4 ms·

The conversations are surely paraphrased and exaggerated—just look at the style of the rest of the article. The position that doctors should be trying new thin

The conversations are surely paraphrased and exaggerated—just look at the style of the rest of the article. The position that doctors should be trying new things to improve their care sounds good but in practice most doctors are strongly biased towards the status quo and usually inaction is preferred to a slightly unknown action, even if that action has better expectancy.

ketzo 6y ago
I dunno. I think tech people have a tendency to assume they know for certain that they have a better solution, and their words/tone can reflect that in a way that can come off as very insulting to people who have been working in the space for literal decades. Not everyone, and not all the time. But many people, and often enough that it's a stereotype. So I think it's worth considering, particularly when you're looking at a customer base who (by and large) really aren't used to being condescended to. Even if you and I personally aren't offended in the slightest by what OP said on sales calls, it's possible a psychologist in the fourth decade of her career might take "Are you sure that's right?" differently than we would.
- james1071 6y ago
  He struck me as completely oblivious to what was likely to have been a complete lack of interest. His approach was never going to work, as doctors do not spend their time evaluating drugs in the way that he imagined.
  - pc86 6y ago
    It's a great example of "I'm going to make a pretty chart, and sell to.... $PROFESSION!" It may have been a great product like you and others have said, he hasn't the faintest idea what physicians actually do day-to-day. He had apparently spent $40k over nearly a year before he talked to the first physician.
    - wartijn_ 6y ago
      That's because his first plan was to sell to consumers. Only when that didn't work out he switched to physicians.
      - fakedang 6y ago
        Like someone else said, he got greedy. Even if he had stuck to the WebMD model, he would have made a fortune. People like to Google symptoms before seeing a doctor, and although unethical, pharma companies would have gone head over heels to market in those spots.
xivzgrev 6y ago
I don’t think that was the point. The point was better healthcare doesn’t necessarily translate to more revenue. Healthcare is weird like that - you get paid a flat fee for visits. There might be an argument to be made that better prescriptions = happier patients = more retention, but it’s a stretch. If your practice is already booked full what’s the point? This biz was clearly made for consumers but yea ads are tough - need a lot of eyeballs.
- dan-robertson 6y ago
  Yeah I agree that’s the point of the article. I think what I wrote would still be a reason even if it is rationalised differently. The argument that “patients won’t know the difference so I can just do whatever” must break down at some point (hopefully before malpractice) but I think an argument of “I’ll just keep doing what I did before, it’s worked fine so far” doesn’t encourage worsening treatment or paying for more experimentation.
  - f6v 6y ago
    As somebody said here, first line drug is prescribed since it’s know to work based on experience. Any experimentation puts too much unwanted responsibility on the doctor.
- redkoala 6y ago
  Better healthcare outcomes are of interest to health insurance companies and employers, not the healthcare providers. A reduction in overall claims over a patient's lifetime and better employee health are quantifiable financial results.
  - cestith 6y ago
    Healthcare providers hope for better outcomes I'm sure, but it's true there's not much financial incentive in most cases. Your comment sort of suggests the model for such a service should be on a per-use model, covered by an insurance company when a doctor uses it for their patient. That's a trickier model than subscriptions, but it may be viable.
loceng 6y ago
Psychiatrists are simply experimenting on each person they prescribe medications to. The status quo is indoctrination, and in this case, the psychiatrist wasn't even willing to use actual research based data to improve the treatment of their patients - even referencing that they won't make anymore money because the patient won't come back more often or refer more patients because of it. This is abhorrent unprofessional behaviour - but it's likely the attitude of 90%+ of the field. Edit to add: if you think a practitioner putting their own revenue/profits above providing quality care, then something's wrong with you.
- deleted 6y ago
  [deleted]
- wolco5 6y ago
  I've seen this happen and the entire process of adding new drugs and waiting a week or more between visits seems cruel.
  - cestith 6y ago
    Lots of psychoactive medications take days or weeks to build up in the body to the point of effectiveness. They're finding out neat things about esketamine and psilocybin, but in general a large enough dose of a mood-altering drug to take immediate effect is a bad or at least very risky thing.
- pc86 6y ago
  In medicine "quality care" is a binary attribute. Something either meets the quality threshold or it doesn't. And as the author found out, physicians do not spend their time researching medications. It's not their job, they're not trained in it, and most of them wouldn't be particularly good at it. So I'm not sure why you would expect a psychiatrist to do something she's not trained to do to (maybe) increase an already acceptable metric some arbitrarily small amount higher.
starkd 6y ago
Right, and both doctors and patients don't want to run another experiment. If they are comfortable with a certain drug, that's a good enough indication its a good first step to getting better.

ketzo 6y ago

I dunno. I think tech people have a tendency to assume they know for certain that they have a better solution, and their words/tone can reflect that in a way that can come off as very insulting to people who have been working in the space for literal decades. Not everyone, and not all the time. But many people, and often enough that it's a stereotype. So I think it's worth considering, particularly when you're looking at a customer base who (by and large) really aren't used to being condescended to. Even if you and I personally aren't offended in the slightest by what OP said on sales calls, it's possible a psychologist in the fourth decade of her career might take "Are you sure that's right?" differently than we would.

james1071 6y ago
He struck me as completely oblivious to what was likely to have been a complete lack of interest. His approach was never going to work, as doctors do not spend their time evaluating drugs in the way that he imagined.
- pc86 6y ago
  It's a great example of "I'm going to make a pretty chart, and sell to.... $PROFESSION!" It may have been a great product like you and others have said, he hasn't the faintest idea what physicians actually do day-to-day. He had apparently spent $40k over nearly a year before he talked to the first physician.
  - wartijn_ 6y ago
    That's because his first plan was to sell to consumers. Only when that didn't work out he switched to physicians.
    - fakedang 6y ago
      Like someone else said, he got greedy. Even if he had stuck to the WebMD model, he would have made a fortune. People like to Google symptoms before seeing a doctor, and although unethical, pharma companies would have gone head over heels to market in those spots.

xivzgrev 6y ago

I don’t think that was the point. The point was better healthcare doesn’t necessarily translate to more revenue. Healthcare is weird like that - you get paid a flat fee for visits. There might be an argument to be made that better prescriptions = happier patients = more retention, but it’s a stretch. If your practice is already booked full what’s the point? This biz was clearly made for consumers but yea ads are tough - need a lot of eyeballs.

dan-robertson 6y ago
Yeah I agree that’s the point of the article. I think what I wrote would still be a reason even if it is rationalised differently. The argument that “patients won’t know the difference so I can just do whatever” must break down at some point (hopefully before malpractice) but I think an argument of “I’ll just keep doing what I did before, it’s worked fine so far” doesn’t encourage worsening treatment or paying for more experimentation.
- f6v 6y ago
  As somebody said here, first line drug is prescribed since it’s know to work based on experience. Any experimentation puts too much unwanted responsibility on the doctor.
redkoala 6y ago
Better healthcare outcomes are of interest to health insurance companies and employers, not the healthcare providers. A reduction in overall claims over a patient's lifetime and better employee health are quantifiable financial results.
- cestith 6y ago
  Healthcare providers hope for better outcomes I'm sure, but it's true there's not much financial incentive in most cases. Your comment sort of suggests the model for such a service should be on a per-use model, covered by an insurance company when a doctor uses it for their patient. That's a trickier model than subscriptions, but it may be viable.

loceng 6y ago

Psychiatrists are simply experimenting on each person they prescribe medications to. The status quo is indoctrination, and in this case, the psychiatrist wasn't even willing to use actual research based data to improve the treatment of their patients - even referencing that they won't make anymore money because the patient won't come back more often or refer more patients because of it. This is abhorrent unprofessional behaviour - but it's likely the attitude of 90%+ of the field. Edit to add: if you think a practitioner putting their own revenue/profits above providing quality care, then something's wrong with you.

deleted 6y ago
[deleted]
wolco5 6y ago
I've seen this happen and the entire process of adding new drugs and waiting a week or more between visits seems cruel.
- cestith 6y ago
  Lots of psychoactive medications take days or weeks to build up in the body to the point of effectiveness. They're finding out neat things about esketamine and psilocybin, but in general a large enough dose of a mood-altering drug to take immediate effect is a bad or at least very risky thing.
pc86 6y ago
In medicine "quality care" is a binary attribute. Something either meets the quality threshold or it doesn't. And as the author found out, physicians do not spend their time researching medications. It's not their job, they're not trained in it, and most of them wouldn't be particularly good at it. So I'm not sure why you would expect a psychiatrist to do something she's not trained to do to (maybe) increase an already acceptable metric some arbitrarily small amount higher.

starkd 6y ago

Right, and both doctors and patients don't want to run another experiment. If they are comfortable with a certain drug, that's a good enough indication its a good first step to getting better.