NEWS 3
ausdoc . com . au 13 SEPTEMBER 2024
NEWS 3
Name change for eponyms ?
Carmel Sparke IT remains a man ’ s world when it comes to the eponyms for 3500 body parts , diseases and surgical techniques .
But two Australian doctors say it is time to adopt medical nomenclature that describes pathological processes rather than historical names .
Gastroenterologist Dr Diana Lewis and hepatologist Dr Leya Nedumannil , both from Northern Health in Melbourne , point to the dark history , with some eponyms “ glorifying ” unethical figures .
They refer to Dr Friedrich Wegener , whose links with the Nazi Party in the 1930s led to Wegener ’ s granulomatosis being renamed granulomatosis with polyangiitis some 70 years later .
But another key issue is eponyms can imply a single scientist was solely responsible for the medical discovery as well as obscure the contributions of female scientists .
“ An example is Crohn ’ s disease , first described in an article that was actually co-authored by two additional medical practitioners , Oppenheimer and Ginzburg ,” they wrote in a Medical Journal of Australia perspective .
“ Numerous women have [ also ] historically had their scientific achievements forgotten or inaccurately credited to men , a notion of systemic bias so widespread that it has ironically acquired an evocative eponymous title itself , named after suffragist Matilda Gage [ the ‘ Matilda effect ’, describing the lack of recognition given to the contributions of women scientists ].”
Of the 3484 eponyms for procedures and diseases generally in use , more than 94 % were named after white men , followed by white women ( 3.7 %), racialised men ( 2.7 %) and racialised women ( just three names or 0.1 % of the total ), according to the authors of a paper published in the Journal of Racial and Ethnic Health Disparities earlier this year .
“ Our results indicate that there are more eponyms named after white men who were Nazis ( Max
‘ Committing atrocities is not a barrier .’
Clara , Friedrich Wegener , Hans Reiter , Hans Eppinger , Walter Stoeckel and others ) than all racialised women ( Henrietta Lacks , Nadia Awni Sakati and Tsuya [ nee Sakurai ] Kitagawa ),” they wrote .
“ Committing atrocities is not a barrier to being a medical eponym namesake , and the victims of crimes committed under the guise of medical experimentation can be overlooked or erased in medical history .”
Another argument against eponyms was the resulting confusion when they were attributed to
Dr Max Clara , of Clara cell fame , was also a Nazi Party member who conducted research on the corpses of executed prisoners . ( right )
Dr Diana Lewis . ( left )
UNIVERSITÄTSARCHIV LEIPZIG , N02144 multiple entities , Dr Lewis and Dr Nedumannil said .
They cited the example of Jean-Martin Charcot , whose name has been loaned to Charcot joint , Charcot disease ( amyotrophic lateral sclerosis , also known as Lou Gehrig ’ s disease ) and Charcot ’ s triad of acute cholangitis .
They acknowledged that moving away from eponyms could lead to “ indignation ” in some quarters , but there was widespread support , including one journal called Pediatric Research declaring it would no longer use eponymous terms in its publication . Med J Aust 2024 ; 13 Aug . J Racial Ethn Health Disparities 2024 ; 4 Mar .
‘ Pressure doctors to reveal fees ’
Staff writer A CABINET minister has suggested putting more pressure on specialists to publish their fees on the government ’ s dust-gathering Medical Costs Finder website .
Since 2019 , only 52 non-GP specialists have listed their fees on the website that has already cost $ 24 million .
Last month in Parliament , Minister for Finance Katy Gallagher spoke of “ the work we ’ re trying to do for private specialists to publish their fees so that people can see , at the earliest opportunity , the going rates ”.
“ The doctors haven ’ t been as fast as we would like to upload some of that information ,” she said .
“ I think we need to continue to put more pressure on there .”
If you are wondering how taxpayers end up paying $ 24 million for a site listing 50 doctors ’ fees , partly redacted documents released under freedom of information laws provide a breakdown .
There is $ 11.5 million spent on website and portal development , over $ 5 million on communications , close to $ 2 million on consultation , $ 2.8 million on labour hire and slightly over $ 1 million on internal cost recovery .
The rise of AI consult scribes
FROM PAGE 1 had come a long way since she first started using it almost a year ago .
“ The spelling and everything was so bad I had to frequently just junk the whole thing and start taking notes just in case ,” the Melbourne practice owner said .
But over time it improved , and she says she is now finding ways to make consults more interesting and more rewarding for her patients .
“ I don ’ t want to work faster ,” she says . “ That is not what this is about for me .
“ What I want is to have a more nuanced and focused interaction with my patients that I enjoy and they get something out of , without me being focused constantly on typing or recording things .”
She said she is also an excellent touch-typist .
“ But even with that , you still have to look down at the keyboard . You have to look away from the patient . There ’ s a disconnection [ that the AI scribes can prevent ].”
One of the purported benefits of the current app is the capacity to categorise elements of the consult under different headings , like ‘ Subjective ’, ‘ Objective ’, ‘ Assessment ’ and ‘ Plan ’.
Dr Franklin said it was important for GPs to spend time setting these parameters to structure the notes in the ways they wanted .
“ You can say , ‘ I don ’ t want you to write the patient ’ s name all the time ,’ or ‘ I want you to make sure you use their preferred name .’”
She also tailors the app when it generates referral letters .
“ For example , if someone came in and talked about their mental health in the consult , then needed a referral to a dermatologist or gynaecologist , the tool can be set up to not include the notes on mental health in the referral ,” she said .
“ Because no-one necessarily wants their depression history or their suicidal ideation going to their dermatologist .”
She said the technology still got the names of medications wrong , but she had been able to identify the errors and use them to teach the AI to not make the same mistake twice .
Both Dr Audehm and Dr Franklin stressed another possible benefit : AI medical scribes would help protect GPs in medicolegal cases given the level of detail they capture .
What of the other practical issues ? The use of AI scribes in the context of a consult needs informed patient consent . How difficult is that conversation ?
Dr Audehm said it had been relatively straightforward for him .
“ I will ask them , ‘ Do you mind if I use it ? It will actually listen in on our
conversation and generate notes for me .’”
None of his patients have said no . In fact , many were fascinated .
“ I would often turn my screen so some patients can see what I ’ m typing in . So at the end of the consult [ with AI ] I ’ d say , ‘ Now watch this !’ And they were amazed .”
In July , the RACGP released new guidelines on AI scribes .
While recognising the potential wonders , the college is cautious — as you would expect .
The main point is simple : ultimately , the GP is responsible for the final medical note , legally and ethically .
Given the potential for the AI to fail , GPs are ultimately on their own .
But the guidelines go further .
They mention the onus on doctors to check what is happening to the data the AI is collecting , particularly as more of these tools are likely to emerge in the marketplace .
Are the data collected by the AI scribe processed or stored outside of Australia ? Are the masses of patient data collected being sold to third parties ?
If software Dr Tamsin Franklin . vendors are unable to provide satisfactory assurances about how data are being encrypted , stored or destroyed , the college says GPs should avoid using them . One problem is that the technology falls into a regulatory grey zone .
If it is classed as a tool purely for record-keeping , then it is not a medical device subject to TGA regulation . Dr Franklin agreed there were data-related risks .
“ Sometimes people don ’ t understand that some of these companies are offshore , or don ’ t understand that you need to get patient consent ,” she said .
“ Some might think some AI tools
‘ I don ’ t want to work faster . That is not what this is about for me .’
are great because they are free . “ Nothing in the world is free . “ If you ’ re not paying for something , then it ’ s because they ’ re selling ads or they ’ re selling your information .”
One of the most significant issues raised in the RACGP standards is the danger of complacency .
The AI is meant to become increasingly reliable through machine learning . Maybe there is a point where the GP assumes nothing can go wrong ?
Or , in the words of the PAGE 4