It’s an all too common refrain to say we are short on time, but from a very personal perspective, suffice it to say time has never meant more to me than it does now as we rally around the care of a dear family member.
I’ve always hoped that TCMP represents a time-saver for our readers. Sifting through the endless stream of new medical data to find the trials that impact practice can be overwhelming. By selecting and presenting trials through the lens of practice change, our mission is to provide you with data and tools to enhance your care of patients across a range of conditions.
This year, inspired by one of our own editors, as well as one of our Top 5 articles, I have implemented an AI scribe to my practice. I can honestly say this was the most impactful change in my own practice that wasn’t directly related to managing a clinical condition. The scribe has greatly boosted my efficiency in generating consult letters, saving literally several hours of time each week. For the first time in over a decade, I get out of the office reliably before 6:30 PM. While it does take time to ensure accuracy, and the AI doesn’t capture my obvious wit and charm, it does a surprisingly good job of summarizing an unstructured, free-flowing conversation with a patient. Editing a document takes less time than generating each word of it, and this has had a palpable impact on my finish time each day.
We are currently in the infancy of generative AI. AI scribes are already making suggested differential diagnoses and investigations based on the conversation. Further down the road, AI agents (watch for the next industry buzzword: “agentic AI”) could scour your medical record, look up and collate historical lab results and flag trends that can identify diseases earlier than we can on our own.
While the future is exciting, traditions can also keep us on track, so in the TCMP tradition, here are the Top 5 articles that your peers felt would likely or definitely change their practice:
Top 5 Articles with Intention to Change Practice:
- “Therapeutic considerations of gabapentin versus pregabalin in treating chronic neuropathic pain” by Anthony Lau, Katherine Daley, Hans Haag, Dr. Martha Ignaszewski
- “Asthma and COPD as-needed inhalers (SABD): where refills matter” by Drs. Kevin Liang and Philip Hui
- “Gouty pitfalls” by Drs. Carson Chin, Nathan Hitchman, and Jordan Friedmann
- “What I talk about when I talk about family planning” by Dr. Michelle C. Chan
- “Talking smart: conversational AI streamlines clinical practice” by Rohit Singla PhD, Drs. Daniel Raff, Hester Vivier, and Andre Van Wyk
As always, on behalf of all of us at TCMP, we wish you all a safe, happy and healthy holiday season, and most of all, more time for the things that matter most.
Steve Wong, MD, FRCPC
Internal Medicine
Clinical Associate Professor, Department of Medicine, UBC
Medical Director, This Changed My Practice
Dear Dr Wong, thank you for this summary of the most impactful TCMP articles of 2024 – TCMPs are indeed time-savers!
It is heartening to see amongst the top 5 an article (the second one) which addresses the greatest threat to our health of this century according to WHO (1): Earth’s rapidly changing climate related to the destruction of the ecosystems (including air, water and soil) upon which our health directly depends. This is a potential threat to the very existence of humanity (2), and it is rooted in many aspects of our current lifestyle including our way of practising medicine (3). As such, it seems wise to consider the ecological impact and related health harms of new (and old!) habits and technologies we use in medicine.
AI is contributing to the persistent increase in global energy demand (4), including electricity produced using fossil fuels which are primary drivers of climate change. The short- and long-term solutions to climate change revolve around reducing our consumption of goods and energy, and unfortunately AI seems to do the opposite. Which places us in a bit of a conundrum – in trying to improve our efficiency in health care, are we ultimately causing a greater stress on the health care system, via the climate impacts of these improvements?
1. https://www.paho.org/en/topics/climate-change-and-health#:~:text=Change%20and%20Health-,Climate%20Change%20and%20Health,threat%20of%20the%2021st%20century.
2. https://climate.mit.edu/ask-mit/why-do-some-people-call-climate-change-existential-threat
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC6887560/
4. https://www.iea.org/reports/electricity-2024/executive-summary
Dear Dr. Wong,
I was wondering which AI scribe you are using. Not looking for an endorsement; just as an example of personal experience that may be more relevant to a fellow BC practitioner than a Google or ChatGPT search result. Thank you very much.
Thanks for the comments.
@Linda Thyer: you’re totally right about the energy costs of AI systems (and thus carbon emissions). I’m hoping we will continue to see improvements in compute and efficiency to drive these down. We may also see more of the compute workloads offloaded to local devices to distribute the energy costs – for example we are already seeing iPhones incorporating a smaller large language model to process speech and AI tasks on device without cloud infrastructure. There’s a huge race amongst the tech giants to add local AI coprocessors to computers and phones.
@Stephen Cheung: I personally use Empathia – but this isn’t an endorsement- I pay full price for it. Empathia is one of the more expensive options out there. I have also used Heidi which has free to use and paid tiers. In the end I honestly just didn’t have enough time to trial other options and incorporate them into my workflow.
I’ve also heard good things about Scribeberry and Tali specifically in the BC use context from both specialists and GPs.