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Adam Rodman Profile picture
Adam Rodman
@AdamRodmanMD
Physician, educator, historian, author, podcaster, researcher @BIDMC_IM @HarvardMed, host of #histmed podcast @BedsideRounds, AE @NEJM_AI, studies 🤖+🧠. 🖖🚲
4 subscribers
May 20 • 23 tweets • 6 min read
Huge update to our preprint today on the superhuman performance of reasoning models in medical diagnosis!

TL;DR – they don't just surpass humans in meaningful benchmarks, but in actual medical care from unstructured clinical data:

A 🧵⬇️:

Some context: like many researchers, we were gob smacked by the performance of o1-preview on our private and VERY difficult benchmarks, eg the complex cases we used in our RCTs in @NatureMedicine and @JAMANetworkOpen, outperforming GPT-4, GPT-4 w/ humans, and humans alone. Image
Feb 8 • 19 tweets • 5 min read
There is a lot of buzz about our new paper in Nature Medicine on the effects of LLMs (GPT-4) on physician management reasoning! I had TONS of fun working on this -- but what it MEANS requires some unpacking.

A 🧵⬇️
First, the main result: GPT-4 DID improve physician medical management in complex cases with no right answers (though not above the performance of the LLM by itself). Image
Dec 17, 2024 • 17 tweets • 6 min read
Preprint out today that tests o1-preview's medical reasoning experiments against a baseline of 100s of clinicians.

In this case the title says it all:

Superhuman performance of a large language model on the reasoning tasks of a physician

Link:

A 🧵⬇️arxiv.org/abs/2412.10849 This is the FIRST TIME I have promoted one of our preprints (rather than the full peer-reviewed study) so caveat emptor. But I truly think our results have implications for medical practice so I wanted to get them out as quickly as possible.
Jun 16, 2023 • 30 tweets • 13 min read
Can GPT-4 solve really hard medical cases and come up with a good list of differential diagnoses?

@zahirkanjee @byrondcrowe and my study is out in @JAMA_current , and the short answer is, “Yes.”

But what does this all mean? 🧵⬇️ First, the topline results – in running all of the post-2021 published @NEJM clinicopathologic conferences, ChatGPT got the final diagnosis in 39% of cases, and had the final diagnosis in its differential in 64% of cases.
Nov 14, 2022 • 16 tweets • 5 min read
Since my thread on the historicity of the exam can gained some traction, here's a reading list if you're interested in gaining perspective on the nature of clinical reasoning -- rather than "just so" stories about imagined halcyon pasts (the era of "the Giants") First a beautiful essay by Faith Fitzgerald (it's only two pages): bumc.bu.edu/facdev-medicin…

"What does curiosity have to do with the humanistic practice of medicine? Couldn’t it just convert
patients into objects of analysis? I believe that it is
curiosity that converts strangers
Nov 13, 2022 • 10 tweets • 2 min read
So many arguments about what's wrong with medicine today are predicated on imagined (and inaccurate) histories. Let's take some examples from my colleagues who imagine a "golden" age of the exam: The physical exam is barely older than modern diagnostic tests. For example, the neurological exam was developed in the 1890s, the same time as the x-ray. We were ALREADY performing blood spears and gram stains and checking hematocrits when the neurological exam was developed.
Jul 28, 2022 • 4 tweets • 3 min read
I want to keep highlighting some of the amazing speakers we have at the @iMedEducation #DigitalEducation2022 conference, held virtually on October 7th, and in person in Boston on October 8th!

Next up -- @AshleyGWinter!

cmecatalog.hms.harvard.edu/digital-educat… Everyone has a professional or educational message that we want to get out to the world.

@AshleyGWinter is an expert at education and advocacy for sexual health and sexual medicine. She is going to be sharing her insights about this journey for all of us!
May 12, 2022 • 15 tweets • 8 min read
Why are medical podcasts like @thecurbsiders, @BehindTheKnife, @emcrit, and @AFPpodcast so popular for learning? And who is making them? And can they be trusted?

We listened to (and coded) the top 100 podcasts on the Apple podcasts US medicine chart to find out!

A 🧵⬇️ Image There were 2⃣ inspirations for this study.

@ShreyaTrivediMD and I at @iMedEducation think that what makes digital education unique from eg an uploaded lecture on YouTube is that that it is produced as part of a virtual community of practice and not traditional institutions. Image
Aug 24, 2021 • 25 tweets • 9 min read
Almost exactly a year ago, I had a modestly controversial tweet about routine daily physical exams -- and about how we should probably spend more time actually talking to our patients daily rather than pretending to examine then.

Well, now that angry tweet is a point-counterpoint-rebuttal series in @JHospMedicine!

The first piece is by me and @ShaneWarnockMD, and I cut right to the point: Routine daily physical exams in hospitalized patients are a waste of time.

🧵⬇️

or
journalofhospitalmedicine.com/jhospmed/artic…
Jul 17, 2021 • 10 tweets • 6 min read
My (preaching to the choir) 🔥 take: digital educational skills -- whether teaching on #MedTwitter, podcasting, or making videos -- are essential #meded skills for the 21st century. And we can teach these to future educators.

A Tweetorial🧵: Last year, @ShreyaTrivediMD @StaciSaundersMD and I at @iMedEducation started a curriculum to teach digital educational skills to our @BIDMC_IM residents.

We just published this article going over our curriculum and providing tips for you to do it too: pubmed.ncbi.nlm.nih.gov/34013623/
Dec 17, 2020 • 10 tweets • 3 min read
A proposal!

Are you:

✅A listener of @BedsideRounds?
✅A medical student at a US or Canadian medical school?
✅Interested in medical history, philosophy, and epistemology?

And then question 2:

✅Do you want to collaborate on a research project?

If so, 🧵⬇️ Image First, some details! Over the past six years, I've made a lot of podcasts (some of them better than others), and I know they're being used for teaching at medical schools across the country.
Aug 14, 2020 • 26 tweets • 10 min read
Why do we use godawful blue-background-with-bright-yellow-text for medical school lectures?

A 🧵on magic lanterns, darkrooms, path dependence, and “things we do for no reason”

👇 Image Projecting images is quite old, dating back to the 18th century with images painted directly on glass plates -- a magic lantern. During the Spanish Flu, the Surgeon General toured with a magic lantern with information on the pandemic. Image
May 30, 2020 • 9 tweets • 4 min read
@COREIMpodcast Interesting thread, though some very common misconceptions about "primum non nocere" are present here. First do no harm is not in the Hippocratic Oath at all, and the "non-malfeasance" present in oath would likely make most modern doctors squeamish. @COREIMpodcast It has diktats against performing abortion, and against physician-assisted suicide. Even the commonly cited "do not cut for stone" isn't because of preventing harm, but suggesting that a lithotomist do it.

(good translation here: nlm.nih.gov/hmd/greek/gree…)
May 13, 2019 • 31 tweets • 15 min read
It’s time for another #histmed Tweetorial -- this time I'm going to talk about the pesky definition of a fever, and where the 98.6 F average body temp came from!

Full disclosure: will use C AND F for temp, but no K or R. FYI this is a complementary Tweetorial to @tony_breu's amazing one on why we have night sweats
Jan 12, 2019 • 22 tweets • 7 min read
It's time for me to channel my inner @tony_breu -- which means it's Tweetorial time!

So let's talk about azotemia (elevated blood urea nitrogen) after an upper gastrointestinal bleed! It’s a well-known phenomenon on the medical wards that after an upper gastrointestinal bleed, the blood urea nitrogen will rise considerably more than the creatinine. In fact, it’s a common teaching “pearl”
Sep 12, 2018 • 27 tweets • 6 min read
Time for a Tweetorial! Though this will only be partially #histmed and mostly about philosophy. Inspired by @chrischiu -- so let’s talk about Occam’s Razor and Hickam’s Dictum! But before we get going, let’s start with a little pre-test. Case #1. A young man presents with acute onset of severe fevers and chills, rhinorrhea, headache, confusion, and neck stiffness. What does he have?
Aug 23, 2018 • 47 tweets • 11 min read
Hey #medtwitter, it’s time for another #histmed #FOAMed Tweetorial! I’m giving a couple of lectures this fall, and in the spirit of #FOAM I’m going to (try my best) to do a Tweetorial for each, so anyone can benefit/watch me flounder/vehemently disagree with me. So thank you to @BostonChiefs, and let's talk about semiotics and the development of the physical exam!