6 ms·

Kaiser nurses say AI, surveillance are making their jobs and patient care worse

563 points by gnabgib 3mo ago

Avicebron 3mo ago
Obligatory dystopia reminder. It doesn't have to be this way https://marshallbrain.com/manna1 https://marshallbrain.com/manna1
- ori_b 3mo ago
  But we're all in on making it that way!
- jbxntuehineoh 3mo ago
  but but but... the line! it has to go up, doesn't it?
  - Avicebron 3mo ago
    Yes brother. This is the way. We pray to the line, only it can shelter us in these dark times of labor revitalization. HODL. May your returns be colossal.
14 3mo ago
I would love to learn the cost of the AI versus how many new workers they could afford to hire and get more calls done. But I assume the end goal will be full replacement of human workers once the AI has had enough time to learn the job.
- BeetleB 3mo ago
  The AI is a lot cheaper. Kaiser nurses are amongst the highest paid in the nation.
  - apercu 3mo ago
    Subsidized Gen AI maybe. Also, California has a high cost of living.
  - indoorfish 3mo ago
    How dare the people who take of the sick and dying be paid well. Unacceptable waste that must be optimized! We're liberating them from work so they can focus on what matters
  - saltcured 3mo ago
    Now let's talk about how AI could replace Kaiser middle management and streamline bureaucracy to preserve more budget for doctors and nurses...
    - joe_the_user 3mo ago
      People enjoy saying "AI can replace middle management" as a comeuppance but it's not what people think. In many ways, AI is primarily serving as middle management, yes. But what happens is that instead of one manager engaging in petty surveillance, harassment and browbeating to increase work intensity, you have ten clones of the manager doing the same thing. That's not the "woo hoo, automated middle management!" you were looking for.
      - saltcured 3mo ago
        Understood and agreed. I admit I was feeling a bit pithy with that comment. I shouldn't really have referenced "replace" at all, but rather "optimize". And not targeting middle management but the whole non-medical structure above. This is where I think most of the waste in our modern US medical system lives. But I understand it is still mostly a half-baked concept. We'd need a revolution far outside of just some management system. I believe it's the whole enclosing system that is rotten and driving medical costs away from the actual encounter costs. Profiteering, risk management, regulatory capture, etc. I woudl argue there was a point, long ago, where these things have taken on a life of their own and no longer serve the need of improving care outcomes and the actual medical cost-benefit tradeoff we should be optimizing in a just and caring society.
- caturopath 3mo ago
  The article doesn't seem to be about replacing nurses staffing their phones with AI. It seems to be about making sure the care they're providing is what the company wants.
neaden 3mo ago
If you think using a machine to evaluate how well a human is showing empathy is a good idea, you probably shouldn't have any position of power.
- BeetleB 3mo ago
  If you employ a few hundred nurses, how exactly would you evaluate how well they show empathy? You can't rely on asking the customer. When they're upset (they often are in these calls), they'll lean towards the negative regardless. I don't know how well these AIs evaluate, but if they're even a little bit good, it makes sense to use it to screen for outliers, then have a human listen to those outliers and judge.
  - malfist 3mo ago
    Actually, you can rely on the customers. They're the only ones that can tell you.
    - lostlogin 3mo ago
      > you can rely on the customers. Patient or customer? I even struggle with that, but I guess that’s what people are in a privatised healthcare system.
      - munk-a 3mo ago
        Most of the folks here on HN are dealing with customer feedback in systems automation in one form or another - it's pretty unavoidable in this age of LLM trendiness. The customers of healthcare (in both private and publicly funded systems) are the patients. So while the term might not be super natural it's an understandable one to use.
        datsci_est_2015 3mo ago
        Patients are not customers, or at least I don’t want to live in a world where patients are considered customers. Customers and vendors are usually more of a symmetric relationship: price transparency, alternatives, lack of urgency. These are all characteristics of transactions that healthcare often lacks.
deleted 3mo ago
[deleted]
munk-a 3mo ago
> "Nurses fear that having long calls can lead to bad performance reviews" > A company spokesperson said, "Kaiser Permanente does not use Average Handle Time to assess agent performance" So uh, average time wasn't raised as a concern, calls beyond a certain threshold was. I wish this semantic discrepancy was better highlighted in the article.
- BeetleB 3mo ago
  I have some inside information (but not much!) They claim they do not use average handle time, but it is very common to get called into meetings to discuss why they spent a lot of time on some calls. The nurses get defensive (by definition - they have to justify the time used - it is a defense). They also do get called into meetings if their average handle time is large. It may still be true they don't use it for evaluating performance, but they absolutely do utilize it to "coach" the nurses.
  - toomuchtodo 3mo ago
    Are these nurses currently represented by a union?
    - BeetleB 3mo ago
      Yes.
      - toomuchtodo 3mo ago
        Tremendous.
        BeetleB 3mo ago
        It helps with their pay ;-)
  - munk-a 3mo ago
    Yeah, I didn't even want to lean out that far but I'm sure average handle time is incorporated in some manner. But, just purely semantically, the statement Kaiser gave in response was worded in a precise smug corporate America style to dodge the main concern raised. I think it's important to call out weasel words.
btown 3mo ago
> Nurses are instructed to stick to a script on phone calls and give no more than two to three pieces of advice, Capulong and other nurses said, which means they may sometimes need to decide whether to withhold advice or face a performance evaluation hearing. > Another nurse speaking on condition of anonymity said “AI did not understand our job and would grade us wrong all the time.” It's always worth remembering Goodhart's law https://en.wikipedia.org/wiki/Goodhart%27s_law https://en.wikipedia.org/wiki/Goodhart%27s_law - "When a measure becomes a target, it ceases to be a good measure." In theory AI could usher in the first time in history where one can escape from this trap - because qualitative judgments can be made at scale, from an unbiased and universal baseline. In this situation, for instance, rather than collapsing call transcripts and reports into metrics, it could evaluate whether red flags are encountered in the context of a call, and allow for qualitative guidance on improvement, across a comparative corpus of situations that are themselves chosen qualitatively. But very few managers are empowered to take this kind of approach; they're evaluated by their ability to report quantitative metrics, and thus they must implement regimes of quantitative metrics. And leadership instructs them to use AI to build that regime more quickly. If you want to see an "AI native" organization, it's one where leadership actively fights this tendency, and sees managers as product designers who make the end-user experience a beloved and empathy-driven one, as opposed to a gear that turns accountability into a single number on a screen.
- lostlogin 3mo ago
  > Nurses are instructed to stick to a script on phone calls and give no more than two to three pieces of advice So stupid. If you had ever made a phone call to a patient, or their family member, you’d soon realise how bad this is. You need to talk to the patient and something a family member too. Be too hasty and you cause more harm than good.
  - btown 3mo ago
    For clarity, those > quotes are from the article, and I'm explicitly advocating against that approach!
ori_b 3mo ago
There's a reason that among Americans, telekinesis and creationism are more mainstream positions than sloptimism. About 14% of Americans think AI is moving us towards a better world. About 17% are creationists. About 26% believe in Telekinesis.
- doodlebugging 3mo ago
  With all of that in mind I have to wonder whether there is overlap between these response groups and if so, how much. Could be zero to 100% without more information.
  - ori_b 3mo ago
    Good question. How many people that you know are in all three groups?
    - doodlebugging 3mo ago
      >About 14% of Americans think AI is moving us towards a better world. About 17% are creationists. About 26% believe in Telekinesis. 0 people that I know are in all three. Pretty confident about that. For the any two of three cases where [A] includes creationists and those favorable to AI; [B] includes creationists and those who believe in telekinesis; [C] includes those favorable to AI and who believe in telekinesis. [A] 0 ; [B] 0 ; [C] 0 Considering people that I know who could be part of one of the three groups now is an interesting question. I am pretty sure that two relatives are creationists based on interactions over the years. I haven't ever heard anyone I know talking about telekinesis so I probably have to say that this could be a non-zero number. If it is a non-zero number then [B] could end up being non-zero. AI is universally hated or even feared by those that I know who are being forced to use it or whose employer is adopting AI tools in their workplace. So based on my own recollections I have to say that there are only 2 people that I know who belong to one of the three groups you identified. Interestingly enough, the children of those two creationists are not religious as adults. I think they had all they could stand growing up in that environment and as soon as they went to college they 'rebelled', leaving the parents disappointed that the kids didn't want to tote all that baggage in their own lives. Sample size is small though since I don't know many people.
nojito 3mo ago
Kaiser has some of the best healthcare outcomes in the country/world due to their protocols and how good they are in ensuring adherence to them. It’s going to be very improbable that these statements are true.
- bmitc 3mo ago
  > Kaiser has some of the best healthcare outcomes in the country/world due to their protocols and how good they are in ensuring adherence to them. Where and how is that determined? I.e., any references to back that up? And you can't in one breath say they have the best healthcare but then say their employees' reports of their experience are unreliable.
  - nojito 3mo ago
    Not sure if you’re serious but just search the name Kaiser in any research search engine. https://pmc.ncbi.nlm.nih.gov/articles/PMC8032167/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8032167/ Their secret sauce is their ability to standardize protocols throughout their entire organization.
    - lostlogin 3mo ago
      That’s the measure for one pathology, but in terms of a provider comparison, what’s the measure? It isn’t dollars versus life span or morbidity.
    - guelo 3mo ago
      Study is from 2000-2013, their care has deteriorated significantly since then. I know because I've been a patient the whole time.
      - sgarman 3mo ago
        I agree. The last 5 years especially.
      - nojito 3mo ago
doodlebugging 3mo ago
This problem with workplace AI interfering with nurses ability to manage healthcare obligations for their clients is not confined to Kaiser. UHC has also introduced the AI surveillance tools and are using it to do similar things.
- inigyou 3mo ago
  Isn't that the insurance company whose CEO was murdered because of the terrible quality of care they delivered?
  - doodlebugging 3mo ago
    Yes it is. Somehow that might appear to be incentive to improve quality of care but maybe their corporate culture is a bad fit for quality.
    - Joel_Mckay 3mo ago
      Psychopaths don't care about other peoples pain. Some MBA only care about their own ego, power, and money. They do well in corporate cultures that reward parasitic relationships with customers. =3
      - doodlebugging 3mo ago
        Slurping their way up to the C-suite.
    - teachrdan 3mo ago
      > that might appear to be incentive to improve quality Their goal isn't to provide high quality care. Their goal is to increase profits. It's not hard to imagine how improved quality would lead them to spend more money. (faster diagnoses of serious illnesses and recommending expensive care)
      - doodlebugging 3mo ago
apercu 3mo ago
Maybe healthcare shouldn’t be primarily for profit?
- bendergarcia 3mo ago
  But what about competition!?!?
- arjie 3mo ago
  Well, I suppose you can rest easy on that count. Kaiser is principally a non-profit.
  - ButlerianJihad 3mo ago
    > principally a non-profit. I hate to break it to you, but "non-profit" doesn't mean what you literally think it means. https://en.wikipedia.org/wiki/Kaiser_Permanente https://en.wikipedia.org/wiki/Kaiser_Permanente Also, KPMGs are indeed "for-profit" while Kaiser Permanente as a whole is constituted as a "consortium" of both types.
    - wilg 3mo ago
      Do you suppose thats why they wrote "principally"?
      - ButlerianJihad 3mo ago
        You're absolutely wrong! And here is why: I guarantee you that the nurses are working in the "for-profit" units, and also, that still betrays ignorance of what "non-profit" actually means, which is the load-bearing topic of this thread.
        procflora 3mo ago
        Ok fine, but I bet you can't come up with a good gluten free banana bread recipe.
        3mo ago
Sol- 3mo ago
While I'm sympathetic to the frictions of newly introduced AI and the fact that AI in healthcare, especially calls, can seem very uncaring, between the lines the article reads a bit like the typical union complaining about modern tech that reshapes their work, given the multiple mentions of protests, nurses union, etc. Given how healthcare is one of these sectors that seems to relentlessly resist efficiency increases and is the prime example of Baumol's cost disease, I think any developed country with a costly healthcare system needs to do these AI experiments. The current versions will be shit, but the only way out is through if you still want to provide affordable care. I honestly have no doubt that AI going forward will be able to do a good job at triaging via calls and also being empathetic about it. But of course it needs careful experimentation.
- deleted 3mo ago
  [deleted]
throwaway13337 3mo ago
What these complaints always boil down to is autonomy and control. The more centralized an organization, the more it relies on metrics to understand and exert control over its employees and customers. People started hating tech right around the time metrics became popular. I don't think it's a coincidence. AI just accelerates the trend. The problem is the misidentification of AI as the issue. As long as we don't understand the real issue, we won't solve it. AI is just a tool. It's being used in a way that denies human agency. Our cultural values need to shift away from safetism that demands centralization. And shift toward valuing human agency. That starts with talking about the core issue.
- einpoklum 3mo ago
  > AI is just a tool "To the man with a hammer, everything looks like a nail." [1] There is no such thing as "just" a tool. ---- [1] - https://en.wikipedia.org/wiki/Law_of_the_instrument https://en.wikipedia.org/wiki/Law_of_the_instrument
- neumann 3mo ago
  Everyone pushing tools/AI during initial development/investment and building its demand in the cultural discourse always highlights its ability for good. Now, like many tools, the majority of those selling AI to make money off of large enterprise sell its ability to increase productivity, efficiency, compliance. Either to make money or to minimise risk. And so like you say, they just become tools to make these metrics move or report them at higher granularity. And often there is either a lack of imagination or a willful ignorance of the perverse outcomes with relationship to humans because they are in service of the organisation not it's employees.
  - throwaway13337 3mo ago
    Certainly, I agree that using AI to dehumanize - generally what companies seem to be doing with it - is super bad. And it's also what is being sold to existing companies right now. But that same AI could cause those companies to no longer exist. The AI I'm happy about allows people without much tech knowledge create small apps to do exactly what they want. And, for those that know just a little more, use it to help them extend open source software for their niche use case. This makes computing more personal and gives back agency to the computer operator. Mix that with the rise of much more competition in much more custom software, and you'll see that a future can exist, if we want it, where software becomes more personal and humane. The software vendor will capture less value, though - the margins will be thinner. Instead that value will be captured (in non-money terms) by the end users. That also means that software companies, unable to capture so much value, must shrink and become more boutique. The software that contributes to our centralized world would lose a lot of power. That's the future I can see. The only way it doesn't happen is if a cynical narrative wins out and manages to lock it out through regulatory capture so that only licensed operators can use or provide AI. The anti-AI narrative helps the cynics.
dependsontheq 3mo ago
Thinks that are not allowed in the EU thanks to the AI Act.
cromka 3mo ago
I'd like to think it's not meant to make life better for a regular nurse, but rather to weed out the abusive ones? At least that's how I see it from my flawed, post-communist country perspective.
uhhhhwhaaaa 3mo ago
Unpopular opinion: People want to be lazy and hate things that force them to work harder. They will vocally rationalize it. I did it. "I'm more productive work from home." But then I do dishes, take an hour break, paid. Foucault says that when people are observing them, power is placed over them. If you are a worker you should hate this. If you are a customer or owner, you should like this. But I certainly won't be automatically believing people under surveillance who make claims it makes their quality worse.
- caycep 3mo ago
  clearly you have never been a floor nurse at a hospital...
- cindyllm 3mo ago
  [dead]
- CodeMage 3mo ago
  Your anecdote talks about taking breaks and doing dishes, but fails to talk about measures of productivity.
9x39 3mo ago
It sucks because AI reduces call center costs in many toil tasks very effectively, regardless of whether you want to help or dissuade customers - it's just well-suited to the task and it's going to accelerate. It's a win for capital and the technology implementers, even if it's a loser for the call center employees and callers. Some of the tech is pretty scary. One big vendor's solution [0] can provide not just AI agents but also use AI to snoop on calls in progress, evaluating sentiment from both sides [1], verifying phrases are said - pretty dystopian in theory. From experience, these things tend to go downhill based on the attitude at the top - is the mission to slash costs or take care of customers? A 1000 decisions follow from this one, and like Jira, it can be a useful tool or a prison-like hell. [0] https://www.cisco.com/c/dam/en/us/products/collateral/contact-center/unified-contact-center-express/webex-workforce-optimization-ds.pdf https://www.cisco.com/c/dam/en/us/products/collateral/contac... [1] https://www.cisco.com/c/en/us/products/contact-center/webex-workforce-optimization/index.html https://www.cisco.com/c/en/us/products/contact-center/webex-...
- pydry 3mo ago
  90% of the time when I call a call center I need a human to fix an organisational bug - e.g. faulty billing or some other kind of mixup. AI cannot help with this. If it's to do something normal you could do through the website there was no need for AI - a website or app suffices - provided it isnt terrible. Capital definitely thinks it can save costs here but capital is getting increasingly delusional these days.
  - ACCount37 3mo ago
    Neither can an average call center human. A good 90% of call center humans are flesh interpreters for support scripts. They are being paid to act like they don't have free will.
  - r0m4n0 3mo ago
    The HN crowd is not the usual demographic for call centers. Im willing to generalize a vast majority of callers can find the info they are looking for if they tried a little
abeindoria 3mo ago
That is surprising. My primary care provider had a different response. Basically he said something in line of "You wouldn't believe how much of a relief it has been. In your last visit, you saw me typing everything you were saying, right? I don't have to. I can listen to you and take very specific notes as necessary as opposed to focusing on both typing and listening to you at the same time. It has bought my stress levels down to here." (Indicated by his hand lowering)
- xmprt 3mo ago
  Nursing and PCP are very different jobs. Ones a lot more cognitive than the other whereas the other involves actually doing/executing on a plan. I can see how AI would help reduce the cognitive burden while actually increase stress on the execution side.
  - Loughla 3mo ago
    Do you still get doctors for primary care? Our local hospital is hiring nothing but nurse practitioners now. They're amazing in a support role, but not equipped as well for primary care roles.
    - soared 3mo ago
      I’d rather have an NP 10 times out of ten for primary care
      - TylerE 3mo ago
        If you're more or less healthy they're fine. When things start to go sideways my experience is that they get out of their depth pretty quick.
      - abeindoria 3mo ago
        Eh. There's a reason the entire noctor subreddit exists. NPs have their places. Replacing doctors with them isn't it.
      - 3mo ago
fhub 3mo ago
There is an unfortunate cycle that has been playing out this year in USA. Insurance companies are arming up with AI to deny billing codes charged by providers. Providers are arming up with AI to listen in on provider-patient sessions to prove the billing codes are legit (And teach providers to use keywords in session). The loser, as always, is the patient's quality of care.
- jmye 3mo ago
  > Providers are arming up with AI to listen in on provider-patient sessions to prove the billing codes are legit This is not a decrease in quality of care - this is your provider having actual evidence of the care needs they discussed with you when they close their note, hours or days after seeing you.
  - rockskon 3mo ago
    Except AI has an unacceptably high rate of hallucinations that will result in adverse health outcomes if not outright death.
insane_dreamer 3mo ago
the more I read about how AI is being used, the more I'm coming to the conclusion that despite me personally find it quite useful in my work, and even my personal life to some extent, it is a net negative to society as a whole, and if the choice is between zero AI or the AI that is being deployed, we'd be better out without it what significant improvements to society or humanity have come about as direct result of AI, that wouldn't have been achieved without it? faster protein folding is the only one I can think of and that more a matter of "faster" than "impossible without AI" I think at some point there's going to be some version of the Butlerian Jihad
- bogtap82 3mo ago
  I mean, "AI" as it presents itself in the zeitgeist is in its infancy. It's like making conclusions about the internet in the late 90s. Whatever it becomes likely hardly resembles what it is now. For better or for worse.
lukeschlather 3mo ago
The article mentions uses of AI but doesn't really give any examples of harm from AI. It does give specific examples where it sounds like Kaiser is optimizing calls to minimize cost rather than improve quality of care. It's also pretty easy to expect that the examples given (treating longer calls as a problem and penalizing nurses for giving more than 3 pieces of advice) reduce the quality of care.
- gorszon 3mo ago
  They talk about workplace survillience. They use a machine learning tool that try to assess their emphaty, and such. The AI, while the tool technically can be called that, in the article is there to be a buzzword.
derekdahmer 3mo ago
I RFTA and the majority of the complaints are about call center metrics and the pressure to ration care. These are real concerns about misuse of metrics, but not AI. The AI empathy thing was a 2024 pilot that was discontinued. FWIW my wife works for Kaiser and finds a lot of value in the the medical LLM tools available to her. She tells me being able to do live translation, summarize notes, and quickly get comprehensive answers save her time and help her give better care. Her older patients also frequently come in bringing AI-powered alerts from their apple watches that detected cardiac events. It's annoying that we use broad terms to describe a set of technologies that in some ways can be problematic and in another ways are very beneficial. We gotta evaluate each of these as they come rather than talk about blanket bans.
- api 3mo ago
  “AI” in title gets clicks. So “AI” must be in title.
  - nerevarthelame 3mo ago
    AI is directly mentioned in 24 of 53 paragraphs from the article.
  - wrecked_em 3mo ago
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- aaron695 3mo ago
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- ihsw 3mo ago
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- ai_fry_ur_brain 3mo ago
  I personally will not use a provider who uses llm tools. I know it makes me and my coworkers less careful and lazier. Qualities I dont want in a health care providor. Ive actually moved primary care physicians over this once already, found the oldest guy I could who barely knows how to use a laptop but spends a bunch of extra time with me.
api 3mo ago
Every time “relentless push for efficiency destroying X” comes up I should repost this: https://sohl-dickstein.github.io/2022/11/06/strong-Goodhart.html https://sohl-dickstein.github.io/2022/11/06/strong-Goodhart.... This is a well understood phenomenon.
syngrog66 3mo ago
AI is making lots of jobs and workplaces worse.
profdevloper 3mo ago
Just think -- with the increased efficiency, they will have more time for Tik Tok dances.
none_to_remain 3mo ago
They want you to blame "AI" like Claude jumped up and decided to start hassling nurses, not individuals in management
- dqv 3mo ago
  ... They're aware that it's individuals in management, which is why they want to use their union contract to dictate how management can use AI.
- gorszon 3mo ago
  If you read the quotes from the union, they blame the management, and they cite workplace survillience as one issue, wich is happened to be a machine learning tool. So, of course the article talks about AI, because thats the trendy buzzword.
  - dqv 3mo ago
    They already did a trial which used the trendy buzzword to surveil the nurses. The nurses want to implement controls on that trendy buzzword before it is further misused by management to cause harm to patients (by way of making the nurses focus on meeting some arbitrary performance metric rather than focusing on patient care).
  - BeetleB 3mo ago
    > and they cite workplace survillience as one issue, wich is happened to be a machine learning tool. That tool was a trial that they put away (but may come back). The rest of the stuff all existed pre-LLMs and isn't even machine learning (time per call).
nttylock 3mo ago
[flagged]
Loughla 3mo ago
The nurses at our local rural hospital are tagged and tracked wherever they go on the hospital campus. Time spent in one spot is part of their review. I wondered why they zip in and out of the rooms, when just a few years ago they would spend fifteen to twenty minutes in each room. The patient load hadn't grown. The number of nurses has gone up, not down. So I'm blaming the stupid metric on their evaluations for a worse standard of care.
- whimsicalism 3mo ago
  > The patient load hadn't grown. The number of nurses has gone up, not down. Healthcare utilization, number of unique patients, amount of care per patient has all gone up. American has a massive overutilization problem driving cost but is unwilling to be honest with itself about it.
  - BeetleB 3mo ago
    AKA the "Be your own advocate and demand more testing!" crowd. Although Kaiser tends to repel such patients (they'll happy say "No" and tell you to find some other provider). The bulk of complaints I've heard about KP in California boil down to "They wouldn't give me a referral to a specialist".
    - whimsicalism 3mo ago
      Yes, Kaiser is a great model. We need to figure out a way to balance cost sharing with preventing over utilization, both on the supply side and managing demand and restricting interventions to those that are measurably changing outcomes (generally drugs, less so human-capital intensive care).
- Tomis02 3mo ago
  That's horrible.
segfault99 3mo ago
Workplace metrics and surveillance... What could possibly go wrong? That being said, more than one (female at that) doctor has told me in confidence and based upon their observations during residencies, etc. that if I'm ever admitted, be very careful how I modulate my interactions with nurses. They're not all Florence Nightingale and Mother Theresa and there exist those who will @#$% you up on various pretexts or are just plain sloppy and negligent. Despite all the moralising fluff, it's just a job, not some saintly vocation. Some safety oversight is needed, just as it is for any other work function. Still, can bet that anything 'Corporate' has mandated will be Goodharted up the wazoo.
- andrekandre 3mo ago
  > Mother Theresa off topic perhaps, but i would hope they were not like mother teresa at all [0] [0] https://allthatsinteresting.com/mother-teresa-saint https://allthatsinteresting.com/mother-teresa-saint
  - gsky 3mo ago
    Yea. She's seen as a devil where i live
  - probably_wrong 3mo ago
    Since we're off-topic, most of the information in that article (as it's often the case) is based mostly on Christopher Hitchen's work (book and documentary), a man who describes himself as "antitheist" and made a living out of publicly fighting religion. So not exactly an objective reporter. I read a good chunk of the criticism against Mother Theresa as either willfull misunderstanding and/or just repeating the same literal three quotes from Hitchen's book (seriously, they're always there). I cannot say whether she was a good person or not, but I can say: if you ask "which evidence is there which doesn't lead back to a man with a personal vendetta?", the list gets significantly shorter.
27183 3mo ago
https://www.youtube.com/watch?v=DpQamTrynBY https://www.youtube.com/watch?v=DpQamTrynBY [edit] preemptively, if you're going to claim "but this isn't art so irrelevant" then I claim bull fucking shit. It's the same problem no matter how you slice it whether it be engineering, support, art, or medicine. Get real. Look inward. Touch grass. If you think AI is a good thing for your profession--whatever that profession might be--you're probably a delusional psychotic. It's OK, you'll thank me later.
ProAm 3mo ago
Kaiser was the first insurance company in america. If they cant make it work then we are lost.
- lotsofpulp 3mo ago
  That is because the problem was never the sub 3% profit margin or non profit insurance companies (in the case of Kaiser and many others). The problem has always been pharmaceutical prices, liability costs, and inadequate supply of healthcare. The government does not want to decrease the price of medicine by funding trials so medicine is in the public domain and cheaper, the government does not want to increase the number of matriculating doctors and bring down their time/money/stress costs, and the government does not want to enact tort reform so every step of the healthcare chain is spending inordinate amounts of time and money to prevent litigation. In the US, you should always be double checking what your provider (or guidelines or whatever) is telling you to ensure that the information is maximizing your benefit instead of minimizing their liability.
bozhark 3mo ago
Kaiser has priorities, healthcare being #4 or 5
VerifiedReports 3mo ago
And Kaiser already sucks big-time, so... that's not good.
dyauspitr 3mo ago
I can guarantee this is because the nurses don’t like the extra oversight and surveillance.
- bpodgursky 3mo ago
  Yes the amount of credulity here is laughable. This is like when cop and teacher unions complain about being evaluated on outcomes.
Malice 3mo ago
Population highly incentivized to denigrate new technology denigrates new technology. Film at 11.
w10-1 3mo ago
motivated reasoning: study in advance of nursing union contract negotiations The sad thing is that there are many issues, but the study didn't really address them. One would hope for more effective critics. The AI application I'd like to see would be to identify the elective hyper-utilizers (so we could try to demotivate them by addressing what's really bothering them). That would improve quality of care for them and quality of life for providers, and create time for outreach to the under-utilizers who need preventative care.
xxd2 3mo ago
Does "Manna" by Marshall Brain still sound futuristic? https://marshallbrain.com/manna https://marshallbrain.com/manna
JumpCrisscross 3mo ago
> where they were found to have done everything right on a call — except staying on the line for more than 15 minutes Do these idiots not know how intelligent assholes work? If you make this a policy, everyone who has a gripe will eventually learn to delay a call to 14 minutes and then make an absurd ask.
oidar 3mo ago
I'd like my providers to use Abridge for their notes, but because Abridge doesn't allow patients to opt out of using the data for training I decline every time.
MetroWind 3mo ago
My wife has been visiting an eye doctor several times. The doctor always use ChatGPT to double check (I'm giving him the benefit of the doubt; another way to frame this is the doctor didn't know shit and just used AI for answers). I'm sure he doesn't think AI is making his job worse.
hopemelisa20 2mo ago
[flagged]

563 points by gnabgib 3mo ago

Obligatory dystopia reminder. It doesn't have to be this way https://marshallbrain.com/manna1 https://marshallbrain.com/manna1

ori_b 3mo ago
But we're all in on making it that way!
jbxntuehineoh 3mo ago
but but but... the line! it has to go up, doesn't it?
- Avicebron 3mo ago
  Yes brother. This is the way. We pray to the line, only it can shelter us in these dark times of labor revitalization. HODL. May your returns be colossal.

14 3mo ago

I would love to learn the cost of the AI versus how many new workers they could afford to hire and get more calls done. But I assume the end goal will be full replacement of human workers once the AI has had enough time to learn the job.

BeetleB 3mo ago
The AI is a lot cheaper. Kaiser nurses are amongst the highest paid in the nation.
- apercu 3mo ago
  Subsidized Gen AI maybe. Also, California has a high cost of living.
- indoorfish 3mo ago
  How dare the people who take of the sick and dying be paid well. Unacceptable waste that must be optimized! We're liberating them from work so they can focus on what matters
- saltcured 3mo ago
  Now let's talk about how AI could replace Kaiser middle management and streamline bureaucracy to preserve more budget for doctors and nurses...
  - joe_the_user 3mo ago
    People enjoy saying "AI can replace middle management" as a comeuppance but it's not what people think. In many ways, AI is primarily serving as middle management, yes. But what happens is that instead of one manager engaging in petty surveillance, harassment and browbeating to increase work intensity, you have ten clones of the manager doing the same thing. That's not the "woo hoo, automated middle management!" you were looking for.
    - saltcured 3mo ago
      Understood and agreed. I admit I was feeling a bit pithy with that comment. I shouldn't really have referenced "replace" at all, but rather "optimize". And not targeting middle management but the whole non-medical structure above. This is where I think most of the waste in our modern US medical system lives. But I understand it is still mostly a half-baked concept. We'd need a revolution far outside of just some management system. I believe it's the whole enclosing system that is rotten and driving medical costs away from the actual encounter costs. Profiteering, risk management, regulatory capture, etc. I woudl argue there was a point, long ago, where these things have taken on a life of their own and no longer serve the need of improving care outcomes and the actual medical cost-benefit tradeoff we should be optimizing in a just and caring society.
caturopath 3mo ago
The article doesn't seem to be about replacing nurses staffing their phones with AI. It seems to be about making sure the care they're providing is what the company wants.

neaden 3mo ago

If you think using a machine to evaluate how well a human is showing empathy is a good idea, you probably shouldn't have any position of power.

BeetleB 3mo ago
If you employ a few hundred nurses, how exactly would you evaluate how well they show empathy? You can't rely on asking the customer. When they're upset (they often are in these calls), they'll lean towards the negative regardless. I don't know how well these AIs evaluate, but if they're even a little bit good, it makes sense to use it to screen for outliers, then have a human listen to those outliers and judge.
- malfist 3mo ago
  Actually, you can rely on the customers. They're the only ones that can tell you.
  - lostlogin 3mo ago
    > you can rely on the customers. Patient or customer? I even struggle with that, but I guess that’s what people are in a privatised healthcare system.
    - munk-a 3mo ago
      Most of the folks here on HN are dealing with customer feedback in systems automation in one form or another - it's pretty unavoidable in this age of LLM trendiness. The customers of healthcare (in both private and publicly funded systems) are the patients. So while the term might not be super natural it's an understandable one to use.
      - datsci_est_2015 3mo ago
        Patients are not customers, or at least I don’t want to live in a world where patients are considered customers. Customers and vendors are usually more of a symmetric relationship: price transparency, alternatives, lack of urgency. These are all characteristics of transactions that healthcare often lacks.

deleted 3mo ago

[deleted]

munk-a 3mo ago

> "Nurses fear that having long calls can lead to bad performance reviews" > A company spokesperson said, "Kaiser Permanente does not use Average Handle Time to assess agent performance" So uh, average time wasn't raised as a concern, calls beyond a certain threshold was. I wish this semantic discrepancy was better highlighted in the article.

BeetleB 3mo ago
I have some inside information (but not much!) They claim they do not use average handle time, but it is very common to get called into meetings to discuss why they spent a lot of time on some calls. The nurses get defensive (by definition - they have to justify the time used - it is a defense). They also do get called into meetings if their average handle time is large. It may still be true they don't use it for evaluating performance, but they absolutely do utilize it to "coach" the nurses.
- toomuchtodo 3mo ago
  Are these nurses currently represented by a union?
  - BeetleB 3mo ago
    Yes.
    - toomuchtodo 3mo ago
      Tremendous.
      - BeetleB 3mo ago
        It helps with their pay ;-)
- munk-a 3mo ago
  Yeah, I didn't even want to lean out that far but I'm sure average handle time is incorporated in some manner. But, just purely semantically, the statement Kaiser gave in response was worded in a precise smug corporate America style to dodge the main concern raised. I think it's important to call out weasel words.

btown 3mo ago

> Nurses are instructed to stick to a script on phone calls and give no more than two to three pieces of advice, Capulong and other nurses said, which means they may sometimes need to decide whether to withhold advice or face a performance evaluation hearing. > Another nurse speaking on condition of anonymity said “AI did not understand our job and would grade us wrong all the time.” It's always worth remembering Goodhart's law https://en.wikipedia.org/wiki/Goodhart%27s_law https://en.wikipedia.org/wiki/Goodhart%27s_law - "When a measure becomes a target, it ceases to be a good measure." In theory AI could usher in the first time in history where one can escape from this trap - because qualitative judgments can be made at scale, from an unbiased and universal baseline. In this situation, for instance, rather than collapsing call transcripts and reports into metrics, it could evaluate whether red flags are encountered in the context of a call, and allow for qualitative guidance on improvement, across a comparative corpus of situations that are themselves chosen qualitatively. But very few managers are empowered to take this kind of approach; they're evaluated by their ability to report quantitative metrics, and thus they must implement regimes of quantitative metrics. And leadership instructs them to use AI to build that regime more quickly. If you want to see an "AI native" organization, it's one where leadership actively fights this tendency, and sees managers as product designers who make the end-user experience a beloved and empathy-driven one, as opposed to a gear that turns accountability into a single number on a screen.

lostlogin 3mo ago
> Nurses are instructed to stick to a script on phone calls and give no more than two to three pieces of advice So stupid. If you had ever made a phone call to a patient, or their family member, you’d soon realise how bad this is. You need to talk to the patient and something a family member too. Be too hasty and you cause more harm than good.
- btown 3mo ago
  For clarity, those > quotes are from the article, and I'm explicitly advocating against that approach!

ori_b 3mo ago

There's a reason that among Americans, telekinesis and creationism are more mainstream positions than sloptimism. About 14% of Americans think AI is moving us towards a better world. About 17% are creationists. About 26% believe in Telekinesis.

doodlebugging 3mo ago
With all of that in mind I have to wonder whether there is overlap between these response groups and if so, how much. Could be zero to 100% without more information.
- ori_b 3mo ago
  Good question. How many people that you know are in all three groups?
  - doodlebugging 3mo ago
    >About 14% of Americans think AI is moving us towards a better world. About 17% are creationists. About 26% believe in Telekinesis. 0 people that I know are in all three. Pretty confident about that. For the any two of three cases where [A] includes creationists and those favorable to AI; [B] includes creationists and those who believe in telekinesis; [C] includes those favorable to AI and who believe in telekinesis. [A] 0 ; [B] 0 ; [C] 0 Considering people that I know who could be part of one of the three groups now is an interesting question. I am pretty sure that two relatives are creationists based on interactions over the years. I haven't ever heard anyone I know talking about telekinesis so I probably have to say that this could be a non-zero number. If it is a non-zero number then [B] could end up being non-zero. AI is universally hated or even feared by those that I know who are being forced to use it or whose employer is adopting AI tools in their workplace. So based on my own recollections I have to say that there are only 2 people that I know who belong to one of the three groups you identified. Interestingly enough, the children of those two creationists are not religious as adults. I think they had all they could stand growing up in that environment and as soon as they went to college they 'rebelled', leaving the parents disappointed that the kids didn't want to tote all that baggage in their own lives. Sample size is small though since I don't know many people.

nojito 3mo ago

Kaiser has some of the best healthcare outcomes in the country/world due to their protocols and how good they are in ensuring adherence to them. It’s going to be very improbable that these statements are true.

bmitc 3mo ago
> Kaiser has some of the best healthcare outcomes in the country/world due to their protocols and how good they are in ensuring adherence to them. Where and how is that determined? I.e., any references to back that up? And you can't in one breath say they have the best healthcare but then say their employees' reports of their experience are unreliable.
- nojito 3mo ago
  Not sure if you’re serious but just search the name Kaiser in any research search engine. https://pmc.ncbi.nlm.nih.gov/articles/PMC8032167/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8032167/ Their secret sauce is their ability to standardize protocols throughout their entire organization.
  - lostlogin 3mo ago
    That’s the measure for one pathology, but in terms of a provider comparison, what’s the measure? It isn’t dollars versus life span or morbidity.
  - guelo 3mo ago
    Study is from 2000-2013, their care has deteriorated significantly since then. I know because I've been a patient the whole time.
    - sgarman 3mo ago
      I agree. The last 5 years especially.
    - nojito 3mo ago

doodlebugging 3mo ago

This problem with workplace AI interfering with nurses ability to manage healthcare obligations for their clients is not confined to Kaiser. UHC has also introduced the AI surveillance tools and are using it to do similar things.

inigyou 3mo ago
Isn't that the insurance company whose CEO was murdered because of the terrible quality of care they delivered?
- doodlebugging 3mo ago
  Yes it is. Somehow that might appear to be incentive to improve quality of care but maybe their corporate culture is a bad fit for quality.
  - Joel_Mckay 3mo ago
    Psychopaths don't care about other peoples pain. Some MBA only care about their own ego, power, and money. They do well in corporate cultures that reward parasitic relationships with customers. =3
    - doodlebugging 3mo ago
      Slurping their way up to the C-suite.
  - teachrdan 3mo ago
    > that might appear to be incentive to improve quality Their goal isn't to provide high quality care. Their goal is to increase profits. It's not hard to imagine how improved quality would lead them to spend more money. (faster diagnoses of serious illnesses and recommending expensive care)
    - doodlebugging 3mo ago

apercu 3mo ago

Maybe healthcare shouldn’t be primarily for profit?

bendergarcia 3mo ago
But what about competition!?!?
arjie 3mo ago
Well, I suppose you can rest easy on that count. Kaiser is principally a non-profit.
- ButlerianJihad 3mo ago
  > principally a non-profit. I hate to break it to you, but "non-profit" doesn't mean what you literally think it means. https://en.wikipedia.org/wiki/Kaiser_Permanente https://en.wikipedia.org/wiki/Kaiser_Permanente Also, KPMGs are indeed "for-profit" while Kaiser Permanente as a whole is constituted as a "consortium" of both types.
  - wilg 3mo ago
    Do you suppose thats why they wrote "principally"?
    - ButlerianJihad 3mo ago
      You're absolutely wrong! And here is why: I guarantee you that the nurses are working in the "for-profit" units, and also, that still betrays ignorance of what "non-profit" actually means, which is the load-bearing topic of this thread.
      - procflora 3mo ago
        Ok fine, but I bet you can't come up with a good gluten free banana bread recipe.
      - 3mo ago

Sol- 3mo ago

While I'm sympathetic to the frictions of newly introduced AI and the fact that AI in healthcare, especially calls, can seem very uncaring, between the lines the article reads a bit like the typical union complaining about modern tech that reshapes their work, given the multiple mentions of protests, nurses union, etc. Given how healthcare is one of these sectors that seems to relentlessly resist efficiency increases and is the prime example of Baumol's cost disease, I think any developed country with a costly healthcare system needs to do these AI experiments. The current versions will be shit, but the only way out is through if you still want to provide affordable care. I honestly have no doubt that AI going forward will be able to do a good job at triaging via calls and also being empathetic about it. But of course it needs careful experimentation.

deleted 3mo ago
[deleted]

throwaway13337 3mo ago

What these complaints always boil down to is autonomy and control. The more centralized an organization, the more it relies on metrics to understand and exert control over its employees and customers. People started hating tech right around the time metrics became popular. I don't think it's a coincidence. AI just accelerates the trend. The problem is the misidentification of AI as the issue. As long as we don't understand the real issue, we won't solve it. AI is just a tool. It's being used in a way that denies human agency. Our cultural values need to shift away from safetism that demands centralization. And shift toward valuing human agency. That starts with talking about the core issue.

einpoklum 3mo ago
> AI is just a tool "To the man with a hammer, everything looks like a nail." [1] There is no such thing as "just" a tool. ---- [1] - https://en.wikipedia.org/wiki/Law_of_the_instrument https://en.wikipedia.org/wiki/Law_of_the_instrument
neumann 3mo ago
Everyone pushing tools/AI during initial development/investment and building its demand in the cultural discourse always highlights its ability for good. Now, like many tools, the majority of those selling AI to make money off of large enterprise sell its ability to increase productivity, efficiency, compliance. Either to make money or to minimise risk. And so like you say, they just become tools to make these metrics move or report them at higher granularity. And often there is either a lack of imagination or a willful ignorance of the perverse outcomes with relationship to humans because they are in service of the organisation not it's employees.
- throwaway13337 3mo ago
  Certainly, I agree that using AI to dehumanize - generally what companies seem to be doing with it - is super bad. And it's also what is being sold to existing companies right now. But that same AI could cause those companies to no longer exist. The AI I'm happy about allows people without much tech knowledge create small apps to do exactly what they want. And, for those that know just a little more, use it to help them extend open source software for their niche use case. This makes computing more personal and gives back agency to the computer operator. Mix that with the rise of much more competition in much more custom software, and you'll see that a future can exist, if we want it, where software becomes more personal and humane. The software vendor will capture less value, though - the margins will be thinner. Instead that value will be captured (in non-money terms) by the end users. That also means that software companies, unable to capture so much value, must shrink and become more boutique. The software that contributes to our centralized world would lose a lot of power. That's the future I can see. The only way it doesn't happen is if a cynical narrative wins out and manages to lock it out through regulatory capture so that only licensed operators can use or provide AI. The anti-AI narrative helps the cynics.

dependsontheq 3mo ago

Thinks that are not allowed in the EU thanks to the AI Act.

cromka 3mo ago

I'd like to think it's not meant to make life better for a regular nurse, but rather to weed out the abusive ones? At least that's how I see it from my flawed, post-communist country perspective.

uhhhhwhaaaa 3mo ago

Unpopular opinion: People want to be lazy and hate things that force them to work harder. They will vocally rationalize it. I did it. "I'm more productive work from home." But then I do dishes, take an hour break, paid. Foucault says that when people are observing them, power is placed over them. If you are a worker you should hate this. If you are a customer or owner, you should like this. But I certainly won't be automatically believing people under surveillance who make claims it makes their quality worse.

caycep 3mo ago
clearly you have never been a floor nurse at a hospital...
cindyllm 3mo ago
[dead]
CodeMage 3mo ago
Your anecdote talks about taking breaks and doing dishes, but fails to talk about measures of productivity.

9x39 3mo ago

It sucks because AI reduces call center costs in many toil tasks very effectively, regardless of whether you want to help or dissuade customers - it's just well-suited to the task and it's going to accelerate. It's a win for capital and the technology implementers, even if it's a loser for the call center employees and callers. Some of the tech is pretty scary. One big vendor's solution [0] can provide not just AI agents but also use AI to snoop on calls in progress, evaluating sentiment from both sides [1], verifying phrases are said - pretty dystopian in theory. From experience, these things tend to go downhill based on the attitude at the top - is the mission to slash costs or take care of customers? A 1000 decisions follow from this one, and like Jira, it can be a useful tool or a prison-like hell. [0] https://www.cisco.com/c/dam/en/us/products/collateral/contact-center/unified-contact-center-express/webex-workforce-optimization-ds.pdf https://www.cisco.com/c/dam/en/us/products/collateral/contac... [1] https://www.cisco.com/c/en/us/products/contact-center/webex-workforce-optimization/index.html https://www.cisco.com/c/en/us/products/contact-center/webex-...

pydry 3mo ago
90% of the time when I call a call center I need a human to fix an organisational bug - e.g. faulty billing or some other kind of mixup. AI cannot help with this. If it's to do something normal you could do through the website there was no need for AI - a website or app suffices - provided it isnt terrible. Capital definitely thinks it can save costs here but capital is getting increasingly delusional these days.
- ACCount37 3mo ago
  Neither can an average call center human. A good 90% of call center humans are flesh interpreters for support scripts. They are being paid to act like they don't have free will.
- r0m4n0 3mo ago
  The HN crowd is not the usual demographic for call centers. Im willing to generalize a vast majority of callers can find the info they are looking for if they tried a little

abeindoria 3mo ago

That is surprising. My primary care provider had a different response. Basically he said something in line of "You wouldn't believe how much of a relief it has been. In your last visit, you saw me typing everything you were saying, right? I don't have to. I can listen to you and take very specific notes as necessary as opposed to focusing on both typing and listening to you at the same time. It has bought my stress levels down to here." (Indicated by his hand lowering)

xmprt 3mo ago
Nursing and PCP are very different jobs. Ones a lot more cognitive than the other whereas the other involves actually doing/executing on a plan. I can see how AI would help reduce the cognitive burden while actually increase stress on the execution side.
- Loughla 3mo ago
  Do you still get doctors for primary care? Our local hospital is hiring nothing but nurse practitioners now. They're amazing in a support role, but not equipped as well for primary care roles.
  - soared 3mo ago
    I’d rather have an NP 10 times out of ten for primary care
    - TylerE 3mo ago
      If you're more or less healthy they're fine. When things start to go sideways my experience is that they get out of their depth pretty quick.
    - abeindoria 3mo ago
      Eh. There's a reason the entire noctor subreddit exists. NPs have their places. Replacing doctors with them isn't it.
    - 3mo ago

fhub 3mo ago

There is an unfortunate cycle that has been playing out this year in USA. Insurance companies are arming up with AI to deny billing codes charged by providers. Providers are arming up with AI to listen in on provider-patient sessions to prove the billing codes are legit (And teach providers to use keywords in session). The loser, as always, is the patient's quality of care.

jmye 3mo ago
> Providers are arming up with AI to listen in on provider-patient sessions to prove the billing codes are legit This is not a decrease in quality of care - this is your provider having actual evidence of the care needs they discussed with you when they close their note, hours or days after seeing you.
- rockskon 3mo ago
  Except AI has an unacceptably high rate of hallucinations that will result in adverse health outcomes if not outright death.

insane_dreamer 3mo ago

the more I read about how AI is being used, the more I'm coming to the conclusion that despite me personally find it quite useful in my work, and even my personal life to some extent, it is a net negative to society as a whole, and if the choice is between zero AI or the AI that is being deployed, we'd be better out without it what significant improvements to society or humanity have come about as direct result of AI, that wouldn't have been achieved without it? faster protein folding is the only one I can think of and that more a matter of "faster" than "impossible without AI" I think at some point there's going to be some version of the Butlerian Jihad

bogtap82 3mo ago
I mean, "AI" as it presents itself in the zeitgeist is in its infancy. It's like making conclusions about the internet in the late 90s. Whatever it becomes likely hardly resembles what it is now. For better or for worse.

lukeschlather 3mo ago

The article mentions uses of AI but doesn't really give any examples of harm from AI. It does give specific examples where it sounds like Kaiser is optimizing calls to minimize cost rather than improve quality of care. It's also pretty easy to expect that the examples given (treating longer calls as a problem and penalizing nurses for giving more than 3 pieces of advice) reduce the quality of care.

gorszon 3mo ago
They talk about workplace survillience. They use a machine learning tool that try to assess their emphaty, and such. The AI, while the tool technically can be called that, in the article is there to be a buzzword.

derekdahmer 3mo ago

I RFTA and the majority of the complaints are about call center metrics and the pressure to ration care. These are real concerns about misuse of metrics, but not AI. The AI empathy thing was a 2024 pilot that was discontinued. FWIW my wife works for Kaiser and finds a lot of value in the the medical LLM tools available to her. She tells me being able to do live translation, summarize notes, and quickly get comprehensive answers save her time and help her give better care. Her older patients also frequently come in bringing AI-powered alerts from their apple watches that detected cardiac events. It's annoying that we use broad terms to describe a set of technologies that in some ways can be problematic and in another ways are very beneficial. We gotta evaluate each of these as they come rather than talk about blanket bans.

api 3mo ago
“AI” in title gets clicks. So “AI” must be in title.
- nerevarthelame 3mo ago
  AI is directly mentioned in 24 of 53 paragraphs from the article.
- wrecked_em 3mo ago
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aaron695 3mo ago
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ihsw 3mo ago
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ai_fry_ur_brain 3mo ago
I personally will not use a provider who uses llm tools. I know it makes me and my coworkers less careful and lazier. Qualities I dont want in a health care providor. Ive actually moved primary care physicians over this once already, found the oldest guy I could who barely knows how to use a laptop but spends a bunch of extra time with me.

api 3mo ago

Every time “relentless push for efficiency destroying X” comes up I should repost this: https://sohl-dickstein.github.io/2022/11/06/strong-Goodhart.html https://sohl-dickstein.github.io/2022/11/06/strong-Goodhart.... This is a well understood phenomenon.

syngrog66 3mo ago

AI is making lots of jobs and workplaces worse.

profdevloper 3mo ago

Just think -- with the increased efficiency, they will have more time for Tik Tok dances.

none_to_remain 3mo ago

They want you to blame "AI" like Claude jumped up and decided to start hassling nurses, not individuals in management

dqv 3mo ago
... They're aware that it's individuals in management, which is why they want to use their union contract to dictate how management can use AI.
gorszon 3mo ago
If you read the quotes from the union, they blame the management, and they cite workplace survillience as one issue, wich is happened to be a machine learning tool. So, of course the article talks about AI, because thats the trendy buzzword.
- dqv 3mo ago
  They already did a trial which used the trendy buzzword to surveil the nurses. The nurses want to implement controls on that trendy buzzword before it is further misused by management to cause harm to patients (by way of making the nurses focus on meeting some arbitrary performance metric rather than focusing on patient care).
- BeetleB 3mo ago
  > and they cite workplace survillience as one issue, wich is happened to be a machine learning tool. That tool was a trial that they put away (but may come back). The rest of the stuff all existed pre-LLMs and isn't even machine learning (time per call).

nttylock 3mo ago

[flagged]

Loughla 3mo ago

The nurses at our local rural hospital are tagged and tracked wherever they go on the hospital campus. Time spent in one spot is part of their review. I wondered why they zip in and out of the rooms, when just a few years ago they would spend fifteen to twenty minutes in each room. The patient load hadn't grown. The number of nurses has gone up, not down. So I'm blaming the stupid metric on their evaluations for a worse standard of care.

whimsicalism 3mo ago
> The patient load hadn't grown. The number of nurses has gone up, not down. Healthcare utilization, number of unique patients, amount of care per patient has all gone up. American has a massive overutilization problem driving cost but is unwilling to be honest with itself about it.
- BeetleB 3mo ago
  AKA the "Be your own advocate and demand more testing!" crowd. Although Kaiser tends to repel such patients (they'll happy say "No" and tell you to find some other provider). The bulk of complaints I've heard about KP in California boil down to "They wouldn't give me a referral to a specialist".
  - whimsicalism 3mo ago
    Yes, Kaiser is a great model. We need to figure out a way to balance cost sharing with preventing over utilization, both on the supply side and managing demand and restricting interventions to those that are measurably changing outcomes (generally drugs, less so human-capital intensive care).
Tomis02 3mo ago
That's horrible.

segfault99 3mo ago

Workplace metrics and surveillance... What could possibly go wrong? That being said, more than one (female at that) doctor has told me in confidence and based upon their observations during residencies, etc. that if I'm ever admitted, be very careful how I modulate my interactions with nurses. They're not all Florence Nightingale and Mother Theresa and there exist those who will @#$% you up on various pretexts or are just plain sloppy and negligent. Despite all the moralising fluff, it's just a job, not some saintly vocation. Some safety oversight is needed, just as it is for any other work function. Still, can bet that anything 'Corporate' has mandated will be Goodharted up the wazoo.

andrekandre 3mo ago
> Mother Theresa off topic perhaps, but i would hope they were not like mother teresa at all [0] [0] https://allthatsinteresting.com/mother-teresa-saint https://allthatsinteresting.com/mother-teresa-saint
- gsky 3mo ago
  Yea. She's seen as a devil where i live
- probably_wrong 3mo ago
  Since we're off-topic, most of the information in that article (as it's often the case) is based mostly on Christopher Hitchen's work (book and documentary), a man who describes himself as "antitheist" and made a living out of publicly fighting religion. So not exactly an objective reporter. I read a good chunk of the criticism against Mother Theresa as either willfull misunderstanding and/or just repeating the same literal three quotes from Hitchen's book (seriously, they're always there). I cannot say whether she was a good person or not, but I can say: if you ask "which evidence is there which doesn't lead back to a man with a personal vendetta?", the list gets significantly shorter.

27183 3mo ago

https://www.youtube.com/watch?v=DpQamTrynBY https://www.youtube.com/watch?v=DpQamTrynBY [edit] preemptively, if you're going to claim "but this isn't art so irrelevant" then I claim bull fucking shit. It's the same problem no matter how you slice it whether it be engineering, support, art, or medicine. Get real. Look inward. Touch grass. If you think AI is a good thing for your profession--whatever that profession might be--you're probably a delusional psychotic. It's OK, you'll thank me later.

ProAm 3mo ago

Kaiser was the first insurance company in america. If they cant make it work then we are lost.

lotsofpulp 3mo ago
That is because the problem was never the sub 3% profit margin or non profit insurance companies (in the case of Kaiser and many others). The problem has always been pharmaceutical prices, liability costs, and inadequate supply of healthcare. The government does not want to decrease the price of medicine by funding trials so medicine is in the public domain and cheaper, the government does not want to increase the number of matriculating doctors and bring down their time/money/stress costs, and the government does not want to enact tort reform so every step of the healthcare chain is spending inordinate amounts of time and money to prevent litigation. In the US, you should always be double checking what your provider (or guidelines or whatever) is telling you to ensure that the information is maximizing your benefit instead of minimizing their liability.

bozhark 3mo ago

Kaiser has priorities, healthcare being #4 or 5

VerifiedReports 3mo ago

And Kaiser already sucks big-time, so... that's not good.

dyauspitr 3mo ago

I can guarantee this is because the nurses don’t like the extra oversight and surveillance.

bpodgursky 3mo ago
Yes the amount of credulity here is laughable. This is like when cop and teacher unions complain about being evaluated on outcomes.

Malice 3mo ago

Population highly incentivized to denigrate new technology denigrates new technology. Film at 11.

w10-1 3mo ago

motivated reasoning: study in advance of nursing union contract negotiations The sad thing is that there are many issues, but the study didn't really address them. One would hope for more effective critics. The AI application I'd like to see would be to identify the elective hyper-utilizers (so we could try to demotivate them by addressing what's really bothering them). That would improve quality of care for them and quality of life for providers, and create time for outreach to the under-utilizers who need preventative care.

xxd2 3mo ago

Does "Manna" by Marshall Brain still sound futuristic? https://marshallbrain.com/manna https://marshallbrain.com/manna

JumpCrisscross 3mo ago

> where they were found to have done everything right on a call — except staying on the line for more than 15 minutes Do these idiots not know how intelligent assholes work? If you make this a policy, everyone who has a gripe will eventually learn to delay a call to 14 minutes and then make an absurd ask.

oidar 3mo ago

I'd like my providers to use Abridge for their notes, but because Abridge doesn't allow patients to opt out of using the data for training I decline every time.

MetroWind 3mo ago

My wife has been visiting an eye doctor several times. The doctor always use ChatGPT to double check (I'm giving him the benefit of the doubt; another way to frame this is the doctor didn't know shit and just used AI for answers). I'm sure he doesn't think AI is making his job worse.

hopemelisa20 2mo ago

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