The Physical Exam - Raw Transcript
The physical exam. I've been thinking about the physical exam recently, because, well, they're physical. What do I mean by that? So, I've been kind of wiring up and testing a live dictation module on my computer using synthetic data, and I guess I found that I think it might, I know I've been a little bit critical in the past, thinking, oh, I'll have to actually, you know, talk to the AI. But honestly, I think for most of a visit, that's not really true. I think that the AI can form to you. And honestly, I think a live, sort of live transcription to note is actually perhaps more accurate than the post-visit dictation in the setting of more is captured. Really, it depends on the fidelity of the audio you capture, but like, usually, I think that the things are pretty good. If anything, like, it's not a bad idea to go through the plan with the patient while you're in there. There may be parts that you need to edit of the note afterwards, but I think that the, for in it, mostly for workflow status, I think that the idea of having like 95% of your note done when you leave a room is pretty enticing compared to, you know, less than that. And I think the actual quality of the note can be significantly better. But the one aspect of, I guess actually, the synthetic data I have is, you can be found at, and I'm going to put a placeholder here for where I put the data. And I've actually even thought about, sort of like taking that part of what I built and putting it into like an open source repository on GitHub, independent of the rest of the app, mostly for this note I'll ask later about that. But as far as moving on with this article, the physical exam is the one thing that live transcription really can't do unless you tell it exactly what you're doing, which is kind of weird. There's nothing wrong with saying, like, all right, your lungs sound good and your heart sounds are normal. Your thyroid is supple. Honestly, these things may actually come, now that I'm saying them out loud, it may come at this point. I'm not sure, like, when I do an exam, I'm usually not speaking about it. I think that, but perhaps, you know, that's not really a bad thing. It's kind of like if someone can read your note, it might be worthwhile. I guess, where does this bring us to in the future? It's an interesting idea. Like, I guess I'm just, I guess now that I'm thinking about it, let's think of the different parts of the exam itself. There's the history taking. This is largely done talking. It can be done in person or not in person. I guess it could even be done over text, although I don't think that's very efficient for most problems. Talking is much faster. And so I think it would take a lot less, like, I think that at this point, talking will be the predominant way we get a good, accurate history, at least to start things off. After I talk to someone, I do an exam, usually, for most problems, I would say. Whether it's a physical exam, like an annual physical exam, I like to kind of take a look and make sure everything's normal. I'm old fashioned that way. Or if there's a specific problem on the body, I like to do an exam as well, especially targeted to that area. Now this is not something, unless I could definitely speak out what's happening, but say I... I'm just wondering, like, am I, I'm pretty good at physical exams, I think. I'm not the best at the terminology of the physical exam, but I'm pretty good at knowing what to do, is what I would say, to make sure I can, like, hone in on my specific thought, like diagnoses I've thought of. With that in mind, I guess you, like, how could a physical exam actually fit into an AI world? You could just have a dedicated physical exam people who, I guess, you know, maybe come to your house or just go in the room if you are not there specifically, who do physical exams for you. You'd have to really trust their physical exams, though. It's going to be a tricky spot. Like a professional physical exam artist would be an interesting thought, but that doesn't really exist right now. So the physical exam might be the thing that really grounds medicine to the office visit, at least for the foreseeable future that I can tell. And then the last part is the plan. Usually, I would say the physical exam is important still, because it definitely changes what I think is happening depending on what I, what I see on the physical exam. A lot of times the history gives you, like, sort of a direction, and then the physical exam either confirms or negates the direction in which you're going. And depending on how compelling the history is, you have to sort of like, even if the, sometimes the physical doesn't fit, but you move forward anyways. And sometimes the physical does and you feel strongly. And sometimes the physical changes everything you've thought of up to now. So I think they really are entwined and can't be taken apart. And they all fit into your plan. A plan can definitely be done orally and doesn't really need someone present for that. And I guess honestly, like, sort of thinking about the three steps of this, you know, like, what could an AI do? An AI could probably take an accurate history. I think it'll take a while for it to actually, like, get a great one. I think you'll see a lot of examples, if this ever does go into production, of similar to the refill where you have, like, hey, it does pretty good on, like, 80%, and people think, wow, that's really pretty impressive, but I do want to let you know that the last 20 is gonna take you a really long time because there are so many, like, edge cases in medicine. And I think AI is not bad at synthesizing information and coming up with a plan. I imagine that one of the issues would be you'd have much like, it would probably be over, like, you want your AI to be overconfident, or not overconfident, but like, kind of like cautious things to not miss. And I think that really the doctor, like one of the things I do is sort of let people know that I have thought about it and I don't think it's likely and I don't think we have to work it up so people don't get too overwhelmed. But it probably will be able to come up with a plan. So you're left with the physical exam. So the physical exam is this thing that sort of like, I think is plus minus for a lot of people. It might end up being really holds practice of medicine, at least office, clinical practice, office medicine in place for now. It doesn't need to be done by a doctor. It could be done by a sort of an exam specialist. These are certainly questions that are not having answers. And I don't know who will answer them. There's a lot of red tape around these kind of things, so I'm sure it won't change quickly. But anyways, that's just a quick thought about that, the physical exam.