The Role of AI in the Orthopedic Surgery Practice

Summary

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The Role of AI in the Orthopedic Surgery Practice

Podcast: The AOFAS Orthopod-Cast
Date: February 25, 2026
Episode Theme:
Exploring the practical integration, opportunities, and ethical challenges of artificial intelligence (AI) in modern orthopedic surgery practices, especially in foot and ankle care. The episode brings together several leading surgeons at the AOFAS summer meeting to discuss AI’s impact on clinical efficiency, documentation, patient communication, medical-legal considerations, training, and the future of the profession.

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Main Discussion Points

1. How AI is Currently Used in Orthopedic Practices

• Clinical Documentation and Note Generation:
  • Many surgeons are using AI, often paired with a scribe, to produce clinic notes.
  • AI-generated notes are reviewed for accuracy before signing; this minimizes clerical burden.
  • Some systems automatically transcribe and structure physical exam findings based on spoken dialogue.
• Letters of Recommendation & Administrative Tasks:
  • AI is widely used to draft letters for residency, fellowship recommendations, and promotion.
  • Dr. Joe emphasized the importance of reviewing and personalizing AI-generated letters:
    "I think it's fine for AI to generate the letter, but you've got to review and agree with all the content." (01:32)
• Patient Education:
  • AI-generated patient-facing materials are being explored, though integration remains tentative.
• Surgical Documentation & Coding:
  • AI helps optimize operation notes to ensure comprehensive and accurate coding for billing.
  • Dr. Anish Kadakia described dictating generalized op notes into his phone and using AI (e.g., ChatGPT) to structure them for maximal code clarity and efficiency (13:09).

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2. Medical-Legal, Consent, and Privacy Considerations

• Transparency and Oversight:
  • Disclosure to patients about AI-generated notes and recordings is increasingly common.
  • Concerns about oversight: Will transcripts be routinely retained? How long should these records be stored?
• State Laws & Written Consent:
  • In some states (e.g., Illinois), dual-party consent is legally required to record conversations.
    "Our system basically said you have to have a written consent. So legally you need to have a written consent of the patient in Illinois." – Dr. Anish Kadakia (05:22)
• Medical-Legal Documentation:
  • More comprehensive dialogue transcripts may help defend care quality in legal cases.

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3. Patient Reactions and Cultural Shifts

• Mixed Patient Acceptance:
  • Some patients are uncomfortable with full-transcript documentation or being recorded.
  • There are generational and privacy issues: not all patients are willing to have AI or audio involved.
  • Dr. Nick Strasser noted:
    "Some patients don't like it. Now we've been doing it long enough where I've had a couple patients say, I would prefer not to, you know, have the AI note. And... it captures everything." (04:46)
• Recording by Patients:
  • Surgeons report increasing incidents of patients recording (audio/video) without disclosure.
  • Surgeons generally support transparency but are wary of malice-driven recordings.

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4. Efficiency and Workflow Improvements

• Coding and Billing Optimization:
  • AI aids in separating operative note components, maximizing code capture, and aiding template reuse.
    "It makes sure that you separate deep incision, separate paragraphs so it's easier for your coders." – Dr. Anish Kadakia (14:33)
• Pre-Authorizations and Work Comp:
  • AI produces insurance-specific templates for pre-authorization and can generate work comp impairment ratings using standardized references.
• Patient Inquiries and Portal Messages:
  • AI provides more thorough, empathetic responses to patient portal messages than many physicians, which can enhance patient satisfaction (32:01).

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5. Training, Skills, and Generational Concerns

• Losing Documentation Skills & Critical Thought:
  • Worry over future trainees relying solely on AI without learning to synthesize clinical information, write notes, or craft letters.
  • Dr. Ben:
    "If you don't get the training, like writing a good letter, knowing good grammar and syntax, if you don't have that... that check, I'm not sure [future generations are] going to get that training." (22:14)
• Changes in Education:
  • Analogous to the shift from handwriting and manual typing to digital tools.
  • Incumbent on educators to ensure critical thinking and clinical synthesis skills are preserved.

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6. AI, Patient Empowerment, and Professional Identity

• Patients as Informed Consumers:
  • Tools like Grok and ChatGPT are used by patients to interpret MRIs, recommend surgeons, and suggest treatments.
  • Surgeons shared anecdotes about patients trusting AI over expert opinion, sometimes leading to contentious interactions.
  • Dr. Anish Kadakia:
    "That is the next level... Grok is interpreting their MRI, telling them what their diagnosis is… what the appropriate procedure is, and then telling them who the expert… is." (17:20)
• Erosion of Physician Authority:
  • Some panelists foresee a diminishment in the physician’s role as trusted information gatekeeper as AI becomes more competent and accessible.
  • Concerns about eventual reductions in compensation for consultative and diagnostic services as AI takes over non-procedural knowledge work (33:01).

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7. AI in Surgery and the Future of Practice

• Surgical Video and Data Collection:
  • Surgeons are beginning to record all surgeries for data analysis and AI learning/training purposes.
  • AI has already demonstrated proficiency in technical procedures (34:40).
• Potential for Robotic Surgical Automation:
  • Surgeons discuss the prospect of fully automated procedures and the impact on job security and training.
  • The near future likely brings further job stratification; technical procedural skills may remain the final domain exclusive to surgeons, but even these may eventually be challenged.

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8. Ethical and Societal Questions

• Loss of Human Touch:
  • Concerns about the loss of personal connection in patient care and professional camaraderie, driven by technology’s prevalence in daily life, especially for younger generations.
  • Discussion about the fading art of the personal letter, gratitude, and nuanced communication.
  • Dr. Ben:
    "If you get to the point where... everybody's using ChatGPT to write out your little rec, then you shouldn't have a letter of rec as part of what you need. Get rid of that." (24:30)
• Professional Adaptation:
  • The panel agrees adaptation is inevitable; AI will radically change the profession, but those who learn to use it to their advantage will thrive in the near term.

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Notable Quotes & Memorable Moments

• Dr. Anish Kadakia:

  "AI is like the computer, it's over. It's 100% going to impregnate every aspect of our life." (05:17)

• Dr. Nick Strasser:

  "What I like so much is it assigns… what is changing so much is billing and coding and using the correct language. And so that's what I've really liked it for..." (16:00)

• Dr. Joe:

  "I think the biggest thing that's been more accurate for me is my documentation about risk and benefits... I'd say one liner instead of, like, when you're having some major surgery… So I agree... the more I document that, the better it is." (09:24)

• Dr. Ben:

  "I'm afraid that the younger generation, if you don't get the training... if you just go automatically to this, that filter... I'm not sure they're going to get that training." (22:14)

• Dr. Eric Silverman:

  "They prefer the AI response because we answer quickly... Right. But instead it says all that. Well, thank you so much for reaching out. I appreciate your concern..." (32:01)

• Dr. Anish Kadakia:

  "Our value as physicians is going to diminish over the next 10 years. I hope you got jobs, but I, I, that's my real fear." (34:01)

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Key Timestamps

• [00:49] — Introduction to AI in orthopedic practice
• [01:11] — Practical AI uses: note generation, letters, patient education
• [02:33] — Medical-legal challenges and need for guardrails
• [03:53] — Transparency, dialogue transcription, and patient consent
• [05:17] — State laws about recording; consent requirements
• [12:48] — AI in surgical coding and operation notes
• [17:20] — Patients using AI (Grok) for medical interpretation
• [19:23] — AI’s role in work comp and impairment ratings
• [22:14] — Concerns over loss of critical documentation skills
• [24:30] — Ethical implications of AI-written letters/communications
• [32:01] — AI vs. human responses to patient inquiries
• [33:01] — Erosion of physician’s role as information gatekeeper
• [34:08] — Future of surgery and surgical data for AI learning

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Takeaways for Practice

• Adopt AI Early and Wisely: Using AI for documentation and coding leads to immediate workflow improvements but must be paired with critical review.
• Stay Vigilant about Privacy and Consent: Always adhere to legal requirements and maintain patient trust through transparency.
• Teach and Preserve Critical Skills: Ensure new trainees learn basic synthesis and communication, not just how to edit AI drafts.
• Prepare for Shifting Patient Expectations: Be ready for highly informed patients and more scrutiny regarding decision-making.
• Recognize the Direction of Change: The future will see more automation, with non-procedural roles shrinking and even procedural roles potentially threatened.
• Advocate for Appropriate Use: Look for opportunities to shape AI policy in healthcare to preserve quality and professional integrity.

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Final Thought

"Right now, it's definitely to our advantage. And there are real concerns in the next 10, 20 years that we are going to either be paid a lot less or we may be supplanted by some sort of machinery. But that's a worldwide concern." – Dr. Anish Kadakia (35:23)

The panel wraps up with a consensus that AI will transform orthopedic practice, and the profession must adapt urgently—using AI as a tool, not a replacement, while safeguarding the art, ethics, and value of surgical care.

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Transcript

[Dr. Anish Kadakia]

Welcome to AOFAS Ortho Podcast, where leaders in foot and ankle orthopedic surgery discuss the issues that affect you and your practice. Please note that the views expressed on

[Dr. Ben]

this podcast do not necessarily represent the

[Dr. Anish Kadakia]

views of the AOFAS or its members.

[Dr. Nick Strasser]

Welcome to the AOFAS Ortho Podcast. My name is Nick Strasser. I'm here with our esteemed committee members at the AOFAS summer meeting in Savannah, Georgia. I guess it's September now and, you know, we're talking about things that are maybe outside of specifics in foot and ankle and talking about some of the challenges we face in our everyday practice. And one of the things that I think has come up recently has been

[Dr. Anish Kadakia]

the role of AI.

[Dr. Nick Strasser]

And we know that's coming. It's changing medicine. And, you know, we're seeing it at least in my practice, where we're using some of the AI for notes generation. But I'm curious, you know, what you guys have seen in your practice. Do you use it? Is it something that you think is going to change the way you practice? So, Ben, are you using AI at all?

[Dr. Joe]

It's a. I'd break it down into three different areas. So one way I'm using it a lot is for letters of recommendation. So I've been doing that a lot. I've written it both for people going to residency for fellowship and also for people getting promotion. The way in which I do it is, let's say for promotion, that's probably one of the more difficult ones. I'll take the criteria, which generally published online. I'll take this criteria and I'll take their CV and I'll upload that together and say, how does that sort of match? And then please say these few things about them. And then I obviously review all the content, which I think is really important. I think it's fine for AI to generate the letter, but you've got to review and agree with all the content. And so I've done that again for those three areas. That's one which I found to be extremely helpful. Thing number two, that we use a combination of AI with an overlying scribe for our notes. So they use AI on the background. Then they have a human scribe that. That overreads it and then sort of corrects it, which is really nice for our notes. So our notes essentially come back completely done. I just have to review and sign them. They're good enough that my review is incredibly minimal because they do such a nice job. So that's one way to do it. And then they can know that you and I published a couple papers and Joe as well, looking at patient education, I would say I'm still trying to figure out how to integrate that into my practice. I think the AI does a pretty good job with it, but I can't decide if that's something I should be giving to patients or maybe just referring patients to that resource or what the best way to integrate that in my practice is. So I'd love to hear other people's thoughts on that, too.

[Dr. Eric Silverman]

I just had a conversation with a friend of mine who's big in the AI world, and he was saying that one of the big things that we have to start thinking about, not just in medicine in general, like, you have to have, you know, guardrails on the content because it's getting so much and being so voluminous that all of a sudden it can start creeping in on your stuff if you're not careful. So he said, you've got to have barriers around everything that you're doing. And the biggest question I kind of have about AI, and I think it's interesting, fascinating area, but, you know, where does it stand in the medical legal world? Like, you know, did you generate this node or did a computer generate your node? Like, right. So, I mean, that's something we haven't really kind of, I think, explored. I don't think it's really been looked at or challenged. So how that affects us in the future.

[Dr. Nick Strasser]

So we use it in our clinic notes. And I, you know, when I go in, I'll, you know, disclose to the patient, hey, I'm using my phone to take some notes. It's going to generate a note. And. And the thing that's interesting is it develops a transcript and medical legally. Now I'm wondering if we're going to get to a point where you almost need to have that level of oversight, I guess maybe, you know, so it's not just the note being generated from the AI program, but then you can also have access to the entire dialogue. Right? The patient, which is interesting. Interesting, yeah. I don't know. What do you guys think about that? Good idea, Bad idea, a little scary.

[Dr. Joe]

I actually like the dialogue because I feel like I talk to my patients, I do a good job, I'm thorough, I examine them, and I think more transparency is better. It's going to be hard to argue that I didn't see and examine a patient when I spent 10 minutes talking to them and examining them. And, you know, with my current system, I have to say my physical Examination out loud so they'll know exactly what I did and did not do. And I think it's gonna be hard to argue with that. Well, you did touch the patient. Well, actually I did because here's the transcript of my, you know, two minute physical examination. Everything that I did touch on the patient what they could and couldn't do. I sort of like it. I don't know what Joel's thoughts on it.

[Dr. Ben]

I think we sped up a little too fast and didn't have all the right. Like what was saying about the barriers placed. Like, I don't think we have anything oversight in terms of policies about consent, even though we say that is that adequate in a, you know, court of law about them actually giving consent in that way. And when you start having all these other documentations, how long do you keep them for?

[Dr. Nick Strasser]

Well, and some patients don't like it. Now we've been doing it long enough where I've had a couple patients say, I would prefer not to, you know, have the AI note. And I'm like, it's, you know, because it captures everything. And sometimes if I'm not really thorough in my editing because some of the stuff is just, you know, know doesn't need to be in the note, but it captures everything. And so I think sometimes they feel a little bit like, well, we talked about that confidentiality.

[Dr. Eric Silverman]

And so that's their concern.

[Dr. Nick Strasser]

Yeah, that's their concern. And so it's kind of like I'm not sure what the right answer is. And some of this stuff. What do you think? You got an opinion on this? I'm sure.

[Dr. Anish Kadakia]

Oh, I always have an opinion. I think, you know, AI is like it or not, it's like the computer, it's over. It's 100% going to impregnate every aspect of our life. So we've, you know, my, my partner and I, we jump on things and so our system has jumped on it. Some patients don't like it. They're not going to have a choice in a few years. Easy. Our system basically said you have to have a written consent. So legally you need to have a written consent of the patient in Illinois. So every state is different. It's like in Illinois, you're not allowed to record a conversation unless both parties consent. I know it's a state, by state law in Illinois, you have to have consent. So we have a written consent. Most good AI apps, if you use them, will have a physical consent thing that the patient should click or you click in lieu of the patient. I consent Then it's a physical consent form or electronic version of it with regards to the transcript. Although it exists, it doesn't exist forever. So you know, I know a lot of this stuff. And so it's all about how much data are you willing to pay for. So most will keep the transcript for 90 days. If so medical legally. I think it's very curious. I think it's good. I do, I do a lot of med mal and expert witness testimony in general. The more the merrier for us on our side to mitigate loss. The more the merrier. It's always not in our interest to have less. So all of this stuff we worry about, med mal, how's it going to affect us? Unless you're doing some crazy stuff or you literally never touch the patient, it's always in your best interest to have more. But really what fundamentally is the only thing that's kept is the final thing. They're not going to keep transcripts. It's expensive as heck. Too expensive.

[Dr. Joe]

Yeah.

[Dr. Anish Kadakia]

So you're not going to get to keep those. You're going to get to keep the bottom, the end transcript, the note. And I actually think overall the notes are way better because patients are looking at all our notes and a lot of the confusion we get of like, well, that's not what I said. I fell 15ft from this and all that's not an issue anymore. So I think it's, you know, there's a different versions that are out there. Multiple apps that exist are going to keep coming and you either have to accept AI or you're done. Yeah.

[Dr. Nick Strasser]

So then along the question of recording conversations, how many of you have had patients recording conversations when they're like, hey. And sometimes they don't tell you, you just all of a sudden I kind of look down, I'm like, oh, they're recording this. Yeah. How do you all manage that? It's a little bit of an offshoot, but somewhat related.

[Dr. Eric Silverman]

Yeah, I think, I mean, I think this, they're right. I don't have a problem with it that they report me. I mean I'd prefer if they disclosed it so that way I can be as clear as possible.

[Dr. Nick Strasser]

Because ultimately you don't swear, that's why.

[Dr. Anish Kadakia]

Right?

[Dr. Eric Silverman]

I never swear, but yeah, well, no, actually if they're reporting it, their hurts and. Right. But like, hey, I'm just doing this because I want to remind myself that's great.

[Dr. Nick Strasser]

I think that's wonderful because they, I mean they forget a lot.

[Dr. Joe]

Right?

[Dr. Anish Kadakia]

They do.

[Dr. Eric Silverman]

And we know that that data's out there. Right. Like, they don't remember. Nine shows up. We say to them, so I think that's great. You know, the red flag would be if somebody's doing this without my knowledge, and like, they're basically just trying to set me up for something. And it could be like, whatever, like malice, which I don't like that idea.

[Dr. Joe]

Yeah.

[Dr. Eric Silverman]

But I don't have any issues with it. And, you know, I even tell them sometimes, especially if it's like, maybe a college kid and they're, you know, not with their family and family can't get there. And I said, well, you put mom on the phone or down the phone over here. Let's record this. Yeah, go and let them listen to it. So they have some connection there too. Because I get it, you know, kids awake moment. You know, it's a scary situation.

[Dr. Joe]

So.

[Dr. Anish Kadakia]

Yep.

[Dr. Joel]

I think one thing I've seen is sometimes you'll see a patient who's had surgery elsewhere, and then they're seeing you as a second opinion. And they want this recording as like, documentation of how bad the last surgery was. And for that, I tell them I'm still comfortable doing that. And I always try to go back to the fact that, you know, this visit is about your problem. It's not. I'm not going to be your expert witness. I'm your provider and, you know, if you want my help, that's fine. But, you know, I think coming in and saying I'm recording this because I right upset about my last outcome, I think that puts us. Puts us in a difficult position.

[Dr. Eric Silverman]

It's a very challenging position because now you're on record and like, if that comes up later, I mean, something happens.

[Dr. Joe]

Yeah. My thought is I'm recording you so you can record me as part of it. So I never mind. When the patients do it, I think their intent is sometimes different. Like, my intent is to make my documentation actually more accurate. I totally agree with that. I think the biggest thing that's been more accurate for me is my documentation about risk and benefits. Because, I mean, for me, when I was dictating it, I'd say I discussed thoroughly the risk, benefits, alternative surgery, and patient. Agreed. And all the questions for their satisfaction. Right. I'd say one liner instead of, like, when you're having some major surgery or revision. I tell you about all the risks that I think and what the percentage are and the chances. So I agree with. With what Anish was saying. I think the more I document that, the better it is. The thing that I curious if you guys Have a different thought. On is video recording. So what I. Audio, I never have a problem with personally, because I figure I've recorded you record. What I see is a patient's family where they're holding their phone up, you know, with the camera on, like, pretty. They're recording everything I'm doing. You know, if you guys have that. I mean, I definitely have. I can just tell.

[Dr. Nick Strasser]

Pretty sure, yeah.

[Dr. Joe]

That I'm 90%. Well sure. That that's what's happening and that they're video recording.

[Dr. Anish Kadakia]

I've never had that in Illinois. It's illegal. And I would tell them, put the phone down and get out of the office. Because in our state, you can't do that.

[Dr. Joe]

So it's video or audio?

[Dr. Anish Kadakia]

Either one. Video comes with audio. Obviously, you're not allowed to report someone without their consent in the law. So if somebody's doing some unusual stuff, I asked who's on the phone? I'm not doing that. And they're like. But I'm like, we're not doing that. I'm just going to do this conversation. If you have to have that, you can find another doctor. Because if they ask you up front, that's a different discussion. When they say, hey, can I report for my parents or my wife or husband? I'm like, yeah, whatever, I don't care. Or can they be on the phone with us? No problem. And I tell them, though, you're not allowed to ask questions because I don't do questions from the person out there. I said, you're happy to sit, but I'm not gonna answer any questions. And the video thing, I'm like, you need to get out. And I've had it once or twice. I've had to do some weird. We're not doing this. We're done. Because it comes from a place of malcontent maliciousness. And I don't. We're not here to do that.

[Dr. Joe]

If you guys.

[Dr. Ben]

I mean, I've had patients who ask who. It's more just like the younger generations who want to then post it on Instagram or TikTok or something. They want to have their sutures taken

[Dr. Joe]

out or they're in further.

[Dr. Ben]

It's like, just. Don't include me. You can just have your leg. But like, they find that fascinating. But they.

[Dr. Anish Kadakia]

They ask.

[Dr. Ben]

Yes, that's always fine. I agree with Anish.

[Dr. Anish Kadakia]

Pictures with me and all that stuff. I'm like, that's. I don't lie. They take a picture with me. You're telling me it's okay.

[Dr. Joe]

I'VE definitely had patients that or patients family members that have. I could tell that they're video. I've actually seen it. So I know similar. I mean they're holding the phone like this a couple times I've looked around and see that they're video recording me holding the phone. Like this is natural. Yeah, you're right. Correct. I mean you can tell.

[Dr. Eric Silverman]

No, I'm not recording.

[Dr. Anish Kadakia]

For those in the audience are holding the phone like bend not straight.

[Dr. Joel]

Sometimes I'll use video. Like if I'm putting on a particular like bunion dressing or turf toe taping or something, I think it can be helpful. But again it's under a different context where we're trying to leave something as a record for education.

[Dr. Eric Silverman]

Right. Which I think is positive.

[Dr. Joe]

Yeah.

[Dr. Anish Kadakia]

I don't honestly know.

[Dr. Eric Silverman]

I mean now that you say that

[Dr. Anish Kadakia]

it's kind of freaked me out a little bit.

[Dr. Eric Silverman]

It's like maybe it has been done. I didn't even notice. Like I don't.

[Dr. Joe]

That's.

[Dr. Eric Silverman]

Hey, that's creepy to me.

[Dr. Anish Kadakia]

X me, I'm fine. But

[Dr. Eric Silverman]

you're staring at my window at night or something.

[Dr. Nick Strasser]

What about. All right, so going back to the AI conversation. What about AI and the role of surgery coding? What do you all think about that?

[Dr. Anish Kadakia]

It's amazing. I mean I can. I. I use it curiosity to help me do my coding and then I'll have to dig bit on my own again.

[Dr. Nick Strasser]

So how do you, how do you do it logistically?

[Dr. Anish Kadakia]

So I have, I made a chart of like a word document of like what I want the op note to say and I tell it to maximize coding and then I'll dictate with no patient name. Just like you know.

[Dr. Nick Strasser]

And you're doing this just into like a general.

[Dr. Anish Kadakia]

Into my phone?

[Dr. Nick Strasser]

Into your phone.

[Dr. Anish Kadakia]

My phone by definition is secure because it doesn't go anywhere.

[Dr. Eric Silverman]

This is probably just making macros for yourself.

[Dr. Anish Kadakia]

So the word documents I generalize. You know, put the date and then I want. I'm going to have and as I've messed with it over the last few months and so you kind of keep tweaking it. You're telling what ChatGPT to do and I just dictate the OP mode into my phone. But it's more general now like okay, left side standard pre op stuff. Page taken back. Left side was done. Incisions was made. Usual structures were avoided. I did a brass from standard technique using an internal brace. Use your data to identify the exact technique of the internal brace. Sulfur 475, 375, two knotless fiber attacks. Secondary reconstruction oscill was removed greater than 1cm. And everything is already said that it should be in separate paragraphs. They can put codes and we don't put codes in. But I've had to do that out of curiosity. It will separate everything out, maximize your coding. You have to mess with it over and over and over. And then you just then cut and paste and throw it in your chart.

[Dr. Joe]

Yeah.

[Dr. Anish Kadakia]

It's comical. Yeah. How good it can be. It doesn't mean you can't just be like left Achilles rupture. But if you start getting good@n ChatGPT and Gemini, there's multiple versions out there. We'll start remembering a little bit. You just have to be careful. You can't use patient names. You can make it general, but if you're talking into the chart, it's that patient. So it doesn't. You don't need to dictate a name.

[Dr. Joe]

Yeah.

[Dr. Anish Kadakia]

Or you can just type it in at the end. And it's unbelievable. Now, I'm sure insurance will go back. They have their own AI that will kick half the coats off. But it's. You actually get more because what it does, it makes sure that you separate deep incision, separate paragraphs so it's easier for your coders. And they'll be appetite that will do this for you quickly. I mean, these are all things that are going to go down. Hospitals are going to want it because they want to grab as much as they can.

[Dr. Joe]

So what did that. I mean, you know a lot about coding, which why you're able to make the PARF work. So I would ask, why were you doing all that work? How's it getting you more codes?

[Dr. Anish Kadakia]

Because I would dictate it all. Then it would depend on the transcriptionist to put the paragraphs exactly where I want it.

[Dr. Joe]

You don't say any paragraphs.

[Dr. Anish Kadakia]

I do. I'm going to be surprised. Like, they should do like eight. You do four. Told you. Okay. Separate and separate. And you just get tired. Some days you've done like eight cases. You're like, yeah, just, you know, we did hammer toe 2 through 5. Same thing over and over. And they'll be like, this would be like three. This comes out like a little bit less ideal than you want because, you know, I get tired at the end of the day. I'm sure like Everybody. And what ChatGPT does is make sure that it's separated and it as it gets smarter. I mean, right now we're on chat GPT5 it was 3.5 like a year ago. It's going to go rapidly, fast. The leap frog is like 6% more intelligent. Was last time. It's going to go fast. Where you. This is going to go down so fast in the next couple of years that you only had chat to be 7, 8. You'd be like left Achilles after speed bridge done. I guarantee it'll pop the thing out.

[Dr. Nick Strasser]

Yeah, I've done the same thing where I use it for that purpose, almost exactly the same. And what I like so much is it assigns. You know, what we don't get trained on a lot of times is the language. And what is changing so much is billing and coding and using the correct language. And so that's what I've really liked it for is I can basically dictate, like I'm almost like doing an op note into it. And then it just, it's very generic, but it kicks out an example. And then in some of the charts you can just turn that into a saved document or a saved, you know, template that you could use in the future as well. So it's, it's really valuable for that.

[Dr. Anish Kadakia]

I think as surgeons, we are in general, in medicine as very lazy. Yeah, he's scared of tech. So we're late adopters. If you look at like tech people and medicine, medicine is a late adoption system because so much risk, big heavy thing to move. Your system's not going to suddenly jump to anything new. But AI is definitely. It is what it is. You like it or not. I don't think anybody cares anymore. It's coming either. You learn it, use it to your advantage. You're going to fall behind really fast. Like my notes, I see 42 people, clinic ends at 1:30. I walk out the door. Now, I usually BS and do nonsense, but what I don't do is dictate anything anymore. And they're going to. I mean, well, we have other things about AI to talk to, but it is. I've had one person already and I just threw him out of my office. He's like, well, Grok said. And I just yell like, Grok said my MRI report. And I was like, look, dude, you can have Grok do your surgery. Don't. Don't ever ask me about AI again. He's. Then he emailed the team again. I said, Grok said, this person's the best in the country. I'm like, side again. I'm not operating and you're seeing you again. Go to that person. But that is the next level of you thought Google was bad? Grok is interpreting their mri, telling them what their diagnosis is and all of them do the same thing. Telling them what the appropriate procedure is and then telling them who the expert of the country is. You can even grok anything should grok right now.

[Dr. Joe]

I am groing right now. Who's the best foot and ankle surgeon in the country.

[Dr. Anish Kadakia]

I'll let you know my name. 37 does not show up so. But it's a headache which I think we can talk about too. But I just got angry which might not the best response. Yeah, that was my response. That's your response too I realize. I think, I think we're going to see this a lot more.

[Dr. Nick Strasser]

Yeah, I think you're right Grok. Joe, any thoughts?

[Dr. Joel]

I think one thing you could help us with is maybe pre authorizations making sure that our notes are effective to get things pre approved because that's becoming harder and harder.

[Dr. Joe]

Yes.

[Dr. Anish Kadakia]

So like Total ankles for example we got Blue Cross has been a real pain in the rear for us kicking out post op. So what I did was I went to Blue Cross's website. I got the indication for total ankle what their demands are. It's nonsense. So then we do all these things right? Patients will have like I saw someone four years ago had injection, had a bricks but they may not have had it. I my visit. I didn't order everything on my visit. So I told the I need a template. Every time we see a patient and they want a total ankle before we get the surgery my team does a telephone note, we kick in. I told the I need this to make sure we get approved based on this criteria. He made a beautiful note. We just throw it into the chart so they can't deny it. They weren't.

[Dr. Joe]

I'm going to get back to you. I'm going to get back to you what Grog said. So I'm going to summarize this. No single surgeons at best they led to Castle Connelly, AOFAS US News and World Report which ranks HSS number one the top regarded foot necklace number one Jonathan deland number two David Thor Arts and number three Michael Coughlin number four Tom Clanton. I think both of them are retired. Trinity Bombheimer is number five, John Kennedy is six and Dracos is number seven. There you go. They've got some other notable specialists here is Cardi B there Cardi B is not A Michael Klein, Dr. Eric Silverman. There you go. So that would be the Grok list so you can refer to any of those two of the top seven are. Here's the list.

[Dr. Anish Kadakia]

None of them are on this podcast. I think as a society, you know, we had a little AI session today, but, you know, and we have to adopt it and get used to it and learn to deal with it.

[Dr. Nick Strasser]

One other area that I've used it has been work comp. I don't know if you all deal with work comp, but you know, that kind of final rate and release form that they want. And it's actually fairly surprising when I put into that, you know, what my last note said in terms of their limitations when they're maximally or MMI and those kinds of things. It does a pretty good job of showing not only the calculation, but putting the exact chart that it used to do it and it'll reference the appropriate book. I don't know. Have you anybody tried that?

[Dr. Joe]

That's a great. I. I send everybody for functional capacity evaluation with rating recommendations. It sort of does the therapist only for. But I didn't. That's a great. It is. It's also great for law work. Just on a side note, if you need like, like legal stuff done. But this sort of that right. There's a published book. It's going to reference a published book and give you that information events.

[Dr. Anish Kadakia]

If you do right. You do an ime.

[Dr. Joe]

Yep.

[Dr. Anish Kadakia]

They will ask you sometimes I don't. I'm not certified to do ratings, but I don't want to deal with it. But you do the IME. Plug the whole thing into ChatGPT as you've dictated it and it'll make it all pretty for you. We'll ask you at the end of it as if you use ChatGPT. Would you like to do an AMA impairment rating?

[Dr. Joe]

Sure.

[Dr. Anish Kadakia]

Out of curiosity. I did that. It does a beautiful.

[Dr. Nick Strasser]

It was. It's pretty good.

[Dr. Anish Kadakia]

And you're like, yeah. Huh. You're not making it up, you're just inputting it. You just don't have to do the math for it and all the heavy

[Dr. Nick Strasser]

flip through the book and like the whole thing. But I do recommend. I'm going to say that with all of these things, like you. It's not like you just were just using it and blindly using it and we're checking over. It's helping improve our flow, our workflow. But you still have to double check and make sure that what it's giving you is accurate.

[Dr. Anish Kadakia]

There is garbage in, garbage out, garbage in, garbage out. I think we talked about it today. Like it'll start making stuff up.

[Dr. Joe]

Yes.

[Dr. Anish Kadakia]

You say, give me the Literature on this, they'll have to lay it on and it's getting better, but it will make stuff up.

[Dr. Ben]

I think the big concern for us though, like at least our generation, our training and the years above us, we have that ability to check in.

[Dr. Nick Strasser]

Yes.

[Dr. Ben]

But I'm afraid that the younger generation, if you don't get the training, like writing a good letter, knowing good grammar and syntax, if you don't have that and you just go automatically to this, that filter and that, like that check, I'm not sure they're going to get that training. And how do you, how do you do that?

[Dr. Joe]

I think it's similar to like people that only do minimally invasive surgery and have never done open surgery. I think that's more challenging.

[Dr. Nick Strasser]

Total knee and hip.

[Dr. Joe]

Right. You know, I think that's more challenging. And the last thing that we have not talked about at all is for research. You asked me, I didn't mention that. I think that I found AI to be very helpful for sometimes creating. I've only done it once or twice for creating a first draft of a paper, like, hey, here's what I want to do in the data then. Yeah, not the data.

[Dr. Anish Kadakia]

All those guys get out of here.

[Dr. Joe]

So. But because somebody said it earlier today with like a letter of recognition, it's much easier to edit or with the notes, so much easier to edit than that than to write the whole note yourself. So it gives me a starting point. It's almost like a medical student writing it. Right. I may change 50% of it. Somebody got the words on the paper. And I found that to be fairly helpful too. Like I said, I've only done it a couple of times at this point. But if you put the data in and what the question is like, I think it can be a good starting point.

[Dr. Anish Kadakia]

Yeah, I understand your writing question, but my kid is, my oldest, is 17 now and he writes a lot because he's like in some academic program. But most kids write very little and the machine kicks it out. And I, I do agree with you. I fear that our children and the young generation will no longer synthesize, like write a beautiful letter on their own. And the truth is, if you are doing that, you're wasting 45 hour every time the next person's doing it. And you can't tell the difference. You could have told AI difference by looking at it. Maybe a year ago I wrote a, I did a, a legal letter for somebody and I dictated the whole thing spastically. Curiosity made, AI told it to do this, set to report on lawyer wrote, this is the best legal letter I've seen in my entire life. It's my ideas, but the way it writes, yes, it's common. You can make it whatever you want. You can make it more academic, less. The skill is going to go. And it is what it is. Just like our parents are worried about God knows what. Who in God's name is gonna spend hours writing?

[Dr. Ben]

I definitely believe that the efficiency's there, but, like, as even just kind of us communicating together and, like, having a conversation. And maybe this is just a more social, moral question than, like, medical efficiency in us helping patients, but if we're gonna go this way. I was having a thought about this when we were in your AI symposium. It's like if. If you get to the point where the next level is everybody's using ChatGPT to write out your little wreck, then you shouldn't have a letter of rec as part of what you need. Get rid of that. And then if I write it like, I think it's still personal and it's important to write a thank you letter. You know, like when I applied to fellowship. And if you can't have a person, a. A person that's applying to get to know them in that way, or you have someone that you trust as a colleague that's writing this and really supporting, then what's the, like, interconnectedness between people?

[Dr. Joe]

I've had the exact same goal. I would say I do have personal anecdotes. I'll write a story about something I did with that person or interaction we had or surgery did together. So I put the personal anecdote in there. But I've wondered the same thing, like, particularly for medical student applications. For us, everything's vanilla now, right? There's no more class rank. There's no more USMLE step one board score. The letters of recommendation are AI. I mean, only mine. Hey, you have ten publications, and none of which are written by ChatGPT. Like, I don't. I mean, so what's.

[Dr. Anish Kadakia]

Yeah, what do you.

[Dr. Ben]

What do you have to rely on?

[Dr. Anish Kadakia]

As I just watched my kids and I realized I was talking to my chairman today, getting on the ferry, I. I told myself, you know, it's the first time, whatever's happened in the world in the last few weeks and days, I don't think I belong as much as I thought I did anymore. The world has moved past where I think I belong. My kids, when you see them socialize, they're normal kids, mostly on the phone. It's every single Kid in the school. It's not like my kids. They, they, they get together, they sit down, they start playing games on their phones. They chit chat a little bit. If they're not phones are never this, this could never happen. There's how many people? Six people in the room all hold my phones. I particularly always put my face down chit chatting. Don't have to look there never will happen. And I don't think the young people

[Dr. Ben]

maybe I have to accept that. Yeah that'll just me me being depressed about accepting the new reality.

[Dr. Anish Kadakia]

It's our, it's our generation know patients are going to come in with AI they're going to come in, they're going to, they're going to come in, talk to the AI, tell it when its problem is get an MRN before you see that MRNA is going to tell them what to do. They're going to come to us all this information and it won't be that long before you're going to be a problem.

[Dr. Joe]

But maybe that's great because I'm a surgeon. I think that's a technical skill that I have. I can't fly an F16 fighter jet but there are guys that can and they should do that and I should do to search around people. So maybe all of a sudden we have a hundred percent generation a clinic because basically the primary care doctor or grox they will work up everybody and when they come to me they have a surgical problem, a surgical need to drive all the non surgical stuff and I operate on you and I'm a technician that's like patient relationship and I agree with you about all your concerns and then part of me thinks like well I don't know how to use a typewriter, you know because I use a computer. Quite frankly I would prefer to never type again. Voice to text, everything because I hate typing and I can clearly talk faster than I can type. So is it really a pathing clearly,

[Dr. Nick Strasser]

clearly talk faster than you can type.

[Dr. Joe]

I've had cheap words don't want to slow down. They told me it's more than 500 words there and that wasn't fast like dictating fast. So but I mean like so is that a bad skill set to lose if I never need to use it because voice to text is so perfect. Is it a big deal that my typings worked for they're slower. I asked myself the same question.

[Dr. Anish Kadakia]

Our fellow residents don't have to make a anymore almost entirely in the system because some still do. But we have multiple AIs people they. They use whatever the name of the AI doesn't matter. They don't make a note. Now, they've made notes before, but let's suppose you get a brand new intern, five years. They've never synthesized it or in their brain.

[Dr. Joe]

Right.

[Dr. Anish Kadakia]

They. And the real question is, are they able to synthesize it for what's happening or will they? Because when you make the notes now with AI, we've done it so much, it's fine. I synthesize it. I summarize that, yeah, this is my plan, is what I want to do. So you have this practice and knowledge of how to take all this interaction between me and a patient, synthesize it correctly so that it's transcribed appropriately so you remember what the hell happened and what you want to do if they have not ever done that.

[Dr. Ben]

That's what I mean.

[Dr. Anish Kadakia]

And so what's going to happen when they're like, doing their own job?

[Dr. Ben]

Exactly.

[Dr. Joel]

They won't.

[Dr. Ben]

They'll be on them.

[Dr. Anish Kadakia]

I don't know. Like, they've never dictated this exam, which means they never thought through the. You think to the physical exam when you dictate.

[Dr. Joe]

Yes.

[Dr. Ben]

Right.

[Dr. Joe]

Yep.

[Dr. Nick Strasser]

And the plan.

[Dr. Anish Kadakia]

And the plan. Oh, shoot.

[Dr. Joe]

You know.

[Dr. Anish Kadakia]

Yeah, that is a rigid. Okay, I should do this. If they never thought that through. What's going on.

[Dr. Ben]

There's a learning skill for it. It's not just.

[Dr. Nick Strasser]

Yeah, it's a good point.

[Dr. Ben]

That's the part that we lose.

[Dr. Joe]

Yeah.

[Dr. Nick Strasser]

It's because there's. Sometimes you go back through it and you're doing the. No later and you're dictating it.

[Dr. Joe]

You're like, oh, shoot, I forgot to

[Dr. Nick Strasser]

order, you know, labs or whatever.

[Dr. Anish Kadakia]

Or there was another shirt or another.

[Dr. Joe]

Yes, it's. It may. It's incumbent on us as the teachers, educators to make sure they are learning that skill. Cause I would take in my clinic because of the whole AI scrap thing. They do no notes and they don't. So there are only a couple attendings that make notes in their entire reserve. So the only notes they write are console notes, consult console and rounded notes because they have to use Dragon or whatever. But like, that's it. I mean, there are very few. It's probably many programs like that with ad. If you were never. Unless your wrestling clinic, I think, you

[Dr. Anish Kadakia]

know, as we get familiar with AI, you know, you look at your PAs and answering patient questions, a lot of that. Everyone should look into it as we go on. It should be answered, but will be answered by AI just like when you call any company now you actually, I guarantee you, you've talked to an AI person in an. A person. Yeah, had no idea. And now I know I did for FedEx. I order something from FedEx that had to come to me and I've kept talking to this person like person that sounds like a person. Either I'm an idiot or they're an idiot. This is conversation. It's just like going in circles. But it was. Thank you so much for help. How else can I help you? Well, the package, as we said, ask for liberty at home and signed by somebody. Can I come and pick it up? No, as we said before, same voice. I'm like, this is a freaking AI person. But it doesn't sound robotic. It's like a person now patient calls, hammer calls around. This is right. I didn't get a response in two hours. Why not? I bet you the next level for us is to start getting AI to help our PAs.

[Dr. Joe]

The other thing, Joe, I think this would be a great topic for a whole symposium or pre meeting course or something like that. We just had one on mental Malaysia surgery. I think all the different parts that we've talked about and breaking that out and people that are really doing it are doing it well and even just some practical recommendations. I know at the AOA this, this past summer they had an entire symposium on AI and you're probably saying one of the vice presidents willing Microsoft come that's big into their AI and copilot what it can and can't do and people talking about how they even use copilot to answer their emails, you know, and, and one of the guys there who was my program director said oh, respond to Benjak's email, tell him I've had set up a meeting at this time, check my calendar, you know, created an entire email listening to one sentence, an entire email back to me, those professionals.

[Dr. Nick Strasser]

And we've talked quite some time on AI. But you know, the other thing is you talked about patient phone calls and patient, you know, after hours and there's actually, I think I was trying to find the, the resource but I think there's been some comparison to nursing responses chatgpt versus like a nurse's response to common commonly asked questions and pretty darn

[Dr. Joe]

what do they prefer? I've seen this for doctors. They prefer the AI response because we answer quickly. Again, the risk mental turns risk patient on surgery, all the gross satisfaction. Right. But instead it says all that. Well, thank you so much for reaching out. I appreciate your concern. What I hear your concern is that you have cast Filling. I know cast filling can be really concerning something you're really worried about, particularly after surgery. I'm so glad you reach out to me. I'm so glad you called. I'm worried cast filling could be a sign of dvt. I think the next best step for you to be getting ultrasound. We'll plan on ordering that ultrasound right away. We'll get back to you by my staff. They'll call you within the next three hours. Get that schedule for you. We look forward to following up immediately after those results. If you need anything else, please call our office. Like what sounds nicer? I'm going to say sounds good. Let's get an ultrasound. Right. Because we want to be efficient, but they want that long, lengthy customer service kind of response and AI can generate that much better than I can. So I've even seen where the doctor responds to questions better with AI in our hospital, which our department is not used. But I think for the medical doctors, you get a million of these. They're using AI to respond to the patient portal questions.

[Dr. Eric Silverman]

Yeah, yeah.

[Dr. Anish Kadakia]

The other heading for surgeons is going to be you do an ankle placement, what's the standard of care? What's the best implant? And AI will give you an answer. And so there's a lot that's the standard of care. Like, so are we going to get paid less than, I mean, look, I mean, you all know who I am. Like, are we going to get paid less in the future? Because our value is the keepers of information. This is my personal philosophy. Our value is that we are the holders of information. Right. We're the wizards of the medieval times, but no longer. And so now what are we paid for? We're paid for our knowledge, the consultation, for the. We have the information. Somebody comes and says, yes, I have pain in my plantar foot. You can put that in grommets. What are they coming to you for? A PT prescription. Why are we getting paid? Yeah, they're not going to pay you well, I already checked. I need a HOKA shoe or whatever. Shoe Grab my dear cell shoes. I didn't care less. But I need shoe. I need an insert, I need an ipt. I need my stretchy. They're coming to you so you can get an order for a few of these things. They're not paying you. But government's not going to pay us for that. No. So that is going to for sure. Our value as physicians is going to diminish over the next 10 years. I hope you got a jobs, but I, I, that's my real fear.

[Dr. Joe]

Less for surgeons. Less for surgeons.

[Dr. Anish Kadakia]

Less for surgeons. Let me go. No medical doctors. They're all going home.

[Dr. Joe]

Well, I think I, I think there's

[Dr. Ben]

a potential chance to lose a surgery. You're a skill too.

[Dr. Joe]

Eventually. Eventually me. But I think there are too many things that we do. And I saw something very interesting. So he was talking about they were going to actually start like wearing some kind of GoPro thing and videoing all their surgeries because they believe that content to be able to, for the AI to learn is going to be critical. So if you have 10 years worth of your surgeries, of recording and what you did, somebody's going to pay you for that data because they want to be able to teach their AI, like, how to do surgery.

[Dr. Eric Silverman]

It's.

[Dr. Ben]

It's already happened. I mean, they said they did a general surgeon did a cholecystectomy with a robot after it learned of the videos, watched it, and it did it technically perfectly.

[Dr. Joe]

And I'm curious, because what people define as robot, I mean, so our joints partners use a quote unquote robot. We all not controlled. Yeah.

[Dr. Anish Kadakia]

Not a human control.

[Dr. Ben]

Not controlled. Independent. Yeah, independent.

[Dr. Anish Kadakia]

You know, you think as a surgeon we're, we may foot and ankle at least is so goofy that we may be the last to go. But it is, it is a. I mean, what are you gonna do? Freak out in life? There's no point in that. But these are all ill concerns. I think the next few years, you adapt, you use it, take it to our advantage and then, you know, learn an outside skill.

[Dr. Nick Strasser]

Outside skills.

[Dr. Anish Kadakia]

Outside skills like dj.

[Dr. Joe]

Dj.

[Dr. Anish Kadakia]

But it's, it's really. Right now, it's definitely to our advantage. And there are real concerns in the next 10, 20 years that we are going to either be paid a lot less or we may be supplanted by some sort of machinery. But that, that's, that's a real concern. But that's a worldwide concern.

[Dr. Joe]

Right?

[Dr. Nick Strasser]

Well, this has been a really great discussion on AI. Thanks everybody for joining in and it'll be interesting to see what happens. Full disclosure, this podcast was not created

[Dr. Anish Kadakia]

by AI

[Dr. Nick Strasser]

Actual Voice, but I think

[Dr. Joel]

it would be a great symposium. So hopefully for Seattle. That's a great idea.

[Dr. Anish Kadakia]

That's a good idea. Thank you for listening to the AOFAS Ortho podcast, a Convey Med production. To learn more about joining our dynamic community of highly skilled orthopedic specialists, visit aofas.org.