Med Op-Ed: Squandered Transcripts, CVD Evidence Gap, More

In this installment of Med Op-Ed: should healthcare institutions keep recordings of patient encounters; how to ensure common cardiology patients are reflected in clinical trials; and a medical device proves less accurate for patients with darker skin.

Preserve Artificial Intelligence (AI) Transcripts of Patient Encounters?

Healthcare institutions are routinely destroying AI-generated transcripts of clinical encounters due to concerns about malpractice liability, but doing so limits researchers’ ability to check the accuracy of AI scribes and explore other research questions, according to Katherine E. Goodman, JD, PhD, and Daniel J. Morgan, MD, writing in The New England Journal of Medicine.

The Context

The widespread adoption of AI scribes has led to the creation of audio recordings and transcripts of patient-clinician conversations on an unprecedented scale.
Most or all institutions seemingly delete the original audio and transcripts after a note documenting a visit has been finalized.
Keeping deidentified transcripts could mitigate legal risks, but additional statutory protections may be needed to maintain records in a way that would allow investigators to link transcripts to individual patients or clinicians for research purposes, the authors suggest.

In Their Own Words

“By capturing the exact words used by patients and clinicians during visits, transcripts open new possibilities for studying clinical communication, diagnosis, and disease. For example, does the likelihood of diagnostic error increase when clinicians interrupt patients more often? Do patients with rare cancers mention subtle, unappreciated symptoms years before diagnosis?”

Read it: Digital Exhaust or Digital Gold? The Value of AI-Generated Clinical Visit Transcripts

Cardiac Trials Overlook Typical Patients

Older adults with complex conditions are often excluded from cardiovascular trials, leading to a disconnect between scientific evidence and the day-to-day realities of treating patients, Harlan M. Krumholz, MD, wrote in the Journal of the American College of Cardiology.

The Context

Cardiologists routinely see older adults who have multiple chronic conditions and cognitive, sensory, and mobility impairments, while trials have often excluded or underrepresented these patients.
In one recent study, more than 60% of patients hospitalized with heart failure met criteria for frailty, which was linked to worse outcomes.
Standardizing geriatric assessment in clinical practice, adapting trial designs to include complex patients, and incorporating functional and cognitive metrics into risk prediction models could help address knowledge gaps, Krumholz suggests.

In Their Own Words

“The chief residents preparing their Grand Rounds in 2050 will inherit either a system that has finally integrated the science of aging into cardiovascular care or one that continues to treat our most common patients as exceptional cases.”

Read it: Older Patients and Cardiovascular Disease: At the Center of Care, on the Margins of Science

Skin Color Skews Pulse Oximetry Readings

Pulse oximeters overestimate oxygen saturation in people with darker skin tones and may miss hypoxemia in these patients — a finding that necessitates action by clinicians, regulators, and device manufacturers, wrote Thomas S. Valley, MD, and Andrew W. Fogarty, MBBS, in BMJ.

The Context

Researchers recently evaluated several pulse oximeters used by the National Health Service in England in a prospective study that included simultaneous arterial blood gas measurements and objective measurement of skin tone using spectrophotometry.
They found oxygen saturation measurements were falsely elevated in patients with darker skin.
Although this phenomenon was first described in 1990, device manufacturers have yet to resolve the flaw, and some clinicians do not appreciate the importance of interpreting pulse oximeter readings for patients with darker skin “with care and caution,” the editorial notes.

In Their Own Words

“Pulse oximeters guide millions of decisions each day — from home monitoring to emergency response to anesthesia. Inaccuracies may delay treatment across a wide range of conditions, including cardiorespiratory emergencies, sickle cell crises, and chronic respiratory failure.”

Read it: Pulse Oximetry in People With Darker Skin Tones

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.