Pelvic Exams

[Mount Asclepius]

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I guess I’m spoiled. If you can call it that? Single self swab for our sites can be used to check GC/CT, trichomonas, candida and BV panel. Haven’t done a wet prep in a decade. If you don’t have multiplex PCR panels where you are at, I’d push to start using them.

 

[Mount Asclepius]

@thegenius I don’t have to just rely at looking at people anymore. They can swab themselves!

In seriousness though, I wonder how improved diagnostic testing coupled with AI is going to obviate the need for a physician to be involved at times. Not that I ever want to be involved with this area of medicine.

 

[bravotwozero]

I have seen UAs with trich, but yes not commonly

 

[DocEspana]

I have seen UAs with trich, but yes not commonly

The data says if you swabbed *everyone* for trich, you would get about the same number of positives as "incidental positives" youre getting on UAs. Or twice as many if you used NAAT. Thats just a function of 1) it not being all that prevalent any longer and 2) lots of people just dealing with goopy genitals in silence.

I've been at my place for about 12 years and I don't ever recall seeing trichomonas commented on a urine microscopy. I'm not saying you are incorrect, I just dont remember seeing it. I don't see a lot of trichomonas anyway, maybe 1-2/year.

see the above comment. That's just a function of the prevalence, which isn't super high.

 

[thegenius]

@thegenius I don’t have to just rely at looking at people anymore. They can swab themselves!

(1) In seriousness though, I wonder how improved diagnostic testing coupled with AI is going to obviate the need for a physician to be involved at times. Not that I ever want to be involved with this area of medicine.

Yea I have patients swab themselves now anyway. Our ER is so full almost all the time, that they can wait 3-4 hours to get a bed for me to swab, or they can go right now to the bathroom and can swab themselves.

(1) For simple stuff, like urgent care issues, it will probably make a dent and maybe 1/3 to 1/2 of patients won't go to Urgent Care anymore. Especially if it's just an issue of getting an Rx. ER traffic will go down a little but not much.

AI can't help old people who are weak, or all people who can't adult and need society to take care of them. That's probably 80% of our "clientele".

 

[Mount Asclepius]

Yea I have patients swab themselves now anyway. Our ER is so full almost all the time, that they can wait 3-4 hours to get a bed for me to swab, or they can go right now to the bathroom and can swab themselves.

(1) For simple stuff, like urgent care issues, it will probably make a dent and maybe 1/3 to 1/2 of patients won't go to Urgent Care anymore. Especially if it's just an issue of getting an Rx. ER traffic will go down a little but not much.

AI can't help old people who are weak, or all people who can't adult and need society to take care of them. That's probably 80% of our "clientele".

The ED population has gotten older and sicker over time. Every ED is roughly 20% ESI 1-2s, 60% ESI 3s, and only 20% 4-5s. EDs mostly aren’t gunshot wounds and ankle sprains. They are 80 year olds who still live at home falling down with no injuries too weak to get up and 50 year olds with abdominal pain and vomiting. Gone are the days when everyone was more straightforward and already sorted out as either sick or not sick.

I’m not convinced though that once AI has taken out the self swabs and urgent cares that it won’t come for ordering a CT abdomen/pelvis on anyone over age 65 with abdominal pain, reading the scan as normal and discharge, or perfed and instant General Surgery electronic consult.

As people become comfortable with the risk and liability of self-driving car accidents then I could see that extending to medicine. Minimize the medicolegal risk and you also minimize utilization. Or, that goes out the window and health care costs continue spiraling out of control until a reckoning. I think resource utilization though might come to fruition driven more so by AI than gatekeepers or insurance preauthorization (granted those are non-ED outpatient issues).