I hope AI replaces most of them. My experience in the ER, at least in Canada. You're not getting a doctor. You're getting a doctor's 10 minutes attention, while they're running around from patient to patient. Don't expect your diagnosis to be anything more then the most obvious, A -> B diagnosis. When your problems conflate from the drugs they just wrongly gave you, and add in random screw ups, staff and equipment shortages. You will be getting reactive medicine, as your condition worsens. A death spiral, from which you will not escape. Many will be transitioned to the after life in hospital in this way.
Give AI better diagnostic testing data, and AI will make better care decisions then any doctor. The doctors/nurses will still be needed to take care of the patient. But it seems pretty clear that AI will be making the decisions, in the short future.
A fourth of U.S. health visits now delivered by non-physicians
51–60 of 158 posts
Re: A fourth of U.S. health visits now delivered by non-physicians
#52Earlier quoted context omitted.
i already understand the economics, these types of systems exist everywhere, usually to the detriment of everyone. However, all they need to do is not deflect me from specialist care, so im not sure it applies 100% here. Check back in a month when i go to the office again and insist on seeing a specialist.
Mine was more of a general comment on these types of systems rather than an explanation for what you are going through. I have no clue why they are treating you in the way you describe. It might be interesting if you could ask them why they haven't referred you. Even more interesting if they gave you an honest answer. Good luck.
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Re: A fourth of U.S. health visits now delivered by non-physicians
#53Earlier quoted context omitted.
> Ive had chronic health issues for 3 years now without much relief, despite having been to the doctors office 20+ in that time. This is the problem with all of these systems that try to violate the laws of physics (aka: free market economics). They invariably results in substandard care, if you receive care at all. Keeping people alive isn't the same thing as actually solving problems with quality care. This is my b…
i already understand the economics, these types of systems exist everywhere, usually to the detriment of everyone. However, all they need to do is not deflect me from specialist care, so im not sure it applies 100% here. Check back in a month when i go to the office again and insist on seeing a specialist.
Not sure what you need a specialist for specifically, but for ~$300 you can get an appointment here in South Africa for any specialist you want. If I want to see a specialist, any specialist, I call their office, book, and X amount of time later, they see me. The reason I mention it is that SA has a medical tourist visa you can get, so flying here for your medical needs may well be within the realm of cost-effective for a lot of people in the Western world.
As a general aside. That you have to plead, motivate or beg your government to let you get healthcare from a specialist seems alien to me. I just don't even have the words - your government does not own you!
Re: A fourth of U.S. health visits now delivered by non-physicians
#54Earlier quoted context omitted.
This was my experience going through a half dozen doctors. I found a great one finally, but they didn't even bother taking insurance, and it was very expensive.
Excluding emergency situations, the biggest issue IMO is diagnosis. So many tests, scans, listening, observation, etc. is all about understanding what the problem actually is. Once you accurately identify the problem, treatment can be effectively given (if one exists) via the current system. For mysterious problems that elude a simple diagnosis you can really be stuck. Most doctors don’t have the time for complex cas…
The first doctor I had wanted to send me to get my thyroid nuked because it was inflamed after a viral infection.
After 2 years and 6 doctors I found I basically had long covid years before it was recognized. Probably from a low grade garden variety viral infection. My gut developed food sensitivities and I started to develop autoimmune problems from that.
After finding the right doctor who could handle researching chronic conditions, things improved within months and a few years later I completely recovered.
Typical doctors have 5-10 minutes to listen to you and click on drop-down boxes on the computer. They won't care about chronic or complex issues. They are good for low hanging fruit and steering you towards pharmacological intervention but unusable for anything more involved.
Re: A fourth of U.S. health visits now delivered by non-physicians
#55MD here. I'm of two minds about this. On the one hand, obviously there's a bit of defensiveness since I went through 12 years of school and training to be an independent physician (4 years college, 4 years medical school, 4 years residency) and I've definitely seen subpar care from other "providers" (not a fan of the term) with less training. The wide variety of different "providers" is also confusing to patients who…
The current choices are
1) Uniterested, slapdash care from an MD with 12+ years of training and no ability to listen or empathize but eager to make the money s/he went into medicine to make
2) The same from an assistant of some kind who uses ever-degrading search engines to look up not-your-problem and give you potentially dangerous suggestions
The future will undoubtedly be worse. As someone mentioned below, we'll pay current premiums (+inflation) for a touchscreen interface to Chat-whatever-it-will-be.
Re: A fourth of U.S. health visits now delivered by non-physicians
#56I get annoyed when I send a message to my doctor and it takes 3 back-and-forths to get a message from him, and not the nurse. The nurse's advice tends to be along the lines of what I would find with Google, some semi-relevant copy/pasted advice. I get the sense that they make the messaging system useless so that you have to sign up for appointments/video appointments. They know that for GP appointments, you only pay…
They don't want to solve your problem over a messaging system - and prefer you to come in - the MD can't bill anyone for answering you questions over the phone or even via messaging - which is why they push for an appointment. Not sure what line of work you are in, but are you willing to answer endless emails and or voice mails from customers, all for free? I know I am not - and while you personally may only ask one…
If they don't want to have a way to ask a question, they shouldn't have one. The assistant who answers questions has literally never provided value. She is just wasting her time, and mine. I would actually prefer if they didn't pretend you could get useful info through the "ask a non-emergency medical question" option.
And as tssva said, these questions are often follow-ups on topics discussed at an appointment, so it's not untethered from revenue.
Re: A fourth of U.S. health visits now delivered by non-physicians
#57If you go to urgent care, you most likely won't get a physician. 9/10 visits are urgent care you only see a PA or NP and they can't even really do much. Urgent care seems to also provide really poor results--every time I've gone it's a long wait, the workers seem over-stressed, you barely get any time with the doctor, and usually they just do a strep test or give you a Zithromax pack and hope you'll go away.
Anecdote that isn't remotely data: I went to an urgent care facility the first time I had a migraine aura without headache. I described it to the receptionist as a "visual hallucination", since it was a flashing checkerboard pattern that obviously wasn't real.
The receptionist _ran_ to the back to get a doctor. The doctor, in an exam room, very careful, and with significant compassion, explained that they don't have the ability to treat me at that location -- but would I accept an ambulance if they called it?
I took an Uber to the ER, where the admitting nurse gave me a flat stare and said "That's not a hallucination," but still put me at the front of the line to have an attending doctor and a bunch of students stare into my eyeballs before confirming that it was a headacheless migraine.
To this day, I use that experience as an example of a lay person and a professional completely failing to understand each others' word choice.
Re: A fourth of U.S. health visits now delivered by non-physicians
#58MD here. I'm of two minds about this. On the one hand, obviously there's a bit of defensiveness since I went through 12 years of school and training to be an independent physician (4 years college, 4 years medical school, 4 years residency) and I've definitely seen subpar care from other "providers" (not a fan of the term) with less training. The wide variety of different "providers" is also confusing to patients who…
I definitely understand your perspective here.
I'm a critical care paramedic, have several friends who are (perhaps unsurprisingly) generally emergency medicine physicians and related (surgeons, anesthesiology, nurses, etc.).
I see the spectrum too. Extremely competent PAs who have long and detailed in depth discussions with physicians as "peers", on one side, and then I see horror shows from people who went from zero to ARNP in programs with "accelerated RN" where they are not functioning providers with far less schooling and clinical experience than even a PA (which is then galling to the PAs, as why are NPs independent practitioners, and PAs not?).
I do think a lot of the issue is in the education and certification process. The AMA is only recently making the slightest inroads into well, not admitting they went too far in restricting physician flow, but maybe acknowledging that there is a problem there. Nature abhors a vacuum, and all.
I had a friend, extremely intelligent, in a BSN program. Called me one day to ask about flow rates for various oxygen adjuncts (nothing fancy, just like "what do you typically run your nasal cannulas at? What about NRBs?") and I was blown away. "Oh yeah, somehow that got overlooked. I know how to set them up, add humidifiers, etc., etc. - they just assume, I suppose, that someone at some point will say some magic numbers to us".
And I'll also say that you see the same pre-hospital too. In PNW, while there are valid criticisms that can be leveled against two of the pre-eminent paramedic programs (UW Harborview, and Tacoma Community), there are far, far, too many "strip mall schools" in other states that will take you from "zero to hero" in 4 or 5 months (of 6 days a week, 8 hours a day, of just class time), and dump you out on the world with just enough retained knowledge to pass your NREMT and the barest amount of ride time to meet DOT mandated minimums. It's scary, to be blunt. These people go out with no clinical experience and are now expected not just to work as a team on a 911 call, but to lead it.
It's the medical equivalent of high school > college > MBA > management position without a day of work experience in your life beforehand. Except now there are literally (at least occasionally) lives at stake.
Re: A fourth of U.S. health visits now delivered by non-physicians
#59Honestly, I don't have any problem with this, and I see it as a great thing. 95% of the time when I go to the doctor it's something routine and basic, e.g. I just need someone to diagnose my cold/flu/infection etc. My question, though, is where are all the "savings" going if so many visits are now seen by lower paid professionals? I was referred to a sleep study, where a PA or nurse practitioner just proceeded to ask…
Why go to the doctor to be told it's a flu or a cold? There's nothing to do but treat yourself well and wait, right? I wonder what portion of visits are for common viruses.
Re: A fourth of U.S. health visits now delivered by non-physicians
#60In a very meaningful way the line between physician and non-physician had been blurring anyway. There's a software called Epic which is used by virtually all large healthcare centers, and while most know it as a database system to store patient history and health records (problems and conditions they've been diagnosed for, lab work results, medicine they're currently taking or have taken in the past), it also has a l…
Having worked in healthcare IT, and as a prehospital provider who has seen and interacted with many EHR systems, including Epic, Meditech, and ESO (moreso for prehospital)... the sooner Epic dies in a fire the better.
Keyword-driven differentials should be, if anything, the baseline, bottom rung, pattern matching to inspire and drive critical thinking, focused assessment, and diagnostic skills. Not to "easy mode" the path of least resistance.