Speaker 1: So ChatGPT continues to take the world by storm. It's being used so many different ways in health care today. In today's video I want to show you how you can actually use it in your day-to-day activities as a doctor or as a resident. The first three prompts I'm going to cover are actually all focused on patient care directly, looking at drug-to-drug interactions, looking at how to use ChatGPT as a curbside consult for example, and then the last three I'm going to focus more on medical documentation to boost your productivity. So a quick disclaimer about ChatGPT. Really whenever you're using ChatGPT for medical care you should really be using it out of an abundance of caution and you should really use it at your own discretion. What I'm showing here are just examples on how you can leverage this technology but I think that a lot needs to be done to make sure that this is safe and this is accurate. So anything that's actually put out of ChatGPT, always make sure to fact check it to make sure that it's actually correct and also make sure that you're not putting in patient-sensitive data that could potentially violate HIPAA for example. So the first use case I want to show of ChatGPT is to use it as a medical consultant and so this is basically whenever you're wanting to do a curbside. So for example if you're a physician in the ER and you want to consult ID or infectious disease about a question or if you're a surgeon trying to consult internal medicine about a question, ChatGPT actually does a pretty good job as serving as a basic curbside consultant. And so the first example I want to show is that I asked ChatGPT to please assume the role of an experienced interventional cardiologist with over 20 years experience in treating chest pain, heart attacks, and heart arrhythmias. So I am an emergency room physician and would like to discuss the case of a 65 year old male patient with a history of strokes that presented with severe chest pain in his right arm with radiation to the fingers. What lab should I get? What medication should I start? And what other diagnoses should I really be considering? And so ChatGPT does a pretty good job about this. It says as an AI language model, I'm not a medical professional, that's great, but I can provide some basic information. And so they reiterate the case here and then it also points out that it's really important to rule out life-threatening causes first, which is great because that's what you should be doing in the emergency room. So they provide a differential diagnosis which includes acute coronary syndrome including MIs or heart attacks, pulmonary embolisms, aortic dissections, PVD, cervical radiculopathy, and also MSK sort of causes. They also provide you with a lab of the labs and the test that you should use, CBC, BMP, tropes, BNP, EKG, chest x-rays, and then also provides a list of medications if they're applicable. But now let's say I want to dive deeper. If the patient has a pulmonary embolism, what signs and symptoms, labs, and treatments should I perform? And so when it says here if you suspect a PE, you should then have these signs and symptoms, sudden onset, shortness of breath, tachycardia, hypoxia, cyanosis, and then it also suggests some labs that you should order. And it's really nice because it also says that the gold standard for diagnosing a PE is going to be the CTPA or the CT pulmonary angiography. And it also provides some treatment options here. And so I think that this is overall a really good way to be able to approach and be able to think about your differential diagnosis. You're going to basically ask CHAT-GBT for things to follow up on saying, you know, I think it might be a PE. What else should I be doing? And we can also go more further than that. We can say that I am concerned that the patient may have a pulmonary embolism or a heart attack. Can you please provide a table indicating the lab values that would distinguish these two conditions? And then here it provides the lab tests for PEs versus myocardial infarctions with the D-dimer, trope levels, BMP, CKMB, EKG, and ABG changes. So it actually did a really good job being able to summarize this in a quick manner so that if I had some disease or if you have some condition that you're not super familiar with, you can basically use CHAT-GBT to be able to summarize that information quickly. Now let's move on to the next prompt. So sometimes we have those patients that come in and they have a laundry list of medications. And it's really important to be able to understand which medications may be interacting with each other so that it may influence the medication that we're prescribing or a medication that we may even need to take off of the list because there may be too much of a drug-to-drug interaction. And so in this case, I asked CHAT-GBT for a patient that is on isotretinoin, which is basically high vitamin A for their acne. I'm thinking about adding doxycycline as well. And then can you tell me about any potential medication interactions I should be aware of? And so from my own experience so far, I've learned that basically isotretinoin and doxycycline could cause a high risk of intracranial hypertension. And so saying it does respond here, combining isotretinoin and doxycycline may not be recommended. Both isotretinoin and doxycycline can increase the risk of intracranial hypertension or pseudotumor cerebral. So it actually does a pretty good job about identifying that and also provides some symptomatology and signs of increased intracranial hypertension. And so that's always good to know too. I wanted to do another example. And so in this case, we say, please take on the role of a doctor with several decades of experience. Take the example list of medications below and tell me if there's any concerning medication interactions I should be aware of. And so here we have current medications include Tylenol, Lisinopril, hydrochlorothiazide, aspirin, warfarin, and furosemide. And then I'm thinking about adding on spironolactone, which is another diuretic. And so it provides potential drug-to-drug interactions for medications that the patient is already on, such as aspirin and warfarin. And then also goes through to add hydrochlorothiazide, furosemide, and spironolactone, which it says here that hydrochlorothiazide and furosemide are diuretics, water pills that help reduce fluid retention. Adding spironolactone, another diuretic, could potentially exacerbate the diuretic effect, leading to excessive fluid loss, dehydration, or electrolyte imbalances, particularly low potassium or sodium levels. So that's really good to know. And then say that we want to use chatTBT to actually help us with the prescription itself, in terms of how frequent to be doing lab checks and what labs to be checking at baseline, and also for the frequency of screening labs moving forward. I have decided to move forward with prescribing spironolactone. Can you please tell me what labs I should order and what frequency? When prescribing spironolactone, it's essential to monitor the following labs. Electrolytes, radial function, and blood pressure. It provides the important fact that spironolactone can affect electrolyte levels, particularly potassium. So monitoring serum potassium and managing any hyperkalemia. And the next prompt I wanted to focus on was using chatTBT to actually help you connect with patients better, so that you can provide better support and better comfort whenever they're in a time of need. And so in this example, I mentioned regarding the patient above, I am concerned that she may be also suffering from anorexia nervosa. How do you think I should best approach this as a doctor? And then it punches out, as a doctor, addressing concerns about anorexia nervosa requires a compassionate, sensitive, and multidisciplinary approach. It provides different sort of tips and suggestions, including building a wrapper, choosing the right moment to be opening up. And it also provides you with the verbatim questions that you can directly use. So it says, for example, you might ask, how do you feel about your eating habits? Or can you tell me more about the relationship with food and your body? And then it can also says that you can share your observations, express your concerns about the patient's health by sharing observations without judgment or blame. I've noticed that you've lost a lot of weight recently, and I'm concerned about how this may be affecting your health. And so I think that this is really good and really helpful if, for example, you haven't dealt with anorexia nervosa for a long time, or if you haven't dealt with a particular condition for a long time, you can always think about how to approach that from a compassionate care standpoint. And let's take this another one step further. You can actually use ChatTPT to kind of think about what the patient may be feeling. And I see that this can be really useful in medical education, for example, when medical students are just starting to learn about how to deal with these sort of difficult conversations and challenging conversations. And you can ask ChatTPT, can you tell me a little bit about the emotions and feelings that someone with anorexia nervosa may have, particularly about their condition. And so it goes on to say that some common emotions that individuals with this condition may experience include fear, control, anxiety, guilt, or shame, low self-esteem, perfectionism, depression, isolation. And so it goes through this whole thing. And I think that this is really nice because whenever you're reading it, before you go into the patient's room, for example, you're able to kind of put yourself in their shoes and think about what they may be experiencing. And that really equips you to be a better compassionate doctor whenever you're talking with them through their challenges and through their care. And I think that this is a really interesting application in ChatTPT to be able to help us connect with patients on an individual and on an emotional level, just by reading maybe through what the patient may be experiencing. Let's jump ships now over to the medical documentation prompts. The first prompt I wanted to demonstrate in this category was using ChatTPT to actually summarize text in a reading level that may be more appropriate for your patient. For example, at the fifth grade reading level, at a high school reading level versus a college reading level. And so here I say, can you please provide an explanation for how spironolactone can be used to treat hormonal acne? Explain at the fifth grade level and provide an analogy, please. And it initially punched out something that I thought wasn't the greatest in terms of having an analogy, so then I subsequently removed it. But here we can see that after I said, make the explanation a little bit simpler for a fifth grader level, and also remove the analogy. Spironolactone is a medication that helps with hormonal acne. Hormonal acne helps when there are too many hormones in your body, like androgens. These hormones make your skin produce extra oil, which causes pimples. So spironolactone, the medication that we are going to be prescribing in this encounter, works by blocking these hormones. When the hormones are blocked, the skin doesn't make as much oil, and so you get fewer pimples. This helps your skin stay cleaner and clearer. So I thought this was a really good synopsis about how spironolactone works. It's pretty simple, and I feel like that's already able to be put into the after visit summary. And here's an example of me actually using it to write the after visit summary. In this prompt, I'm saying I am planning to start spironolactone for a patient, starting with 50 milligrams daily, then increasing it to 100 milligrams daily. Please write an after visit summary about this, explaining that it's being used to treat her acne, and then tell her what potential side effects to then notify us about. And then keep the explanation to a fifth grade level and succinct. So it says, Dear patient, thank you for your visit today. We discussed your acne and wanted to start you on a medication called spironolactone. And then it goes through the methodology or the pathophysiology of why it works, and it goes through the side effects that would be concerning. And then remember to keep all your appointments and let us know if you have any questions or concerns. So that's basically the after visit summary already. So I don't actually necessarily need to be in the room typing this all out if I wanted to write this after visit summary. The next prompt I wanted to cover in this section was also using ChatGPT to be able to translate text. So if we wanted to translate one of those after visit summaries, for example, I can ask ChatGPT, can you please translate the following explanation to Spanish, Chinese, Vietnamese, and Arabic? And so it actually did a pretty good job. And so I copy and pasted this basically into Google Translator and actually was able to show that it did a pretty good job. And so let's use ChatGPT to write another letter of medical necessity for an orthopedic surgeon trying to get an MRI for his patient. And so here, the prompt says that I am an orthopedic surgeon that specializes in joints. A patient has been declined the MRI for his shoulder, and I would like to get a letter of medical necessity for him to get his MRI. I do a little bit of a brief summary about the patient. He's a 60-year-old male patient with a history of right shoulder pain, progressively worsening despite physical therapy and science, other conservative managements, including rest, compression, ice. On exam, I provide the exam so that I think that he should be looking at his MRI. And so ChatGPT does a really good job of being able to generate a letter of medical necessity. And I think that the best one-liners here is that it says here, in light of these facts, I respectfully request that you reconsider the decision to deny coverage for an MRI of my patient's name, right shoulder. The MRI is medically necessary to provide a definitive diagnosis, guide treatment decisions, and ultimately improve the patient's quality of life. So overall, this is a really good letter of medical necessity that's written by ChatGPT. It only took a few minutes. And then I can also ask this for citations as well, like I did as above. So that's it for this video, guys. I hope you like this video. There's going to be a part two and probably a part three, just because there's so many different ways that ChatGPT can be used in day-to-day activities as a doctor. So if you like this video, go ahead and hit that like and subscribe button below. And then I'll also be coming out with a book about ChatGPT in healthcare, and it's going to be more of a practical guide for doctors on how to leverage this technology. So if you want to hear more about the upcoming book, go ahead and go down to the descriptions below, and there's a newsletter button, and you can go ahead and join that and hear any exclusive updates or deals that's coming out. All right, see you guys. Bye.