Vital Signs: Drug deaths down, AI continuously creates breakthroughs in medical field

[MUSIC PLAYING] CATHY WURZER: It's Minnesota Now. I'm Cathy Wurzer. Time for our segment Vital Signs. Every month, we talk about topics that are important to your health and take a deep dive into medical news or what's top of mind at the doctor's office. Joining us is Dr. Jon Hallberg, a family medicine physician at Mills City Clinic and a professor at the University of Minnesota Medical School. Good to see you.

JON HALLBERG: Likewise, Cathy. Great to see you.

CATHY WURZER: We've talked in the past about a rise in COVID cases and measles. So we're going to start with some good news for a change. Drug overdose deaths are dropping nationwide. They've dropped about 10%. Minnesota saw an 11% drop. Hard to say why. But I'm wondering, is it the availability of Narcan? And the question I have to you is, in the clinic, do you see patients struggling with addiction? How do you help them?

JON HALLBERG: Yeah. I mean, first of all, this is such great news. It's been so depressing for so long. And I think about this. I started practicing medicine in 1995. So 1995 to 1996, my first year of practice. 1996 is when OxyContin hit the market. So I remember the pitches. And if anyone's seen the show Dopesick and read the book that that's based on. I mean, it was just amazing how insidious that was.

And so my entire career, approaching 30 years now, has been tied into the opioid epidemic, in a way. And there's been such a sea change over these last 25 years or so. So, I mean, it's been just depressing news after depressing news regarding opioid overdoses and deaths. And this little glimmer of hope, let's hope that it's not just a blip. That it's really trending in this downward direction.

So, of course, why? Why now? Why is this happening? Is it Narcan? Maybe. I mean, I think that we've changed the rules about that drug. And it's truly an antidote. It is a true lifesaving medication. You squirt that in someone's nose, and it almost instantly reverses this binding that occurs at the receptor sites with opioids and causing respiratory arrest. I mean, people die by they stop breathing.

And it's absolutely amazing. What an amazing medication. And to have that in more hands of people, whether it's policemen, firemen, EMS, clinics, passersby, people that work in different shelters, it's absolutely amazing. But that's going to stop the death that could occur right there and then. There has to be something more to it. And we have to hope that it's more access to treatment. That we're doing a better job of helping people with these medications.

And yeah, at the clinic level, we've got a whole host of things in place now that we didn't have before that I think have really made a difference.

CATHY WURZER: I want to go back when you said that you remember the first time that OxyContin hit the market. Gosh, I remember taking it myself. Because I had surgery. And I remember the doctor saying, you're going to love this. This is really good. It's a great painkiller. I thought, OK. But look what's happened, as you say. I'm wondering, are doctors more careful about what they prescribe for pain now because of that experience?

JON HALLBERG: Yeah, absolutely. And let me say this, too. So I'm a primary care physician. I have a thousand patients in my particular practice. I've had some folks who are on opioids every day. Have been. Major spine surgery. A variety of conditions. Things that are not surgically correctable. There are people out there who have chronic pain.

So I just want to say that this is a mainstay of therapy. And those patients, they're basically doing well. They're productive. They're working. They're not pain free, but they're doing OK. So I just need to say that. Because it's not like everyone who goes on OxyContin becomes addicted to it and abuses it. It's the stories we hear. And of course there are problems with it.

But yeah, we have become so much more careful. Dentists, surgeons are very careful after doing a procedure. You don't just prescribe 30 Vicodin tablets for a tooth extraction. That used to be the norm.

CATHY WURZER: Yes.

JON HALLBERG: No, 30 pills for something that should like maybe one pill, you know? Maybe Tylenol. Maybe ibuprofen is all you need to take care of that pain. So there's been a sea change of prescription habits. In the clinic, if I've got these people I described that were on this all the time, they have to sign a controlled substance agreement.

It's very clear about if you lose your prescription, we're not going to refill it. You have to wait a month. Or maybe we're going to cut you off entirely. You can't be sloppy with this. You can't lose your pills. They can't be dumped down the toilet by accident. The dog can't eat them. If there's a story, we've heard it. And so you can't do that.

We have people leave a urine sample. We check their urine. Not just to see, is there cocaine in the urine as well, but rather, is the opiate in the urine? So we want to make sure that they're actually taking it. That they're not diverting it. They're not selling it because these drugs have huge street value. And then we also make sure that in the chart we've diagnosed them as chronic continuous use of opioids. This is all considered part of an outpatient composite score for quality of clinic. So we're all following that, especially in primary care. So why are these numbers down? I think it's a ton of reasons. But it's all pointing in a good positive direction.

CATHY WURZER: Absolutely. We're going to switch gears. I bet you saw the New York Times reporting that MyChart-- of course, many folks are familiar with MyChart-- has this AI tool that doctors are using to send messages to patients. Are you using AI tools to communicate?

JON HALLBERG: Well, yes and no. So not this one. And I will just start by saying that I tell my colleagues, I tell patients this sometimes, I think I'm a little bit like Jacob Marley in A Christmas Carol. I am not dead. I'm not floating through the afterworld. But he points out that he is carrying behind him all these chains and coin boxes, the chains that he forged in life.

I think as a primary care physician, I feel a little bit like that with open charts and MyChart messages I haven't responded to and lab results. I mean, it never ends. And my better days, I think if I use Greek mythology, it's Sisyphus. It's like rolling the thing up. The next day, it's rolled right back down.

And I also think of a state fair metaphor. I think of Whac-A-Mole. I can literally sit at my computer, and I can have it completely empty. And if I just sat there every minute, something's going to pop in. And then I'm taking care of it. I mean, it never, never ends. So I can see why AI is looking like a little bit of salvation for some of that. If we had the ability to auto generate a response, that's pretty cool. But we're not doing that yet. I'm not doing that yet. And I personalize my messages so much, I can't quite imagine using an AI response. But boy, that's tempting.

CATHY WURZER: Well, I mean, do you think that this might take off in other clinics?

JON HALLBERG: Well, so it's in its infancy. It's not like we're starting over, like remember when the internet was new. I mean, I'm old enough that when I started medicine, I had manila folders with notes that were sometimes handwritten or you'd dictate into a phone and then somebody would print off and you'd take this big sticker and you'd peel off the back and stick it on a piece of paper. I mean, it's just amazing what's happened in the last 25, 30 years.

So I think that we are on the cusp of something big. The AI that a lot of my colleagues are starting to experiment with is note generation. So when you're talking to the doctor, they're using your phone and using an app. And it's generating the note as you're talking.

CATHY WURZER: So it's to have a scribe-- because, of course, there's people who are scribes as well.

JON HALLBERG: That's one option. And I've used that. But otherwise, what I do is I talk into my phone later as a voice recognition software. Dragon is what I use. And it populates a note. But it's me, I have to do that. But this software, it's pretty amazing. It actually records the visit in real time. I mean, there's some glitches. But that could be something that I don't want to say saves primary care, but it could be a huge benefit.

But some people, and I understand why, are a little reluctant to think that, that phone, your phone on the table right now, is recording our conversation. Where is that going? I mean, and we have to explain why it's a good thing and why it's very safe and it's actually secure and it's not recording personal health information, that kind of thing. It's not recording your name or your date of birth or your medical record number or insurance information. But still, it's a leap of faith to allow that to happen. But it's an evolution. And I think this is the way things are headed.

CATHY WURZER: Where else is AI being used in the clinic?

JON HALLBERG: Well, in the clinic thing, so between documenting the note, some responses out. I think that my other colleagues, like in pathology and radiology, they're starting to use AI GI to help with detection of things. Cells under the microscope, or what is that I'm looking at? And plugging all this data in and happening instantaneously. Coming up with better diagnoses or honing in diagnoses. So it's a brave new world with that right now is where it will be in the future.

CATHY WURZER: But medicine is still a human science, right? I mean, you still have to have that human touch. I wonder about that.

JON HALLBERG: Yeah, I personally do not have any worry about us as physicians, as health care workers in various capacities. Everything from something mundane, like drawing blood, it needs a person to do that. You need a person to do that. And to take that physically, to take that vial and process it and send it off. Two more obvious things. Like, I mean, I can't tell you how many patients come to my office petrified by what they've been reading online.

And I challenge any AI system to provide context and fear reduction and wisdom than an actual person can do. So I think we've got good job satisfaction. Even surgeons. People have a hernia repair. That's done robotically with the Da Vinci. Right, robotically assisted surgery. It sounds like a robot is doing it. It's not a robot. It's the doctor, but using this really interesting, minimally invasive way to do something.

Sounds really high tech. It is high tech, but it's still a person behind that. It's not like you just go into some room and this robot's doing the surgery automatically. It's a person involved. So I think it's going to be a blend. I think some of the mundane things that really burden us, boy, if AI could help offload some of that, that would be great.

CATHY WURZER: It's always fun talking to you. Thank you so much.

JON HALLBERG: My pleasure.

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CATHY WURZER: Dr. Jon Hallberg is a family medicine physician at Mills City Clinic and a professor at the University of Minnesota Medical School.