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    Doctors, A.I. and Empathy for Patients

    More from our inbox:Breast Cancer ScreeningWalz’s MisstepsMental Health Support for SchoolchildrenTo the Editor:Re “ChatGPT’s Bedside Manner Is Better Than Mine,” by Jonathan Reisman (Opinion guest essay, Oct. 9):Dr. Reisman notes that ChatGPT’s answers to patient questions have been rated as more empathetic than those written by actual doctors. This should not be a call for doctors to surrender our human role to A.I. To the contrary, we need to continue to improve our communication skills.For the past 25 years, I have been facilitating seminars in doctor-patient communication. The skills to communicate bad news listed by Dr. Reisman are exactly the techniques that we suggest to our medical students. However, doctors can avoid the temptation to surrender their “humanity to a script” as if it were “just another day at work.”Techniques are a valuable guide, but the real work consists of carefully listening to the responses and their emotional content, and crafting new words and phrases that speak to the unique patient’s confusion, fear and distress.In my experience, patients know when we are reciting a script, and when we are paying attention to their thoughts and feelings. Unlike A.I., and especially when conversations are matters of life and death, we can reach into the depths of our humanity to feel and communicate empathy and compassion toward our patients.Neil S. ProseDurham, N.C.To the Editor:Mention the words “A.I.” and “doctoring” to most physicians in the same sentence, and the immediate reaction is often skepticism or fear.As Dr. Jonathan Reisman noted in his essay, A.I. has shown a remarkable ability to mimic human empathy in encounters with patients. This is one reason many practicing physicians worry that A.I. may replace doctors eventually.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    A Blood Test Accurately Diagnosed Alzheimer’s 90% of the Time, Study Finds

    It was much more accurate than primary care doctors using cognitive tests and CT scans. The findings could speed the quest for an affordable and accessible way to diagnose patients with memory problems.Scientists have made another major stride toward the long-sought goal of diagnosing Alzheimer’s disease with a simple blood test. On Sunday, a team of researchers reported that a blood test was significantly more accurate than doctors’ interpretation of cognitive tests and CT scans in signaling the condition.The study, published Sunday in the journal JAMA, found that about 90 percent of the time the blood test correctly identified whether patients with memory problems had Alzheimer’s. Dementia specialists using standard methods that did not include expensive PET scans or invasive spinal taps were accurate 73 percent of the time, while primary care doctors using those methods got it right only 61 percent of the time.“Not too long ago measuring pathology in the brain of a living human was considered just impossible,” said Dr. Jason Karlawish, a co-director of the Penn Memory Center at the University of Pennsylvania who was not involved in the research. “This study adds to the revolution that has occurred in our ability to measure what’s going on in the brain of living humans.”The results, presented Sunday at the Alzheimer’s Association International Conference in Philadelphia, are the latest milestone in the search for affordable and accessible ways to diagnose Alzheimer’s, a disease that afflicts nearly seven million Americans and over 32 million people worldwide. Medical experts say the findings bring the field closer to a day when people might receive routine blood tests for cognitive impairment as part of primary care checkups, similar to the way they receive cholesterol tests.“Now, we screen people with mammograms and PSA or prostate exams and other things to look for very early signs of cancer,” said Dr. Adam Boxer, a neurologist at the University of California, San Francisco, who was not involved in the study. “And I think we’re going to be doing the same thing for Alzheimer’s disease and hopefully other forms of neurodegeneration.”In recent years, several blood tests have been developed for Alzheimer’s. They are currently used mostly to screen participants in clinical trials and by some specialists like Dr. Boxer to help pinpoint if a patient’s dementia is caused by Alzheimer’s or another condition.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    I Was a White House Doctor. Presidents Should Have to Take Cognitive Tests.

    The job of president is physically and mentally demanding. I witnessed this firsthand as a White House physician for three presidents, including as the designated physician to the president for Barack Obama during his first term. My presidential patients often worked 12-hour days seven days a week. The leader of the free world travels constantly, and participates in or leads briefings in which he must retain huge amounts of information.Health scares can happen at any moment. My role as White House physician was to keep the president healthy and performing optimally, and to provide the public with a candid medical assessment of his ability to carry out the duties of his office.I participated in tabletop exercises in the Situation Room to go over how to follow Section 3 of the 25th Amendment, which deals with succession in the event the president is disabled or incapacitated. Typically, the 25th Amendment came into play when a president was going under general anesthesia for a colonoscopy or scheduled surgical procedure.It is widely assumed that the physician to the president will gather and provide pertinent medical information to those contemplating whether the amendment needs to be invoked. This is not stipulated, but most in the medical community agree that the appropriate role for a physician is to offer a medical opinion, based on facts, that is then weighed by the patient — in this case the president — and those around him.The debates around the fitness of Joe Biden and Donald Trump in the last several weeks have created new pressure to start having serious conversations about exactly how the White House medical team should evaluate presidents and determine their fitness for duty — cognitively as well as physically. This has been the subject of decades of discussion within the White House medical team as well as with the broader medical community.Many Americans may want the White House medical team to take a more active role in declaring the president fit for duty. Many would probably like to see the same standard apply to candidates running for president as well. For those things to happen, these medical teams will need access to more data about these individuals than they now collect. And perhaps even more important, we should seriously consider the need for an age limit for those running for president, given the high stakes of the office and the realities of cognitive decline with aging.Many cognitive abilities decrease with ageWhile we retain much of our vocabulary as we get older, cognitive abilities such as speed and reasoning tend to decline more rapidly after age 60. More

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    White House Doctor Kevin O’Connor Discussed Business With James Biden

    Before Dr. Kevin O’Connor was appointed White House physician at the beginning of the Biden administration, he discussed a business venture with the president’s brother James Biden, but the doctor ultimately received no compensation, Mr. Biden’s lawyer said.The discussions revolved around James Biden’s involvement with a health care company called Americore, which was looking to expand a network of hospitals in underserved rural areas of the United States.Republicans have seized on the episode to suggest that Dr. O’Connor might have had incentive to minimize issues related to President Biden’s health. The White House rejected the speculation, with a spokesman calling it “ridiculous and insulting.”In his current role, Dr. O’Connor produced letters each of the three years following Mr. Biden’s physicals that attested the president was healthy and “fit to successfully execute the duties of the presidency.” The assessments have come under renewed scrutiny in recent weeks as Mr. Biden’s decline has become more apparent, particularly after his feeble performance in last month’s debate against former President Donald J. Trump, the presumptive Republican nominee.Representative James R. Comer, a Kentucky Republican who is chairman of the House Oversight Committee, sent a letter this week asking Dr. O’Connor to turn over documents related to James Biden and Americore, and to submit to a transcribed interview with committee staff.The White House dismissed Mr. Comer’s effort to draw a link between Dr. O’Connor’s statements about the president and his consultation with James Biden.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Your Hologram Doctor Will See You Now

    A Texas hospital is experimenting with hologram technology for doctors to see patients. Some health care experts wonder if it’s beneficial.A patient walks into a hospital room, sits down and starts talking to a doctor. Only in this case, the doctor is a hologram.It might sound like science fiction, but it is the reality for some patients at Crescent Regional Hospital in Lancaster, Texas.In May, the hospital group began offering patients the ability to see their doctor remotely as a hologram through a partnership with Holoconnects, a digital technology firm based in the Netherlands.Each Holobox — the company’s name for its 440-pound, 7-foot-tall device that displays on a screen a highly realistic, 3-D live video of a person — costs $42,000, with an additional annual service fee of $1,900.The high-quality image gives the patient the feeling that a doctor is sitting inside the box, when in reality the doctor is miles away looking into cameras and displays showing the patient.The system allows the patient and doctor to have a telehealth visit in real time that feels more like an in-person conversation. For now, the service is used mostly for pre- and postoperative visits.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Some States Say They Can’t Afford Ozempic and Other Weight Loss Drugs

    Public employees in West Virginia who took the drugs lost weight and were healthier, and some are despondent that the state is canceling a program to help pay for them.Joanna Bailey, a family physician and obesity specialist, doesn’t want to tell her patients that they can’t take Wegovy, but she has gotten used to it.Around a quarter of the people she sees in her small clinic in Wyoming County would benefit from the weight-loss medications known as GLP-1s, which also include Ozempic, Zepbound and Mounjaro, she says. The drugs have helped some of them lose 15 to 20 percent of their weight. But most people in the area she serves don’t have insurance that covers the cost, and virtually no one can afford sticker prices of $1,000 to $1,400 a month.“Even my richest patients can’t afford it,” Dr. Bailey said. She then mentioned something that many doctors in West Virginia — among the poorest states in the country, with the highest prevalence of obesity, at 41 percent — say: “We’ve separated between the haves and the have-nots.”Such disparities sharpened in March when West Virginia’s Public Employees Insurance Agency, which pays most of the cost of prescription drugs for more than 75,000 teachers, municipal workers and other public employees and their families, canceled a pilot program to cover weight-loss drugs.Some private insurers help pay for medications to treat obesity, but most Medicaid programs do so only to manage diabetes, and Medicare covers Wegovy and Zepbound only when they are prescribed for heart problems.Over the past year, states have been trying, amid rising demand, to determine how far to extend coverage for public employees. Connecticut is on track to spend more than $35 million this year through a limited weight-loss coverage initiative. In January, North Carolina announced that it would stop paying for weight-loss medications after forking out $100 million for them in 2023 — 10 percent of its spending on prescription drugs.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Abortion Pills May Become Controlled Substances in Louisiana

    A bill that is expected to pass would impose prison time and thousands of dollars in fines on people possessing the pills without a prescription.Louisiana could become the first state to classify abortion pills as dangerous controlled substances, making possession of the pills without a prescription a crime subject to jail time and fines.A bill that would designate the abortion pills mifepristone and misoprostol as Schedule IV drugs — a category of medicines with the potential for abuse or dependence — passed the state’s Republican-controlled House of Representatives on Tuesday by a vote of 63 to 29. Should the Senate follow suit, Gov. Jeff Landry, a Republican and a vocal opponent of abortion, is likely to sign the legislation into law.The measure — which would put abortion pills in the same category as Xanax, Ambien and Valium — contradicts the way the federal government classifies mifepristone and misoprostol. The federal Food and Drug Administration does not consider abortion pills to be drugs with the potential for dependence or abuse, and decades of medical studies have found both to be overwhelmingly safe.Under the legislation, possession of mifepristone or misoprostol without a prescription in Louisiana could be punishable with thousands of dollars in fines and up to five years in jail. Pregnant women would be exempt from those penalties; most abortion bans and restrictions do not punish pregnant women because most voters oppose doing so.“These drugs are increasingly being shipped from outside our state and country to women and girls in our state,” Attorney General Liz Murrill, a Republican, said in a statement on social media. “This legislation does NOT prohibit these drugs from being prescribed and dispensed in Louisiana for legal and legitimate reasons.”Louisiana already bans most abortions, except when women’s lives or health are in danger or fetuses have some fatal conditions. As a result, abortion rights advocates and legal scholars said that in practice, the measure might not prevent many abortions among Louisiana women. Since the state imposed its strict abortion ban after the Supreme Court overturned Roe v. Wade, many patients have traveled to states where abortion is legal or have obtained pills under shield laws from doctors or nurses in other states who prescribe and mail the medications to Louisiana. Such circumstances would not be affected by the new bill, experts say.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    The Disease Detectives Trying to Keep the World Safe From Bird Flu

    As Dr. Sreyleak Luch drove to work the morning of Feb. 8, through busy sunbaked streets in Cambodia’s Mekong river delta, she played the overnight voice messages from her team. The condition of a 9-year-old boy she had been caring for had deteriorated sharply, and he had been intubated, one doctor reported. What, she wondered, could make the child so sick, so fast?“And then I just thought: H5N1,” she recalled. “It could be bird flu.”When she arrived at the airy yellow children’s ward at the provincial hospital in Kratie, she immediately asked the child’s father if the family had had contact with any sick or dead poultry. He admitted that their rooster had been found dead a few days before and that the family had eaten it.Dr. Luch told her colleagues her theory. Their responses ranged from dubious to incredulous: A human case of avian influenza had never been reported in their part of eastern Cambodia. They warned her that if she set off the bird flu warning system, many senior government officials might get involved. She risked looking foolish, or worse.Anxious but increasingly certain, Dr. Luch phoned the local public health department, located just across the street. Within minutes, a team arrived to collect a sample from the child, Virun Roeurn, for testing in a lab.By then, Virun’s distraught parents had lost faith in the hospital. They demanded that he be sent by ambulance to the capital, Phnom Penh. His flu swab sample traveled with him.Virun died on the journey. At 8 p.m., Cambodia’s National Public Health Laboratory confirmed Dr. Luch’s suspicion: He had died of highly pathogenic avian influenza.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More