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Background: Creating clinical vignettes requires considerable effort. Recent developments in generative artificial intelligence (AI) for natural language processing have been remarkable and may allow for the easy and immediate creation of diverse clinical vignettes., Objective: In this study, we evaluated the medical accuracy and grammatical correctness of AI-generated clinical vignettes in Japanese and verified their usefulness., Methods: Clinical vignettes were created using the generative AI model GPT-4-0613. The input prompts for the clinical vignettes specified the following seven elements: (1) age, (2) sex, (3) chief complaint and time course since onset, (4) physical findings, (5) examination results, (6) diagnosis, and (7) treatment course. The list of diseases integrated into the vignettes was based on 202 cases considered in the management of diseases and symptoms in Japan's Primary Care Physicians Training Program. The clinical vignettes were evaluated for medical and Japanese-language accuracy by three physicians using a five-point scale. A total score of 13 points or above was defined as "sufficiently beneficial and immediately usable with minor revisions," a score between 10 and 12 points was defined as "partly insufficient and in need of modifications," and a score of 9 points or below was defined as "insufficient.", Results: Regarding medical accuracy, of the 202 clinical vignettes, 118 scored 13 points or above, 78 scored between 10 and 12 points, and 6 scored 9 points or below. Regarding Japanese-language accuracy, 142 vignettes scored 13 points or above, 56 scored between 10 and 12 points, and 4 scored 9 points or below. Overall, 97% (196/202) of vignettes were available with some modifications., Conclusion: Overall, 97% of the clinical vignettes proved practically useful, based on confirmation and revision by Japanese medical physicians. Given the significant effort required by physicians to create vignettes without AI, using GPT is expected to greatly optimize this process., (© 2024. The Author(s).)

Background: Physicians frequently experience patients as difficult. Our study explores whether more empathetic physicians experience fewer patient encounters as difficult., Objective: To investigate the association between physician empathy and difficult patient encounters (DPEs)., Design: Cross-sectional study., Participants: Participants were 18 generalist physicians with 3-8 years of experience. The investigation was conducted from August-September 2018 and April-May 2019 at six healthcare facilities., Main Measures: Based on the Jefferson Scale of Empathy (JSE) scores, we classified physicians into low and high empathy groups. The physicians completed the Difficult Doctor-Patient Relationship Questionnaire-10 (DDPRQ-10) after each patient visit. Scores ≥ 31 on the DDPRQ-10 indicated DPEs. We implemented multilevel mixed-effects logistic regression models to examine the association between physicians' empathy and DPE, adjusting for patient-level covariates (age, sex, history of mental disorders) and with physician-level clustering., Key Results: The median JSE score was 114 (range: 96-126), and physicians with JSE scores 96-113 and 114-126 were assigned to low and high empathy groups, respectively (n = 8 and 10 each); 240 and 344 patients were examined by physicians in the low and high empathy groups, respectively. Among low empathy physicians, 23% of encounters were considered difficulty, compared to 11% among high empathy groups (OR: 0.37; 95% CI = 0.19-0.72, p = 0.004). JSE scores and DDPRQ-10 scores were negatively correlated (r = -0.22, p < 0.01)., Conclusion: Empathetic physicians were less likely to experience encounters as difficult. Empathy appears to be an important component of physician perception of encounter difficulty., (© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Competing Interests: Statement The authors declare that they do not have a conflict of interest.

Competing Interests: The authors declare that they do not have a conflict of interest.

Competing Interests: The authors declare that they do not have a conflict of interest.

A 72-year-old woman was referred for a 15-year history of brief attacks of generalized weakness that occurred when she was tense or startled. During these episodes, she squatted, closed her eyes, and had difficulty speaking, but there was no disturbance of consciousness. The cerebrospinal fluid level of orexin/hypocretin was low (92 ng/L), leading to a diagnosis of narcolepsy with cataplexy according to the International Classification of Sleep Disorders (ICSD)-2 criteria. Cataplexy should be considered for sudden attacks of weakness lasting less than 2 minutes and with no alteration of consciousness. Measurement of cerebrospinal fluid levels of orexin/hypocretin is recommended when the diagnosis is uncertain.