6 ms·
"I don't know whether this is a result of..." The cause is pretty easy. Patients aren't treated like mysteries, they're treated like BAU Jira tickets - just ge
by giantg2 1y ago
"I don't know whether this is a result of..."
The cause is pretty easy. Patients aren't treated like mysteries, they're treated like BAU Jira tickets - just get it done so you're on to the next one. The system is built to handle the 90%. If you fall into that other 10%, it won't work well for you. If you have provider companies and insurances pressing you to hit some metric, that's what you have to do. If you are concerned about malpractice, then you have to just read from the Epic system. No surprise we're in this situation.
- KaoruAoiShiho 1y agoYep this is something that only AI can solve. Same situation applies to education, sales, HR. Human powered bureaucracies and systems suck.
- dayofthedaleks 1y agoAny AI will most certainly reflect the biases of the bureaucracies responsible for their creation.
- KaoruAoiShiho 1y agoNah AI can easily be programmed to be much more patient and investigate edge cases and figure out personalized solutions thoroughly and provide bespoke service. This problem would be solved, though of course there are other issues with biases of the bureaucracies.
- hluska 1y agoIf you can do that easily, you will have no shortage of investors. But it’s not easy - getting the data alone is a huge problem.
- deleted 1y ago[deleted]
- KaoruAoiShiho 1y agoI think OpenAI has plenty of investors... https://x.com/deedydas/status/1933370776264323164 https://x.com/deedydas/status/1933370776264323164
- nradov 1y agoOpenAI doesn't lack investment capital. What they still don't have is a good source of high quality clinical data. And this isn't just a matter of buying access to deidentified patient charts from some large health system. Most clinical data quality is kind of crap so using it directly for model training produces garbage output. You need an extensive cleansing and normalization pipeline designed by human clinicians who understand the data at a deep level.
- KaoruAoiShiho 1y agoAbsolutely true, but is there a system that works perfectly that I can use now that has all that that isn't AI? In the absence of such a thing OpenAI is already quite good, some theoretical perfect shouldn't be trotted out as a counter if it doesn't actually exist.
- hluska 1y agoThere is a massive difference between being able to discuss symptoms and actually being diagnosed. Diagnosing edge cases is precisely the kind of thing that a generative AI needs massive amounts of data on. Where is this magical data source that violates doctor patient confidentiality? And all the doctors just contribute to it and everything is fine? Come on…
- hluska 1y agoThat’s true but they have a massive shortage of clinical data. Doctor patient confidentiality is a thing.
- deleted 1y ago[deleted]
- majormajor 1y agoAI would be deployed to behave like the median doctor (at best - or maybe the lowest-common-denominator) to avoid blowing up costs with 99%-likely-to-turn-up-nothing hunts for super-rare conditions. Today you can try to cajole your human doctor into listening more, or ordering more tests, or considering things you heard online or from acquaintances. AI will be guided to take that into account less because a doctor being more sympathetic and bypassing "standard practice" is an expense caused by humanity that the machine can be trained to avoid. Today you can go across town and try your luck with another doctor. If it's all AI, you'll just repeat your story to the same basic model and get the same basic dismissal. The problem arose from trying to make people behave like machines in order to save money. Making a machine behave like a machine ain't gonna help. You need to shift the goal from "saving money" to "helping people." AI doesn't do that.
- KaoruAoiShiho 1y agoThe costs are so low you can easily inference a bit longer. The idea that a computer would be as lazy as a human is not even close to reality.
- nemomarx 1y agoNot the cost of running the ai, the cost of potential tests and medical treatment if they do find something, I think?
- KaoruAoiShiho 1y agoNah those make money not cost money (for providers).
- sfn42 1y agoYou can do an obscene amount of inference for a fraction of the cost of an average doctor's appointment.
- snitty 1y ago>Yep this is something that only AI can solve. [citation needed]
- tbrownaw 1y ago> Yep this is something that only AI can solve. How? I'd expect them to already have standardized lists of the most useful next thing to investigate given what's already known, and a modern "AI" would actually be worse at that than some sort of solver engine with a database of costs/risks (for tests) and conditional probabilities. Maybe if they're still using (digitized versions of) paper flowcharts things could be improved, but the most powerful tech should be old-school stuff rather than modern "AI".
- KaoruAoiShiho 1y agoNo normal person would actually be able to use a specialized solver database, the woman in this story would already be dead before the guy figures out that such a thing exists and manage to make an account. https://x.com/deedydas/status/1933370776264323164 https://x.com/deedydas/status/1933370776264323164 LLMs already work fantastically with pretty good UX.
- tbrownaw 1y agoDoes "here are the most useful things to find out next" really need that complex of a user experience?
- renewiltord 1y agoAmusingly this is why people say LLMs will beat doctors. It’s because the 90% of cases is so easy that a motivated guy with Google can get there and a smart NP can get there too. It isn’t that it’s easy to do all a doctor does. But their training and knowledge shines in the 99th percentile case except they never exercise it there so you can usually get there with Google. “Oh but an LLM will guess the common case and never think of the rare!” Yeah but so will a doctor given 10 minutes on it. They’re not exactly going to House MD you. You’re gonna die.
- giantg2 1y agoI think a great use case for AI is to act as triage for a new case so that it can send you to the right specialist and have them evaluate you. It could potentially remove the need to see a GP for a referral to a specialist, thus freeing the GP up to spend more time treating others.
- cess11 1y agoHow are you going to make it reliably stop people that lie to get into contact with medical professions?
- rincebrain 1y agoWhy does it matter if they do? I've seen a lot of doctors who insist patients must be making up things when they say "but XYZ", and my question becomes...so what? If someone credibly lies to you and gets codeine or ritalin or something once or twice...that's not really significant, in terms of negative outcomes. If someone lies to reach a medical professional, then you treat them like any other bad customer interaction and stop doing business with them after some point.
- cess11 1y agoYou're going to have to choose, denying people in need directly, or doing it indirectly because other people game the process and get in the way of those in need.
- ipaddr 1y agoPublic or private medicine shares the same issue. In fact there is no John Hopkins you can pay in the public system so things never get solved.
- paulryanrogers 1y agoUp to 25% of women have endo, in some communities at least. We need more doctors. The nation has grown, our medical professionals and courts must scale up. Automation isn't going to solve everything.
- kulahan 1y agoWe need more of all healthcare professionals. Nurses and CNAs are getting run ragged just the same.
- verisimi 1y agoHave you heard of Iatrogenesis? https://www.wikipedia.org/wiki/Iatrogenesis https://www.wikipedia.org/wiki/Iatrogenesis > In 2013, an estimated 142,000 persons died from adverse effects of medical treatment, up from an estimated 94,000 in 1990. Careful what you wish for! And, imo, an awful lot of deaths are due to issues that cannot be classified as caused by doctors - eg dosage error over time, something that mitigates symptoms but allows the underlying to deteriorate, etc.
- jmcgough 1y agoMost premature death in this country is from chronic disease. It's nearly impossible to get a PCP in many parts of the country. Gastroenterology is like a four month wait here.
- kulahan 1y agoI’m very ready to have a conversation about whether or not there is a point where we should stop advancing healthcare because people probably shouldn’t be immortal, but doing it by making your healthcare workers struggle under the extreme weight of all the patients they need to care for probably is not the approach. I simply don’t think we have the medical knowledge necessary yet to know what the “right” number of health care professionals is.
- chongli 1y agoWe need more doctors. Yes, unfortunately we've made doctors the gatekeepers and they don't want more doctors because that will eat into their income. This happens with every single licensed occupation where the license body is run by members of the occupation, with the possible exception of bar associations. My theory on that one is that the more lawyers you have in society the more lawyers you need because lawyers do a great job creating work for one another (both through litigation but also through legal documentation which needs to be read and interpreted by other lawyers).
- BobbyTables2 1y agoIndeed. Imagine if asking a specialist the time meant they had 3 broken clocks on the wall and picked one. That’s pretty much how initial medical diagnoses are done. Insurance companies then limit what’s types of care/investigation can be done for various conditions. Doctor may know that medicine X will work best but insurance demands that Y and Z be first tried before covering X. Same with tests. I’m tired of it.
- nradov 1y agoWhat would you propose as an alternative? Healthcare costs are already high. Imposing step therapy requirements to try cheaper treatments first is one of the few ways that insurers have to control costs. And the cheaper treatments do work well for many patients (or they recover on there own just due to time).
- kulahan 1y agoLook at any nation that doesn’t have these unbelievably, ridiculously, insanely high costs. This isn’t an unsolved problem, nor is it a sensible one. What’s with the stupid “here’s the cost” bill you get, followed by the insurance company just, like, deciding things are a different price? What’s with the unreasonably stupid “out of network” medical charges? What’s with the fact that you can walk into a pharmacy and request a discount, but they can’t tell you about it once the transaction has been rung up? There are SO MANY stupid rules in this system, I literally cannot imagine a system with more low-hanging fruit.
- nradov 1y agoMany of the nations with lower healthcare costs also have step therapy requirements, or simply don't make the most expensive treatments available at all. That is literally one of the cost control mechanisms they use.
- kulahan 1y agoOk, that’s fine? We still don’t have an easy time accessing the cheap and simple stuff here. I have to keep going in to get a doctor to approve a non-controlled substance I’ve been taking for a decade. It has no habit-forming effects. It has no use as a precursor. It has no use recreationally. It’s a worthless, ongoing expense. Why are you defending this awful, awful system? Have you had even one good experience? Not “well, that wasn’t awful”, but truly one GOOD experience? Hospitals here don’t even follow up to see if your medical care was effective. Hell, I’d even take Australia’s approach, where basic stuff is free and you pay for additional coverage.
- NBJack 1y agoWell, that, and deviation from the established practices can make it difficult to get paid by the insurance company and/or open you up to legal risk (particularly if something goes wrong). Or so I understand from those in the system in the US.
- MisterBastahrd 1y agoI've had three doctors in the past year tell me that either I wasn't a candidate for cancer treatment because I was gonna die in the next 3 years anyway, or that my best bet was a liver and heart transplant. All of them read the first page of my medical records upon being admitted to a hospital in January. Not a single one of them read anything after that and it shows. One of them was stricken and amazed that I was walking into his office without aid or an oxygen mask. Gives me great confidence in their ability to pay attention to detail.