A Country Doctor Writes:

I have many patients who google their symptoms in order to come up with a diagnosis. I also have many who google tests and treatments. Right now I have very few who use ChatGPT, but one in particular seems to have an ongoing relationship or dialogue where they exchange medical history, prior treatments, new treatment ideas and tests to request that I, the primary cre physician, order.

What I put in a patient’s chart is protected by HIPAA, the privacy law in this country. That law doesn’t apply to ChatGPT from what I understand and that doesn’t seem right to me.

ChatGPT knows the identity of my patient and their medical history, their test results and medications. I have only used the app for writing purposes just to see what it can do, but I don’t see any consents or privacy warnings when I do that. I actually suspect ChatGPT could “learn” and then share my ideas or concepts that I asked it to flesh out for me.

I think the use of AI for medical advice when health information is entered into its vast data base needs to be regulated or at least should require informed consent about what could possibly happen to individual patients’ otherwise protected health information.

I happened to read an article about the use of pilocarpine for age related difficulties reading up close. As a primary care physician with an interest in ophthalmology and a lifelong amateur photographer, I knew darn well that these ancient eye drops constrict your pupils and therefore give you a better depth of field, just like when you choose a smaller aperture on your camera. The same phenomenon is involved when I have to pull out my reading glasses instead of my progressives, trying to read the menu in a dimly lit restaurant that forces my pupils to dilate to pretty much see anything. It never occurred to me that this ancient drug could actually be used in lieu of reading glasses.

Old drug with new application, and obviously this particular formulation is patented by Abbvie.

https://en.wikipedia.org/wiki/Pilocarpine#:~:text=Pilocarpine%20was%20isolated%20in%201874,the%20South%20American%20plant%20Pilocarpus.

https://eyewiki.org/Vuity

Looking at the statistics of my WordPress blog, I’m struck by the performance of what people in this line of writing call Evergreen posts.

Back in 2019 I wrote a piece titled “A Science of Uncertainty and an Art of Probability”. My readers know I like to play with words and I guess many people would think that probability is a science and constantly dealing with uncertainty is an art. I chose reversing the expected words just to illustrate the tension between those two concepts. That particular post has had more views every single following year than the year I published it. It’s like the Energizer Bunny, it keeps going and going.

In frontline medicine, uncertainty is a constant and my own way of dealing with it is to think out loud and explain how I arrive at the conclusions I’m drawing in each visit or communication as a “case“ in primary care isn’t usually a one time deal but can evolve between visits and incoming test results.

There is such a fine balance between admitting uncertainty and instilling confidence. Not enough of either one and you’re dead in the water with your patients. The way to do this is to share your thinking and also volunteer, without bragging, the background knowledge that makes you arrive at the conclusion you arrive at. I once wrote a piece about just that, titled “Clinical Depth: Knowing More than the Minimum”.

So here are those two reflections:

A Science of Uncertainty and an Art of Probability

Clinical Depth: The Power of Knowing More than the Minimum

I am not running a business with my writing, I write or republish old WordPress material that I think is relevant today as well when a topic pops into my head. I read about creating editorial calendars and all this stuff, but right now I have a full-time practice and a side telemedicine clinic for opiate addicts and I have my little farm with horses and livestock guardian dogs requiring a lot of manual labor. I haven’t been real slick with auto responders when people subscribe to my writing and I hardly ever put anything behind a pay wall. My writing is just a hobby. But because my publishing is erratic, I would suggest if anybody likes what I put out there that they just become a free subscriber. You will see no pressure to upgrade to a paid subscription, but it would make sure that you see what’s new without having to check in vain if I have a silent week. My creativity has had ups and downs, and I had a prolonged illness last month that slowed me down, but I’m back in the saddle as I had posted a little while ago.