-Made to wait 45-60 minutes past their appointment time bombarded with pharmaceutical advertisements
-Spend another 20 minutes sitting in the examination room staring at pharmaceutical company sponsored ads
-Nurse takes your history with a bunch of redundant questions they already have the answers to
-Finally the physician arrives
-Assesses the patient without laying their hands on them
-Ignores everything you say
-Does no tests and cultures no pathogens
-"take some antibiotics and I'll bill your insurance company $500, see ya"USA's mean household Net Worth is $500K more than Norway's, and average household is about 3 people (some households are single people) so the oil fund approximately cancels that out.
Is there any study that shows how prevalent they are?
The only place I haven’t seen brochures is my direct patient contract doctor (concierge) and even then he has natural herbal supplements for various things.
So just saying your experience is atypical. But it sounds like a dream.
> they do the required tests and examinations
Do you have a source or is this anecdata? I do agree with your other claims though.
I don't mean to contradict your observations, but our experiences could have been different based on our age, location, gender and what we're being treated for. Selecting a good GP matters a lot too.
-“take some antibiotics and our billing dept will bill your insurance company for the maximum amount they estimate your insurance can pay, plus some margin, see ya”Canada's various provincial public health care systems (with a corresponding lack of private health care offerings) tend to be like that.
Many Canadians don't have a dedicated physician. Even if they want one (or want a new one), it's often difficult, if not impossible, to find one who's close by and who's accepting new patients.
Having a dedicated physician still often results in an experience much like that other commenter described. It's not an exaggeration. Long waits even with appointments, rushed examinations, and low-quality service are the norm.
Another option, which is sometimes used even by people who have dedicated physicians, is a walk-in clinic. Unfortunately, they can be quite rare and inconvenient to get to, even in Canada's largest cities, assuming they're even open when you need them. You'll usually face an even longer wait, even less time with the doctor, and typically see a different doctor if any sort of followup is needed.
Then there are hospital emergency rooms. That usually means getting to the nearest sizable city, and even once you're there, you've got to be prepared to wait many hours, even for relatively serious situations.
Ultimately, in Canada, it doesn't matter whether you see your family doctor (if you even have one), use a walk-in clinic, or go to a hospital emergency room. It's going to be a horrible experience, and there's pretty much nothing the average person can do about it.
Given the lack of competition and due to other government-imposed market distortions, there's no incentive for doctors to offer anything resembling good service to the general public.
The best situation is to have a doctor who's a close friend or family member, and who may be able to help mitigate at least some of the typical problems.
The next best option for Canadians, assuming they have the money for it, is often to seek treatment in the US or overseas.
Just "finding a new doctor" isn't feasible, unfortunately.
Being forced to wait for routine care isn’t a big deal, but having a doctor unwilling to listen to you is a life threatening situation.
If your local area lacks access to proper medical care that’s a serious enough problem where you should move. Medical care is like clean drinking water or working breaks for your car, it’s not optional.
The code of medical ethics advises physicians to not treat themselves or members of their own families.
https://code-medical-ethics.ama-assn.org/ethics-opinions/tre...
To be fair, they were so heavily booked that they weren't taking new patients and you had to wait weeks or months for non-urgent visits
Also some of them went out of business..
The potential seems there: cash payments accepted, many convenient locations, possibly lower wait times.
Of course CVS is Aetna, for better or for worse.
That’s not a killer argument in a comparison with an AI.
Then when the patient asks ChatGPT if the tests could give false negatives, it could provide some very valid-sounding answers that say repeat testing might be necessary.
This isn’t a hypothetical. It’s currently happening to an old friend of mine. They won’t let it go because ChatGPT continues to give them the same answers when they ask it the same (leading) questions. At this point he can get ChatGPT to give him any medical answer he wants to hear by rephrasing his questions until ChatGPT tells him what he wants to hear. He’s learned to ask questions like “If someone has symptoms _____ and ____ could they have <rare disease> and if so how would it be treated?” A real doctor would see what’s happening and address the leading questions. ChatGPT just takes it at face value.
The difference between ChatGPT and real doctors is that he can iterate on his answer-shopping a hundred times in one sitting, whereas a doctor is going to see what’s happening and stop the patient.
ChatGPT is an automated confirmation bias machine for hypochondriacs.
The subtext you're missing here is that GPT with access to the entire corpus of medical data could undermine the entire money printing machine (referring to US healthcare here). What test would cost thousands of dollars if the only human cost to run it is drawing some blood and putting it in a machine?
The actual process of doing blood work is often surprisingly complicated.
However, the basic idea actually is possible, but only for a very select few of the tests they proposed (which they still unfortunately didn't really get right of course). My point is that, unfortunately, the tests that are possible to do now won't get a company to form out of it - simply because they ruined the scene for everyone. Anyone trying to get a company going in this area and raising money for it will be met with a complete block of resistance because of the precedent set, even if the technology is actually completely reliable.
So, no very quickly people were calling Theranos either incompetent or fraudulent.
My point is that the general idea was not a bad idea, and because it was so badly mismanaged (trying to add too many products and run before walking, using other companies' tech illegally, etc, etc) we now are worse off because few people want to attempt doing the possible ideas in this space (because people think none of it is possible - which is simply not true).
The company that could reliably be made is far less 'attractive' of course, but it would still be quite beneficial.
We looked it up and it cost a little less to *buy the FDA approved equipment for your house, and run the test every day for an entire month*.
It's absolutely heinously broken - almost completely due to insurance companies. Insurance should be made illegal and obsolete due to the insane hindrance it is to progress in humanity.
You really didn’t provide enough information for a more detailed analysis, but for example there’s a reason hospitals don’t just use the cheap COVID tests and call it good.
There is a reason I mentioned FDA approved equipment though - it is substantially more expensive to have that label (despite being able to purchase items that claim similar parameters, those need to be exhaustively tested). Despite this, the statement that purchasing some types of equipment for your home and using it regularly, is still often far cheaper than going to the physicians office and getting a test once.
I suppose I am a bit out of the typical demographic though, as I would rather use my own TEM made in my garage to do quick analyses of lab materials than take it to my colleagues across the hall and sign up for a slot on their more resolute EM. Being able to work independently and have your own data is a nice thing sometimes.
When they're cheap outside the USA, it often just means the companies aren't attempting to recoup any r&d costs outside the US
Your friend kinda sound like a moron in general tbqh
I'm a BIG supporter of using things like ChatGPT, google, and sci-hub to do your own medical research because the whole system where some physician diagnoses you based on an extremely limited amount of data collected in a haphazard manner after a few minutes of observation because he's experienced and smart or whatever is incredibly dumb. The way people hold it up as the ethical standard which we cannot deviate from because it would be too dangerous is utterly baffling to me. The status quo totally lacks ethics and mostly serves to line the pockets of a cartel of doctors with a monopoly on access to medication and treatment who often condescendingly think patients are simply too irrational to treat themselves without their help.
I legitimately cannot wait for this field to mature and medical self-help with AI assistance becomes the norm.
When I finally blacked out and fractured my spine, first responders detected a lifelong cardiac arrhythmia in the back of an ambulance. Only with that knowledge have I been able to receive care and begin to heal emotionally from that abuse.
AI-assisted medicine will prevent many of these mistakes in the future.
I had to see the only available primary doctor to see anyone else, which automatically prompted medical releases that, even if unethical, would have still made it technically legal. If it was an emergency room trip, there were always the same 2-3 physicians there, so they were all fully aware of me from the first episodes. Same deal with labs when you've got only one or two options in town for anything, and they have your consent to release PHI since that's the only way to send results.
I hope that more founders build and innovate in the field to provide efficiencies throughout the whole system to lower costs and provide high quality care for everyone that needs it.
Especially the people that will read about diseases and get anxious they have them, and while you can validly say they have anxiety issues they don't have whatever they just read about 99% of the time.
Even if there's a real disease of some sort, you don't want to diagnose with the latest guess in someone that keeps guessing different things. Their treatment needs improvement, but confirmation bias is not how you do it.
And it's pretty clear that for many people, they don't feel like their needs are being met.
Happened to my granma when she was 90. She had convinced her doctor prescribing her 5 or 6 drugs. She swallowed them until she was so weak she had to go to hospital, where the tests revealed that she was 100% sane. She didn't like it.
If you’re a nurse and your job is to take histories, it’s better to take the history in the same way every time, systematically. This minimizes the chance of making mistakes.
Moreover the notes may be wrong, or you may give a different answer this time around. You might give an important detail this time around that you didn’t give the last several times, which actually turns out to be consequential.
It might seem like a waste of your time but it’s really not. Measure twice cut once.
Citation needed. For example, patient may get bored and only answer the first few questions accurately each time.
Screw with the answers if you want but don’t pretend you are sticking it them or some kind of agent of change blazing the path of defiance.
Are you a bot? Your comment doesn't make any sense.
Calling this an “internal process” that’s none of your concern, a much more egregious wilful misrepresentation of this situation. There is a situation or phenomenon of human behaviour, this is how the healthcare system deals with it.
Who are you as presumably some software person to come in telling them to knock the gate down without understanding why it was put there in the first place? God knows you’d hate it if someone did that to you in your area of expertise. I understand that the proliferation of VC-backed money-losing companies which parachute clueless software people into other domains have given developers an undue sense of transferable expertise, but perhaps exercise some self-awareness.
If you are still thinking of making another snarky reply, then you truly are lost. Be a better person.
People get their medications wrong just as likely as they get it correctly. This is in addition to many people being on complicated medication as regimens and/or just mostly disinterested in change.
The questions are one thing, the reviewing with a person who make above assessments is still, for now at least, a human job.
Seems like a very weird hill for you to die on, considering the provider's desire to ensure they have an accurate history for you to be a "problem".
Be better.
Who said anything about dismissing or doubting a history or complaint? "So, just to review, your medical history includes X, Y and Z?" or "Says here, you take A, B and C, is this correct?"
That's not dismissive, but important, especially if I'm going to be administering potent cardiac or other medications to you via IV, that could have serious complications.
But hey, you do you, keep grinding that ax.
Is this a regular occurrence or have you found a better physician since then?
- Your 40 minute in-depth appointment is finished in an amazing 5 minutes
- They can do this amazing appointment time compression because of an encoding technique called "one size fits all"
- The physician's assistant is so efficient that they've already scheduled your follow-up appointment - for three months from now, because they know you just love the suspense.
Meanwhile my mom has had cronic pain without any proper diagnosis. However, the German public health care system must have spent €50-100k in tests and to my astonishment she is currently in a clinic for 3 weeks that focuses on undiagnosed pain. As close to Dr House as it gets.
- remove your clothes and wait in a freezing room for 30+ minutes
A friend of mine, who is a primary care physician, just quit her job after the clinic changed its policy so that she had to fill her schedule with 10 minute appointments (6 per hour) and double book at least 10% (because the clinic was losing SO much money to no-shows /s). She burnt out after 6 months of this and moved somewhere they give her a more reasonable 15 minute time slots and no double-booking…
All this is to say, it may be a doctor thing, but I would bet it’s more likely a clinic trying to squeeze as much money as possible, and the doctor getting none of the extra profit from it.
BTW this is done to verify the records and make sure you are who they think you are. Giving someone another persons treatment can be… bad.
You forgot at least mildly insulting the patient by calling him stupid.
Do you know if the subreddit does anything to address that?
It’s almost always the headlines and PR pieces that exaggerate it.
“ChatGPT is more empathetic than Reddit doctors” isn’t interesting. Strip the “Reddit” out and then everyone can substitute their own displeasures with doctors and now it’s assumed true.
I knew students who were rejected from medical school, but I also knew far more students who were at one time pre-med, saw how much effort and debt that would-be doctors would need to take on, and saw the risk of pursuing an e.g. biology degree where their entire future hinges on getting into med school, and they chose a different field.
That is definitely happening here.
https://jamanetwork.com/journals/jamainternalmedicine/fullar...
> evaluators did not assess the chatbot responses for accuracy or fabricated information
Yikes. (I do fault the researchers quite a bit for quietly slipping that little detail into a page-long "limitations" section.)
My experience with most doctors is that they are among the least empathic people I have ever dealt with. I think that using AskDocs actually gives doctors an unrealistic _advantage_ in the study.
So we have here "ChatGPT performs better than doctors *"but* we sampled on an unpaid internet forum"
The other one thats doing the rounds where noone is verifying the source is "ChatGPT develops lethal chemical compounds *but*" It would be too unethical to verify with an actual chemist if any of these compounds it dreamt up actually do anything".
ChatGPT is showing how bad the economics of journalism are for understanding a topic outside of taking press releases at face value*
> In this cross-sectional study, a public and nonidentifiable database of questions from a public social media forum (Reddit’s r/AskDocs) was used to randomly draw 195 exchanges from October 2022 where a verified physician responded to a public question
They didn’t go to physicians in a patient setting. The physician answers were taken from Reddit threads where they were interacting with people who were not their patients.
Reddit has its own dynamic and people tend to get snarky/jaded. Using this as a baseline for physician responses seems extremely misleading.