Comment by idiot900 | Hacker News Reader

Comment by idiot900 | Hacker News Reader

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> greater human trust in computers and recommendation systems

I am an MD and have a degree in CS. Expert systems are not remotely there yet for this purpose. On no planet would I trust care of my patients to a computer. Far too many subtleties involved in accurate diagnosis and treatment that are not encoded in a machine-readable format.

> legal regime which mandates DOCTORS perform procedures, and only after a lengthy course of study

Good reasons for this - it actually takes that lengthy course of study to safely perform many procedures, and, more importantly, to fix things when they go wrong.

NPs and PAs are helpful but based on the quality of care that I personally observe they should not function without physician oversight.

There is no escaping that medicine is an extremely complex field, and it is only getting more so. Not long ago, many of the people who today are restored to their usual state of health would simply have died. The sicker a patient is, the more complex and difficult to manage they are. By definition a doctor is the one who is able to do so.

I am still waiting to meet a patient who comes to the hospital and prefers to have their care rendered by non-physician providers over physicians, or would even settle if there were an option.

It's not that simple. A society cannot afford the triple-A gold standard of everything for everybody. Not everybody can live in a McMansion and not everybody can afford to have an MD/CS for their every single health need, no matter how minor or how routine. Tradeoffs have to be made.

US medicine has been very successful at creating a guild system that's prevented lower-cost provision of care for decades, all under the concern of "it'll lower the standards of patient care." End result has been millions of people who can't afford medical care at all.

One anecdote: for a time I was splitting living in the UK and the US and had health care experiences in both places. It was fascinating to see the differences in treating my (very ordinary) health issues. One time I came down with a mild rash that rebounded a few times before it finally went away. In the UK, the GP looked at the rash, punctured the pustules with little pokey thing so they'd drain, and they cleared up in a few days. In the US, the dermatologist wheeled in a big machine filled with liquid nitrogen and froze the pustules; they went away in a few days after that too. End result the same; cost to administer - orders of magnitude different. In the US, it seems like there's no medical treatment that we can't make more expensive by requiring more specialists with more years of training, using ever more expensive machines and medications.

I love modern medicine. My dad's a retired doctor and I almost became an MD myself. But the system we've created has costs out of control while simultaneously creating worse societal health outcomes than other countries.

> It's not that simple. A society cannot afford the triple-A gold standard of everything for everybody.

The society in question has not realized it.

> US medicine has been very successful at creating a guild system that's prevented lower-cost provision of care for decades, all under the concern of "it'll lower the standards of patient care." End result has been millions of people who can't afford medical care at all.

Even the bottom rungs of the doctors in the "guild system" are not very good - lowering standards even more is very hard to agree with when push comes to shove. Especially there is no guarantee that this will actually lower costs to society.

But I guess this is what will have to happen, at least in primary care, because that is a miserable field that I am incredibly glad I didn't go into. I hope that at least some kind of care turns out to be better than none at all.

I like people from the US who want to cut out people poorer from being helped by an MD because it's "impossible"; when so many other developed countries seem to manage with it just fine.

I'm still amazed some want to go back to a system that charged them more for marketing it to themselves than actual care-- boggles the mind.

> I am still waiting to meet a patient who comes to the hospital and prefers to have their care rendered by non-physician providers over physicians, or would even settle if there were an option.

Attach a price tag to each and find out. Maybe someone who couldn't afford a $500 consultation with an MD could settle for a $250 or $100 consultation with a PA, or an expert system. You really don't know until you experiment, and find out.

True, that is the experiment to do.

It is not without ethical concern though. Unfortunately, most patients are not sufficiently informed about medicine to make a rational market choice. (Indeed, outside my specialty, I am not really either, and would seek the advice of a trusted physician friend, which is a luxury most don't have.)

For example, the PA and expert system would not reliably know when they are in over their heads and require an MD. Some subset of people would suffer serious injury or death through no fault of their own other than not having had the information necessary to allocate their funds in a manner most benefiting their interests.

There's some research that at least some expert systems("decision support system") implemented in the right culture do improve medical services[1].

But still due to huge resistance by doctors, who like the autonomy of the job, such systems are rarely used.

I could only imagine how rapidly such systems would improve if the backbone of medicine would be dependent on them, and enough revenue would be shifted towards them.

[1]http://www.ncbi.nlm.nih.gov/pubmed/24573664

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