Comment by bluetwo | Hacker News Reader

Comment by bluetwo | Hacker News Reader

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(In my opinion) Doctors have done a good job of protecting them selves from technological disruption by only allowing it to be used where it is profitable to them (billing) and not where it would threaten them (diagnosis).

Even the concept of electronic medical records has been resisted, and is currently poorly implemented. The gov't had to literally bribe doctors to convert to electronic systems and most seemed to go out and get the least poorly built products on the market.

I'm not trying to paint them as evil. Heck, even NASA scientists were suspicious of computers taking their jobs. I see this in other fields all the time.

Seeing the potential and seeing the current state of affairs kind of makes me sad. I want to live in the world where a balance has been reached. Where my medical record is a salient form of AI that checks if I lost those 10 pounds I promised and loops in the doctor when my flu symptoms linger too long. I want it to eliminate the hassle for doctors, hospitals, insurance companies as well as patients, and I think in the process it can drive costs down and raise quality of life.

I think this is way off. Doctors generally actually just have no idea about technology. I'm a programmer and a doctor so all I ever see is ways we can improve things with technology.

I've never seen a doctor shun technology to keep themselves relevant (I've no doubt it will become a thing more in the future).

I don't think that is fair. I think Doctors would love to use a technology to help them with diagnosis, particularly if it can corroborate an uncertain diagnosis. But I think there are a lot of liability problems with systems that try to provide a definitive diagnosis, as well as issues of patient trust.

I had come to similar conclusions about doctors but after interacting with a few doctors closely, my perspectives changed. This is in India though where the regulatory environment is a lot different.

Per my interaction, the best doctors will do whatever it takes to improve their efficiency. Their biggest problem is the sheer volume of patients. Everyone wants to go to the best doc, and word spreads pretty fast. If you start doing good, very soon you are swarmed with patients 24/7. So any tool that can speed up their patient handling time is welcome. This is not a scheduling problem. People built a ton of scheduling tools and those tools have done next to nothing to move the efficiency needle.

What's needed is, what you said, a diagnostic tool with automated feedback from patient's activities and dramatic physiological changes. The best doctors that I know will take it up in a heart beat.

> If you start doing good, very soon you are swarmed with patients 24/7.

I'd argue that the answer to this is, "Sorry, but we're full up on appointments that day/week/etc". And if you start needing to book your normal clients too far out, you stop taking new patients. The fact that people want to see a doctor doesn't mean they get to see that doctor. The answer is not to take more patients but give each one less time, resulting in sub-par treatment.

You have to visit one of the hospitals in Bangalore - St.Johns to see the volume of patients. It's insane.

And if you start needing to book your normal clients too far out, you stop taking new patients

What's a normal client ? Do you mean repeat clients ?

Doctors aren't the ones making these decisions - hospital administrators generally are choosing what to invest in. Most MDs I know are excited about research and not necessarily afraid entertaining some amount of change.

The adoption of new technology for diagnosis butts up against the same legal problem as driverless cars. Even if this system is better at detecting skin cancer than the average dermatologist (or even the expert), people are going to sue the manufacturer when it doesn't detect their cancer.

People sue doctors, too, but I'd put money on the proposition they'll be more willing to sue a company than the individual they met who seemed like he had their best interests at heart.

> Doctors aren't the ones making these decisions - hospital administrators generally are choosing what to invest in.

Most doctors don't work in hospitals, they work in family practices and most definitely are making the decisions about how their practices operate. Most of us don't go to hospitals to see our doctors, we go our doctors private office.

Here in the Silicon Valley, there are three very large medical groups: Kaiser Permanente, Sutter Health, and Sanford Health Care. They represent over 22,000 doctors.

Specialists still seem to work from private offices, but my experience is that most doctors work for large medical groups where they do not make the technology decisions.

You're right - I was thinking about HMOs where care is very systemically administered. I think we'll see players like Kaiser introduce these tools before smaller private offices.

They have more data than most other networks, and more resources to invest in R&D.

I think most doctors would go without any billing tech if possible, but most also hire billing employees to deal with billing to insurance companies - and to bill an insurance company, you have to conform to their standards...

Citation needed for this one

Doctors protect themselves from technology changes by forcing themselves to be included in any technology change. Get blood tests? You can't get the results until a doctor looks at it. MRI? Same. ML will provide another batch of tests for them to order, and if they work better, that's great for the patient, but you'll still need to make an appointment with the doctor for ordering test, and another for diagnosis.

Whether this is a good thing or not is open to interpretation. Doctors make mistakes, but people often catastrophize their test results.

Unfortunately, most of our tests aren't all the good and in and of themselves the results are pretty meaningless.

Back in medical school we were taught that 80% of the diagnosis comes from the history, 10% from the physical examination and 10% from the investigations. Or something like that, it's the idea, not the numbers that matter.

As a young computer nerd, this didn't sit well with me, but the more I practice medicine the more I understand it.

My teachers didn't realise at the time, but I think they were actually talking about Bayesian probability.

I think we are talking about this more and more in medicine, but unfortunately not all specialities have embraced it.

There are lots of likelihood ratios published and good statistics available to help with diagnosis, but we don't use them effectively. There are some online tools and apps available to help navigate the literature, but I'm not really sure why we don't use them more.

You can get most blood tests yourself. No doctor is needed.

http://www.healthtestingcenters.com/lab-locations/georgia/bl...

i think the law in California requires that a physician or health care practitioner give the order to the lab. i don't think the average patient in California is allowed to order their own medical lab tests.

https://www.cdph.ca.gov/programs/lfs/Documents/LFS-OrderTest...

in this particular area, one might argue that Georgia is more enlightened than California.

The primary reason why there wasn't much automation in the past was the combination of doctors being conservative (which is a good thing) and lack of competition among established medical companies (the ones conservative doctors depend on). You can see how the two couple stifling innovation not through any conspiracy but just preferences.

Both of those aspects are being relaxed today. Doctors are become tech-oriented and more diagnostic companies (run by first-rate medical/engineering teams) are starting up that may upend more established medical companies. We will see a rapid change in the diagnostics landscape in the next decade. This may also add some risk to the diagnostic field, but the benefits far outweigh the risks.

Test results mean nothing without expert interpretation. This isn't some doctor conspiracy.

The test results list what the normal ranges are.

I saw an asthmatic woman in A+E today, all her blood tests were in the 'normal' range, does that mean she's well?

No, she was very unwell. However the test results would either be normal in someone regardless of the severity of their asthma, or would be expected to be 'abnormal' in someone with mild asthma, and 'normal' in someone with severe asthma. The ability to interpret those test results, and take a history and examine the patient is important.

Similarly, we used the latest evidence-based guidelines to assess the patient's asthma severity, and based on several objective criteria (breathing rate, oxygenation of blood, peak flow, etc) the guidelines determined she had moderate-severe asthma

However we called the ICU doctors to see her. The ICU consultant, with many decades of experience managing acutely unwell asthmatics, simply looked at the patient for two minutes, observing how her chest moved during breathing, and the sounds and respiratory effort she was making, and decided to take her to ICU. This was a good decision as she ended up deteriorating and requiring very aggressive treatment. Whilst guidelines can make a suggestion based on the interpretation of some objective data points, the ability to assess a patient as a whole, based on history and examination, is still an important skill, and one which it is hard to automate

The test results list the 95% confidence interval range for the population the sample they used to calibrate the test is theoretically representative of. That's not the same thing as normal.

I know...

Tests are usually done for a clinical purpose, not just to find out what your result is. What do the numbers mean to you?

Many straightforward tests people can do and interpret themselves, like people with diabetes on insulin (measuring BSL). They're not all so straightforward.

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