so probably not going to be impacting our practice at all but maybe within the next 10 years we'll start using it to like augment our ability to be more efficient make sure we don't miss differentials and stuff and really just help us become better clinicians but like you know maybe 20 30 years from now who knows it might be it might just be better than us because think of how many millions and millions of patient scenarios that it can go through whereas the top most experienced clinician at your hospital may have seen what 10 000 patients in their lifetime or 50 000 I don't know what an actual you know number is going to be but this thing is going to be able to see millions of cases or hundreds of millions of cases depending on how much data you give it and it's going to be able to learn a lot you know 20 years from now I wanted to briefly mention that this is not just limited to uh language they also have it for art so you've been seeing a lot of fictional art previously where you just give it a prompt and it automatically generates a lot of crazy art for you so this is called the doll E2 and you know this one is somebody gave this prompt an astronaut riding a horse in a photorealistic style okay but you can do teddy bears mixing sparkling chemicals as mad scientists and as a 1990s Saturday morning cartoon so you see this here and it generates all sorts of different variations of it too these are all AI generated and it looks like somebody actually Drew this right a bowl of soup that is a portal to another dimension as digital art okay pretty nice one but like wow this is pretty cool too like it's got so many different variations and it's able to just generate this based on whatever you throw at it okay I was watching this actually um four months ago I was watching this video and uh this guy was saying end of an artist career AI creates art for you okay so these are all examples here of some examples that the this this AI was just able to generate on its own of pictures it was able to create [Music] I'm absolutely speechless so I'm just going to show it to you so let us say you want to imagine an elderly woman so let's type it so imagine an elderly woman walking up the stairs to heaven and he can give the artificial intelligence as much detail as you want so in this case let us say you want it to be hyper realistic and something ethereal you can even say things like you want dramatic lighting and let us say as she's going up the stairs we want a little bit of Rim Lighting on her so let's simply type that and hit enter let's see what it does and the image is slowly and gradually taking shape take a look at this this is not crazy I don't know what is now we have got four versions of this whatever version you like you can choose that and upscale it add more details to it or if there's a version you like and you want to generate more versions from it we can do that as well and I also want to upscale the fourth one take a look at it so this is generated have a look now you can upscale it even more by clicking on upscaling to the max or create more variations from it by clicking this button make variations take a look at this one we have barely begun to scratch the surface do you want to see something that's going to completely blow your mind let us dive in something that just does not exist painting of Taj Mahal by Van Gogh something that would be crazy to see let's say we wanted to be in style of bangkok's famous painting starry night and we also want it to be vibrant this is insane it actually did take the elements from starry night now although some of it doesn't look anything like Taj Mahal it has caught the basic sense of it and let us say we like the second one right here so these are the four quadrants first second third and fourth so we want more variations of the second one so we press V2 along with that we also want to generate an upscaled version of the second one so let's press U2 as well so there you go now you have more variations just look at the details of the brush strokes this is some other level stuff you can even upscale it even more so you can click on upscale to the max let's open the original and if you zoom in take a look you can actually see these individual brush strokes this is just I'm telling you I'm sorry I'm running out of adjectives so let us say Leonardo da Vinci a person of the past what it would look like if he sketched a spaceship so let's imagine sketch of a spaceship by Leonardo da Vinci oh my dear God take a look at it it has completely replicated Leonardo da Vinci's those technical sketches that he used to do there was another video that I was watching at some point that was like uh hell generated by a AI hell as envisioned by Ai and uh it was also like yeah I asked an AI to show me hell and it terrified me very very interesting stuff guys whatever the case will this Vision be where the AI thinks we go or where it goes I asked an AI to show me a vision of hell this according to artificial intelligence is a representation of Hell the AI created what you were seeing right now this is a computer's idea of what hell looks like okay and not only this but you can actually turn it into a video so it's not just a still image it will be a like live action video that you can have the AI generate as well go ahead and dive into the lungs of hell look how crazy it just like morphs and like random random images start showing up out of nowhere like those skulls just came out of nowhere [Music] whoa okay no more jump scares you guys a little too scary I'm gonna keep this YouTube channel PG-13 or below okay I don't want to scare people all right so I'm sorry for ending with uh those videos of the creepy hell Landscapes and Hell pictures and stuff but I remember watching that video several months ago and I was like oh my gosh like is this is this the sign that you know AI is finally going to take over Radiology because Radiology always has to deal with this question is AI going to take over radiology and every single time you see the comments and the Radiologists are very very confident that it's not gonna happen and Nick I'm hoping to hear your opinion on this but I agree I don't think it's going to take Radiology over anytime soon it's just going to augment radiologist's ability to interpret things and not miss things but there is a part of me that is a little concerned uh that the day where it does eventually take over our jobs maybe a little bit sooner than we actually think curious to hear your thoughts about that and it's not just limited to Radiology I mean just look at those soap and hmp notes like that is based on a prototype like first year version like I was watching another video that was like you know when the iPhone one came out it was revolutionary and what are we on now we're on like iPhone 14. imagine when Chad GPT 14 is out like yo that that hmp is going to be solid at that time and yeah okay hopefully at first it's just gonna help us become really fast and like it'll just type the hmp for us and we can just make some edits to it it'll be really nice but at some point it's going to get there and it's gonna just not even need us anymore right A lot of people are using this for marketing they're using it for making YouTube videos and generating scripts for YouTube videos they're using it um they're afraid that students in high school and college are just going to use this to generate really really good essays because there's a lot of essays that this chat gbt has generated that are really fantastic and you really honestly couldn't tell that it was not written by a human you know some of my friends were like doing random things too you can like really give it any kind of prompt possible like one of my friends put in a prompt like hey put in this prompt about Jonathan who's like an anesthesia resident who really likes Yeezys or whatever and make a poem about it and it was like Jonathan is such a cool anesthesiologist he's so good at intubating his patients and he's like the best and he works hard and Jonathan a man of style and Care collecting sneakers he's got Flair he's on his feet a sight to see but his true passion lies in the hospital you'll agree and anesthesiology resident he works with Grace bringing comfort and healing to every patient's place like come on this is like freaking crazy as chat gbt please write an extremely sarcastic and hurtful explanation of what a radiologist does oh boy where do I even begin with this one a radiologist is a medical doctor who spends their days staring at blurry black and white images of people's insides yep that's right they get to spend their days looking at X-rays and MRIs and CT scans and all sorts of other fun things and don't even get me started on the hours they spend in dark windowless rooms isolated from the rest of the world oh and let's not forget about the radiation they're constantly exposing themselves to I mean who wouldn't want to spend their days in a cramped poorly lit room surrounded by machines that emit dangerous levels of radiation sounds like a blast to me so basically if you want a career that is both tedious and potentially hazardous to your health Radiology might be the perfect fit for you enjoy like this thing's got a bit of a personality it can it could totally write with some personality the implications of this are going to be huge not only for medicine but obviously in this channel we're concerned about how it's going to have implications of medicine but even for non-medicine things and you know people are going to generate writings like reviews and movies and all these crazy other things and you're not going to know if they actually wrote it or if an AI wrote it anyways I really thought it was an interesting topic I thought it was very pertinent because of how big it is on the internet right now and very curious to hear you guys thoughts about it thanks again for watching I'll see you in the next one and peace

Channel: Conan Liu, M.D.

Views: 14,377

Keywords: suppy, dr. suppy, conan liu, internal medicine, internal medicine residency, residency life, life as a resident, chatgpt doctors, chatgpt physicians, will chatgpt replace physicians, will chatgpt replace doctors, how will ai affect doctors, will ai take over radiology, will ai take over medicine

Id: ZLdlqu2dvtQ

Length: 28min 16sec (1696 seconds)

Published: Thu Dec 29 2022