3 ms·

I have wondered why we even need primary care doctors when it seems like if you really need treatment, you see a specialist. Not to be the "disruptive technolog

I have wondered why we even need primary care doctors when it seems like if you really need treatment, you see a specialist. Not to be the "disruptive technology will fix X industry" guy, but wouldn't it make sense to have nurses and techs just run a diagnostic on you and feed it into a computer, which can spit out a list of possible causes, which you then take to a specialist? I don't really know much about this stuff so I'm genuinely curious why our system seems to suck so bad from the outside.

jmye 3y ago
I think 90% of everyone’s needs are handled by primary care (family med, IM, peds) - most people aren’t going for anything really complicated, and basic preventive care like a yearly physical can be really, really powerful. I think there’s a movement to move away from needing MDs for primary care, which should generally help with availability and costs, as well, but I do think the majority of people don’t need specialty care. I think adding AI makes sense, though the biggest focus right now (for major providers, at least) is on admit prevention (and, specifically, readmit prevention) and reading imaging. I imagine eventually you could get to quality diagnosing/suggesting, but I think it’s further away than the tech sector thinks. That said, I who knows, if an AI stops hallucinating, maybe you can get closer faster. The biggest issue in the US, in my opinion, is that fee-for-service models are absolutely, completely broken. They (and bad reimbursement rates) encourage doctors to see too many patients, sell too many non-medical services (see how many ads your dermatologist has for Botox, for instance), and suggest too many irrelevant tests (radiology for lower back pain, for instance). You really need a massive structural change to convince everyone to move to value-based models (which also aren’t perfect, but at least align incentives). This is a long comment (leaving a lot of space for people to nitpick and/or disagree!), but I’d just end with: healthcare is really, really complicated. Anyone selling an Easy Solution is either a neophyte (I don’t say negatively), or a huckster. What might work in SF will probably work very differently in West Texas or Eastern Montana.
nradov 3y ago
That is completely unrealistic. There is no magic "diagnostic" which can gather all of the necessary data. And in most cases the diagnosis isn't even the hard part. The hard parts are coming up with a workable treatment plan that the patient will comply with, and in many cases directly performing procedures on the patient's body. Primary care physicians are cheaper than specialists and so in order to hold down costs and waiting times we should use specialists only when necessary. And for routine cases the trend is to have physician assistants or nurse practitioners handle those.
SpicyLemonZest 3y ago
"Run a diagnostic on you" is a fair summary of what primary care doctors do. It's hard because the human body is complicated, often unintuitive, and most of us need coaching to explain even our own experiences with the required precision. (My PCP saved me from a misdiagnosis once because I incorrectly told her I'd been waking up "wheezing" - apparently that term refers to a specific whistling sound and not general breathing problems.)

jmye 3y ago

I think 90% of everyone’s needs are handled by primary care (family med, IM, peds) - most people aren’t going for anything really complicated, and basic preventive care like a yearly physical can be really, really powerful. I think there’s a movement to move away from needing MDs for primary care, which should generally help with availability and costs, as well, but I do think the majority of people don’t need specialty care. I think adding AI makes sense, though the biggest focus right now (for major providers, at least) is on admit prevention (and, specifically, readmit prevention) and reading imaging. I imagine eventually you could get to quality diagnosing/suggesting, but I think it’s further away than the tech sector thinks. That said, I who knows, if an AI stops hallucinating, maybe you can get closer faster. The biggest issue in the US, in my opinion, is that fee-for-service models are absolutely, completely broken. They (and bad reimbursement rates) encourage doctors to see too many patients, sell too many non-medical services (see how many ads your dermatologist has for Botox, for instance), and suggest too many irrelevant tests (radiology for lower back pain, for instance). You really need a massive structural change to convince everyone to move to value-based models (which also aren’t perfect, but at least align incentives). This is a long comment (leaving a lot of space for people to nitpick and/or disagree!), but I’d just end with: healthcare is really, really complicated. Anyone selling an Easy Solution is either a neophyte (I don’t say negatively), or a huckster. What might work in SF will probably work very differently in West Texas or Eastern Montana.

nradov 3y ago

That is completely unrealistic. There is no magic "diagnostic" which can gather all of the necessary data. And in most cases the diagnosis isn't even the hard part. The hard parts are coming up with a workable treatment plan that the patient will comply with, and in many cases directly performing procedures on the patient's body. Primary care physicians are cheaper than specialists and so in order to hold down costs and waiting times we should use specialists only when necessary. And for routine cases the trend is to have physician assistants or nurse practitioners handle those.

SpicyLemonZest 3y ago

"Run a diagnostic on you" is a fair summary of what primary care doctors do. It's hard because the human body is complicated, often unintuitive, and most of us need coaching to explain even our own experiences with the required precision. (My PCP saved me from a misdiagnosis once because I incorrectly told her I'd been waking up "wheezing" - apparently that term refers to a specific whistling sound and not general breathing problems.)