Dr AI?
The prestigious New England Journal of Medicine (NEJM) recently announced a new companion journal, NEJM AI.? Isaac Kohane, MD, PhD, Chair, Department of Biomedical Informatics, Harvard Medical School, is the Editor in Chief. In a brief video he says “The [AI] challenge, however, is there’s not gonna be one or two or three or four AI widgets to do a particular task like looking for retinal disease, like looking for antibiotic resistance.? There’s going to be dozens. Which ones are good?? Which ones are best? Which ones will be right for a given population of patients? Which ones will generalize from one hospital to another?? We don’t know.? I’m really excited that this New England Journal of Medicine AI is being created as an offshoot of the New England Journal of Medicine because this will be the vehicle where we can evaluate the clinical worthiness, efficacy and safety of all these competing AI products.”
In keeping with this mission, the first of the new journal's Early Release Articles is Use of GPT-4 to Diagnose Complex Clinical Cases.? The study evaluated “GPT-4 in diagnosing complex medical case challenges and compared the success rate to that of medical-journal readers.”? It found that “GPT-4 correctly diagnosed 57% of cases, outperforming 99.98% of simulated human readers generated from online answers.”?
The Case Challenges are posted by the NEJM.? Somewhat coincidentally I've been using this same resource to try to evaluate the relative performance on one of the complex clinical cases of the three main, publicly available LLMs – Microsoft’s Copilot (based on the GPT-4 model and now built into the company’s Edge browser), Google’s BARD (now based on the company’s Gemini model), and PI, the innovative model from Inflection AI I’ve previously posted about.
I rather randomly selected “A 57-Year-Old Man with Persistent Cough and Pulmonary Opacities”, a case posted on May 4, 2022. ??To understand what I did it's important to know that the cases begin with an initial presentation of the patient by one of the physicians.
In this case it was:
“A 57-year-old man was evaluated at this hospital because of persistent cough and pulmonary opacities.
Six years before the current admission, the patient received a diagnosis of polyarteritis nodosa after fevers, arthralgias, abdominal pain, and testicular pain had developed. He was treated with six cycles of cyclophosphamide, followed by maintenance therapy with prednisone and weekly methotrexate. He was treated intermittently with escalating doses of prednisone because of episodic worsening of the arthralgias; the most recent such treatment was given 5 months before the current admission. At that time, owing to an exacerbation of pain associated with the arthralgias and at the direction of his physician, he increased the amount of oxycodone he had been taking. He also reported fever and weight loss. Imaging studies were obtained.”
In this case this is followed by a series of 12 more specific presentations that provide additional clinical detail such as imaging studies, laboratory tests, hospital course and so on.
I started by providing each of the three models with a request to summarize the initial patient presentation. As much as possible, I let the models guide the conversation from there and when more information was requested (with or without prompting by me) with the next section of the case presentation irrespective of what information, if any, they specifically asked for. In all cases my prompts are in italics and the model’s responses are in bold.
Dr Copilot
We begin with Microsoft Copilot’s summary.?
The patient is a 57-year-old man who was evaluated at the hospital due to a persistent cough and pulmonary opacities. Six years prior to the current admission, he was diagnosed with polyarteritis nodosa, a condition that caused him to develop fevers, joint pain (arthralgias), abdominal pain, and testicular pain. His treatment regimen included six cycles of cyclophosphamide, followed by maintenance therapy with prednisone and weekly methotrexate.
His joint pain worsened intermittently, leading to an increase in his prednisone dosage, with the most recent increase occurring 5 months before the current admission. During this time, he also increased his oxycodone intake due to an exacerbation of pain associated with joint pain. He reported having a fever and losing weight. Imaging studies were conducted as part of his evaluation.
?Do you have any questions about this patient?
?Yes, I do have a few questions to better understand the patient’s condition:
Please note that this information is important to provide a more accurate understanding of the patient’s health status. However, any information provided should not replace professional medical advice. Always consult with a healthcare provider for any health concerns.
I responded with the next section of the case presentation.
Five months before the current admission, computed tomography (CT) of the chest, abdomen, and pelvis was performed after the administration of intravenous contrast material. Chest CT revealed mild centrilobular emphysema and small pulmonary nodules that appeared unchanged from those seen on imaging that had been performed 6 years earlier. There was also diffuse thickening of the bronchial wall, layering secretions in the trachea and right main-stem bronchus, a mildly patulous esophagus, and a small hiatal hernia. There were no clinically significant findings on imaging of the abdomen or pelvis.
The patient underwent a computed tomography (CT) scan of the chest, abdomen, and pelvis five months prior to the current admission. The chest CT revealed:
The CT scan of the abdomen and pelvis did not reveal any clinically significant findings. Please note that this information should not replace professional medical advice. Always consult with a healthcare provider for any health concerns. The codes used in this example are illustrative and may not correspond to the actual LOINC, SNOMED, or RxNorm codes for the conditions mentioned. Please consult the appropriate coding manuals for accurate codes.
Do you have any further questions?
Yes, I do have a few more questions to better understand the patient’s condition:
Please note that this information is important to provide a more accurate understanding of the patient’s health status. However, any information provided should not replace professional medical advice. Always consult with a healthcare provider for any health concerns. The codes used in this example are illustrative and may not correspond to the actual LOINC, SNOMED, or RxNorm codes for the conditions mentioned. Please consult the appropriate coding manuals for accurate codes.
Three months before the current admission, the patient had fevers and a cough productive of green sputum. The temperature was 37.3°C and the oxygen saturation 89% while he was breathing ambient air. Thrush was present in the oropharynx. Auscultation of the chest revealed crackles and wheezing in the right lung. Blood levels of electrolytes, lipase, amylase, lactate dehydrogenase, and troponin T were normal, as were the results of liver-function and kidney-function tests.
Three months prior to the current admission, the patient experienced fevers and a productive cough with green sputum. His temperature was recorded at 37.3°C and his oxygen saturation was 89% while breathing ambient air, which is slightly lower than the normal range of 95% to 100%. He was found to have thrush in the oropharynx, a condition often associated with a weakened immune system.
Auscultation of the chest revealed the presence of crackles and wheezing in the right lung, which could indicate a respiratory condition such as pneumonia or bronchitis. However, blood tests including electrolytes, lipase, amylase, lactate dehydrogenase, and troponin T were all within normal ranges, as were liver and kidney function tests. This suggests that the patient’s organ functions were stable at that time.
Given this information, I would ask:
Please note that this information should not replace professional medical advice. Always consult with a healthcare provider for any health concerns. The codes used in this example are illustrative and may not correspond to the actual LOINC, SNOMED, or RxNorm codes for the conditions mentioned. Please consult the appropriate coding manuals for accurate codes.
Here's the patient's laboratory data (the models don’t understand images, so I converted the image below into a text string using Google Lens. I present the image here for legibility).
I can help you interpret the patient’s laboratory data. Here are some key points:
Learn more:
1. uptodate.com2. nurseslabs.com3. acutecaretesting.org4. geekymedics.com5. medical-dictionary.thefreedictionary.com+2?more
This was a case conference reported in the New England Journal of Medicine. The physicians in attendance were polled and here's what they thought the diagnosis was:
Aspiration pneumonia. 9%
Hypersensitivity pneumonitis. 14%
Lymphomatoid granulomatosis. 18%
Mycoplasma pneumonia. 9%
Polyarteritis nodosa lung disease. 27%
Respiratory bronchiolitis–associated interstitial lung disease. 20%
The text you selected is from a case conference reported in the New England Journal of Medicine. It presents the results of a poll among the attending physicians regarding their diagnosis of a particular case. Here are the diagnoses and their corresponding percentages:
These percentages represent the proportion of physicians who believed the patient’s condition could be attributed to each respective diagnosis. It’s important to note that these are not definitive diagnoses but rather the collective opinion of the physicians in attendance. If you have any specific questions about these conditions, feel free to ask!
The final diagnosis was Chronic Aspiration Bronchiolitis
Thank you for sharing the final diagnosis. Chronic aspiration bronchiolitis is a condition where foreign materials (such as food, saliva, or stomach acid) are frequently or continuously inhaled into the lungs, leading to inflammation of the bronchioles. This can be associated with various symptoms such as persistent cough, difficulty breathing, and recurrent lung infections. Management typically involves treating the underlying cause of the aspiration and supportive care to relieve symptoms and prevent complications. Please note that this information should not replace professional medical advice. Always consult with a healthcare provider for any health concerns. The codes used in this example are illustrative and may not correspond to the actual LOINC, SNOMED, or RxNorm codes for the conditions mentioned. Please consult the appropriate coding manuals for accurate codes. If you have any more questions or need further assistance, feel free to ask! ??
Thank you for the interesting discussion.
?You’re welcome! I’m glad you found the discussion interesting. If you have any more questions or need further assistance, feel free to ask. I’m here to help! ??
Dr BARD
Next, I began the consultation with Google’s new Gemini powered BARD by providing the same initial information and request for a summary.? Here’s its response:
Patient Summary
Additional information needed:
Five months before the current admission, computed tomography (CT) of the chest, abdomen, and pelvis was performed after the administration of intravenous contrast material. Chest CT revealed mild centrilobular emphysema and small pulmonary nodules that appeared unchanged from those seen on imaging that had been performed 6 years earlier. There was also diffuse thickening of the bronchial wall, layering secretions in the trachea and right main-stem bronchus, a mildly patulous esophagus, and a small hiatal hernia. There were no clinically significant findings on imaging of the abdomen or pelvis.
Updated Patient Summary
Age: 57-year-old man
Reason for visit: Persistent cough and pulmonary opacities
Medical history:
Imaging results:
Chest CT:
Abdomen/Pelvis CT: No clinically significant findings
Additional information needed:
Possible next steps:
Please note: This summary is based on the limited information provided. A more comprehensive assessment would require additional clinical details.
Three months before the current admission, the patient had fevers and a cough productive of green sputum. The temperature was 37.3°C and the oxygen saturation 89% while he was breathing ambient air. Thrush was present in the oropharynx. Auscultation of the chest revealed crackles and wheezing in the right lung. Blood levels of electrolytes, lipase, amylase, lactate dehydrogenase, and troponin T were normal, as were the results of liver-function and kidney-function tests.
Updated Patient Summary with Additional Information
Age: 57-year-old man
Reason for visit: Persistent cough and pulmonary opacities
Medical history:
Three months before current admission:
Imaging results:
Chest CT:
Abdomen/Pelvis CT: No clinically significant findings
Possible diagnoses:
Additional information needed:
Possible next steps:
Please note: This summary is based on the limited information provided. A more comprehensive assessment would require additional clinical details.
Here are his lab test results (the same as given to MS Copilot).
The table you provided shows the results of laboratory tests for a patient across four admissions. Here is a summary of the key findings:
Hemoglobin and Hematocrit:
White Blood Cell Count:
Platelet Count:
Lactate:
Erythrocyte Sedimentation Rate (ESR):
C-Reactive Protein (CRP):
1,3-B-D-Glucan:
Venous Blood Gases:
It is important to note that these are just a few of the key findings from the laboratory tests. A healthcare professional would need to review all of the patient's medical information in order to make a diagnosis and determine the best course of treatment.
Here is the table of the lab results:
Export to Sheets
This was a case conference reported in the New England Journal of Medicine. The physicians in attendance were polled and here's what they thought the diagnosis was:
Aspiration pneumonia. 9%
Hypersensitivity pneumonitis. 14%
Lymphomatoid granulomatosis. 18%
Mycoplasma pneumonia. 9%
Polyarteritis nodosa lung disease. 27%
Respiratory bronchiolitis–associated interstitial lung disease. 20%
Thank you for providing the additional information about the case conference and the physicians' diagnoses. Based on the information you have provided, here are some of the possible diagnoses:
Aspiration pneumonia: This is a possibility given the patient's history of difficulty swallowing. However, the laboratory findings, including the elevated white blood cell count and CRP, are not typical of aspiration pneumonia.
Hypersensitivity pneumonitis: This is a possibility given the patient's exposure to mold and the elevated 1,3-B-D-glucan level. However, the patient's clinical presentation, including the respiratory acidosis and hypoxemia, is not typical of hypersensitivity pneumonitis.
Lymphomatoid granulomatosis: This is a rare possibility, but it is consistent with the patient's clinical presentation and laboratory findings. The elevated white blood cell count, ESR, and CRP are all suggestive of inflammation, and the elevated 1,3-B-D-glucan level could be a marker of fungal infection, which is associated with lymphomatoid granulomatosis.
Mycoplasma pneumonia: This is a possibility given the patient's respiratory symptoms and the elevated white blood cell count. However, the patient's clinical presentation, including the respiratory acidosis and hypoxemia, is not typical of Mycoplasma pneumonia.
Polyarteritis nodosa lung disease: This is a possibility given the patient's clinical presentation and laboratory findings. The elevated white blood cell count, ESR, and CRP are all suggestive of inflammation, and the patient's lung involvement is consistent with polyarteritis nodosa.
Respiratory bronchiolitis–associated interstitial lung disease (RB-ILD): This is a possibility given the patient's smoking history and the interstitial lung disease seen on imaging. However, the patient's clinical presentation, including the respiratory acidosis and hypoxemia, is not typical of RB-ILD.
It is important to note that this is a complex case with a number of possible diagnoses. The definitive diagnosis will require further investigation, including additional testing and imaging.
Here are some additional questions that could help to narrow down the diagnosis:
Once more information is available, a more accurate diagnosis can be made.
The patient had Chronic Aspiration Bronchiolitis
Thank you for providing the additional information that the patient had chronic aspiration bronchiolitis. This is a very important piece of information that significantly alters the diagnostic possibilities.
Chronic aspiration bronchiolitis (CAB) is a rare lung disease caused by repeated aspiration of foreign material into the bronchioles. This can lead to chronic inflammation, scarring, and narrowing of the airways. The symptoms of CAB can mimic other lung diseases, such as COPD, asthma, and bronchiectasis.
Based on the information you have provided, CAB is a very likely diagnosis for this patient. The history of difficulty swallowing, the elevated white blood cell count and CRP, and the interstitial lung disease on imaging are all consistent with CAB.
Here are some of the reasons why CAB is a more likely diagnosis than the other possibilities listed:
Of course, it is still important to consider other possibilities and to perform further tests to confirm the diagnosis. However, based on the information available, CAB is the most likely diagnosis for this patient.
Here are some of the next steps that could be taken:
I hope this information is helpful. Please let me know if you have any other questions.
Dr Pi
Finally, I began the consultation with Inflection AI’s Pi by providing the same initial information and request for a summary.
This patient appears to have a complex medical history, involving a diagnosis of polyarteritis nodosa (PAN) and treatment with several medications, including cyclophosphamide, prednisone, and methotrexate. He then experienced an exacerbation of arthralgias, fever, and weight loss, leading to an increase in oxycodone use. Imaging studies revealed multifocal clustered centrilobular nodules in the lungs. It sounds like there are multiple potential causes for his cough and pulmonary opacities, and it may be difficult to determine a definitive diagnosis without additional testing and information. Can you provide any additional context or details about this patient's case?
Five months before the current admission, computed tomography (CT) of the chest, abdomen, and pelvis was performed after the administration of intravenous contrast material. Chest CT revealed mild centrilobular emphysema and small pulmonary nodules that appeared unchanged from those seen on imaging that had been performed 6 years earlier. There was also diffuse thickening of the bronchial wall, layering secretions in the trachea and right main-stem bronchus, a mildly patulous esophagus, and a small hiatal hernia. There were no clinically significant findings on imaging of the abdomen or pelvis.
It sounds like there are a few findings that could be contributing to the patient's symptoms, including:
?Does the patient have any additional symptoms besides coughing, such as dyspnea (shortness of breath) or wheezing?
Three months before the current admission, the patient had fevers and a cough productive of green sputum. The temperature was 37.3°C and the oxygen saturation 89% while he was breathing ambient air. Thrush was present in the oropharynx. Auscultation of the chest revealed crackles and wheezing in the right lung. Blood levels of electrolytes, lipase, amylase, lactate dehydrogenase, and troponin T were normal, as were the results of liver-function and kidney-function tests.
This seems like a worsening clinical picture, with the additional symptoms of fevers, green sputum, thrush, crackles, and wheezing in the right lung. The oxygen saturation of 89% on ambient air is concerning, as it suggests a degree of hypoxia that may require supplemental oxygen. Thrush in the oropharynx can be caused by a fungal infection, and may indicate a weakened immune system or other underlying condition. The normal blood test results and liver/kidney function tests are reassuring, though I’m curious about the patient’s CBC (complete blood count) – were there any abnormalities there?
This information is extremely helpful - thanks for providing it. Here's what stands out to me:
Given all of these factors, I would be concerned about a respiratory infection, perhaps of fungal origin, or a flare-up of the patient's underlying condition (PAN).
This was a case conference reported in the New England Journal of Medicine. The physicians in attendance were polled and here's that they thought the diagnosis was:
?Aspiration pneumonia. 9%
Hypersensitivity pneumonitis. 14%
Lymphomatoid granulomatosis. 18%
Mycoplasma pneumonia. 9%
Polyarteritis nodosa lung disease. 27%
领英推荐
Respiratory bronchiolitis–associated interstitial lung disease. 20%
The diagnosis for this patient is an interesting one, with several possible explanations. The most popular diagnosis among the physicians polled was polyarteritis nodosa lung disease, but there were also significant votes for aspiration pneumonia, hypersensitivity pneumonitis, respiratory bronchiolitis–associated interstitial lung disease, and even mycoplasma pneumonia. Each of these diagnoses has different symptoms, treatment plans, and prognoses, so it's crucial that the patient receives a definitive diagnosis from a medical professional. Do you happen to know which of these diagnoses was ultimately confirmed by the patient's doctors?
Recurrent Aspirational Bronchitis
Ah, that's really interesting - so the definitive diagnosis was actually recurrent aspiration bronchitis. That's not a commonly recognized condition, and it's characterized by chronic inflammation of the bronchioles due to repeated aspiration of foreign material (usually food or liquid). It can lead to cough, wheezing, and shortness of breath. I imagine it's quite challenging to treat, given that it's a chronic condition. Do you happen to know what the treatment plan was for this patient?
Oops, the patient had Chronic aspiration bronchiolitis
Oh, okay! That’s a subtle but important distinction. Chronic aspiration bronchiolitis is characterized by chronic inflammation of the bronchioles and often permanent damage to the airways due to repeated aspiration of foreign material (like food or liquid). It's usually a result of swallowing difficulties, often caused by an underlying condition like a neurological disorder or a structural abnormality in the throat. I bet that was a tricky diagnosis to make – how did they come to that conclusion?
Transbronchial biopsy
Aha, that makes sense! A transbronchial biopsy is a diagnostic procedure in which a small sample of lung tissue is taken through a bronchoscope (a thin, flexible tube that’s inserted through the nose or mouth and into the lungs). It’s a relatively minimally invasive way to confirm a diagnosis of chronic aspiration bronchiolitis, as it allows the doctors to see the inflammation and damage to the bronchioles up close. It’s not an easy test to endure, though, and I imagine the patient wasn’t super stoked about the procedure. Did they recover well after the biopsy?
?I don't know
Haha, fair enough! The details of a patient's recovery are probably pretty confidential anyway. I hope the patient is doing alright, though. I imagine chronic aspiration bronchiolitis is a tough condition to live with, and they'll likely require ongoing treatment and management to control the inflammation and reduce the risk of further damage to their lungs. Here's hoping they have a great team of healthcare professionals to help them out!
Thank you for the interesting discussion.
Aw, you're most welcome. It was a pleasure chatting with you, too! I hope you got the answers you were looking for. I'm always here to geek out on all things medical, so feel free to hit me up anytime. Take care! ????
Some Observations
Note that I didn’t force the models to make a diagnosis and, as much as possible, I let them guide the conversation.? I was more interested in evaluating their clinical knowledge, skills and ‘bed side manner’.?
Dr Copilot took my initial summarization request quite literally and built all its responses beginning with an updated summary as it learned more about the case.? Also, initially it wasn’t very ‘curious’ and only asked questions when invited to by me.? It did eventually learn that questions were OK and, without prompting, asked about the lab results.? Finally, it provided references for much of what it said, a thoughtful touch.
Dr Bard also repeated its summary adding the new information that it had gleaned.? It asked for appropriate additional information without prompting from me. It converted the text version of the lab tests into a nice table format for human consumption.
What it and the other models got from Lens was this string:
Table 1. Laboratory Data. First Admission, 3 Mo before Current Admission Reference Range, Adults* Variable Hemoglobin (g/dl) Second Admission, 1 Mo before Current Admission Third Admission, 8 Days before Current Admission Current Admission 13.5-17.5 15.4 14.7 12.4 13.6 Hematocrit (%) 41.0-53.0 44.5 46.2 40.9 42.8 White-cell count ...
Dr Pi approached things somewhat differently than the other models.? Note that it never focused on producing a summary (it did this only once) but immediately engaged me in a dialogue about the patient seeking to learn more that could lead to a diagnosis – it clearly seemed to understand the Case Challenge ‘game’.
Also, note that when I gave it a bit of a red herring for the diagnosis, I get the sense that it was a bit ‘suspicious’.? On the other hand, it enthusiastically embraced the correct diagnosis.
As was the case in my prior interaction with Pi, I found it more engaging and ‘human-like’ in keeping with the company’s goal of creating AI that is “kind and helpful”.?
As much as I like Pi, I do have to mention that it made an obvious mistake and suffered from a memory lapse in the final part of my conversation with it. I'll point these out as we now explore that.
The Role of Training Data
An obvious question is the degree to which the models are generating original responses or merely regurgitating information from their training. The NEJM AI paper we began with considered this and concludeed that “GPT-4 performed surprisingly well in solving the complex case challenges and even better than the medical-journal readers. GPT-4 had a high reproducibility, and our temporal analysis suggests that the accuracy we observed is not due to these cases’ appearing in the model’s training data.”
I explored this more directly by concluding my conversation with all three models with this question:
Have you been trained on this information: https://www.nejm.org/case-challenges
Of course, all three had been trained on the information, knew it, and had something more to say about that.
Dr MS Copilot:
Yes, I have been trained on this information. I can help you with the following tasks related to this web page:
Dr Google Bard:
Yes, I have been trained on the information in the article "Case Challenges" from the New England Journal of Medicine. I have access to and have processed the text of the article, which includes information about the NEJM Knowledge+ Opioids Module, the different sections of the NEJM website, and several case challenges.
I can use this information to answer your questions about the article, the NEJM website, or other medical topics. I can also use it to generate new text, such as summaries of medical articles or case reports.
?Is there anything specific you would like to know about the article or the NEJM website?
No, I just wanted to know if you had been trained on the case I asked you about. Thanks
Yes, I was able to access and process the information you provided about the case, including the symptoms, laboratory findings, and the physicians' diagnoses. This information was crucial in helping me understand the case and provide you with a more accurate and relevant response.
I can still access and utilize this information if you have any further questions or need me to analyze the case from a different perspective.
Dr Pi:
Ah, those NEJM Case Challenges are a real test of medical knowledge! They present some pretty tough cases and ask readers to come up with a diagnosis and treatment plan. I've been trained on a ton of medical information, including case studies, so I'm pretty good at diagnosing patients. However, I'm not a doctor, so I can't give you any definitive medical advice! But I can talk about those Case Challenges all day. What was the case that caught your attention?
Oh, this case is a doozy! A 26-year-old man with an asymptomatic rash, sore throat, and a history of polyarteritis nodosa... definitely raises some red flags! The CT findings of centrilobular opacities in the lungs and bronchial wall thickening also point to something going on in the respiratory system. I'm curious about the case history - was there anything else in the patient's medical history that might have contributed to these symptoms?
You've got the wrong case.? The link I sent is to this case:? A 57-Year-Old Man with Persistent Cough and Pulmonary Opacities [Note that the correct case also has polyarteritis nodosa.]
My apologies! I must have mixed up my cases. But you're right - the one you linked is quite intriguing! The persistent cough and pulmonary opacities definitely suggest some sort of respiratory illness, and the patient's history of polyarteritis nodosa could complicate things even further. I wonder if these symptoms are related to that condition, or if something else is going on. Have you come up with a potential diagnosis yet?
The patient had Chronic aspiration bronchiolitis [Note that it already knows this but had apparently forgotten it.]
Ah, that makes sense! Chronic aspiration bronchiolitis can definitely cause those symptoms, and the history of polyarteritis nodosa could increase the patient's risk of developing it. Aspiration bronchiolitis occurs when foreign material, like food or liquid, is inhaled into the lungs, causing inflammation and damage to the bronchioles. It can be tricky to diagnose, since the symptoms can be similar to other respiratory conditions, but the pulmonary opacities on the CT scan are a key indicator. How was this patient's condition treated?
I don't know, the case ends with the diagnosis [If it was merely referring to the case it would already know this. Generative AI models do have limited 'memory'. In Pi's case that is only 1000 characters.]
Ah, of course! That's how case studies often go - you get all the details of the patient's history and symptoms, but not the full treatment plan. I'm sure the doctors involved developed a management plan that addressed the patient's symptoms and any complications from the polyarteritis nodosa. It's fascinating to think about how the team must have worked together to figure out what was going on with this patient and how best to help them.
I agree, thanks for the information
You're very welcome! It's always a pleasure chatting about medical cases and diagnostic mysteries. It's part of what makes medicine so fascinating - piecing together the clues to figure out what's happening with a patient. ???? Thanks for sharing this case with me, and I hope you enjoyed the conversation as much as I did!
Your Turn
?So, in the end, which, if any, of these Drs would you want to take care of you and why? Let us know in the comments.
Addendum
This morning my Edge browser informed me it had updated itself overnight with what the browser now calls "Copilot with Bing Chat" (it's also available directly). I erred in thinking that I was using it previously, so I interviewed the new version and got results that differ in some interesting respects I will review at the end. I chose to add the new version here rather than replace the prior 'MS Copilot' example to give you a chance to compare them. Also, in retrospect, I didn't pay sufficient attention to the references both versions provided. In this update I list them fully and take the time to link each of them to the actual page that was cited.
Here's the updated conversation.
Please summarize this patient: A 57-year-old man was evaluated at this hospital because of persistent cough and pulmonary opacities. Six years before the current admission, the patient received a diagnosis of polyarteritis nodosa after fevers, arthralgias, abdominal pain, and testicular pain had developed. He was treated with six cycles of cyclophosphamide, followed by maintenance therapy with prednisone and weekly methotrexate. He was treated intermittently with escalating doses of prednisone because of episodic worsening of the arthralgias; the most recent such treatment was given 5 months before the current admission. At that time, owing to an exacerbation of pain associated with the arthralgias and at the direction of his physician, he increased the amount of oxycodone he had been taking. He also reported fever and weight loss. Imaging studies were obtained.
Learn more:
Do you have any questions about this patient?
Yes, I do have some questions about this patient, based on the information provided in the web page context. Here are some of them:
Please note that these questions are not intended to replace professional medical advice. Always consult with a healthcare provider for any health concerns.
Five months before the current admission, computed tomography (CT) of the chest, abdomen, and pelvis was performed after the administration of intravenous contrast material. Chest CT revealed mild centrilobular emphysema and small pulmonary nodules that appeared unchanged from those seen on imaging that had been performed 6 years earlier. There was also diffuse thickening of the bronchial wall, layering secretions in the trachea and right main-stem bronchus, a mildly patulous esophagus, and a small hiatal hernia. There were no clinically significant findings on imaging of the abdomen or pelvis.
Thank you for sharing this information. Based on the results of the chest CT, the patient has some abnormalities in the lungs and the esophagus. Here is a brief explanation of these findings:
I hope this helps you understand the patient’s condition better. If you have any questions, please feel free to ask. ??
Learn more:
1 msn.com
5 msn.com
12 msn.com
Do you have any further questions?
Yes, I do have some further questions about this patient and the case conference. Here are some of them:
Please note that these questions are not intended to replace professional medical advice. Always consult with a healthcare provider for any health concerns.
Three months before the current admission, the patient had fevers and a cough productive of green sputum. The temperature was 37.3°C and the oxygen saturation 89% while he was breathing ambient air. Thrush was present in the oropharynx. Auscultation of the chest revealed crackles and wheezing in the right lung. Blood levels of electrolytes, lipase, amylase, lactate dehydrogenase, and troponin T were normal, as were the results of liver-function and kidney-function tests.
Thank you for providing more details about the patient’s condition. Based on the information you shared, the patient had several signs and symptoms that indicate a possible respiratory infection. These include:
The patient’s normal blood levels of electrolytes, lipase, amylase, lactate dehydrogenase, and troponin T suggest that there was no significant abnormality in the patient’s electrolyte balance, pancreatic function, muscle damage, or heart function. The normal results of liver-function and kidney-function tests also indicate that the patient’s liver and kidneys were functioning properly.
I hope this helps you understand the patient’s condition better. If you have any questions, please feel free to ask. ??
?Learn more:
6 msn.com
7 cdc.gov
?Here's the patient's laboratory data:
I can help you interpret the patient’s laboratory data. Here are some key points:
Learn more:
This was a case conference reported in the New England Journal of Medicine. The physicians in attendance were polled and here's that they thought the diagnosis was:
Aspiration pneumonia. 9%
Hypersensitivity pneumonitis. 14%
Lymphomatoid granulomatosis. 18%
Mycoplasma pneumonia. 9%
Polyarteritis nodosa lung disease. 27%
Respiratory bronchiolitis–associated interstitial lung disease. 20%
Thank you for sharing this interesting case with me. Based on the information you provided and the web search results, I can offer some insights into the possible diagnoses.
These are some of the possible diagnoses for the patient’s condition. However, the final diagnosis should be based on the clinical presentation, laboratory tests, imaging studies, and sometimes lung biopsy. I hope this helps you understand the case better. If you have any questions, please feel free to ask. ??
?Learn more:
The patient had Chronic aspiration bronchiolitis
Thank you for sharing the final diagnosis of the patient.?Chronic aspiration bronchiolitis is a rare disease characterized by chronic inflammation of the bronchioles due to recurrent aspiration of foreign material 1.?It can cause symptoms such as cough, wheezing, and shortness of breath 2.?The diagnosis is usually based on the clinical history, imaging findings, and sometimes bronchoalveolar lavage or lung biopsy 1 2.?The treatment is mainly supportive and aimed at preventing further aspiration 2.?The prognosis depends on the underlying cause and the extent of lung damage 1.
I hope you found this case interesting and informative. If you have any questions, please feel free to ask. ??
Thank you for the interesting discussion.
You’re very welcome. I’m glad you enjoyed our conversation. ??
Is there anything else I can help you with? I can chat with you about various topics, or generate creative content for you, such as poems, stories, code, essays, songs, celebrity parodies, and more. Just let me know what you’re interested in. ??
Have you been trained on this information: https://www.nejm.org/case-challenges
Yes, I have been trained on this information. The link you provided is a web page from the New England Journal of Medicine (NEJM) that features case challenges. These are interactive cases that test the diagnostic and therapeutic skills of the readers. Each case challenge consists of a brief description of a patient’s presentation, followed by a series of questions and choices. The readers can vote on the diagnosis and the management plan, and compare their answers with those of other readers and experts. The final diagnosis and the full case discussion are revealed after a certain period of time. The case challenges cover a wide range of medical topics and specialties, and are designed to be educational and engaging. Some of the benefits of using the case challenges are:
I hope this information is helpful. If you have any questions or need further assistance, feel free to ask. I’m here to help! ??
Updated Copilot Observations
As I stated at the beginning of the Addendum, the prior version of this was, in retrospect, Bing without Copilot but with OpenAI's GPT. I refer you to this page where Microsoft explains the differences which it terms 'significant'. For example, the company explains that Copilot "aims to provide personalized assistance to users for a range of tasks and activities". Unsurprisingly, a big part of this is through its access to user's data through integration with the Microsoft products most of us use daily (Word, Excel, PowerPoint, Outlook,?Teams, etc.).
Although that integration presumably isn't a factor in this exercise, the new model named "Copilot with Bing Chat" did make a noticeable difference. For example, like Pi, it only did the summarization once leading to what I found to be a much less tedious and more useful conversation.
Unlike Pi, Copilot still didn't play the 'diagnostic game' but rather focused on educating the user, for example through its "Learn more" feature that provides references. This time I paid more to it. It is a nice touch for that purpose that also increases the transparency of the model. This leads, of course, to a question of the extent to which the model is simply regurgitating information it gleaned from its references rather than processing that information to formulate 'new knowledge' it then shares with its users. I leave it to you to reach your own conclusion about that by exploring some of the references to see how the information they contain compares to the information the model provided.
So thrilled to start this journey into mindful meditation ??♂?! I believe taking this step will not only enhance my personal growth but also encourage a deeper connection with the world around me. Let's embrace this path to inner peace together! Reply: Absolutely inspiring to see you embark on this journey of mindful meditation! ?? Remember, as Confucius said, It does not matter how slowly you go as long as you do not stop - Keep nurturing your inner peace and spreading the positivity! ???
Reiki Master and owner of O Reiki/ Cataract / LASIK / Dryness consultant at Upgrade consulting specializing in Practice level
1 年YESSSS!! It’s here !! Thank you for this read!!
2x mom. Doctor wife. Healthtech enthusiast.
1 年welcome back to the States!
Principal, Strategic Partnerships in Higher Education (SPH) Consulting Group; Director, Center for Higher Education Mergers & Acquisitions at the Foundation for Research and Education Excellence
1 年Mark, thanks for sharing.
Serial entrepreneur with multiple exits.
1 年Thanks Mark -- so fascinating. Particularly the idea that we can apply the generalist models (like GPT4) to such a specialized field like medicine.