5 ms·

I think that many people don't understand that clinicians are not investigators and generally do not have any research experience, despite having the title of '

I think that many people don't understand that clinicians are not investigators and generally do not have any research experience, despite having the title of 'doctor' (a fairly recent appellation outside of academia). They are, as you say, trained to arrive at a diagnosis to the best of their ability and provide treatment. A challenging diagnosis, however, is a fully-fledged scientific investigation. This is where clinical researchers (MD PhD) can really shine, but it's hard to apply this to individuals; the typical direction follows funding first, which may not be of much help to any given patient. At any rate, this approach ultimately does not scale. My hope is that new tools (accessible databases, better data collection, and a dash of ML) will get more patients in front of the right pair of eyes more often. The situation with life-threatening diseases is bad enough, but there are also huge opportunities for improved quality of life from vague, nagging, or intermittent illness diagnosis.

Omniusaspirer 10y ago
To contrast your first sentence, nearly every physician younger than 50 most likely has some experience with research and a good percentage of those have been published prior to even being accepted to medical school. Beyond that, the numbers I'm finding state ~1.5% of current MDs primarily spend their days doing research. I think the issue here is not that physicians "are not investigators" but more-so that the financial realities are in no way aligned with dedicating massive amounts of time to any given patient. Physicians generally bill around $300/hour in cash only clinics, so I think it's a poor allocation of resources to expect them to dedicate 100s of hours to a more obscure patient. PhDs are dirt cheap, better to hand the odd case study off to them and let those with clinical skills focus on being clinicians to the more typical patient.
- toomuchtodo 10y ago
  Can we replace physicians yet with expert systems? $300/hr seems egregious for a decision tree expert system.
  - specialist 10y ago
    Maybe not replace. Supplement, sure. Kinda like card catalogs don't replace librarians. I'm a unicorn. No one knows what to do with my diseases. I've been told, with absolute certainty, for 25+ years that my worst one will eventually go away. Finding effective treatments are more the result of drunken sailor's walk thru the solution space, than finding a leaf in a decision tree. I believe (but cannot prove) that'll be true of all rare multi-factor diseases. The key point, advice is to never stop asking for help. Someone, somewhere out there has the answer.
  - jt2190 10y ago
    300 USD per hour pays the medical assistants, support staff, rent, electricity, taxes, etc. The number that employee physicians (a much more typical case than private cash-only practices) gross is closer to USD 95 per hour, assuming a 40 hour workweek and an annual salary of 200 000 USD. (Few physicians work only 40 hours per week, so the real number is much, much lower.)
    - toomuchtodo 10y ago
      Just give me a Watson iPhone app that kicks me out to a professional if it can't confidently diagnose. I am appreciative when medical staff is required. But when it's not, ruthless automation must be out into place to contain costs.
  - JamesBarney 10y ago
    We could also open up the medical schools so we don't have to pay them $300/hr.
    - maxerickson 10y ago
      And the other various diagnostic roles that require less training than an MD/DO, nurse practitioners and physicians assistants and so on.
  - tclAmockingbird 10y ago
    Do you believe that you have or can quickly acquire the specialized domain knowledge and experience necessary to accuately describe your conditions for the expert system? Do you think you can sufficiently document your findings in your medical record? Do you foresee any problems in occupying both the patient and diagnostician role? Automated triage systems are already used at intake for urgent care clinics. They suck, partly because GIGO.

Omniusaspirer 10y ago

To contrast your first sentence, nearly every physician younger than 50 most likely has some experience with research and a good percentage of those have been published prior to even being accepted to medical school. Beyond that, the numbers I'm finding state ~1.5% of current MDs primarily spend their days doing research. I think the issue here is not that physicians "are not investigators" but more-so that the financial realities are in no way aligned with dedicating massive amounts of time to any given patient. Physicians generally bill around $300/hour in cash only clinics, so I think it's a poor allocation of resources to expect them to dedicate 100s of hours to a more obscure patient. PhDs are dirt cheap, better to hand the odd case study off to them and let those with clinical skills focus on being clinicians to the more typical patient.

toomuchtodo 10y ago
Can we replace physicians yet with expert systems? $300/hr seems egregious for a decision tree expert system.
- specialist 10y ago
  Maybe not replace. Supplement, sure. Kinda like card catalogs don't replace librarians. I'm a unicorn. No one knows what to do with my diseases. I've been told, with absolute certainty, for 25+ years that my worst one will eventually go away. Finding effective treatments are more the result of drunken sailor's walk thru the solution space, than finding a leaf in a decision tree. I believe (but cannot prove) that'll be true of all rare multi-factor diseases. The key point, advice is to never stop asking for help. Someone, somewhere out there has the answer.
- jt2190 10y ago
  300 USD per hour pays the medical assistants, support staff, rent, electricity, taxes, etc. The number that employee physicians (a much more typical case than private cash-only practices) gross is closer to USD 95 per hour, assuming a 40 hour workweek and an annual salary of 200 000 USD. (Few physicians work only 40 hours per week, so the real number is much, much lower.)
  - toomuchtodo 10y ago
    Just give me a Watson iPhone app that kicks me out to a professional if it can't confidently diagnose. I am appreciative when medical staff is required. But when it's not, ruthless automation must be out into place to contain costs.
- JamesBarney 10y ago
  We could also open up the medical schools so we don't have to pay them $300/hr.
  - maxerickson 10y ago
    And the other various diagnostic roles that require less training than an MD/DO, nurse practitioners and physicians assistants and so on.
- tclAmockingbird 10y ago
  Do you believe that you have or can quickly acquire the specialized domain knowledge and experience necessary to accuately describe your conditions for the expert system? Do you think you can sufficiently document your findings in your medical record? Do you foresee any problems in occupying both the patient and diagnostician role? Automated triage systems are already used at intake for urgent care clinics. They suck, partly because GIGO.