I like your idea - but I fear the industry might have already ruled it out.
-edit- Granted, I've done this in my own life by going to specialists at their own offices/outside of a hospital or medical group.
The side effect of all this, honestly, is that doctors stop learning how to turn off 7-minute-mode. When it comes to very serious problems, it pays to go to a practice that doesn’t accept insurance at all, because they never got into the bad habit to begin with.
There are some doctors at teaching hospitals who specialize in diagnosing rare diseases and don't take insurance for this reason.
Oh, you grossly underestimate what people are capable of. At least in China there are many reported cases of such horrible patients. Maybe US being a developed country have fewer these people, but definitely not zero.
Probably there are other professions in which one gets better service if one has an inside connection, but this situation really speaks ill of how medicine is practiced.
Having a doc in the family is a mixed blessing at best. You can get priority treatment, and the benefit of your family members full attention. On the flip side, all the docs I know that aren’t fools or morons don’t treat their own family for anything more serious than a scrape. You’re biased, you don’t want the guilt of an error, and you don’t want to be the bearer of bad news. I frequently ask my wife not to ask me about her mother’s health developments; I’d rather tell comforting lies than be a source of sour truth.
Being a VIP in a medical center due to your relatives gets you more ass kissing, not better care. People don’t want to step on toes, or give the impression that useful care is being withheld. And if your relative is a worse doc than the one you’re seeing? No one is going to overrule your family member to your face.
Personally, all I ever want from a patient is a clear timeline of events, their best attempt to articulate what they felt, a list of scripts, and old medical records (especially imaging.) The patient that can give me that has made the task of helping them 1000x easier.
I wish that were so, but disease is not confined to the reasonable, the rational, the kind, the respectful, or the grateful. On the contrary, the stress of disease and it’s associated burdens (social, financial, psychological, etc) tends to diminish those qualities in even the best of us.
Harvard did a huge study on malpractice suits a while back. They found that most medical errors that caused the death of a loved one did not result in suits, and most suits did not originate from medical errors. That is to say, the good or ill you do a patient isn’t the reason they sue.
Having to slip the doc and the anaethetist a red envelope and hoping it's the enough that they'll take proper care of you is not a good system to live under.
I’d never heard of this before.
https://www.seattletimes.com/opinion/the-red-envelope-capita...
Clearly healthcare can be free to the recipients while doctors still get a good salary.
The only thing I can say in their defense is that at least docs in those countries don’t generally take on massive, private, un-dischargeable debt in order to do the job. In the US we treat the medical workforce as a public good, though they have to take on all the risk of entering that workforce through private financing.
Not that outcome matters much to your question, but I have fewer scars, more original body parts, and better overall body function than I would have had with my HMO's original plan.
I'm curious if any others have succeeded.
Create a team consisting of one or more human doctors with a medical diagnostic AI.
From the article it sounds to me that a lot of the research could have been done by an AI, with the human doctors making the final decision on the "best" diagnosis.
https://en.wikipedia.org/wiki/Clinical_decision_support_syst...
The problem with residency slots is that they’re funded as part of the larger Medicare legislation, and no one wants to push for the bump in funding/taxes for Medicare needed to expand it.
The reason visits are seven minutes long is because part of a trend that started with the HMOs in the 80s. The hypothesis on the part of insurers was that docs have a general target income - that they don’t work at maximum capacity (in general - obviously wonky things happen at the extremes.) If you reduce per-service billing, docs would maintain constant output to hit their personal target income goal. And... that’s exactly what happened. Since then, insurers have continued to hit against per-service fees, and docs and facilities have continued to shrink the time they alot to each service in order to keep afloat. In fairness, docs don’t have an awful lot of flex on this - they have to meet overhead costs which are fixed regardless of how small their reimbursement gets, and even with pitifully short visits doc real earning power has gone down quite a lot in the last 30 years. Docs work about 3x as hard as they used to, for about one third of the real income.
It’s actually a bit scary: there’s not a lot of leeway left in this, and medical education is more expensive than its ever been. Docs carry the financial risk and massive increase in burnout, patients bear the risk of the reduction in time and quality of care, and everyone else is squeezing the juice out of the grapes. Something’s gonna give.
[1] http://articles.baltimoresun.com/1997-03-01/news/1997060012_...
[2] http://www.nytimes.com/1997/03/01/us/doctors-assert-there-ar...
[3] https://www.cnn.com/2017/03/13/health/train-more-doctors-res...
The 1997 cap on medicare-funded residency slots has remained in place since that time, unchanged despite population growth and an aging population. The current crisis and physician shortage is in large part a result of that two-decades-old legislation which was engineered by the AMA and other major medical groups.
Based on your comment history, you trained as a doctor, which is great and absolutely commendable [1].
However, do you feel compelled to troll and post obviously slanted information due to your personal association with the AMA?
For the record, I think doctors should get paid well and more than they currently do. Clinics should be run by physicians. But allowing guilds like the AMA to artificially restrict the availability of critical healthcare has resulted in millions of avoidable deaths and serious suffering across the entire population.
"The predicted physician shortages will result in decreased access to care for millions of individuals. [...] [A]dding one PCP per 10,000 people would reduce predicted all-cause mortality [...] by 5.31 percent. Translated nationally, this would avert 127,617 deaths." [2]
[1] https://news.ycombinator.com/item?id=16337410
[2] https://web.stanford.edu/group/sjph/cgi-bin/sjphsite/the-loo...
See also the 1997 senate finance committee hearings on graduate medical education [2].
[1] http://annals.org/aim/fullarticle/717927
[2] https://www.finance.senate.gov/imo/media/doc/hrg105-901.pdf
The difference is that given their prestige and the number of out-of-state (read: mostly cash-paying) patients, they get much higher reimbursement than most places and can afford not to push the patient mill so hard. Normal hospitals have a patient base that is mostly insured or, if uninsured, the impoverished kind, not the globe-trotting wealthy kind. So their reimbursement is negotiated with insurers, so... they have to push the mill hard.
I'm sure there's enormous value in chucking economic realities out the window for everyone's job, but that doesn't make those realities go away.
No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read: hospitals) have no intention of going into the red.
Do note the key to this diagnosis wasn’t finding a brilliant or deeply experienced path: it was about putting it into the hands of a curious trainee, who had the time to chase that curiosity.
I’ve said it before and I’ll say it many times in the future: when it comes to complex patients, there’s enormous value in chucking insurance out the window and just paying the doc for their time. A moderately clever doc afforded more than 7 minutes to work on a case can solve a lot of problems.