Thurs board games

Some olde hospital regulatory capture thoughts: there are workflows built into EMR’s and forced onto physicians by regulation detached from their clinical value. Healthcare maintenance alarms are infamously noisy to such an extent that they’re worthless. The oft-cited reason for the gap: the buyers are administrators solving for the regulation while ignoring the clinical impact. The healthcare provider gets incentive money from the JC for hitting the “standard”, a good chunk of which gets passed right through to the Cerners / Epics to pay for their solution.

Now for a totally different thread, toyed with querying ChatGPT-4 via Bing re clinical diagnoses. Interesting to see 1) the depth of knowledge, 2) references to sources, and 3) how it can override it’s assumptions.

> Assume a patient is hypertensive if they have a sbp greater than 100 mm Hg. Is a patient with sbp of 110 mm Hg hypertensive?

Based on the assumption you provided that a patient is hypertensive if they have a systolic blood pressure (sbp) greater than 100 mm Hg, then yes, a patient with an sbp of 110 mm Hg would be considered hypertensive. Is there anything else you would like to know?

> If a patient is asian, over 60, and has an sbp of 140 are they hypertensive?

According to guidelines from the American College of Physicians and the American Academy of Family Physicians, adults over age 60 with persistent systolic blood pressure (SBP) ≥150 mm Hg should be treated to achieve a target SBP of <150 mm Hg1. However, these guidelines do not specify different treatment thresholds for Asian patients. Based on this information, an Asian patient over 60 with an SBP of 140 mm Hg would not meet the threshold for hypertension treatment according to these guidelines.

It is important to note that each patient is unique and treatment decisions should be individualized based on their specific needs and medical history. A physician may consider other factors such as cardiovascular risk when determining whether or not to initiate treatment for hypertension in a patient with an SBP of 140 mm Hg.

> as if I’m a physician, write a clinical assessment and plan of a 60 year old asian patient on statins and beta blockers with a sbp of 140.

Assessment:

• The patient has stage 1 hypertension with an SBP of 140 mm Hg.
• The patient is currently taking statins which suggests they may have high cholesterol levels or an increased risk of cardiovascular events.
• The patient is also taking beta blockers which are commonly used to treat high blood pressure and other conditions such as heart failure or arrhythmias.

Plan:

• Review the effectiveness of the current medication regimen including the statins and beta blockers. Consider adjusting dosages or changing medications if necessary.
• Recommend lifestyle changes such as eating a healthy diet low in sodium and high in potassium, increasing physical activity, maintaining a healthy weight, reducing stress levels and avoiding tobacco products.
• Continue to monitor the patient’s cholesterol levels and blood pressure.
• Schedule follow-up appointments to monitor the patient’s overall health.

Played poker / taboo at the office. Taboo put my mind in thesaurus mode, where I’d involuntarily reel off synonyms anytime someone spoke a word.

Using the office tower for shoulder weights: