I recently got a referral from another specialty for evaluating a kid with suspected severe depression. I was ALMOST impressed by how the referral went down because everything they told me over the phone was textbook procedure done and complete assessment. That's pretty damn rare for me to get one of those because I usually get snippets of information then I'm just left to figure out things once I see the patient.
For more context, the patient was an 18 year old, female who came in with difficulty urinating for 2 weeks. I'm already thinking "what does this have to do with depression?"... and I just let them ramble on the history and physical examination findings. The last part about using a some screening tools showed indications for depression as a last incidental finding. They were treating the case as psychogenic dysuria vs uncomplicated cystitis.
I immediately call this bullshit for the salient points such as
- A history of being treated for hypertension last year and on maintenance medication like amlodipine
- The difficulty urinating was intermittent and only less than a few cups estimated per day.
- The symptoms of anxiety and depression sort of started with the chief complaint of not being able to urinate.
- The kid was large.
But of course, I had to be civil and not actually say bullshit did you assess this right?
I went to see the patient and without talking to the patient and just observing them a few feet away, in less than a minute the things I noticed that made me convinced this wasn't my area were:
- The patient starting to become drowsy from their previous alert state. Their breathing picking up pace.
- The nurse monitoring their vitals says 130's heart rate and 130/80 mmHg.
- Overhearing the mother claiming that only a few drops of urine came out of her when she tried to void.
I forgot how I said the lines to the doctor that gave the referral but it was something like their depressive symptoms can be secondary to the underlying medical condition like a kidney problem, their hesitancy or difficulty urinating can be attributed to oliguria, and your patient has been excreting body fluids less which caused the weight gain and they're probably have metabolic acidosis in response to an increase in urea they can't expel, you probably have to worry about their electrolytes like potassium going up, so I highly suggest that you get this patient to the ER now or risk them having a heart attack here.
All delivered in a calm, brief, and chill manner. I was ALMOST impressed with the referral over the phone but assessing the patient without the interview in less than a minute already gave me enough clue that this one isn't a psychiatric problem. I looked at the guy dead in the eye without a word just thinking to myself screaming in thought about how bad his clinical eye was for missing out something so basic. It's like trying to fry an egg where you've done everything except putting the egg on the pan moment.
The patient was brought in to the ER and wasn't referred to psychiatry again since it was a medical case. Labs like creatinine, serum potassium, ECG and ABG tests turned out consistent with a kidney problem.
You got a generation of new doctors post pandemic that had relied on online classes instead of hand on onsite training for a couple of years. Then there's chatgpt making life easier for students with their homework or cheating on exams.
Just my anecdote but I've noticed a lot of new generation doctors just don't have that clinical eye they were supposed to learn while on their last year at internship. This isn't saying that an entire generation is bad at what they're supposed to do, it's just that the toxic life I once thought while I was in their shoes turns out to be exactly what I needed to polish my clinical eye.
I hated some of my consultants and residents because of how much questions I get bombarded in the area and how much of a slave driver they can be at times but the stuff I learned while going through the process paid off nicely. I learned what I need not to do and can do from the struggle. Without that struggle, I would've committed more errors than I could count and this was done outside of zoom classes or AI. So my biggest flex is graduating through college / medschool without using AI.
I've tackled on the issue on a previous post AI chatbots are substitute therapists where:
People relying on AI chatbots for therapy need to reconsider as these could further worsen their mental health issues given how AI assumed what information you enter is correct and does less clarifying questions, and it may also assume you're in the right state of mind making the accounts of your symptoms.
If a psychotic individual with paranoia asks about stuff that confirms their bias, it just worsens their condition and delays help.
You wouldn't believe how many times I get referrals from doctors thinking they're dealing with a psychiatric problem but failing to fix an underlying medical condition that caused the behavioral changes.
I see some doctors in the area formulate their diagnoses based on whatever differentials the AI churns out. Not to say that all doctors that rely on AI are bad, the difference lies in knowing what you're intending to use it for or just knowing what you're doing. I tend to fish for information from the textbooks before AI and so far, the old school method gives me more confidence.
If you made it this far, thanks for your time.
This post has been shared on Reddit by @uwelang through the HivePosh initiative.
haha you should get paid more for being a bullshit detector.
more and more people are leaning towards 'feelings' than logic these days when it comes to decision making, AI aggravates the problem because it is designed to be supportive what the user thinks.