Happy Saturday, and congratulations to the London Ont. man who became the first person in Canada to receive a robotic assisted surgery on his spine!

The patient suffered from chronic back pain that “led to sciatica in his right leg and extreme pain in his lower back.” At London Health Sciences Centre doctors used the MazorX Spinal Robot to perform a direct lateral spine surgery for the first time! We’re so glad those London doctors had his back!

Here are some fun stories to get you pumped for the weekend! (5 minute read)

1: Frontline tales (and fails)

2: Breaking news on the Honda expansion, family doctor shortage, new nursing program, and new AI

3: The end of paperwork?

4: Postcall Crossword

Frontline Tales ⛺️ 

Have a riveting tale of your own? Send us your best story from the OR, ED, or clinic (anonymized, obviously).

Speed Reads 🚤 

1: 🚘 Honda is set to build four new factories in Alliston, Ontario. The expansion will produce 240,000 EV’s and create 1,000 new jobs at its new location. Prime Minister Justin Trudeau and Premier Doug Ford broke the news on Thursday, and said the new facility will “grow the economy and keep the air clean.” The new location is said to be ready by 2028 and will cost $15 billion to produce.

2:👨‍👩‍👧‍👦 The Ontario Medical Association is urging med students to study family medicine after a decrease that’s lasted three years. One of the biggest reasons for the low numbers is the amount of administrative work practitioners have to do. To help combat this Queen’s University set up a new program that will hopefully encourage future generations to study family medicine.

3:🏩 A new nursing program for Cree students in James Bay will allow students to study at home. The Cree Board of Health and Social Services of James Bay is offering a new one-year, two-semester pre-nursing program in Eeyou Istchee. The purpose of the program is to recruit more Cree nurses and to strengthen the Cree language within local clinics. After the program students can further their education at John Abbott College in Montreal.

4:🖼️ Have you ever wanted to see the Mona Lisa rap? Well wonder no more thanks to Microsoft’s new AI, VASA-1. The tech was designed to recognize natural face and head movements, and works best when animating a still photo. Like most AI products there’s a privacy concern surrounding the development and Microsoft says they don’t plan on releasing VASA-1 to the public anytime soon.

5:🚨The Jarjour’s, a family from Montreal are outraged after discovering that the body of their father, who died while vacationing in Cuba was sent to Russia instead of Canada. The Cuban government has refunded the family $10,000, and the Canadian foreign minister have promised Jarjour family that Canada will do everything they can to bring their father home safely.

Paperwork may yet stay awhile 📝

“AI scribes are going to do all your paperwork and save you from burnout“. We’ve all heard it before, but now studies are emerging showing whether or not that claim is true.

What Happened? A study was conducted at Brigham and Women's Hospital to evaluate the impact of using large language models (LLMs) like GPT-4 in handling electronic patient portal messaging.

• Initially, six board-certified radiation oncologists manually responded to patient messages as they would in typical clinical practice.

• Following this, the same oncologists edited responses that had been pre-drafted by the GPT-4 model, ensuring these were clinically acceptable before sending.

• The responses were analyzed using a set of predefined content categories, and statistical significance was determined through pairwise comparisons. Both stages of responses were evaluated by the oncologists through surveys focusing on quality, safety, and helpfulness, with interphysician agreement also assessed to gauge consistency across responses.

So what happened?

The use of LLMs notably improved subjective efficiency in handling patient messages. An impressive "76.9% of 156 cases" reported enhanced efficiency when using LLM-drafted responses. However, this increased efficiency comes with potential dangers. Notably, the LLM drafts were found to pose a risk of severe harm in "11 (7.1%) of 156 survey responses" and resulted in a life-threatening error in one instance (0.6%). This underscores the critical need for oversight and careful editing by clinicians to prevent serious errors.

As well, the adoption of LLM drafts led to a higher interphysician agreement, with Cohen’s kappa (a statistical measure used to quantify the level of agreement between two people who each classify items into categories) increasing from 0.10 in manual responses to 0.52 in LLM-assisted responses. This improvement suggests that LLMs can help standardize responses across different clinicians. However, the content analysis showed a significant shift in the nature of the responses: LLM drafts were "less likely to include content on direct clinical action" and more likely to offer "extensive education, self-management recommendations, and a contingency plan." This shift indicates a possible over-reliance on educational content at the expense of immediate clinical directives.

This study follows other recent research papers by academic hospitals that are revealing limitations of large language models (LLMs) in medical settings, undercutting the AI hypetrain. Another study from University of California, San Diego found that use of an LLM to reply to patient messages did not save clinicians time, and another at Mount Sinai found that popular LLMs weren’t able to correctly map patients’ illnesses to diagnostic codes.

We may yet endure the drudgery of documentation, for now.

Source: Lancet Digital Health

Laugh of the Day

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First question: What the drug does to the body…

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