6 ms·

Medicine comes down to human-to-human interactions (doctor and patient) and those are really hard to scale. One Medical is basically a novelty offering nice of

by karl11 7y ago

Medicine comes down to human-to-human interactions (doctor and patient) and those are really hard to scale. One Medical is basically a novelty offering nice offices and predictable visit times. It takes some of the most common complaints you have about your doctor and removes them. In my experience, the quality of doctor was incredibly low, however, the quality of doctor will not be super important to you if you are 25-40 years old because you're probably pretty healthy on average, especially the young working professionals likely to be One Medical clients. If you actually want good medical care, over your lifetime, your best bet is to build a strong relationship with a good doctor. If you also want to never wait, concierge medicine is where you ultimately need to be (doctor is trading off a higher volume of patients for a fee to a small number of patients).

dbcurtis 7y ago
> In my experience, the quality of doctor was incredibly low, Hmmm... never would have guessed that. In my experience, the One Medical doctor that my wife and child see is excellent. I've met him and think he is great. A colleague is also extremely pleased with her One Medical doctor. Maybe you just had bad luck with your doctor selection? I don't mean to invalidate your experience, but it certainly varies from my experience.
- Godel_unicode 7y ago
  I'm always really curious what people mean when they say a doctor is "great". Is this just biases about smiling and seemingly having it together, or are there medical aspects to the greatness which set them apart as doctors? How does an average person know if your doctor is, in fact, doing a good job?
  - meddlepal 7y ago
    Thanks for asking this question... I was just about to ask this and then I got distracted before coming back. As an engineer I have no idea how to actually qualify whether my doctor is good or not. I _like_ my doctor, he's a personable enough guy, and perhaps I trust him because he hasn't harmed me yet, but I also have no idea if he is any good. The worst graduate in a medical class is still a Doctor somewhere... This is probably the same feeling business guys have about engineers...
  - deleted 7y ago
    [deleted]
  - damnyou 7y ago
    The most important thing to me is an understanding that the patient is in charge of their health and the doctor's just there to support the patient. For example, if a patient is already on meds from an online pharmacy, the doctor (after ensuring that the patient isnt causing grave harm to themselves) should be willing to write a prescription for those meds.
    - epmaybe 7y ago
      At the same time, I think it is unethical for a doctor to continue prescribing medications that they do not believe you actually need based on your current health. To them/me, it would be malpractice. If you were on an antibiotic for strep throat, finished your course, and then asked your doctor for more of it without any symptoms, should they prescribe it again? You wouldn't cause grave harm (unless the aggregate risk of super resistant bacteria counts). All of this shouldn't be conflated with patient centered care, though. I too agree that the patient should be in charge and the doctor should be there to support. But it shouldn't mean that doctors have to do whatever the patient asks of them.
      - damnyou 7y ago
        Of course, antibiotics are special because of their externalities. I'm taking about stuff like modafinil, for example.
  - mantap 7y ago
    A good doctor is one who pays attention. I've met my fair share of bad doctors who are overworked and just are not paying attention to what they are doing. Then they end up making mistakes, such as misdiagnosing a condition, prescribing the wrong medication, etc. It's hard for the average person to know if their doctor is doing a good job until something goes wrong and it's too late. My doctor now is excellent, he's excellent because he actually listens to what I'm saying. That doesn't mean he always agrees with me, I would hope he doesn't! But at least he is paying attention. Many other doctors seem to go into a keyword search mode when listening to patients. It's the difference between reading a page thoroughly and skim reading it.
    - utopian3 7y ago
      Same. I have a GP who takes 40-60 minutes per patient, and gets into detail of what’s going on. I felt he truly cared. Compare that to the ~5-10 minutes of my previous GP
  - hnmullany 7y ago
    Well my one medical doctor missed an important part of a medical test. I had to point out that he had missed it.
- deleted 7y ago
  [deleted]
- totalthrowaway 7y ago
  In my experience, they are often young and at the beginning of their career. They are still medical doctors, not to take anything away from them, but I mostly rely on them for referrals to specialists as needed. One Medical removes some friction from the overall system, which as a non-American I find incredibly frustrating.
  - asdfasgasdgasdg 7y ago
    Fwiw some studies show that young doctors have better outcomes. Maybe because they have been to medical school more recently, when evidence based techniques were taught with more rigor. E.g. https://www.bmj.com/content/357/bmj.j2286 https://www.bmj.com/content/357/bmj.j2286. Now this study only concerns hospitalists, and it's just one study, so it shouldn't make you avoid older doctors necessarily. But definitely what there is no data for is a bias against younger doctors.
- Nuzzerino 7y ago
  I've had 4 different doctors from One Medical. One of them was pretty good but I wouldn't recommend the other three. However the email access and online scheduling makes up for it. And office staff is actually not brain dead like I've see elsewhere.
dr_ 7y ago
They may be difficult to scale compared to pure software based companies, but they can still scale. Hospitals are difficult to grow and maintain, but HCA still commands a market cap of 50 billion. And if you believe healthcare is moving from more inpatient care to more outpatient based care...
trhway 7y ago
> In my experience, the quality of doctor was incredibly low There is significant amount of doctors providing mediocre quality services in US (and given the developments like the rise of AI there will be even more of it). What does economics suggest you're to do with mass amounts of cheap low quality goods? Fastfood it. McDonalds for medical services. If that is what One Medical really does, then we have another Uber/AirBnb/etc. >If you actually want good medical care, over your lifetime, your best bet is to build a strong relationship with a good doctor. If you also want to never wait, concierge medicine is where you ultimately need to be (doctor is trading off a higher volume of patients for a fee to a small number of patients). Yes, good restaurant with star chief and great ambience where you're a valuable regular ...
- novok 7y ago
  With one medical, many of the practitioners are not doctors, but NPs and such. Some were good as far as I could tell, but others I've used are so so. Most of the value of one medical was the easy app based scheduling, but since I've realized that something like zocdoc exists, most of it's value has disappeared for me. Also they don't integrate with things like apple health, while larger hospitals tend to have integration built into them. Because of that, I'm not very bullish about one medical overall, since a combo of zocdoc + apple health provides most of their benefit, with an expanded set of services available with a set of doctors that are larger than what one medical would provide.
damnyou 7y ago
I have serious medical needs and have built long-term relationships with a couple specific doctors at One Medical. Works very well for me — I see my doctors for specialist-y things and a random doctor if it's more urgent.
jhj 7y ago
I've used One Medical in NYC for the past two years but I'll probably drop them the next year. The primary care checkups were nowhere near as thorough as ones I've had with one-off doctors. The only benefit that I value that they provide to me is the ability to schedule appointments online, but I frequently find that it is more and more rare to find an open slot the day of (or I have to travel way further across town than I would like, with degree of urgency affecting how eager I am to do this), and many practitioners seem booked 1-3 weeks into the future. With such full scheduling, sometimes I just end up going to a local chain of urgent care clinics instead and usually see someone within 30 minutes or so.
- jelling 7y ago
  FWIW NYU Langone has a quality app now and obviously the services they offer are much wider. I’ve used One Medical before and felt similar.
rossjudson 7y ago
I'll contribute my anecdata, and state that the One Medical doctor I've seen was great.

by karl11 7y ago

dbcurtis 7y ago

> In my experience, the quality of doctor was incredibly low, Hmmm... never would have guessed that. In my experience, the One Medical doctor that my wife and child see is excellent. I've met him and think he is great. A colleague is also extremely pleased with her One Medical doctor. Maybe you just had bad luck with your doctor selection? I don't mean to invalidate your experience, but it certainly varies from my experience.

Godel_unicode 7y ago
I'm always really curious what people mean when they say a doctor is "great". Is this just biases about smiling and seemingly having it together, or are there medical aspects to the greatness which set them apart as doctors? How does an average person know if your doctor is, in fact, doing a good job?
- meddlepal 7y ago
  Thanks for asking this question... I was just about to ask this and then I got distracted before coming back. As an engineer I have no idea how to actually qualify whether my doctor is good or not. I _like_ my doctor, he's a personable enough guy, and perhaps I trust him because he hasn't harmed me yet, but I also have no idea if he is any good. The worst graduate in a medical class is still a Doctor somewhere... This is probably the same feeling business guys have about engineers...
- deleted 7y ago
  [deleted]
- damnyou 7y ago
  The most important thing to me is an understanding that the patient is in charge of their health and the doctor's just there to support the patient. For example, if a patient is already on meds from an online pharmacy, the doctor (after ensuring that the patient isnt causing grave harm to themselves) should be willing to write a prescription for those meds.
  - epmaybe 7y ago
    At the same time, I think it is unethical for a doctor to continue prescribing medications that they do not believe you actually need based on your current health. To them/me, it would be malpractice. If you were on an antibiotic for strep throat, finished your course, and then asked your doctor for more of it without any symptoms, should they prescribe it again? You wouldn't cause grave harm (unless the aggregate risk of super resistant bacteria counts). All of this shouldn't be conflated with patient centered care, though. I too agree that the patient should be in charge and the doctor should be there to support. But it shouldn't mean that doctors have to do whatever the patient asks of them.
    - damnyou 7y ago
      Of course, antibiotics are special because of their externalities. I'm taking about stuff like modafinil, for example.
- mantap 7y ago
  A good doctor is one who pays attention. I've met my fair share of bad doctors who are overworked and just are not paying attention to what they are doing. Then they end up making mistakes, such as misdiagnosing a condition, prescribing the wrong medication, etc. It's hard for the average person to know if their doctor is doing a good job until something goes wrong and it's too late. My doctor now is excellent, he's excellent because he actually listens to what I'm saying. That doesn't mean he always agrees with me, I would hope he doesn't! But at least he is paying attention. Many other doctors seem to go into a keyword search mode when listening to patients. It's the difference between reading a page thoroughly and skim reading it.
  - utopian3 7y ago
    Same. I have a GP who takes 40-60 minutes per patient, and gets into detail of what’s going on. I felt he truly cared. Compare that to the ~5-10 minutes of my previous GP
- hnmullany 7y ago
  Well my one medical doctor missed an important part of a medical test. I had to point out that he had missed it.
deleted 7y ago
[deleted]
totalthrowaway 7y ago
In my experience, they are often young and at the beginning of their career. They are still medical doctors, not to take anything away from them, but I mostly rely on them for referrals to specialists as needed. One Medical removes some friction from the overall system, which as a non-American I find incredibly frustrating.
- asdfasgasdgasdg 7y ago
  Fwiw some studies show that young doctors have better outcomes. Maybe because they have been to medical school more recently, when evidence based techniques were taught with more rigor. E.g. https://www.bmj.com/content/357/bmj.j2286 https://www.bmj.com/content/357/bmj.j2286. Now this study only concerns hospitalists, and it's just one study, so it shouldn't make you avoid older doctors necessarily. But definitely what there is no data for is a bias against younger doctors.
Nuzzerino 7y ago
I've had 4 different doctors from One Medical. One of them was pretty good but I wouldn't recommend the other three. However the email access and online scheduling makes up for it. And office staff is actually not brain dead like I've see elsewhere.

dr_ 7y ago

They may be difficult to scale compared to pure software based companies, but they can still scale. Hospitals are difficult to grow and maintain, but HCA still commands a market cap of 50 billion. And if you believe healthcare is moving from more inpatient care to more outpatient based care...

trhway 7y ago

> In my experience, the quality of doctor was incredibly low There is significant amount of doctors providing mediocre quality services in US (and given the developments like the rise of AI there will be even more of it). What does economics suggest you're to do with mass amounts of cheap low quality goods? Fastfood it. McDonalds for medical services. If that is what One Medical really does, then we have another Uber/AirBnb/etc. >If you actually want good medical care, over your lifetime, your best bet is to build a strong relationship with a good doctor. If you also want to never wait, concierge medicine is where you ultimately need to be (doctor is trading off a higher volume of patients for a fee to a small number of patients). Yes, good restaurant with star chief and great ambience where you're a valuable regular ...

novok 7y ago
With one medical, many of the practitioners are not doctors, but NPs and such. Some were good as far as I could tell, but others I've used are so so. Most of the value of one medical was the easy app based scheduling, but since I've realized that something like zocdoc exists, most of it's value has disappeared for me. Also they don't integrate with things like apple health, while larger hospitals tend to have integration built into them. Because of that, I'm not very bullish about one medical overall, since a combo of zocdoc + apple health provides most of their benefit, with an expanded set of services available with a set of doctors that are larger than what one medical would provide.

damnyou 7y ago

I have serious medical needs and have built long-term relationships with a couple specific doctors at One Medical. Works very well for me — I see my doctors for specialist-y things and a random doctor if it's more urgent.

jhj 7y ago

I've used One Medical in NYC for the past two years but I'll probably drop them the next year. The primary care checkups were nowhere near as thorough as ones I've had with one-off doctors. The only benefit that I value that they provide to me is the ability to schedule appointments online, but I frequently find that it is more and more rare to find an open slot the day of (or I have to travel way further across town than I would like, with degree of urgency affecting how eager I am to do this), and many practitioners seem booked 1-3 weeks into the future. With such full scheduling, sometimes I just end up going to a local chain of urgent care clinics instead and usually see someone within 30 minutes or so.

jelling 7y ago
FWIW NYU Langone has a quality app now and obviously the services they offer are much wider. I’ve used One Medical before and felt similar.

rossjudson 7y ago

I'll contribute my anecdata, and state that the One Medical doctor I've seen was great.