Artificial intelligence replacing the PA??

[lkth487]

Nah, it'll change, but won't replace it.  I mean, there are websites soon where you can have your CT scan read for a $1 (radiology ct scan read for a dollar).  But anyone who has had their EKG read by a machine knows that there's a long way to go for the machine to read something so [relatively] simple better than a reasonably trained human (let alone a cardiologist).   Will it happen eventually?  Probably.

 

There was a system for anesthesia which was supposed to replace anesthesiologists and from all accounts, it worked REALLY well (Sedasys -https://www.washingtonpost.com/news/the-switch/wp/2016/03/28/its-game-over-for-the-robot-intended-to-replace-anesthesiologists/?utm_term=.b444922d19ad).  But it was pulled from market for various reasons (hint:  not because it didn't work).  So even if you do come up with a replacement, there are other factors at play.  Will it never happen?  No, I'm not saying that.  But I think we are probably safe in our working lives :).

[marktheshark89]

41 minutes ago, katieo said:

Telemedicine is a god send for UTI. If it fills this niche alone I think it’s a success.

Once you learn all the other things a “UTI” could be, we’ll see how you feel about that

[lkth487]

43 minutes ago, katieo said:

Telemedicine is a god send for UTI. If it fills this niche alone I think it’s a success.

No way I would diagnose a UTI over skype.  I'm surprised you would.

[tenjjetnis]

I do see a future with telemedicine and PAs working in conjunction in certain niche areas. Here in our system, we use telemedicine in certain specialties that are complementary to PAs and NPs especially in the smaller hospitals and clinics located in more rural locations. A few dermatology clinics are staffed by only PAs with new patient's seen by the PA and then afterwards briefly by the physician via telemedicine then subsequent f/u visits by the PA.

Hospital rounding for pulmonary when there is no physical doctor present is done via telemed along with a Pulm PA. Same with new office visits in outreach clinics. Our telemed carts are equipped with stethoscopes in addition to a 360 degree swivel HD camera. I believe a few other specialties also use telemed for initial new encounters with patients when a doc is not present in a clinic. Work flow has the PA seeing the patient first, doc then comes on screen briefly at the end after reviewing the chart or quick oral presentation and asks a few questions, he or she hears the plan and gives the blessing. 

The docs are all part of the same medicine institute from our main trauma center.

Infectious disease consults in the smaller hospitals are wholly telemed.

[katieo]

42 minutes ago, lkth487 said:

No way I would diagnose a UTI over skype.  I'm surprised you would.

 

43 minutes ago, lkth487 said:

No way I would diagnose a UTI over skype.  I'm surprised you would.

 

45 minutes ago, marktheshark89 said:

Once you learn all the other things a “UTI” could be, we’ll see how you feel about that

Lol you must be men. I’m talking as a patient. Once you’ve had 30+ UTIs you might feel differently. Urinalysis/culture isn’t recommended for uncomplicated UTIs. Plenty of people with recurrent UTIs are more than capable of self-diagnosis.

[Fernwood]

I think many of you are not fully understanding the telemedicine I have been tasked with utilizing. This is a system in which the patient logs into the portal and simply describes his/her symptoms. I am simply watching and listening, there is no hands on exam, no nurse or PA doing any type of physical exam. I am expected to listen to the patient’s compliant and self described symptoms and then diagnose. Its absurd.

certainly there is merit to a telemedicine system that utilized a healthcare provider doing an exam then consulting via telemed with a specialist. Thats not at all what I am asked to do. 

[lkth487]

1 hour ago, katieo said:

 

 

Lol you must be men. I’m talking as a patient. Once you’ve had 30+ UTIs you might feel differently. Urinalysis/culture isn’t recommended for uncomplicated UTIs. Plenty of people with recurrent UTIs are more than capable of self-diagnosis.

I understand that some studies have shown that it was 80-85% effective for women who have had multiple UTIs.  I just personally would never do it.  I think a lot of people have that compulsion.  Unless there was some legal shield that you wouldn't be responsible for 'missing' anything.    Even then, I wouldn't.  I've been fooled before with UTIs.

[camoman1234]

17 minutes ago, lkth487 said:

I understand that some studies have shown that it was 80-85% effective for women who have had multiple UTIs.  I just personally would never do it.  I think a lot of people have that compulsion.  Unless there was some legal shield that you wouldn't be responsible for 'missing' anything.    Even then, I wouldn't.  I've been fooled before with UTIs.

I have been fooled as well, katieo it shows you are a pre-PA, I would suggest practicing a few years prior to going off what "research" says. When you hear hoof beats what do you think of? It could be that zebra lurking around the corner...I would be careful about self-diagnosis and then coming here saying things like "you must be men." 

[katieo]

27 minutes ago, camoman1234 said:

I have been fooled as well, katieo it shows you are a pre-PA, I would suggest practicing a few years prior to going off what "research" says. When you hear hoof beats what do you think of? It could be that zebra lurking around the corner...I would be careful about self-diagnosis and then coming here saying things like "you must be men." 

That’s really silly. I think most providers disagree with you. I don’t know what “research” you’re talking about. I’m talking about standard healthcare guidelines. I’m all for practical healthcare. It’s hard to understand the burden of recurrent UTI until you’ve experienced it. It’s probably a lot worse than you think. I may be pre-PA, but my view is not different from those of practicing PAs, MDs, DOs, NPs. My argument is not based on any appeal to my own authority.

[katieo]

1 hour ago, lkth487 said:

I understand that some studies have shown that it was 80-85% effective for women who have had multiple UTIs.  I just personally would never do it.  I think a lot of people have that compulsion.  Unless there was some legal shield that you wouldn't be responsible for 'missing' anything.    Even then, I wouldn't.  I've been fooled before with UTIs.

I think in telemedicine as in general you follow up if your symptoms aren’t improving. Telemedicine is really no different from my in person appointments except it’s cheaper and I don’t have to go through the agony/awkwardness of leaving the house and sitting in public when I’m writhing in pain. When I have a PCP I either call for a refill or I already have refills set up. 

[lkth487]

25 minutes ago, katieo said:

That’s really silly. I think most providers disagree with you. I don’t know what “research” you’re talking about. I’m talking about standard healthcare guidelines. I’m all for practical healthcare. It’s hard to understand the burden of recurrent UTI until you’ve experienced it. It’s probably a lot worse than you think. I may be pre-PA, but my view is not different from those of practicing PAs, MDs, DOs, NPs. My argument is not based on any appeal to my own authority.

Can you link to these guidelines?  I'm in pediatrics (and it would never ever happen in pediatrics), and I don't generally closely follow adult guidelines - so I am genuinely interested. 

[LT_Oneal_PAC]

I dont necesssrily agree, because I’ve been fooled before too, especially by women who just know it’s a UTI. However, it is a reasonable approach in the patient with very classic symptoms. We already have a UTI protocol at my previous clinic where a woman could call describe symptoms, and if she met criteria, could go get a UA an UC done and even pick up the meds before it resulted.

FROM UTD:

 

 

 

DIAGNOSTIC APPROACH

Clinical suspicion and evaluation — Acute uncomplicated cystitis should be suspected in women who have acute symptoms of dysuria, urinary frequency or urgency, and/or suprapubic pain, particularly in the absence of vaginal symptoms (eg, vaginal pruritus or discharge). The probability of cystitis is greater than 50 percent in women with any of these symptoms and greater than 90 percent in women who have dysuria and frequency without vaginal discharge or irritation [37]. 

Women should be asked about fevers/chills and flank pain. Physical examination is often not necessary for the diagnosis, but if performed, should include assessment for fever, costovertebral angle tenderness, and abdominal tenderness. A pelvic examination is indicated if factors suggesting vaginitis or urethritis are present. If fever (>99.9°F/37.7°C), other signs or symptoms of systemic illness (including chills or rigors), flank pain, or costovertebral angle tenderness are present, the patient should be evaluated and managed as potentially having complicated urinary tract infection (UTI), which is discussed in detail elsewhere. (See "Acute complicated urinary tract infection (including pyelonephritis) in adults".)

For most women with suspected acute uncomplicated cystitis, particularly those with classic symptoms, no additional testing is warranted to make the diagnosis. 

However, in women who have clinical features that are suggestive, but not clearly diagnostic of cystitis (such as atypical urinary symptoms), urinalysis is a useful diagnostic tool, as the absence of pyuria on urinalysis suggests a diagnosis other than cystitis. Apart from the classic features listed above, features that should prompt urine testing include new or worsening urinary urgency, new incontinence, gross hematuria. Chronic urinary nocturia, chronic incontinence, general malaise, and cloudy or malodorous urine are nonspecific findings that should not routinely prompt urine testing to evaluate for cystitis. We do not routinely test urine in elderly or debilitated patients with nonspecific changes in mental or functional status in the absence of focal urinary tract symptoms, and instead hydrate, carefully observe, and assess other potential contributing factors [44]. If fever is also present, evaluation for infection, including complicated UTI, is warranted. (See "Acute complicated urinary tract infection (including pyelonephritis) in adults".)

When indicated, urinalysis can be performed either by microscopy or by dipstick. (See 'Urinalysis' below.)

Urine culture and susceptibility testing are also generally unnecessary in women with acute uncomplicated cystitis, but should be performed in patients who are at risk for infection with a resistant organism (table 1). (See 'Determining the microbial etiology' below.)

 

 

31 minutes ago, lkth487 said:

Can you link to these guidelines?  I'm in pediatrics (and it would never ever happen in pediatrics), and I don't generally closely follow adult guidelines - so I am genuinely interested. 

[katieo]

8 minutes ago, LT_Oneal_PAC said:

 

Thank you. There are a few articles on aafp.org that go into some detail if anyone’s interested. I didn’t think stating my personal relief would cause so much controversy. My total is probably closer to 45 UTIs over 10 years. I already have to worry about the toll of constant flora disruption and potential connective tissue destruction and allergic reactions and incresing personal abx resistance with excessive abx use. I have to worry about the damage to my urinay tract that may lead to kidney failure or cancer. If I can reduce the financial burden and the discomfort by staying at home, that’s a pretty big relief. Like I said, my personal experience with telemedecine has been no different from in person appointments. 

I shouldn’t have said anything about being men. Who you are doesn’t say anything about the validity of your position. But it’s kind of offensive to hear such dismissive remarks about care I’m grateful for. My gut reaction is you wouldn’t be so dismissive if you’d experienced the other side.

[Joelseff]

Thank you. There are a few articles on aafp.org that go into some detail if anyone’s interested. I didn’t think stating my personal relief would cause so much controversy. My total is probably closer to 45 UTIs over 10 years. I already have to worry about the toll of constant flora disruption and potential connective tissue destruction and allergic reactions and incresing personal abx resistance with excessive abx use. I have to worry about the damage to my urinay tract that may lead to kidney failure or cancer. If I can reduce the financial burden and the discomfort by staying at home, that’s a pretty big relief. Like I said, my personal experience with telemedecine has been no different from in person appointments. 
I shouldn’t have said anything about being men. Who you are doesn’t say anything about the validity of your position. But it’s kind of offensive to hear such dismissive remarks about care I’m grateful for. My gut reaction is you wouldn’t be so dismissive if you’d experienced the other side.

Are you seeing you're Primary for these 45 recurrent UTI's? I hope you've seen Uro or UROGYNE...

Sent from my SAMSUNG-SM-G891A using Tapatalk

[katieo]

12 minutes ago, Joelseff said:

Are you seeing you're Primary for these 45 recurrent UTI's? I hope you've seen Uro or UROGYNE...

Sent from my SAMSUNG-SM-G891A using Tapatalk
 

Yes and yes. No new info. What’s even more disturbing than my 45 UTIs is that I’m not alone. There’s no answer for us. I try to stay up on research. What we know is interesting but we don’t know that much.

[Joelseff]

Yes and yes. No new info. What’s even more disturbing than my 45 UTIs is that I’m not alone. There’s no answer for us. I try to stay up on research. What we know is interesting but we don’t know that much.

Perhaps interstitial cystitis? Hmm sorry you are going through all that...best of luck with it! I hope you find an answer/dx

Back to topic...

I don't think AI can really replace us but I'm sure it will happen since we are being reduced to abx, pain RX, etc vending machines these days.



Sent from my SAMSUNG-SM-G891A using Tapatalk

[camoman1234]

On 2/20/2018 at 10:39 PM, katieo said:

That’s really silly. I think most providers disagree with you. I don’t know what “research” you’re talking about. I’m talking about standard healthcare guidelines. I’m all for practical healthcare. It’s hard to understand the burden of recurrent UTI until you’ve experienced it. It’s probably a lot worse than you think. I may be pre-PA, but my view is not different from those of practicing PAs, MDs, DOs, NPs. My argument is not based on any appeal to my own authority.

How do you know that I have not had UTIs? You will learn quickly to not assume. Standard Healthcare Guidelines are based off "research", how do you think they come up with these guidelines? It is called Evidence Based Medicine (EBM), again I would watch your young Pre-PA mouth as you can burn bridges very quickly with an attitude like that. I have been in the trenches and understand where you are coming from, but there is more behind the story that you may have the honor to see once you get into practice. It is not just all about patient care, you have to think about legal issues, malpractice, etc. It is very easy for you to say Rx me this due to this symptom, but what if I did that via telemedicine and was unable to palpate your abdomen. I could have elicited some tenderness that might make me get an U/S (where you might have thought that suprapubic pain is your "normal" cause it has been there for 6 months), but to me that would prompt investigation. That zebra could be ovarian cancer, bladder cancer, etc... Trust me I get your point, but you have NOT been on the other side so you cannot argue both view points. Lastly, I could care less what other MD/DO/PA/NPs say or do, if you get burnt once then you will re-think that ideology. If all those MD/DO/PA/NPs you are talking about jumped off a bridge, would you? Just because people "do" UTIs via telemedicine does NOT make it right or the best practice. 

[mgriffiths]

It was mentioned earlier, but I think the biggest limitation with AI is the "caring" aspect.  Research has shown that in most medical malpractice cases, the family's perception of the provider is the biggest indicator for whether is lawsuit is filed.  If the family feels cared for by the provider and feels that the provider genuinely cares there was a mistake and takes the moment to spend with the family, the risk of lawsuit is significantly lower.  This level of caring just isn't possible from a machine - at least not any that are available at this time.

Now, I'm not saying malpractice will stop AI, but I don't think patient's will choose it making it a non-issue.  This is also significantly different than telemedicine for acute/minor problems.  If patient's crave that caring model then they will seek it out.  I have worked with two NPs who are absolutely awful diagnosticians and awful providers (not a comment about all NPs, these two people just were NPs).  They are unable to calculate a pediatric dose for amoxicillin, they do not use UpToDate even though it is provided to them free because they don't trust the peer reviewed research.  They both sell "essential oils," touting claims that it helps cure chronic disease and had to be told multiple times to stop offering essential oils to patients, eventually their jobs were threatened and it finally stopped (or at least seems like it did).  One of them references her textbooks from the early to mid-90s.  She will even try to use the old textbooks to argue against UTD recommendations.  The other was just recently fired because she was prescribing norco and percocet at levels where patients would be taking 5000+mg of tylenol per day, levels of ambien double to triple the maximum dose, etc.  She had several patient's OD and die (thankfully she lost her DEA, but she is still a practicing NP 30 minutes away and a lot of her patients followed her).  But, their schedules are full every day because they care and patient's like that they care.  Whether you are an MD, DO, PA, or NP - if you are able to show your patients you care, it unfortunately doesn't really matter what quality of medicine you provide.

[corpsman89]

On 2/20/2018 at 11:39 PM, katieo said:

That’s really silly. I think most providers disagree with you. I don’t know what “research” you’re talking about. I’m talking about standard healthcare guidelines. I’m all for practical healthcare. It’s hard to understand the burden of recurrent UTI until you’ve experienced it. It’s probably a lot worse than you think. I may be pre-PA, but my view is not different from those of practicing PAs, MDs, DOs, NPs. My argument is not based on any appeal to my own authority.

Wow. As someone who hasn't even been accepted to PA school, let alone go through the training, this is concerning that you are so blind eyed to what you may learn while in PA school. I hope you don't carry on this attitude toward diagnosing, and treating into your PA career. The audacity to write that your view is no different from practicing PAs, MDs, DOs, and NPs is astonishing as well.  

[katieo]

4 hours ago, corpsman89 said:

Wow. As someone who hasn't even been accepted to PA school, let alone go through the training, this is concerning that you are so blind eyed to what you may learn while in PA school. I hope you don't carry on this attitude toward diagnosing, and treating into your PA career. The audacity to write that your view is no different from practicing PAs, MDs, DOs, and NPs is astonishing as well.  

I have been accepted to PA school. Ad hominem is a fallacy. But it’s not an opinion that practicing providers agree with me. It’s a fact. Read uptodate. This thread has already been derailed. Give it a rest.

[camoman1234]

2 hours ago, katieo said:

I have been accepted to PA school. Ad hominem is a fallacy. But it’s not an opinion that practicing providers agree with me. It’s a fact. Read uptodate. This thread has already been derailed. Give it a rest.

Again, watch your mouth. You will get ate a live in PA school, that S**T does not settle well with me. I would kick you out of my clinic in a heartbeat. Yes, it is an opinion as YOU have not practiced medicine. Just because you read it or heart it does not mean it is ALWAYS true. Stand of care is based off of research and research is VERY important in medicine, but we are letting you know that common sense and good patient care are just as important. Settle your attitude prior to going into PA school and I mean that in the most respectful way. I am looking out for you and I truly hope you do well. Just stop being an A$$ and a know-it-all. 

[corpsman89]

4 hours ago, katieo said:

I have been accepted to PA school. Ad hominem is a fallacy. But it’s not an opinion that practicing providers agree with me. It’s a fact. Read uptodate. This thread has already been derailed. Give it a rest.

Good luck during clinical year. Nothing is gonna fix your smugness. 

[katieo]

There’s nothing to argue about. Read UpToDate. Don’t get yourselves worked up over the internet. This has become some strange pissing contest - pun intended. I’m sorry this thread’s derailed. Have a good day ?✌️

[marktheshark89]

UptoDate is not the end all be all. Come back to this thread after you start practicing, and you’ll hopefully realize how ridiculous you sound. If not, then I’d be concerned for your future patients. 

[katieo]

22 minutes ago, marktheshark89 said:

UptoDate is not the end all be all. Come back to this thread after you start practicing, and you’ll hopefully realize how ridiculous you sound. If not, then I’d be concerned for your future patients. 

Lol seriously wtf. I feel like I’m in the twighlight zone, which I suppose is fitting on a thread that’s supposed to be about AI - shoutout to black mirror. I’m sure you all understand that ad hominem is a fallacy so why do you insist on using it instead of making a valid argument... or just letting this go because there really isn’t anything to argue? Clearly there are providers who may feel uncomfortable diagnosing UTIs without a PE. That’s fine. Providers disagree on plenty. To make this about the person making the argument doesn’t make any sense. Who I am is irrelevant. There are people higher in status than you who agree with me. They could say the same to you that PAs lack the rigorous education that MDs get and that you don’t know what you don’t know. If you disagree, make all your UTI patients come in to see you. Everyone has to set their own limits on what they’re comfortable with. If my opinion on treating recurrent  uncomplicated UTIs in women between 18-65 had anything to do with a deficiency in education or experience, then it wouldn’t be the consensus of people with more education and experience than both of us.

I’d love to know why everyone’s so worked up and bent on personal attacks. I bet we’d all get along a lot better in real life. It’s almost the weekend. Cheers.