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Comment by mise_en_place | Hacker News Reader

Perhaps the institution of hospitals is outdated. With concierge medicine, a doctor can make house calls with a nurse and solve most medical issues. The ideal should be like Star Trek (hyperbolic, I know). A tricorder should be able to scan me and care should be in the form of a hypo spray.

Hospitals are a single point of failure as an institution and we should be moving away from centralized medical care in the 21st century. As an aside, I’ve noticed a lot of people are in hospital waiting rooms whereas they could be served with a doctor making a house call. Just my 2c

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Concierge medicine is expensive and likely doesn't scale. Centralized medicine helps for a few conditions where you can't fit an MRI, CT-scan, and various medicines into a van you bring to house calls. In some situations, you need access to all of those in order to save one's life.

I work in a hospital and idk where to begin but most of your statements are incorrect. You have no idea how hard it is to find medical staff, like doctors and nurses, for one. Hospitals tiage patients so the most critical cases are served first when demand is high, if there are people waiting its because staff or capacity is unable to meet demand. Idk how you think doctors will be willing to make house calls considering they don't even like walking from one end of building to the other, at least in general. So you think more labs, more equipment for diagnostic testing, and more people to operate this stuff inside of people's homes is more efficient? Are we going to trailer the MRI machine around town?

>You have no idea how hard it is to find medical staff, like doctors and nurses, for one

This is a result of caps on medical school residency positions. The number of doctors per person in the US has actually steadily decreased over the last century, due to measures the AMA lobbied for to restrict the supply of doctors (and hence increase the amount doctors are paid).

>The ideal should be like Star Trek (hyperbolic, I know). A tricorder should be able to scan me and care should be in the form of a hypo spray.

You must have forgotten about the sickbay diagnostic bed with the foot-pumping machine in the wall. How's the doctor supposed to carry that around?

Anyway, back to hospitals: they seem to work fine in my country. If you have a problem that's somewhat urgent (needs more than a clinic visit), you just call for an ambulance and go to the hospital. Having doctors spend at least half their day in transit, going from place to place, seems like a massive waste.

Naturally the diagnostic bed is beamed in by the same transporter that lets the doctor flit around the city making home visits without losing half the day on the road. (Since the whole idea is premised in optimistic sci-fi rather than mundane reality, let's go the whole hog...)

Having patients come to the doctor allows the doctor to see more patients in a day, because the travel time to bring the doctor and any given patient together can be overlapped with the doctor seeing another patient.

When the doctor goes to the patient, travel time is serialize with seeing patient time.

Hospitals exist because CAT scan machines are expensive, and it makes sense for patients to drive to the CAT scanner, rather than the CAT scanner drive to the patients.

Lather, rinse, repeat for every medical device. Sleep analysis tools, XRays, surgical tools and instruments, etc etc.

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Furthermore, doctor time is expensive. It makes more sense for patients (who probably make less money than doctors) to spend their time driving. Not for doctors to be driving around making house calls like a maid or milkman.

> Perhaps the institution of hospitals is outdated.

Not really, but I wish we had more urgent cares available so that people without emergencies don't flood hospitals. The reason a lot of them wait until its serious enough is because healthcare is expensive, so people avoid going to PCPs and Urgent Cares.

We need better way of paying funding/paying for healthcare.

>> We need better way of paying funding/paying for healthcare.

Vouchers?

https://www.brookings.edu/research/a-comprehensive-cure-univ...

Ban for-profit health insurance companies?

https://firstquotehealth.com/health-insurance/news/non-profi...

But I honestly believe there is no simple answer. Healthcare systems are built over time and are continually changing, which needs incremental changes and continual tweaks.

> With concierge medicine, a doctor can make house calls with a nurse and solve most medical issues. T

Concierge medicine is, cost efficiency aside, more of a replacement for office-based visits (probably doesn’t eliminate the actual office, but lets it downsize) and maybe urgent care and some other outpatient clinics. it’s not a replacement for inpatient hospitalization. I suppose if you include upgrading EMS to include medical flying squads with doctors and nurses as kind of “second responders” in your definition of “concierge medicine” (its not the same thing, but I guess conceptually related enough not to be totally unreasonable to include them together), it might replace some ER use, too, but it would probably be ridiculously inefficient in doing that, even more than concierge medicine generaly.

Doctors don't have enough time to spend with their patients under current arrangement and the patients are all lined up in one hallway. Would not house calls be inefficient because a significant fraction of a medical team's time is spend in transit?

When every house has a teleporter, perhaps your model might work.

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