You think medical care provided by effectively anonymous caregivers over the phone is a good idea?

We do it in the status quo in a few very limited fashions: for example, many hospitals have a line for new parents to call in where they will get a nurse who will listen to them, calm them down, and tell them that $SYMPTOM is within normal operating parameters for their new infant and that they should not panic unless $CONDITION happens. My sister in law is a maternity nurse, and she works on one of these. She's a wonderful woman who would be equally wonderful talking you through it if you were in Calcutta when calling her. I assume there is some wonderful woman in Calcutta who can do the same. That would free my very expensive sister in law to do stuff which more uniquely requires her considerable expertise.

90% of medical care is low-skilled well-understood grunt work. Much of it is readily identifiable as such. There are huge structural disincentives from building our medical care processes to take advantage of this.

So, like I said upthread, we're already in the process of divesting day-to-day care from actual MD's. Go to a Walgreens clinic next time you have a sore throat. Even if you have strep, you'll get taken care of without ever setting foot in a doctor's office.

It's easy to see that taking the load off overqualified, overly expensive doctors is a good idea, which is why this idea is actually being implemented.

What I'm more interested in is whether we think it's a good idea to have those providers working in call centers. Because, from what I can tell, the economics of call centers are almost exactly opposed to customer care.

I think a call center is a good idea -- you can call in with your symptoms and they can tell you that it's minor just take some Tylenol and enter the symptoms into the system. They can also tell you that based on your symptoms to call them back if the the condition continues, if you start to experience a fever, etc.

I've called the doctor before (talked to a nurse), and told her my symptoms and asked if I should come in -- they said that if the condition persisted then I should come in, but there were a lot of people with the same flu in the area and rest/fluids would take care of it.

I think the more we can standardize medicine the better, it is a mess of a science. With machine learning and the rapid pace of new sensor development hopefully we'll be able to get more automated care -- that can be reviewed by a doctor/nurse to make sure it's ok.

The economics of call centers are no different than having nurses on staff -- how many people can you treat an hour.

A doctor's office --- or even a regional medical center --- has different scaling pressures than a call center. Call centers are centralized. They're more strongly incentivized to:

* Ramp up new hires as cheaply as possible

* Keep staff maximally interchangeable and minimally accountable

* Keep their resources as close to oversubscribed as possible

A doctor's office has these same pressures, but on a much smaller scale. It is a big deal for your doctor to hire a new full-time nurse. Patients will interact with staff face-to-face and at length. As busy as the office gets during busy hours, there are prolonged lulls.

Call centers also win several extra problems that a doctor's office doesn't have:

* Terrible continuity across multiple calls

* The need to talk lay people through basic medical testing (ever tried to do tech support for someone who doesn't know how to use a mouse?)

* The personnel management problems of having multiple tiers of support staff.

I don't have any arguments about standardizing medicine. If you reread anything I've written today, I'm in favor of the nurse practitioner model, and I see the problem with relying on full-service medical doctors. I just think call centers are terrible for consumers.

Such a service has been running very effectively in the UK for over a decade, called NHS Direct: http://www.nhsdirect.nhs.uk

Can NHS Direct people write prescriptions over the phone?