My impression is that accompanying a patient is super important, it helps to understand illness, to have a plan in case of more complex treatments, etc.
Then my doctor has the ability to know me and gauge my health. She's also very good at probabilities and detecting when something really goes wrong.
I'm sure that being able to do that require a lot more than numbers.
(I'm studying data sciences, I trust them, but my guts tell me that diagnosis is in a whole different ballpark)
There are researchers that conduct experiments to produce meaningful data and extract conclusions from that data. Then there are expert panels that produce guidelines from the results of that research. Most diagnostics and treatments are prescribed following decision diagrams that doctors themselves call... algorithms!
There are several limitations that prevent us from applying other AI techniques to the problem. Off the top of my head:
- We do not have the technology for machines to capture the contextual and communication nuances that doctors pick up on. There can be a world of difference between the exact same statement given by two different patients or even the same patient in two different situations. Likewise, the effect of a doctors' statement can be quite literally the opposite depending on who the patient is and their state of mind. One of the most important aspects of the GP's job is to handle these differences to achieve the best possible outcomes for their patients.
- Society at large is not ready to trust machines to make such intimately relevant decisions. It is not uncommon for patients to hide relevant information from their doctors, and to blatantly ignore the recommendations from them. This would be many times worse if the doctor part wasn't human.
- We cannot apply modern inference techniques (e.g.: deep learning) to the global problem because we have strict rules that prevent medical data collection and analysis without a clear purpose. Furthermore, these techniques tend to produce unexplainable results -which is unacceptable in this field-. As a result, there's not enough political capital to relax those rules.
A computer cannot perform that role with the current paradigm of AI, even the worst and most arrogant doctor is more qualified leader than any computer.
I mean, China will likely do it, as long as they can capture high quality data, so there's that.
Yes, of course, hospital care would be better in many ways if we did have somebody who statefully understood particular patients’ needs.
But what I’m saying is, the GPs in hospitals could be replaced with stateless diagnostic AI without making hospital care any worse than it is now. And hospital care is a large part of the medical system, so only replacing diagnostics there (while leaving primary-care GPs alone) would still be a major optimization, freeing many doctors to provide better care, go into specialties, etc.
That's rarely (if ever) a 1:1 ratio. That attending physician is almost certainly juggling multiple patients. Same with the rest of the care team. There's a reason why the first thing one does when approaching a patient bed is to look at the chart.
> Some things can be documented in the patient chart but there are always gaps.
Then those gaps need closed, stat. Once those gaps are closed...
> Clinical decision support systems for partially automating diagnosis could potentially be helpful in some limited circumstances but the ones built so far mostly don't work very well.
...then this will improve considerably. Garbage in, garbage out.
And in most routine cases the diagnosis is the easy part. The hard stuff is actually working with patients and doing the hands-on procedures, which won't be significantly automated in our lifetimes.
Pattern recognition algorithms do have some promise for computer assisted interpretation of things like medical images and ECG waveforms where the input data is already in digital form. We can't rely exclusively on algorithms for patient care, but if the physician reaches a conclusion different from the human physician, then it's probably worth taking a deeper look and getting a second opinion.
...which is why we shouldn't be wasting such valuable resources (people with an aptitude for medicine) on doing such an easy, routine task all day long, no? It'd be like if chefs spent most of their time hand-grinding spices rather than cooking.
> A skilled, experienced clinician can intuit a great deal from subtle signs like skin color, breathe sounds, tone of voice, small movements, etc. / Pattern recognition algorithms do have some promise for computer assisted interpretation of things like medical images and ECG waveforms where the input data is already in digital form.
You're seemingly contradicting yourself here: you're saying that the places where ML shows the most promise, are exactly with the tasks that would best replace the things doctors are doing. The only reason that ML can't do those things, is that people aren't putting data like "a video exam of the patient by a nurse" into the chart where the diagnostic algorithm can see it / be trained on it.
This is incorrect. Doctors are assigned to patients, and if there is a complication any time or day or night the doctor is contacted to decide what to do. The entire point is so that there is one person who is familiar with the patient, who is also responsible if anything goes wrong. I don't know how malpractice would work with an AI, but given the number of malpractice cases yearly in the US it'd either be sued out of viability or have to be provided with legal immunity(possibly the worst scenario IMO)
There are some people who will never, ever complain about anything. When they complain of severe abdominal pain, for example, you pull out all the stops immediately to figure out what's wrong, because it's probably really bad.
On the other hand, there are hypochondriacs and people will low pain tolerance. While they can certainly also become seriously ill -- and one must never forget this -- the tempo and pace of workup and order of intervention is markedly different, absent other information that shifts the pretest probabilities.
I wouldn’t eliminate GPs from the process, but many people actually would like to hear what the robots have to say about their medical conditions. Having second opinions of this sort available might lead to better patient outcomes.
There isn’t enough humanity in healthcare to begin with. Replacement of doctors with AI sounds pretty horrific. General practice isn’t where healthcare costs are going bonkers, and it seems weird to want to cost-cut something that actually kind of works in favor of bullshit.
Know what would be a great use of AI? Something real like analyzing all of the telemetry in EMRs to provide better guidance to doctors to proactively guide people. Some CVSHealth chatbot telling me whatever is a waste of time.
That’s me. I really, really appreciate a GP that both understands that I’m not doing it on purpose, and can reassure me that nothing is wrong, or figure out that we actually do need more testing this time.
Unfortunately it’s been years since I had one like that :/
I actually suspect it would be trivial to beat my doctor after 5 years of higher frequency full blood panel data collection.
10 full blood panel samples a year, have 20 million people do that for a data set we can do classification on. I think my doctor is kind of out of business then.
Will never happen in my life though with health insurance and health bureaucracy.
https://www.ondemand.labcorp.com/lab-tests/comprehensive-hea...
I've been to private practices where every day at lunch or near end of day there would be some drug rep with food for all the staff.
And a psychiatrist that had stacks of free samples of drugs.
Even contact lenses are marketed with free samples.
I mean, yeah? If a shoe company required you to buy a shoe before trying it on without free returns, the shoe may as well not exist.
In my experience at a specialized neurology practice: they wait outside until the doctor is free, then knock on the door and ask if they have a moment. They would almost always get straight to business, never wasted more than half a minute of people's time socializing.
Sure, there may be some excesses (although the truly major perks like entire vacations dressed up as a "conference" no longer exist), but I would much rather have doctors be aware of new drugs and yes, subject to marketing pitches, than have these drugs languish (eventually leading to drugs not being created) because nobody knows about them.
But.... journal publishers exploit their monopolies, and conferences are funded by corporate sponsors. So perhaps they're not so different.
[1]: https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Ren...
Even if a practitioner took it seriously and wanted to get a real education about actual medical issues, they aren't going to find coverage of brand new drugs in an educational setting unless it was arranged by the drug companies themselves.
With some other mechanism that doesn't have major conflicts of interest? Like, I don't know, attending to actual courses, like any other profession that requires continuing training.
https://www.isms.org/CME/Medical-License/License-Requirement...
They are supposed to study. Continuously.
Merck, Dec 2021: https://www.nejm.org/doi/full/10.1056/NEJMoa2116044
AstraZeneca, Jan 2022: https://www.nejm.org/doi/full/10.1056/NEJMoa2112431
https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA....
There are courses available if you wish to be taught. There are events where people present new developments. There are paid sites like UpToDate. Even textbooks eventually get new editions and there's always plenty of fundamental science in them that doesn't change
The authors have no conflict of interest to declare, but declare lecture honoraria or consulting fees as follows: T.U., Bayer, Boehringer Ingelheim, Hexal, Vifor Pharma; C.B., Servier, Menarini, Merck Pharma, Novartis, Egis, Daichy Sankyo, Gilead; N.R.P., Servier, Pfizer, Sanofi, Eva Pharma; D.P., Torrent Pharmaceuticals; M.S., Medtronic, Abbott, Novartis, Servier, Pfizer, Boehringer-Ingelheim; G.S.S., AstraZeneca, Menarini, Pfizer, Servier; B.W., Vascular Dynamics USA, Inc, Relypsa, Inc, USA; Daiichi Sankyo, Pfizer, Servier, Novartis, Menarini, Omron; A.E.S., Omron, Novartis, Takeda, Servier, Abbott.
These COI disclosures also strike me as hard to interpret. It’s certainly possible that some of these people are deeply invested in a company and are pushing its particular therapy hard to buy a new boat or something. However, I’d bet many of them are $250 to participate in a focus group, or free conference registration to be in a panel. It’s important to know who’s buttering the authors’ bread, but it’d be helpful to know how much it’s being buttered too.
This document https://www.researchamerica.org/sites/default/files/Policy_A... states that in 2017 private industry spent $121 billion on Medical & Health R&D Expenditures in 2017 compared to $39 for the federal govt ($32 of which is NIH). $121 billion in a single year -- I honestly assumed the number was in millions till I re-read it.
This article https://www.baltimoresun.com/health/bs-hs-trial-funding-2015... says "Industry funds six times more clinical trials than feds"
You are probably right that the drug companies are (not surprisingly) focused specifically on drugs while NIH research is more general and widespread. But that is still a very large difference.
I thought we were talking about direct marketing by pharmaceutical company representatives by the way. It is of course impossible to separate modern medicine from the pharmaceutical industry since many therapies depend directly on them. It's still the doctor's job to figure out which medicines are actually good and what's merely some salesman's product.
No conflict of interest, except they're directly paid by drug companies. That's the sort of thing you'd expect to see in a banana republic, not established medicine. It should call the integrity of the entire system into question, frankly.
Do you really want to ban all interactions between researchers/clinicians and drug companies?
Scientific articles are published and read by the community. There are, for example, social media and messaging groups where doctors will post and discuss articles, including their methododology and limitations. There's always the possibility that the study could actually be relevant.
Drug company representatitives talk to doctors in private in order to try and convince them to prescribe drugs. Like all marketing, there's an inherent dishonesty to it. You always assume they're overstating the positives, downplaying the negatives and ignoring alternatives. Doing this is actually the doctor's job. It's our job to pick these claims apart and figure out what's true and what isn't so that patients don't have to do it.
Doctor-drug industry relationship is at its healthiest when they're just giving doctors free samples of the drugs they were already going to prescribe anyway. Doesn't change the doctor's conduct and helps patients with free medicine. Doctors are already going to prescribe angiotensin receptor blockers for hypertension, drug company representatives won't change that. They can and should provide free samples though, free medication helps everyone.
Everything a drug company does is ultimately about selling more drugs. It's not limited to the drug reps.
> they're overstating the positives, downplaying the negatives and ignoring alternatives
Again, not at all exclusive to drug reps. This behavior can be traced all the way back to Phase I of the clinical trial.
Your position in this thread makes no sense. I stated the drug reps help doctors stay up to date on the latest drugs and treatments, you disagreed and said doctors should "study. continuously." What should they study? Articles sponsored by the drug companies. How can you square that? Further, I'm sure you're aware that only a tiny percentage of doctors actually read the fancy journals and fewer understand the statistics and the details (perhaps those are the docs who sit around on the message boards you mention). For the other 90+%, the drug reps are the conduit who deliver relevant info to doctors. Ate they aggressive? Yes. Sneaky? Sometimes. Ultimately, do they help doctors discover drugs that help their patients? Unless you believe the drugs being approved by the FDA are ineffective, the answer is yes.
It is happening. They are called physician assistants and nurse practitioners, "supervised" by a doctor. I assume going forward, they will take more and more of the usual pink eye/ear infection/flu and other common work that does not require 6 to 8 years of post bachelor education.
It’s a very polarizing topic in medicine that patients generally aren’t privy to. Especially for resident physicians who often make half as much as these midlevels yet have more education, there’s a lot of bitterness. The federal government is ultimately to blame… having a fixed number of residency spots to artificially limit the supply of new physicians is terrible, and this is the predictable result.
I think hospitals support inefficient midlevels because they can bill patients for the increased resource usage, but it’s not good for the system overall when unnecessary scans and consults are done, and more complex patients don’t get comprehensive care. Many foresee a two-tiered system developing, where the rich see physicians, and the poor see midlevels.
There already was a tiered system, with rich people being able to buy concierge medicine and getting preferred treatment based on who knows who on the hospital's board or if their name is on a wing of the hospital.
The change now is a more visible and more granular price segmentation.
Healthcare providers with greater proportion of NP/PA will be selling for cheaper, so MCO will sell access to only them in their lower price plans, and healthcare providers where you get to see doctors will be in higher price plans.
This already happens, especially with many healthcare providers not accepting lower reimbursed Medicaid patients.
I agree that Congress should increase funding for residency programs.
https://www.ama-assn.org/education/gme-funding/ama-seeks-mor...
There’s definitely a trade off between resources devoted to education vs. acceptable risks from failed procedures, missed/delayed diagnoses, and increased utilization of imaging and referrals (and the physician radiologists and others who participate in that - it goes full circle). Physicians now are probably on one extreme end of that, and midlevels on the other.
On the topic of servicing rural areas… the problem is that nobody with better options (which includes midlevels) wants to live in these places. These educated, high-earning people want to live in urban areas, and they can. CMS has tried to incentivize this with billing by offering higher reimbursement rates to rural places that have a midlevel on staff. That’s about it, though.
Or the problem is that people are not offered enough money to make the sacrifices they would make by living in rural places.
If midlevels can successfully detect complicated cases to a supervising physician, and handle a whole lot of other care independently... and the net result is equivalent outcomes... this isn't a massive win? You've conserved the really expensive and contended resource for where it's needed and not made anything worse...
#1 - Funky/misleading statistics - Generally they claim that these NPs with uncomplicated patients do as well as physicians with complicated patients. It's not claiming that of any randomly selected patient, regardless of who they see, the outcome is the same. Therefore, if uncomplicated patients saw physicians, outcomes for the physicians could improve. In primary care managing hypertension or diabetes, this isn't as pertinent. For something like anesthesiology, it's more so counting how many times shit hits the fan, and brain cells die when the anesthesiologist takes time to be summoned.
#2 - They're not conserving expensive resources. Imagine a patient comes in with a lump on their hand. An NP might see a weird lump, order an MRI which gets read by a radiologist, refer to an orthopedic surgeon who specializes in the hand, who removes tissue to send to a pathologist, who determines it's a common benign tumor of the fascia. That's three physicians who spent much more time here! The patient no longer has use of their interphalangeal joints. The physician would probably try to shine a light through it, note the patient's Scandinavian ancestry and family history of plantar fasciitis, and tell them to live with it and come back if it changes.
No resources were saved here, but the patient's DASH score (disability of the arm, shoulder, and hand) is still 0 so the outcomes are the same.
This happens all the time.
#3 - Bad incentives - Medicaid would not in a million years cover this, but the game of medical pinball where patients bounce around through in-network referrals can funnel those with decent insurance into procedures. Especially when most people have poor health literacy. A hospital executive probably just splooged in his pants seeing how much money their loss-leader of primary care is driving to radiology and the surgical specialties where they actually make money.
#4 - It's insincere. All of this can be viewed as possibly successful when the midlevels are part of the healthcare _team_ and know their limitations. But the NP groups are increasingly pushing for independent practice and prescribing rights in state legislatures across the country. CRNAs require a physician supervisor... in many places, that doesn't necessarily need to be an anesthesiologist, and the surgeon performing the procedure can suffice. The AANA recently changed its name to the "American Association of Nurse Anesthesiology"... It used to be "Anesthetists". The CEO and president (two different people) of the American Nurses Association both refer to themselves as "Doctor" in a healthcare setting even though one holds a DNP and the other a PhD. It's pervasive.
The studies I've seen have compared practices where NPs are seen first vs. physicians are seen first.
> They're not conserving expensive resources. Imagine a patient comes in with a lump on their hand. An NP might see a weird lump, order an MRI which gets read by a radiologist, refer to an orthopedic surgeon who specializes in the hand, who removes tissue to send to a pathologist, who determines it's a common benign tumor of the fascia. That's three physicians who spent much more time here!
Your claim is this kind of excessive testing and referral doesn't happen with physicians? Do you have some kind of evidence this is more common with NPs?
This kind of overtesting leading to unnecessary procedures and bad outcomes has been pervasive through care in the US. Don't blame it on NPs.
> Bad incentives - Medicaid would not in a million years cover this, but the game of medical pinball where patients bounce around through in-network referrals can funnel those with decent insurance into procedures. Especially when most people have poor health literacy. A hospital executive probably just splooged in his pants seeing how much money their loss-leader of primary care is driving to radiology and the surgical specialties where they actually make money.
Ditto
> It's insincere. All of this can be viewed as possibly successful when the midlevels are part of the healthcare _team_ and know their limitations. But the NP groups are increasingly pushing for independent practice and prescribing rights in state legislatures across the country. CRNAs require a physician supervisor...
Welp, we're not creating anywhere near enough residencies to create enough physicians to do the work, so I'd suggest we'd figure out ways to either do that or use people with lower levels of training well (preferably both!).
All this, and if you don’t complete your residency, you have no prosperous future as a doctor. You might re-match to another residency if you’re very lucky. The hospitals know this and act accordingly. Residents and even medical students paying tuition (!) were assigned to treat COVID patients and couldn’t really decline without risking the future they’re heavily invested in.
Keep in mind, the federal government pays ~150k per year to the hospital for having the resident. Yet the residents are often more indentured workhorses than trainees. It’s not uncommon for entire departments to run overnight with only residents, but no attending physicians.
Now imagine being in this situation, and not being allowed into the “providers lounge” because you’re a resident. Or using a broad-spectrum antibiotic instead of something more specific and being scolded for poor antibiotic stewardship, while the NP who has “completed their training” can’t even properly decide antibiotics are indicated some of the time. And if that NP were ever treated the way a resident is, they could go get a job at the hospital on the other side of town and start in a week.
Basically, they are watching their expected wealth / purchasing power be reduced.
Corps can pay less, and since they have a tenth of the education, they order tons of profitable tests, consults, and scans because they don't know otherwise.
https://www.chcs.org/its-not-just-risk-why-the-shift-to-valu...
Hence the purpose of managed care organizations (MCOs, health insurance companies) employing people to approve and deny (or design systems that approve or deny) payment for unnecessary tests, consults, and scans. And in a taxpayer funded system, the government employs people to performs the same roles.
I don't know if 500hrs of shadowing after a 2yr part-time online only program that you don't need any nursing degree or experience to enter would count as highly trained or skilled. Here's a list of direct entry nursing masters programs - https://nursinglicensemap.com/nursing-degrees/masters-in-nur...
Here's Johns Hopkins doctor of nursing practice program's curriculum - https://nursing.jhu.edu/academics/programs/doctoral/msn-dnp/... - where more than half of your classes are not medicine related and which requires an astounding 1000 clinical hours and less than 10 credits a semester before you can call yourself "doctor". Most medical students will have 1000hrs after 3 months in 3rd year, where they will be expected to diagnose and come up with treatment plans vs just shadowing, and they still have 9 more months of 3rd year, 4th year, and a minimum of 3 more years in residency. Doctors will likely end up with a minimum of 15000 hours of training. The difference really is that large, and I feel bad for the patients and for the NPs who have no idea how deficient their education is. PAs have 2000hrs of clinical experience. Here's a chart - https://i.imgur.com/Cj5z4f8.jpg
Honestly, if not for the weirdness of the US system, mid-level providers shouldn't exist. But we are where we are. There absolutely is no room for independent practise for mid-level providers.
I don't have anything against NPs when the supervision is close, but more and more doctors are put into positions where they are acting as liability sponges for de-facto independent NPs/PAs.
Here are a few studies - (CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. https://www.ncbi.nlm.nih.gov/pubmed/22305625
Comparing urgent care visits between MD/DOs and Midlevels. Doctors saw more complicated patients, addressed more complaints and deprescribed more. https://link.springer.com/article/10.1007/s11606-021-06669-w
NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/
Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. https://pubmed.ncbi.nlm.nih.gov/10861159/
Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. https://www.ncbi.nlm.nih.gov/pubmed/29710082
Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. https://jamanetwork.com/journals/jamainternalmedicine/fullar...
Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696
The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)...
Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. https://www.ncbi.nlm.nih.gov/m/pubmed/26217425/
The private ones might the ones in the public system at least in my country need to see a patient every 10 minutes to keep their heads above water.
It's funny because it's the complete opposite of what family medicine was supposed to be. The doctors were supposed to live and work in those towns so they could get to know the population and form stronger bonds with the community. Instead, they either burn out quickly or move on to far better working environments, specialization or not. Some of these public healthcare units don't even have sinks you can use to wash your hands.
If we want to reduce costs, we need to move to lower level providers like a LPN or CRNP. Most people coming into a GP have the flu or an ear infection or .... and that can be handled by them. There will be one MD and to handle complicated cases and to supervise. We've already switched so that intake is done by CNA making $15/hour. In the US at least working at FAANG pays far more than being a GP.
Not just FAANG, either.
The assertion by grandparent poster that GPs are "astoundingly" well paid is bonkers.
According to the Bureau of Labor Statistics, the mean salary of "family and general practitioners" in May 2020 was $214,370 [1]. This figure includes salaries from GPs throughout the country (i.e., not just in the Bay Area).
You can also look at median salaries. According to the BLS, all ten of the occupations with the highest median incomes in the U.S. are medical occupations [2]. "Family medicine physicians" are 10th on this list.
[1] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
Many specializations come with very low job opportunities, being a GP is very stressfull: low paid assembly line type of work, a GP is expected to see 6 patient per hour, do home visits, follow up with patients and hospitals, and run a practice, manage employees, follow lots of trainings, etc. Having your own practice as a GP is not very popular any more, a lot of GP just want to freelance part time, not having the additional stress of running a practice.
Those are both people problems. Tech can't solve many people problems, especially something as entrenched as healthcare. Isn't it huge, something like 10% of the US economy?
…turns out, it’s $2.7tr!!! [2]
[1]www.tradingeconomics.com [2]https://www.statista.com/study/15826/health-care-and-social-...
If politicians are willing to pork and barrel over a random soy farm employing 2000 people, for sure they're not going to throw away, say, 5% of the US GDP and possibly 5% of all employment in the US.
I don't know how you're going to get out of it...
[1] "There were 22 million workers in the health care industry, one of the largest and fastest-growing sectors in the United States that accounts for 14% of all U.S. workers, according to the Census Bureau’s 2019 American Community Survey (ACS)."
https://www.census.gov/library/stories/2021/04/who-are-our-h...
To put this further into perspective: the US military budget is immense, as we know… and it clocks in at 3.7% of GDP [1]
[1] https://www.statista.com/statistics/266892/military-expendit...
That’s exactly right, but there’s nothing wrong with that.
A good doctor’s memory of patients spanning decades of a career and all of the various treatments that they did or did not respond to is very valuable. It’s a good thing that they offload as much as possible to other people so they can focus on doing what they do best.
Sure, that, and recognizing patterns and adjusting medication and being able to use good judgement for when to escalate to a referral for a specialist. But that's a lot!
I actually go to a teaching hospital for my primary care. It means I get seen by residents, and almost always also by very experienced teaching doctors. It ends up meaning that I get more time and attention by people who are actively learning and trying hard to do the right thing. The trade-off is there's no long-term trust relationship, but I am OK with that. I've also experienced care from elderly family doctors who run a "one-man-band" with a nurse and a receptionist, they're nice but I think I get better care at a teaching hospital.
That sounds like a lot of professions, engineering management included :-)
Right, but there would be a lot of point in making deals with whoever builds Watson-like devices, to turn them ever-so-slightly more likely to prescribe one drug over another or make one diagnosis over another. It might even be cheaper than hiring and sending out a bunch of salespeople.
I’ve seen this in Japan (ish), but in the Netherlands it’s definitely the GP’s doing most of the job. The assistant just does bookings and waves me in when it’s my turn.
At some point, the (possibly subpar) GP will be a costlier decision (whether in dollars/time/frustration).
Just like grocery stores having 10 self-checkouts and 1 cashier.
Perhaps this indicates a major gap in your visibility into and understanding of modern medical practice?
> My mom worked for a GP for about 20 years, and it seemed to me that most of what made that guy a doctor was bedside manner + being able to remember a lot of things.
"being able to remember a lot of things" -- Yes, absolutely. This is an area where AI-assisted decision support (like Watson) could be, and I hope will be, extremely valuable.
OTOH, you also rightly recognize bedside manner -- as anyone who has been a patient or a patient's family caregiver will attest, this is an essential component of core, and I think likely also the healing process. We won't get this from a machine until there is a true general purpose AI, at which point I expect an AI singularity anyway.
But consider that there are other factors of the practice of general medicine that you haven't even touched upon. For example, liability: In the office you envision, where Watson/AI makes medical decisions and these are executed by other roles like nursing, where does ultimate responsibility (and legal liability) lie? Remember that Watson outputs probabilities -- suppose the following:
Chance of disease X: 89% Chance of disease Y: 10% Chance of disease Z: 1%
If disease X, intervention A has an 80% probability of success. However, if disease Y, intervention A has an 80% probability of harm.
(before you object that this is contrived, this represents a realistic situation I encountered recently, where intervention A is high dose steroids)
Now, will we put the onus on the patient to select an intervention? I don't think that would be very popular. While I certainly do not advocate paternalism, when faced with difficult decisions quite many people openly defer to their physician.
> But GPs often make astounding amounts of money
I suppose this could be true for some definitions of "astounding," but it's generally accepted that GP/"primary care physician" pay is essentially the lowest of all specialties , which is a major contributor to lack of access to primary care in industrialized countries (while you'll not have a hard time finding a private pay dermatologist, for instance)
ANd on top of this, we are posting on HN where a mid level software engineer total comp can EASILY outpace the average US primary care physician salary.
> while leaning heavily on their staff to actually handle patients and keep the business running.
Do not all professionals and business executives rely on highly trained staff as force multipliers? This is a fundamental principle of the advancement of human economies. It is grossly inefficient to operate with individuals as "jack of all trades" when they can instead each become specialized to support a bigger or broader goal.
By "leaning heavily on their staff to actually handle patients and keep the business running" are you suggesting that the primary care physician should be performing check-in, insurance verification, rooming, vitals measurement, blood draw, medication administration etc? That is a certain recipe for massively decreased throughput and shortages/decreased access to primary care.
> I thought it could help drugs get a little cheaper too, because there wouldn't be any point in the pharma companies sending out salespeople to do lunch seminars to convince the GPs to prescribe this or that drug (this still happens).
This has been massively curtailed for 20+ years, at least in the US. I am not sure about other countries. But overall I think this is a seriously minor portion of the (exorbitant) price of medications in industrialized countries.
In any case, I doubt it would make much of an impact on utilization in most contexts, as insurance/health plans/prescription benefits have already implemented fairly strict guidelines-based formularies and coverage tiers (again, at least in the US -- I can't speak to other industrialized countries, although I expect they are similar or even more strict)
(edit: another poster points out all the direct to consumder drug advertising -- I agree - this probably has a much bigger influence in 2022; ad budgets are absolutely insance)
> Maybe this will still happen, but it doesn't seem imminent anymore.
Here we agree. I am certain we'll see AI-assisted physician decision support, but (a) the physician won't go away and (b) I think it'll be an unfortunately long ways in the future.
As lame as it may be, but I just used the McDo kiosk for the first time.
Why? I'm a very infrequent customer at McDo and have 0 knowledge of options and combos, but also remember the mutual annoyance when previously asking for menu details from a min-wage clerk.
In a perverse way, the kiosk gives that power to choose back to me, the customer. At the same time relegating the supposedly more able humans to even less meaningful role.
This worked quite right in this case. I can see this approach applicable as well for some medical need that could be mapped onto a sequence of a "few" choices.
This could be resulting in some assistive pre-screening report.
Well, that's the stuff the assistants do at the beginning of a doctor visit. Not that different from a slot-operated scales of ancient times.
But in the end, I still want to see an immediate human responsibility in such transaction. By the same token, a GP won't be leaning heavily on such "assistive report" and would still go on and ask all of the questions again, as trained, as allotted, as billed.
Each doctor visit begins as a custom solution, no matter how cookie-cutter it turns out to be at the end. That's what we expect and that's what it ends up being billed to us.
Come up with a way for better patient outcomes to result in higher profits and you'll see advances in patient care real damn fast.
I have other solutions, but there's no point in listing them because nobody will implement them (for the same reason that one won't be: profits over patients)
There are just too many unknowns and fiddly things going on with human bodies
edit: Haha, I guess Tex's sibling comment makes a good point though..
Most of what the doctor is doing is a type of modern shamanism though. Person doesn't feel good, so the doctor orders a useless test, test comes back negative so the person feels better. Then we complain health care cost too much.
10 full blood panel samples a year with other bio-metric data and a data set of 20 million people to do classification on would crush the doctor over time.
This bullshit health system though makes it impossible to have any real innovation at a mass scale. We will never have personal higher frequency medical data in my lifetime that would actually hugely improve the system and cut most of the cost out.
Every dollar spent coming up with the next automated imaging diagnosis model would be better spent on a model that encourages people to get up and exercise 5x/week, quit smoking (or never start), and get their colonoscopy. Once the patient is presenting to the doctor with heart failure, coronary artery disease, carotid stenosis, COPD, colon cancer, etc. the battle is already lost.
Complain all you want about the healthcare system holding data back. You don't need the healthcare system to make the biggest impact on people's health.
—- I’ll add that your shamanism comment sounds like the typical bs that the 20-something software engineer, who thinks they know everything because they make more than 100k a year and have never had to go to a doctor for anything other than strep throat or generalized anxiety disorder let alone spent anytime in a hospital other than to visit family members, that are everywhere on this site loves to say about physicians or other healthcare workers to shit on them.
Person doesn't feel good. Mild flu-like symptoms. There's a good chance that the patient will get better if I do literally nothing. However, I also know that it could be X, Y, Z... So I order a test to prove that it's not those diseases because if it turns out to be them it would make me guilty of gross negligence.
Concrete example: symptoms of hypothyroidism are similar to depression, therefore you must rule out hypothyroidism in order to diagnose depression.
> 10 full blood panel samples a year
Why? Where's your evidence that this waste of money will benefit anyone? Even yearly screenings are sometimes questioned in medicine and they do have evidence backing them up showing reductions in mortality. What are you even trying to find?
Also, because we haven’t done this at scale, we don’t know the true baseline for most people who may have something on the blood panel samples but never get tested because they are asymptomatic. So then we have this whole group of people with recommended treatment because of the results, even though they are asymptomatic. And they are treated, which then leads to increased costs and side effects…
And now we’ve effectively increased medical costs and decreased quality of life for asymptomatic patients. BUT - if we do it with just a drop of blood, we might be able to start a startup and raise some funding… We could call it Thermos or something…
My mom worked for a GP for about 20 years, and it seemed to me that most of what made that guy a doctor was bedside manner + being able to remember a lot of things. But GPs often make astounding amounts of money while leaning heavily on their staff to actually handle patients and keep the business running. I thought it could help drugs get a little cheaper too, because there wouldn't be any point in the pharma companies sending out salespeople to do lunch seminars to convince the GPs to prescribe this or that drug (this still happens).
Maybe this will still happen, but it doesn't seem imminent anymore.