Doctors Take the Mic

Pregnancy increases strain on the heart and blood vessels, raising blood volume and heart rate. Women with pre-existing heart conditions like arrhythmias or heart valve issues face heightened risks, including blood clots and potential complications for both mother and baby. It emphasized the need for thorough pre-pregnancy evaluation, ongoing monitoring, and carefully managed medications to ensure safety. Conditions such as congenital heart defects and severe heart failure may necessitate careful consideration or even advisement against pregnancy due to significant risks. Collaboration among cardiologists, maternal-fetal medicine specialists, and healthcare providers is crucial in developing tailored care plans for these women.

Women undergoing percutaneous coronary intervention (PCI), also known as coronary angioplasty with stenting, tend to have less complex coronary lesions than men but face higher risks due to older age and more comorbidities. Despite cardiovascular disease being a leading cause of death globally, women receiving PCI often have poorer outcomes compared to men. A 2023 European study led by Antonia Sambola highlights sex-based differences in PCI outcomes, with potential factors including anatomical differences in blood vessels, delayed symptom recognition, and atypical symptom presentation in women. These disparities suggest a need for heightened awareness and earlier referral to cardiologists for women, aiming to improve cardiovascular care and outcomes.

Sambola, A, et al. European Heart Journal, 2024, vol 4, issue 2

Heart disease in women was discussed as distinct from men's heart disease. It was highlighted that heart disease ranks as the leading cause of death for both genders, with an increasing prevalence among women over the past decade, exacerbated by the effects of COVID-19. The discussion pointed out that traditional treatment guidelines primarily stem from studies conducted on men in the 1990s, underscoring a need for revised protocols that account for gender-specific differences in symptoms and risk factors. Women often exhibit atypical symptoms such as shortness of breath, nausea, and fatigue rather than the classic chest pain typical in men.

Preventive measures were emphasized, noting that lifestyle changes—including nutritious diet choices and regular physical activity—can prevent up to 90% of heart disease cases. Specific risk factors for women, such as autoimmune diseases, high blood pressure, high cholesterol, diabetes, and early menopause, were outlined. The importance of seeking medical attention promptly for any concerning symptoms, regardless of their atypical nature, was stressed to ensure early detection and effective management of heart health.

Dr. Gloria Wu interviewed Dr. Paul Wang from Stanford University School of Medicine regarding hybrid surgical catheter ablation for treating atrial fibrillation. This innovative approach involves collaboration between cardiac surgeons and electrophysiologists. By combining surgical intervention outside the heart with catheter ablation inside, the treatment aims to achieve superior outcomes compared to catheter ablation alone. Initial studies, including a pivotal trial, have shown promising results, demonstrating the potential for improved efficacy in managing atrial fibrillation. Ongoing research is underway to further refine the benefits of this dual approach and identify the specific patient populations that would benefit most from it.

Hybrid surgical catheter ablation combines the expertise of cardiac surgeons and electrophysiologists to treat complex cases of atrial fibrillation (AF). This innovative approach integrates minimally invasive surgical techniques with catheter-based procedures to achieve comprehensive and durable rhythm control. Typically performed in a hybrid operating room, the procedure involves a collaborative effort between the surgical team, who create epicardial lesions on the outside of the heart, and the electrophysiologists, who perform endocardial ablation from within the heart's chambers using catheters. By targeting both the inside and outside of the heart, hybrid ablation aims to eliminate the sources of abnormal electrical signals that trigger AF while minimizing procedural risks and maximizing long-term success rates. This multidisciplinary approach represents a promising advancement in the treatment of AF, offering a tailored and effective solution for patients with persistent or longstanding persistent atrial fibrillation.

Dr. Wu recently attended the American Medical Association meeting in Chicago, representing the women physician section on the governing council. A significant topic of discussion was women's pay inequity. A 2018 JAMA Cardiology study by R.U Shah revealed a $2.5 million lifetime pay gap between male and female cardiologists in the U.S., using Medicare data. In 2022, V.L. Crosa's study in Argentina reported that 58% of women cardiologists experienced violence compared to 10% of men, highlighting global issues. S.M. Temkin's June 2024 article in Social Science and Medicine noted that female doctors receive fewer referrals, contributing to pay inequity, and face "untitling," where their titles are not used, belittling their accomplishments.

These disparities extend beyond medicine into other professions. Women are often advised to pursue non-surgical specialties due to subconscious gender norms, and this bias affects their career progression. Despite societal advancements, women in various fields, including sports, still earn less than their male counterparts. For instance, male athletes earn significantly more in sports like golf and soccer, though tennis shows near parity. These persistent issues emphasize the need for ongoing efforts to address gender pay inequality as we move further into the 21st century. Thank you for tuning in to "Doctors Take the Mic."

References:

Shah, RU. The $2.5 million wage gap in Cardiology. JAMA Cardiology, 2018.

Crosa, VL. Labor equity, gender violence and cardiovascular risk factors in cardiology specialists. Rev Argentina, 2022.

Today, we discuss the challenges women face in male-dominated fields, focusing on women pay equity and the need for mentors. Carolyn Conklin, a manager on a catastrophe team for insurance companies, shared her experiences of proving herself in a male-dominated environment. She emphasized the importance of hard work, maintaining high quality, and demonstrating reliability and integrity to counter any biases and secure her position. Both Carolyn and I, a woman retina surgeon, recognized the necessity of building support systems and seeking mentorship to navigate and succeed in our respective fields.

We also discussed the issue of women who have succeeded sometimes not being welcoming to those following in their footsteps. Carolyn noted that these women might build silos around themselves as a defense mechanism. However, she emphasized the importance of understanding that younger women are not in competition but seeking guidance. Open communication can help alleviate this perception. Persistently seeking mentorship, regardless of the initial response, is crucial. This conversation highlighted the importance of support, mentorship, and resilience for women striving to succeed in traditionally male-dominated fields. Thank you, Carolyn Conklin, for sharing your insights, and thank you to our audience for tuning in.

Today, we're discussing large language models and ambient natural language models in healthcare. Ambient natural language models, like those developed by Augmedix Inc., transcribe doctors' spoken words into electronic health records in real-time, enhancing accuracy and reducing physician burnout. This technology alleviates the burden of endless typing into systems like EPIC, which dominates 50% of U.S. hospitals. The pandemic has exacerbated this issue, causing significant physical exhaustion among healthcare workers.

Since the introduction of electronic health records (EHR) by Obamacare, there have been benefits such as instant data sharing and readable records. However, the need to input data manually has been a major drawback, leading to the use of scribes. The advent of AI and ambient natural language models represents the next revolution in healthcare, promising to free up physicians' time, improve patient interactions, and efficiently manage communication tasks. Companies like OpenAI, partnering with Stanford Health and Mayo Clinic, are at the forefront of this change, making this an exciting development for the future of medicine.

Dr. Gloria Wu disscusses AI-mediated chatbots, referencing a New York Times article from April 8, 2024. The article, authored by Cade Metz, Cecilia Kang, Shera Frankel, Stuart A. Thompson, and Niko Grant, highlights how tech companies like OpenAI, Google, and Meta navigate legal and ethical gray areas to harvest data for their AI models. In 2021, OpenAI transcribed over a million hours of YouTube videos to gather conversational text, despite potential privacy rule violations. This practice underscores the ongoing struggle to obtain enough data to train larger AI models, leading companies to increasingly bend corporate policies and laws.

As data sources dwindle, companies turn to synthetic data, where AI generates its own training data. This shift raises concerns about AI models perpetuating their own biases and errors. Additionally, there are legal challenges from entities like the New York Times, suing AI companies for using copyrighted content without permission. The article also mentions researchers like Jared Kaplan, who emphasized the need for vast data sets to improve AI performance. This endless quest for data, including Google's training of AI on trillions of tokens, illustrates the industry's race to advance technology. Users should be aware of these issues and verify information from multiple sources for accuracy.

Check out Dr. Gloria Wu's publications on ChatGPT, LLM, and Internet of Things:

Wu G, Lee DA, Zhao W, Wong A, Sidhu S. "ChatGPT: Is it Good for Our Glaucoma Patients?" Frontiers in Ophthalmology, section Glaucoma. 2023. https://doi.org/10.3389/fopht.2023.1260415.

Wu, G., Zhao, W., Wong, A., & Lee, D. A. Patients with floaters: Answers from virtual assistants and large language models. Digital Health. 2024. https://doi.org/10.1177/20552076241229933

Wu G, Satheesha-Krishna S, Sakai S, Jhangiani R, Kurniawan, S. Google Assistant and ChatGPT: Is it useful for non-medical professionals looking for information about stroke or glaucoma. IOT 2023: The International Conference on the Internet of Things, Nagoya, Japan, November 2023.

https://doi.org/10.1145/3627050.3631579

Wu, G., Lee, D. A., Zhao, W., Wong, A. (2024). ChatGPT, Google Assistant: Which is best for patients with amblyopia? Journal of Medical Internet Research. In press.

Controlling high blood pressure can significantly decrease the risk of dimentia. High blood pressure, also known as hypertension, requires treatment. An added benefit is that the treatment will decrease the risk of cognitive loss. The article cited is in Volume 83, issue 13 of the Journal of American College of Cardiology. The authors of the study are Doctors Frederico Rea, Giusseppe Mancia et al.

Pregnancy drug classes, established by the FDA, categorize medications based on their potential risks to the fetus when taken during pregnancy. Class A drugs have been tested in pregnant women and found to be safe, showing no risk to the fetus in the first trimester and no evidence of risk in later trimesters. Class B drugs have not been tested in pregnant women, but animal studies have shown no risk to the fetus, or animal studies have shown a risk that was not confirmed in human studies. Class C drugs are those where animal studies have shown adverse effects on the fetus, but there are no well-controlled studies in humans. The potential benefits of Class C drugs may warrant their use in pregnant women despite potential risks.

Class D drugs have evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, but the potential benefits from the use of the drug in pregnant women may be acceptable despite the potential risks. Class D category often applies to drugs that are necessary to treat life-threatening conditions. Class X drugs have studies in animals or humans that demonstrate fetal abnormalities, and the risk of using the drug in pregnant women clearly outweighs any potential benefit.

In the United States, several eye medications are considered relatively safe for use during pregnancy, including erythromycin ointment and artificial tears for dry eyes, and prednisone eye drops. However, it is crucial to consult a healthcare provider before using any eye medication during pregnancy to evaluate individual benefits and potential risks.