theyre also going to tell you things other than just what your insurance is agreeing to.
a robo doctor will be corrupt in ways that a regular doctor can be held accountable, but without the individual accountability
Now replace some / all of those humans with... A machine whose function also needs insurance approval.
It's gonna end badly.
I still think healthcare needs to be reformed, and I hope that insurance will someday be a thing of a past, but I've hung up my chain saw for now.
Things were ruined slowly. They unfortunately will need to be fixed very slowly too.
You have to engage with the specific historical events/factors that led to the direction and the pace in order to change either. Broad statements like "society is big so change has to be slow" are just as unwarranted as "slow change results in decline".
There's a correct answer to "how quickly can change in a new direction be achieved". It will probably only become known after the fact. It will certainly not be model-able as a function with variables for "progressive or not" and "speed of change".
I grant that whether that winds up being fast or slow even if the attempt is intended to be fast is out of my or anyone's hands for the most part as the system dampens that barring total collapse and chaos :P
> They unfortunately will need to be fixed very slowly too.
When the wrong targets get destroyed, everyone suffers. When parasitic forces are destroyed, the system functions better. It's the difference between defense and friendly fire.
What’s going to be different now than in 2010?
You mean the one based on Mitt Romney's approach?
We should have stacked the courts ourselves, brandished executive orders etc, had some spine.
Edit: I think I need to make clear my thinking that the right has selectively destroyed institutions and levied them in other areas where it makes sense for their agenda. It's not been wanton. So when I say leverage the playbook it's not a one sided act of destruction.
The latter might notice the former having an easier time, but "hey, it works for them" is the wrong takeaway. Commit to the hard work of building resilient institutions; don't join in the destruction because it's easier.
There's also an element of "Never (...), they will drag you down to their level and beat you with experience."
You are yet another person upset that Democrats cannot overcome the purposeful design of our government that you need a lot of power to build, and little power to destroy.
People who want to fix things need dramatically more power than people who want to stymie and break things. Democrats only rarely get that power, and usually only by one or two votes from people who strictly do not care about fixing things. You want this country to fix things? You need to vote significantly more for a party who will push to fix things.
The minority party in congress has no power by design.
All of you talking about the right destroying things are wrong they’re just building things and enshrining things you wont like.
- Some executive orders are always flipped as soon as the opposition takes office, but some unilateral changes are much harder for a cyclical/pendulum-swing opposition season to reverse than they are to emplace. We don't know which are which yet. The return-to-office mandate for Federal workers is probably one that'll have a lasting effect--even if un-done in the future, the average prospective Federal worker will consider the job as something that has a significant likelihood of requiring in-person work if the political winds change and that EO is restored.
- Some things really do get permanently addressed within an electoral season, if you have the guts to shotgun through enacting a solution to them. The withdrawal of most U.S. troops from Afghanistan under Biden is a good example of this. So is the "Fork"/RIF/firing wave of Federal employees under Trump. I'm not saying those are both good things, but they aren't "reversible" in the sense that, say, the Global Gag Rule was endlessly reversible.
- Success follows success, as well. Part of the reason that momentum holds such a sacred place in electoral planning is the same reason that Trump's "flood the zone" strategy was effective (again--not good, but undeniably effective): capitalizing on/marketing early unilateral wins of any size results in the public and Congress being more likely to support larger, more durable changes. This is complicated by many factors (media landscape, districting, money), but is broadly true.
And I graciously waited and allowed them to do things that will take decades if not more to repair before deciding they were irredeemable. I had hoped a middle ground and bipartisan ship would be reached, but it's clear to me it won't be. We do not inhabit the same universe at this point, the disdain is mutual.
You’re acting like I’ve always thought about them like this or like I haven't spent years observing and thinking about this to come to my conclusion. You'd do well to listen to your own words about theory of mind. I was raised conservative I voted for Romney. I'm a fan of many of the political platforms they run on now (minus originalism, removing bodily rights, religion), but in practice they do not walk their own talk. The wars, the spending, abandoning neo-liberalism except in word the blatant corruption and disdain for the positions they hold and how they appear on the world stage.
No, I’ve watched their actions for 15 years and moved ever closer to the position that I have nothing in common with them even being ideologically close to a version of their party from 20-30 years ago and they do so blatantly want to destroy the middle class, health, and wealth for anyone outside a small oligarchic class.
I'm pissed because they wear a lot of my ideology as cheap dress to fuck someone.
My preferences, while possibly futile, are least an attempt to not just accomplish short term goals but to fix the broken dynamics of the system. That is, in my opinion, far more important than literally any particular policy goal. Policy progress is pointless in a broken system, so fix the system first.
It's possible that my view of focusing on fixing the system, restoring institutions, erecting new guide-rails in places we have observed that the old ones don't work, etc. won't work. But at least it has a chance of producing a good outcome. A good outcome literally can't come from the kind of political behavior you describe. You want your side to seize as much power as it possibly can when it wins, enact as much "good" as it possibly can in however long it can maintain it's grip before the political tides inevitably swing and you lose power again. You don't seem to realize that this is what we have been doing for at least several cycles now. And what we have seen is that the next administration just tears up the progress, does the same thing except in the opposite direction and even harder, and does what they view as "the good thing" and which your side views as nothing but unmitigated evil (the same way they viewed you and yours when you were in power), and so the both sides have accomplished nothing but pushing the pendulum a little bit further, giving it a little more momentum, and shredding up the social fabric a little bit more.
I'm not so naive as to believe that it is possible for just one side to say "no we won't do that, we will unilaterally disarm". But I am of the belief that, if one wants to pretend that one is "on the side of good", that the only rational action is to, when granted power, to spend as much political capital as is possible to slow down the pendulum, tear back power from the bloated executive and the federal branch more broadly. Stop trying to enact your political project and instead make your political project nothing other than the restoration of the norms and principles of the constitution.
This is not something that has been tried and failed. it's the opposite of the past 50 years of federal political dynamics. What has been tried is your plan of "fuck the other side, they are evil, just do what our base wants and ignore consensus and norms".
It doesn't work, it won't work, and it can't work. It's destroying the country.
From my perspective, you are no better than the side you hate. You may want different policy goals, but both you and your polar opposites are collaborating on a shared project: the destruction of the country.
Edit: And coming back to this later I need to be clear the left also needs to be swept out. I think our institutions in general need to be reworked. Not replaced entirely, but it's clear they don't survive contact with people who would abuse them for their own ends nearly as well as we had hoped.
There is an intermediary between customers and seller and it's allowed to take percentage of the sale. No such entity will ever work in the interest of the consumer. It has every incentive to inflate prices. Intermediary is needed but it should be financed by buyers with flat fee (possibly for additional incentives that reinforce the desired behavior). The tragedy here is that initially it was. But it was deemed too expensive for the buyers and got privatized which made it vastly more expensive in the long run.
Insurance is also wrong. Insurance is gambling and gambling needs restrictions. You are allowed to take people's money without providing any service most of the time, so you shouldn't be allowed to refuse legal service for that privilege.
https://my.clevelandclinic.org/health/symptoms/10880-fever
https://www.mayoclinic.org/diseases-conditions/fever/symptom...
https://www.osfhealthcare.org/blog/whats-considered-a-fever-...
https://www.brownhealth.org/be-well/fever-and-body-temperatu...
https://www.childrensmercy.org/siteassets/media-documents-fo...
I can keep going if you'd like. Google has a lot of results and every single one says a fever is around that range (sometimes 100, sometimes 100.4).
You didn't say the doctor disputed you had a fever. You said the doctor told you the fever wasn't concern until 100.4. Which I'm guessing is your fault for misinterpreting. If you google around, it's very easy to see the fever thresholds.
Here, I'll even paste a summary for you, and I can keep going if you like:
Key Temperature Thresholds
- 100.4°F : The standard definition of a fever.
- 103°F : Contact a healthcare provider
- 104°F : Seek medical attention, particularly if it does not come down with - treatment.
- 105°F : Emergency; seek immediate care.
In one of your own links (clevelandclinic.org), here's an excerpt for you:
When should a fever be treated by a healthcare provider? In adults, fevers less than 103 degrees F (39.4 degrees C) typically aren’t dangerous and aren’t a cause for concern. If your fever rises above that level, make a call to your healthcare provider for treatment.
I actually did say that the doctor disputed I had a fever
A fever is 38c, great. What the parents said was that you may have misheard because a fever isn't serious until 104. Which is line's up with the language you used.
> and they said it's not a concern until...
Parent is not suggesting that a fever isn't at 100F, they're suggesting that it's not "a concern" until 104F, a number strangely similar to 100.4 that you claim you heard, presumably, while you had a fever.
- You aren’t considered to have a fever until you get to 100.4. Anything less than that isn’t considered a fever, let alone a concerning one
- A fever isn’t considered concerning (ie dangerous) until it reaches about 104. Anything between 100.4 and 104 is just a regular fever and isn’t considered concerning.
This even translates to the pediatric space. I took all of my kids to the pediatrician because either they don't make comments to me like they do to my wife, or I don't take shit from them. I'm not sure which. Here's an example:
My wife and daughter were there and the doctor asked what kind of milk my daughter was drinking. She said "whole milk" and the doctor made a comment along the lines of "Wow, mom, you really need to switch to 2%". To understand this, though, you need to understand that my daughter was _small_. Like they had to staple a 2nd sheet of paper to the weight chart because she was below the available graph space. It wasn't from lack of food or anything like that, she's just small and didn't have much of an appetite.
So I became the one to take the kids there. Instead of chastising me, they literally prescribed cheeseburgers and fettuccine alfredo.
My daughter is in her 20s now and is still small -- it's just the way she is. When she goes to see her primary, do you know what their first question is? "When was your last period."
I wonder how many units of their training courses are spent on this and how much is spent on the cultural reinforcement of it.
* https://www.health.harvard.edu/pain/the-dangerous-dismissal-of-womens-pain
* https://pmc.ncbi.nlm.nih.gov/articles/PMC10937548/
The weight thing was not the key aspect of my original comment. They chastised my wife for continuing to give my daughter whole milk while being underweight, but did not make similar comments to me. That was the point.
For women, their pains and problems are far too often whisked away by hand waving and "it's hormones and periods" and serious issues are often overlooked. Very little has changed in that area over the last twenty years.
Is that supposed to be a problem? How does it connect to the story in your comment?
The question seems to be warranted to me, since being underweight can stop you from menstruating. So if you find someone thin and her last period was off in the distant past, you can conclude that there's a problem and something should be done about it; if it was a couple of weeks ago, you can conclude that she's fine.
(It could also just be something that is automatically assessed as a potential indicator of all kinds of different things. Notably pregnancy. For me, it bothered me that whenever you have an appointment at Kaiser for any reason, part of their checkin procedure is asking you how tall you are. I'd answer, but eventually I started pointing out to them that I wasn't ever measuring my height and they were just getting the same answer from my memory over and over again. [By contrast, they also take your weight every time, but they do that by putting you on a scale and reading it off.] The fact that my height wasn't being remeasured didn't bother them; I'm not sure what that question is for.)
Particularly given the alarming stories of people being prosecuted for having miscarriages, it feels ridiculous.
If anything I hope more automated diagnostics and triage could help women and POC get better care, but only if there’s safeguards against prejudice. There’s studies showing different rates of pain management across races and sexes, for example. A broken bone is a broken bone, regardless of sex or race.
Doesn't this suggest that they don't care what the answer is?
You need to delete your social media accounts and change where you're getting your news from. Nobody is "being prosecuted for having miscarriages". A few people have been investigated for drug abuse during pregnancy which led to the baby's death, which sensationalist news stories twisted into attention-grabbing headlines.
A doctor asking about cycle is just a core piece of diagnostic data like taking blood pressure and temperature, not some conspiracy to harm you.
It's the same reason why the doctor will take your temperature, instead of accepting your word that you took your own temperature and it is normal.
https://www.who.int/publications/m/item/primary-care-checkli...
You are asking how it connects, and it absolutely doesn't. But they keep asking and won't accept "it's regular" as an answer.
She's in her 20s and is seeing her primary for routine things, not because of her weight -- that part of the story was about how they chastised my wife for giving her whole milk but said absolutely nothing to me about it later on.
However, your argument focuses on the routine intake instead of any listening part. The fact that the doctor measures height, weight, temperature, and blood pressure on intake and then asks about LMP doesn’t surprise me… that’s the part of the script where you just provide the data before you bring up concerns.
Not to say the doctor was not a jerk, just that your argument doesn’t do much for me.
It doesn't have opinions, research, direction of its own. Is this a path of codifying the worst elements of human society as we've known it, permanently?
For instance, transportation is a "human problem". It's being successfully solved with such technologies as cars, trains, planes, etc. Growing food at scale is a "human problem" that's being successfully solved by automation. Computing... stuff could be a "human problem" too. It's being successfully solved by computers. If "human problems" are more psychological, then again, you can use the Internet to keep in touch with people, so again technology trying to solve a human problem.
Sure, some kinds of such "human problems" can be reduced to physics and technology, that's the point. This also doesn't necessarily mean that solutions produced by such reductions are effective: is surveillance good at preventing cheating during exams? Kind of. Does it often fail to catch cheating students? Absolutely.
However, indeed, there can be many different (perhaps equally correct) definitions of what a "human problem" is.
One was against it, the other one saw it as a good idea.
I would love to have real data, real statistics etc.
Also, the very idea that LLMs would prescribe you ritalin at all is laughable... Having no human doctors in the loop is a guaranteed way to cut prescription drug abuse, as ya can't really bribe an LLM or appeal to its humanity...
I have it so strong, that after I was preparing myself, my work desc, my books everything, i was starring into the books i wanted to learn for 15-30 minutes unable to just start or do anything.
With ritalin, i might have this mental block to, but its overcome in a few seconds.
I went from a 'nearly/borderline failing grade' to the nearly the best grade in just one year.
This changed significantly were I am today.
So your solution is to outsource thinking and work? That'll work out great in the long run.
How are you defining technology? How are you defining human problems? Inventions are created to solve human problems, not theoretical problems of fictional universe. Do X-rays, refrigerators, phones and even looms solve problems for nonhumans?
Claiming something that sounds deep doesn’t make it an axiom.
patients -> AI -> diagnosis (you know, with a camera, or perhaps a telephone I guess)
What REALLY happened
patients -> nurse/MD -> text description of symptoms -> MD -> question (as in MD asked a relevant diagnostic question, such as "is this the result of a lung infection?", or "what lab test should I do to check if this is a heart condition or an infection?") -> AI -> answer -> 2 MDs (to verify/score)
vs
patients -> nurse/MD -> text description of symptoms -> MD -> question -> (same or other) MD -> answer -> 2 MDs verify/score the answer
Even with that enormous caveat, there's major issues:
1) The AI was NOT attempting to "diagnose" in the doctor House sense. The AI was attempting to follow published diagnostic guidelines as perfectly as possible. A right answer by the AI was the AI following MDs advice, a published process, NOT the AI reasoning it's way to what was wrong with the patient.
2) The MD with AI support was NOT more accurate (better score but NOT statistically significant, hence not) than just the MD by himself. However it was very much a nurse or MD taking the symptoms and an MD pre-digesting the data for to the AI.
3) Diagnoses were correct in the sense that it followed diagnostic standards, as judged afterwards by other MDs. NOT in the sense that it was tested on a patient and actually helped a live patient (in fact there were no patients directly involved in the study at all)
If you think about it in most patients even treating MDs don't know the correct conclusion. They saw the patient come in, they took a course of action (probably wrote at best half of it down), and the situation of the patient changed. And we repeat this cycle until patient goes back out, either vertically or horizontally. Hopefully vertically.
And before you say "let's solve that" keep in mind that a healthy human is only healthy in the sense that their body has the situation under control. Your immune system is fighting 1000 kinds of bacteria, and 10 or so viruses right now, when you're very healthy. There are also problems that developed during your life (scars, ripped and not-perfectly fixed blood vessels, muscle damage, bone cracks, parts of your circulatory system having way too much pressure, wounds, things that you managed to insert through your skin leaking stuff into your body (splinters, insects, parasites, ...), 20 cancers attempting to spread (depends on age, but even a 5 year old will have some of that), food that you really shouldn't have eaten, etc, etc, etc). If you go to the emergency room, the point is not to fix all problems. The point is to get your body out of the worsening cycle.
This immediately calls up the concern that this is from doctor reports. In practice, of course, maybe the AI only performs "better" because a real doctor walked up to the patient and checked something for himself, then didn't write it down.
What you can perhaps claim this study says is that in the right circumstances AIs can perform better at following a MD's instructions under time and other pressure than an actual MD can.
Excellent. We should be striving for a world where humans are meat puppets for machines.
100% of the cases where some headline makes big claims about "AI" based on some study, you take a good hard look at the study and none of the big claims stand on their own.
It's all heavily spinned, taken out of context, editorialized... It's become almost a hobby of mine lately. And I am glad for have read so many papers and reasoned critically about methods and statistics. But it is also scary to realize just how much people take at face value of bombastic interpretations of datasets that support no such claim or much weaker versions only.
Chasing down sources is something that I often do and I've learned that people take a lot of liberty when divulging opinions about sources they don't think will be checked. Even in high trust environments. I have first hand received work by post-doctoral fellows where some articles in the bibliography didn't even exist.
Humans (doctors/nurses) can still be there to make you feel the warmth of humanity in your darkest times, but if a machine is going to perform better at diagnosing (or perhaps someday performing surgery), then I want the machine.
Even now, I'll take a surgeon that's a complete jerk over a nice surgeon any day, because if they've got that job even as a jerk they've got to be good at their jobs. I want results. I'll handle hurt feelings some other time.
The truly compassionate surgeons will want to improve their skills because they care about their patients. They care if they develop complications and may feel terrible if they do, the jerk may not. Being a jerk may mean that the surgeon can rise to the top, but it may not be due to surgical skill at all, they may be better at navigating politics etc.
Dude you removed my right thumb I was in for an appendectomy!?
You are so right! I ignored everything you asked for. I am so sorry. I am administering general anesthesia now, then I will prepare you for your next surgery.
This seems like an incredibly poor line of reasoning.
Hospitals are often desperate for surgeons. The poorly mannered ones are often deeply unsatisfied, angry at the grueling lives they've opted into, and the hospitals can't replace them. The market is not exactly at work here.
But two facts are also true: a) diagnosis itself can be automated. A lot of what goes on between you having an achy belly and you getting diagnosed with x y or z is happening outside of a direct interaction with you - all of that can be augmented with AI. And b), the human interaction part is lacking a great deal in most societies. Homeopathy and a lot of alternative medicine from what I can see has its footing in society simply because they're better at talking to people. AI could also help with that, both in direct communication with humans, but also in simply making a lot of processes a lot cheaper, and maybe e.g. making the required education to become a human facing medicinal professional less of a hurdle. Diagnosis becomes cheaper & easier -> more time to actually talk to patients, and more diagnosises made with higher accuracy.
Unfortunately is this not likely to happen. More like:
Diagnosis becomes cheaper & easier -> more patients a doctor is expected to see in the same period of time as before
Ok fellas put your money where your mouth is. It’s easy to talk until you put your money behind it (or lack of by getting rid of spending on it) if you are so confident in doctor as a service by llm.
Really? Which ones?
> insurance won't pay for them
Non sequitur, replacing doctors with AI will not help you pay for the preposterous US healthcare system. Vote!
There are extremely short lists of labs you can order yourselves. Virtually all of them are not on those short lists?
PSA and troponin seem trivial to get. Did you look?
I know. I know. Part of it is that talking to patients on average is useless but still this can’t be really used for an argument against AI.
Still doctors can have a more broad picture of the situation since they can look at the patient as a whole; something the LLM can’t really synthesize in its context.
- looking at their medical history/charts
- asking follow up questions
An LLM based system is trivially capable of doing both of those.
I think you'd be incredibly surprised how often charts are super, super incomplete or wrong. Like "pt has no pancreas and presented with pain and weeping from a 6yo pancreatectomy scar" but the chart doesn't mention the surgery or the entire missing organ wrong. Like "pt is a twin whose sibling died traumatically of cancer in front of them a year ago and presents with probable hypochondria about cancer" but the chart doesn't mention any family history wrong. Like "lifelong history of severe cognitive impairment substantiated by a psych eval; attended annual physical before being sent to imaging for head trauma because of observed impairment" but the chart doesn't mention cognition (someone was too polite to note it) nor the psych eval (records sharing wasn't allowed) wrong.
Those are a very few examples off the top of my head. I worked in EMR. I don't know shit about medicine, but man, do I know a lot about the complaints physicians and their staff send when they think it's the records system's fault that the chart was wrong or missing info.
In a big chunk of cases, the MD/NP/whatever's in-person role is determining what's not on the chart so that they can then ask appropriate follow-up questions. Given the massive range of possible dx for a given issue, and how much of getting the right dx doesn't have to do with probabilities/numbers of similar patients with the same symptom:dx data that'd be in the training set, I have major doubt that an LLM can appropriately intuit or appropriately question in order to diagnose.
If I were picking a specialty now, I'd go with pediatrics or psychiatry over something like oncology.
But most of us live in America in 2026. There are a lot of interests that don't give a shit about you who would love if you to got your medical care from a machine that "cannot tell how many r's are in strawberry". And there a lot of useful idiots with no real medical issues who will loudly claim the machine is great.
You, on the other hand, are confusing LLMs from the past with current SOTA LLMs, which can tell how many rs are in strawberry.
If you're going to have strong opinions on a topic, it would behoove you to keep up with it.
Just remember a lot of the posts here are bots and AstroTurf accounts... AI providers had a terrible month in April so they have to find ways to turn it around. Expect an influx of fantasticals this month with really loose grasps on reality.
A) nice chatty friendly and cool doctor and can diagnose correctly 50% of the times. B) robotic ai that diagnoses 60% correctly.
What you chose? If you have a disease than can kill your, the ai is 20% more likely to help you and probably prevent. I can’t see too many people choosing human doctor. Anyway I’m sure there will be people that will chose doctor with 10% correctness vs a 100% ai no matter what.
I time is clear there very little human element.
I don't need to "talk to a human", I need a problem with my meatbag resolved.
> humans need other humans and human problems can't be solved with technology
WTF are you talking about? Is this bait? You can't possibly mean this. Yes humans are social creatures, but what does that have to do with medicine? Are you talking about a priest, a witch doctor, a therapist? Because if you're not, that sentence is utter BS.
Even if your statement is true, it's questionable. People also tend to prefer hearing what they want to hear to hearing what they need to hear, and rank the former interaction higher.
Basically, tech's favorite feedback mechanism, customer reviews, cannot actually be relied upon to tell you how good something is.
Perhaps because they have been persistently failed by other humans, but not by technology; and/or because they believe they don't have the right and/or capability to improve other humans, but may be able to improve the technology?
For complex human reasons, I am effectively deprived of healthcare, in a country where healthcare is socialized. Other services provided by the state are also gatekept by my nominal healthcare provider, making certain "normal" things, indeed things that are required of me in order to participate in society, technically impossible.
(I will not go into concrete detail, because when I request help from anyone with my situation, the "help" consists of implorations to comply with painful nonsense, combined with a random helping of rudeness and idiocy. Yes, we exist.)
If I had "open source" access to just the "knowledge, experience, and pattern matching" that is presumably still involved in medical practice besides this nebulous "talking to a human" (which the other human usually actively works to make impossible, having been fundamentally socialized into language use by means of violence - and thus, the more intelligent my interlocutor, the more quickly they begin to feel threatened by understanding what I'm talking about), I would be able to maintain my body to a better standard than the standard of care that the institutional medical establishment has kindly deigned to make available to me.
Meanwhile, I don't even have "open source" access to the designs of the motor vehicle which hauls said body around. Being a car mechanic is so much more than "knowledge, experience, and pattern matching", too - it's being a part of a web of trust and tacit collusion; a.k.a. a guild.
Come to think of it, I don't even have "open source" access to the internals of the device I'm writing this from. Though at least in the domain of computing there are valiant attempts to produce libre software and hardware.
I'm happy that "talking to a human" has helped you. In my case, requesting help has a >10% likelihood to endanger my life, >25% to imperil my health, and >50% to degrade my sanity. Rough ballpark, eh?
A fully "open source" OS, device, vehicle, body, and mind, would presumably allow me to solve my immediate problems without needing other humans to perform the inexpicably painful sacrifice of comprehending my communications. Without access to these basics, consent to "healthcare" is impossible; we just put our lives in the hands of the medical technopriesthood and hope they don't leave us with permanently crossed fingers.
Medicine is so much more than "knowledge, experience, and pattern matching", as any patient ever can attest to. Why is it so hard for some people to understand that humans need other humans and human problems can't be solved with technology?