4 ms·

The tail end of this article, where the author talks about how many more patients he could see in his life if he had AI assistance, made me realize that part of

by lumb63 4y ago

The tail end of this article, where the author talks about how many more patients he could see in his life if he had AI assistance, made me realize that part of healthcare cannot be solved by AI. The goal is not to see more patients; the goal is to help more patients get better. For a lot of patients who are frustrated and have not had their problems validated and have been to many doctors and seen no results or poor results, having a real, physical, human doctor validate their condition, and work with them to solve it is part of the treatment. Doctors can prescribe whatever medicines and do whatever surgeries they want, but only the patient’s body is capable of healing itself. I worry that a tendency to plug symptoms into an AI that “diagnoses” the patient, that the patient doesn’t trust, will hurt outcomes. The patient benefits greatly from understanding the doctor’s methodology and thought process.

RandomLensman 4y ago
Some medical treatment and surgery is precisely there because the body isn't capable of healing itself at that stage. It might be able to heal itself after the treatment, but not before.
SanderNL 4y ago
"Seeing the patient" is an important step towards "patient getting better". > have not had their problems validated and have been to many doctors and seen no results or poor results, Also, being validated or not is not going to change with AI as you yourself state that seeing actual physical doctors is not helping in the cases you allude to. I agree that having access to professionals that care about their profession is valuable, but that might be becoming a luxery we can no longer afford.. Who thought it was a good idea to have a fixed amount of medical students? Might be worth checking that out first.
- HelloMcFly 4y ago
  > Who thought it was a good idea to have a fixed amount of medical students? A major limiter on the amount of trained medical doctors is not to do with someone "deciding" to have an artificially scarce number of medical students. Two important things come immediately to mind: 1) Medical schools rely on clerkships and preceptors to deliver actual clinical experience critical for learning. These cannot be created out of thin air and often rely on access to urban centers. There is already a shortage of clerkships and preceptors. https://www.aamc.org/news-insights/so-many-medical-students-so-few-clerkship-sites https://www.aamc.org/news-insights/so-many-medical-students-... (not my original source but the nearest to hand one) 2) The real chokepoint for creating practicing clinicians is the number of residency spots. This year there were 43k graduating MD and DO students, but only about 40k residency spots. This doesn't count international medical school graduates. https://www.medicaleconomics.com/view/match-day-2023-a-reminder-of-the-real-cause-of-the-physician-shortage-not-enough-residency-positions https://www.medicaleconomics.com/view/match-day-2023-a-remin.... Creating a new residency program is significantly more challenging than graduating more medical students.
  - SanderNL 4y ago
    I understand, but it feels like only allowing CS students based on the amount of jobs at Meta. I don't understand why you need to walk around a hospital (Meta/Google/etc) to be a GP. Some leveling would be appropriate (IMO - which is shit/ignorant). Future surgeons need to walk different paths than GPs. I get that experience is hard to come by, but I don't really feel we are working really, really hard on solving that problem. Again I am ignorant, but I am also not naive. I know money and status factors greatly into all this.
ChuckNorris89 4y ago
> The goal is not to see more patients Not when you're a doctor in the EU dealing with the shortages of socialized care where you have a limited amount of time to spend diagnosing a patient because there's dozens waiting in the queue. As a doctor you'd like to give everyone better care but you can't because you have too many people to see and too little time. Doctors here are busy AF and sometimes misdiagnose you because they don't have time to look into every possibility of what you might be suffering from. So maybe AI could help there, as in giving them some hints on things they might iss, as waiting for the governments to fix healthcare is like waiting for them to also fix climate change.
- iso1631 4y ago
  Not when you're a doctor in the US dealing with the shortages of privitised car where you have a limited amount of patients who can afford your time
  - ChuckNorris89 4y ago
    How does the US doctor get impacted by that? Your cheap shot jab at an counter argument makes no sense. You probably mean the patience are dealing with the shortages, not the doctors. Also, I'm only commenting on the EU system as that's the one I'm dealing with right now. Why do you feels the need to start a holy war on how the US system is worse? I have no expertise with the US system so I'm avoiding any comparisons with it.
    - iso1631 4y ago
      The US doctor has an incentive to overmedicalise the patients as he'll make more money by upselling stuff they don't need. An AI assisting the diagnosis is detrimental to that as the AI will be doing the upselling and getting the kickbacks from those "ask your doctor about" advertisers. A doctor could choose to see 20 people a day and charge $100 each, or see 10 people a day and charges $200 each. Indeed perhaps there's an incentive to see fewer people as they'll pay the same hourly rate but cost less to treat as they're just paying $250 an hour to talk about last night's game. Reality is though that 28% of US people have to wait more than a day to see a doctor, far higher than Germany, UK, Sweden and Norway. https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country https://worldpopulationreview.com/country-rankings/health-ca... > A common misconception in the U.S. is that countries with universal health care have much longer wait times. However, data from nations with universal coverage, coupled with historical data from coverage expansion in the United States, show that patients in other nations often have similar or shorter wait times. So perhaps AI could help with the disfunctional american system afterall.
thelittleone 4y ago
During my wife's second pregnancy she was admitted to hospital at 6 months due to some intense abdominal pain and inability to hold down food. The put her on PNT, pumped her stomach daily and run a bunch of tests. I logged every test. Weeks passed she was slipping away and the specialist had no real game plan. So I got another Doctor. A busy professor who travelled a lot and was clearly passionate about his field. Yet still dozens of different tests and scans and they couldn't find the cause. Meanwhile she was getting worse. One of the scholar articles I found matched a test result where blood from upper body had a different profile to that in urine (which matched her result) which pointed to a condition called placenta parcreta. The Dr agreed it was possible and as my wife was slipping away we did an emergency c section. Sure enough the cause was placenta parcreta and the Dr showed a picture of a small tear in uterus that he said was about to rupture anytime. The operation saved her life and perhaps my son too. I'm no Doctor but good at research. Doctors are busy AF. They don't have time to research cases like I did. This is a big gap and while it may not always identify cause and save a life, its damn important. And I can't see why AI could not find what I did.
- baremetal 4y ago
  Your story made me tear up. You are a hero.
- davikr 4y ago
  Placenta percreta should have been detected during prenatal care, through ultrasonography, and it's a real shame that kind of visit isn't offered freely. It's also pretty bad that they didn't consider any obstetric causes in their differential. Thankfully, everything is OK now and that makes me happy.
  - thelittleone 4y ago
    I'm sure you're right. The cause was identified. Following first child, postpartum bleeding was treated with a D&C. The D&C (unknowingly) perforated her uterus and the intestine was drawn/sucked inward, plugging the hole. It was only after 6 months into second pregnancy that any symptoms where noticed.
- 4y ago
jeswin 4y ago
> The goal is not to see more patients I previously worked on software which was sold to physicians. That the software will "let them SEE X% more patients" was the big draw. We did that by making some paper processes electronic, and in hindsight it may have been good for sales but not necessarily so for patients.
leobg 4y ago
That’s an argument against legal AI as well. The idea being that the citizen has a right to be heard by the state. And that an AI handling a case is not really “hearing“ the citizen. Then, again, before Al Capone, nobody in their right mind would’ve argued that the state should share the profits of criminals through income tax. That idea went down the drain very fast. Wouldn’t be surprised to see the same thing happening to the idea of “being heard“ by the state.

by lumb63 4y ago

RandomLensman 4y ago

Some medical treatment and surgery is precisely there because the body isn't capable of healing itself at that stage. It might be able to heal itself after the treatment, but not before.

SanderNL 4y ago

"Seeing the patient" is an important step towards "patient getting better". > have not had their problems validated and have been to many doctors and seen no results or poor results, Also, being validated or not is not going to change with AI as you yourself state that seeing actual physical doctors is not helping in the cases you allude to. I agree that having access to professionals that care about their profession is valuable, but that might be becoming a luxery we can no longer afford.. Who thought it was a good idea to have a fixed amount of medical students? Might be worth checking that out first.

HelloMcFly 4y ago
> Who thought it was a good idea to have a fixed amount of medical students? A major limiter on the amount of trained medical doctors is not to do with someone "deciding" to have an artificially scarce number of medical students. Two important things come immediately to mind: 1) Medical schools rely on clerkships and preceptors to deliver actual clinical experience critical for learning. These cannot be created out of thin air and often rely on access to urban centers. There is already a shortage of clerkships and preceptors. https://www.aamc.org/news-insights/so-many-medical-students-so-few-clerkship-sites https://www.aamc.org/news-insights/so-many-medical-students-... (not my original source but the nearest to hand one) 2) The real chokepoint for creating practicing clinicians is the number of residency spots. This year there were 43k graduating MD and DO students, but only about 40k residency spots. This doesn't count international medical school graduates. https://www.medicaleconomics.com/view/match-day-2023-a-reminder-of-the-real-cause-of-the-physician-shortage-not-enough-residency-positions https://www.medicaleconomics.com/view/match-day-2023-a-remin.... Creating a new residency program is significantly more challenging than graduating more medical students.
- SanderNL 4y ago
  I understand, but it feels like only allowing CS students based on the amount of jobs at Meta. I don't understand why you need to walk around a hospital (Meta/Google/etc) to be a GP. Some leveling would be appropriate (IMO - which is shit/ignorant). Future surgeons need to walk different paths than GPs. I get that experience is hard to come by, but I don't really feel we are working really, really hard on solving that problem. Again I am ignorant, but I am also not naive. I know money and status factors greatly into all this.

ChuckNorris89 4y ago

> The goal is not to see more patients Not when you're a doctor in the EU dealing with the shortages of socialized care where you have a limited amount of time to spend diagnosing a patient because there's dozens waiting in the queue. As a doctor you'd like to give everyone better care but you can't because you have too many people to see and too little time. Doctors here are busy AF and sometimes misdiagnose you because they don't have time to look into every possibility of what you might be suffering from. So maybe AI could help there, as in giving them some hints on things they might iss, as waiting for the governments to fix healthcare is like waiting for them to also fix climate change.

iso1631 4y ago
Not when you're a doctor in the US dealing with the shortages of privitised car where you have a limited amount of patients who can afford your time
- ChuckNorris89 4y ago
  How does the US doctor get impacted by that? Your cheap shot jab at an counter argument makes no sense. You probably mean the patience are dealing with the shortages, not the doctors. Also, I'm only commenting on the EU system as that's the one I'm dealing with right now. Why do you feels the need to start a holy war on how the US system is worse? I have no expertise with the US system so I'm avoiding any comparisons with it.
  - iso1631 4y ago
    The US doctor has an incentive to overmedicalise the patients as he'll make more money by upselling stuff they don't need. An AI assisting the diagnosis is detrimental to that as the AI will be doing the upselling and getting the kickbacks from those "ask your doctor about" advertisers. A doctor could choose to see 20 people a day and charge $100 each, or see 10 people a day and charges $200 each. Indeed perhaps there's an incentive to see fewer people as they'll pay the same hourly rate but cost less to treat as they're just paying $250 an hour to talk about last night's game. Reality is though that 28% of US people have to wait more than a day to see a doctor, far higher than Germany, UK, Sweden and Norway. https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country https://worldpopulationreview.com/country-rankings/health-ca... > A common misconception in the U.S. is that countries with universal health care have much longer wait times. However, data from nations with universal coverage, coupled with historical data from coverage expansion in the United States, show that patients in other nations often have similar or shorter wait times. So perhaps AI could help with the disfunctional american system afterall.

thelittleone 4y ago

During my wife's second pregnancy she was admitted to hospital at 6 months due to some intense abdominal pain and inability to hold down food. The put her on PNT, pumped her stomach daily and run a bunch of tests. I logged every test. Weeks passed she was slipping away and the specialist had no real game plan. So I got another Doctor. A busy professor who travelled a lot and was clearly passionate about his field. Yet still dozens of different tests and scans and they couldn't find the cause. Meanwhile she was getting worse. One of the scholar articles I found matched a test result where blood from upper body had a different profile to that in urine (which matched her result) which pointed to a condition called placenta parcreta. The Dr agreed it was possible and as my wife was slipping away we did an emergency c section. Sure enough the cause was placenta parcreta and the Dr showed a picture of a small tear in uterus that he said was about to rupture anytime. The operation saved her life and perhaps my son too. I'm no Doctor but good at research. Doctors are busy AF. They don't have time to research cases like I did. This is a big gap and while it may not always identify cause and save a life, its damn important. And I can't see why AI could not find what I did.

baremetal 4y ago
Your story made me tear up. You are a hero.
davikr 4y ago
Placenta percreta should have been detected during prenatal care, through ultrasonography, and it's a real shame that kind of visit isn't offered freely. It's also pretty bad that they didn't consider any obstetric causes in their differential. Thankfully, everything is OK now and that makes me happy.
- thelittleone 4y ago
  I'm sure you're right. The cause was identified. Following first child, postpartum bleeding was treated with a D&C. The D&C (unknowingly) perforated her uterus and the intestine was drawn/sucked inward, plugging the hole. It was only after 6 months into second pregnancy that any symptoms where noticed.
4y ago

jeswin 4y ago

> The goal is not to see more patients I previously worked on software which was sold to physicians. That the software will "let them SEE X% more patients" was the big draw. We did that by making some paper processes electronic, and in hindsight it may have been good for sales but not necessarily so for patients.

leobg 4y ago

That’s an argument against legal AI as well. The idea being that the citizen has a right to be heard by the state. And that an AI handling a case is not really “hearing“ the citizen. Then, again, before Al Capone, nobody in their right mind would’ve argued that the state should share the profits of criminals through income tax. That idea went down the drain very fast. Wouldn’t be surprised to see the same thing happening to the idea of “being heard“ by the state.