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Session Two — ENT (Harkness)

Busy day. > 50 patients (average is ~40). 6 doctors on floor. Endoscopy performed on almost all patients.

Patients​

All rooms used DAX Copilot for audio transcription.

Patient I​

~50 yo F. Pain only in nasal bridge, no sinus pain, 10 yo pacemaker. Sleep apnea. Dizziness when walking. Vestibular tests (balancing tests) performed. Trauma from bonking nose with washing machine door. Vertigo, nausea, dizziness.

Patient II​

~40 yo M. CC: really bad allergies. Deviated septum. Sinus, nasal discharge. No allergy testing. Endoscopy performed. Caudal septal deviation. Surgery to correct would need 1 wk recovery, nose sore for 6 mos to 1 yr. Sprays can help reduce inferior terminates. 4 wk acclimation.

Patient III​

~40 yo M. CC: nasal obstruction. Spray recommended. Spraying technique shown. Sinus pressure when lying down because of blood pooling; natural.

Patient IV​

~15 yo M. CC: Nasal congestion, inflammation, infection. Heavy snot and crusting, used a suction device to remove. Yet another deviated septum. Chronic sinusitis, polyops. Extended medication, doctor was briefly confused with Rx UI…

Patient V​

~70 yo M. CC: sore throat for 3 mos. SEVERE, bloody crusting/scabbing in hose. Endoscopy/suction to pull a ‘carpet’ of this stuff off. Bactrum course for 2 wks. Asked to continue rinses.

Patient VI​

~45 yo M. CC: inflammation, chronic sinusitis, nasal crusting. Chronic cough. Discussion of Flonase versus Q-nasal. PFT (Pulmonary Function Test) was OK. Takes Symbicort before bedtime. Endo performed. Recommended to take Mometazone rinse. Come back in 6 wks for CT scan.

Patient VII​

~30 yo F. CC: ongoing isses with smell since COVID. Left nostril is OK but right is not; smell needs to go “further up” to register. MRI taken to check olfactory cleft. Deviated Septum. Sensitivity test issued for nostrils.

Patient VIII​

~50 yo F. CC: nasal bleeding and severe congestion. No need for cauterization. AYR gel to keep nose hydrated. Afrin for anotehr nose bleed. Doctor didn’t take too many notes.

Patient IX​

~40yo M. CC: right nostril is severely congested. “Comes and goes”. Deviated Septum. Allergen test and then on some immunosuppresant. Partner spoke a lot and knew everything about patient. Explained that (Oral Steroids + Topical) = High BP, High Sugar, High Energy, Low Sleep.

Patient X​

~80 yo M. With granddaughter. Hard of hearing. Used the iPad on Wheels. Everyone was yelling. Infection in back of throat; may be a tumor; not responding to antibiotics. LOTS of repetition. What was ‘lost in translation’? Doctor → Interpreter → Granddaughter → Grandpa.

Patient XI​

~60 yo F. CC: Affected sense of smell. Husband worried she would not be able to smell gas. Had COVID 4 ygo. Lipomas for 20+ years.

Patient XII​

~70 yo F. CC: Ears blocked. Deviated septum. Tympanogram is normal. Referred to another doctor. Spoke a lot. No effusion (indicates infection).

Random Notes​

  • So much of what I saw was deviated septum-related ‘stuff’.
  • A COW (Computer on Wheels) but with an iPad that allowed for live translation. The speakers were garbage. The mic was garbage. Everyone was yelling.
    • Request translation with (a) Medical Record Number (MRN), (b) Last name of doctor, (c) Interpreter number.
  • “Curbside Counsel”…?
  • EPIC: lots of copypasta and editing.
  • Opportunity: Doctor said he had to “crawl through” the chart for a “proposed summary” of the visit. Can an LLM do this?
  • Opportunity: Doctor used an EPIC screenshotting tool but had to type in the date manually into his note. E.g. a CT scan taken 6 months ago.
  • Physician’s Assistant used eClinicalWorks before EPIC and likes the latter. She likes that EPIC is “annoying but you get your job done” in that it won’t let you proceed until you satisfy the checkpoints or “pause points”. For example, it verifies address, sends reminders; she loved the fidelity.
  • EPIC Haiku used by doctor to check next patient. “Mostly seamless.”
  • Doctor was very fastsidious about his notes. Lots of bullets, short prose. But lots of copypasta.
  • Dennis Poe, a physician, spent a lot of time on the conundrum of “ears blocked but Tympanogram OK”.

Nose Stuff​

  • Nose-related things (traumas, surgeries) take 6 mo to 1 yr to heal.
  • Septum deviation appeared to be a very common cause of visits.
    • You are not born with it, you grow with it.
    • Affects 40% of population. 50% of them come in. 30% of this undergo surgery.
  • Doctor used a “hallway” analogy to explain nasal passages.
  • BreatheRight strips were recommended quite a bit.
  • Staphylococcus is commonest bacterium in nasal passages.
  • Smell is the most challenging sense to come back after COVID and/or nasal/sinus surgery.
  • NeilMed Sinus Rinse given for sinus problems.
  • 10-15% of people suffered acute smell loss with no recovery within 6 mos of COVID; 5% have no smell at all.
  • Smell: immersion instead of retraining works better; you need distinct smells.

Questions​

  • Transcription really appears to take away from doctor/patient interaction. How do clinicians feel about this?