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Comment by legitster | Hacker News Reader

I wish he could have invested more in the idea - I think it's an amazing concept but the creator pulled the plug too early. Sales cycles in B2B can take months, and in healthcare they can take years.

Especially the doctor's feedback, she described the possibility of changing her habits slowly as she got used to using the tool.

Unrelated:

"I always have the best interests of my patients in mind, but, you know, it’s not like they’ll pay more if I prescribe Lexapro instead of Zoloft. They won’t come back more often or refer more friends. So I’d sorta just be, like, donating this money if I paid you for this thing, right?”

This line kills me and it's exactly why I hate the healthcare industry. She clearly understands that the software could improve patient outcomes, but describes it as a donation and still wouldn't change how she writes prescriptions (out of laziness, I guess?)

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Sounds like there's an opportunity to have insurance companies pay for the product. This would directly align incentives and lead to overall cheaper care for the patients.

I had the same thought. The meta-customers here are the insurance companies. If you can prove that the tool improves the performance of doctors so that they get sued less when they use it then the insurance company will give discounts for doctors on their insurance for using it. Presto! We just created a market for doctors to pay for the service.

Actuaries employed by insurance companies are probably already better at this kind of analysis than he is, though.

That anecdotal interaction is extremely damning for the entire US healthcare system. Physician admits she prioritizes practice revenues over patient outcomes. Other physicians express similar preference. Inventor of useful tool tosses it into the mothballs.

That tool isn't just a physician aid. If that's what doctors are really doing, it's more like a physician replacement. If they won't do evidence-based medicine, and prefer to be legal drug dealers, for profitability reasons, we should all be contributing to the creation of the auto-doc, instead of trying to help them.

That $40k would have been better spent lobbying to remove the guild protections from the practice of medicine.

If all general-practice docs do is take height, weight, pulse, BP, blood oxidation, and run a CBC with lipid panel before prescribing your drugs for the year, that doesn't seem like something only an MD or NP could do. But by law, if you want prescription-only medicines, you have to go to a prescription-drug dealer and pay them for the scrip, before going to pay someone else, again, for the actual drug.

And if they're not actually doing (what I perceive to be) their jobs? If they're just "phoning it in" to collect a paycheck? That's one job I'd love to automate out of existence.

I don't know how old you are, but at a certain point, the input of a general practice doctor becomes very valuable. Remember, the doctor doesn't even do the little tests you mentioned, like taking measurements and blood tests - they just order them, and nurses or technicians do the work. The doctor's job is to make decisions and give advice.

About a dozen years ago, my doctor caught my blood pressure shooting up in my annual exam and started treating me for high blood pressure. High blood pressure is a "silent killer" that leads to premature deaths for millions. You don't feel sick, while your heart struggles and your brain risks explosions. And treating it, once diagnosed, isn't straightforward. It took six months of experimenting with various medications to find the combination that worked for me. That's a doctor's judgment and expertise, not something for some technician with a community college associate's degree. And this summer, when a critical potassium depletion drove me to a scary ER visit, she noted that one of my BP meds could affect potassium and adjusted my dosages.

And it's not just an expert-system thing that could be replaced by a robot, either. She's not just dealing with my measurements - she's dealing with my fears, and helping me decide on best approaches. That requires a human touch.

So your doc abrogated her responsibility to warn you about the side-effects of the prescribed drug.

You went to the ER, because you were not aware that cramps, constipation, spiking BP, and muscle weakness are symptoms of hypokalemia, which could be resolved quickly by dissolving KCl from the grocery store in water and drinking it.

That's patient education that needs to happen before you go to the ER.

Just like with the GlacialMD thing, it's no skin off your doc's nose if you have to drop $500-$2000 on an ER copay because you had an electrolyte crisis from the medication she prescribed, and didn't know ahead of time that could be a possibility.

And the rest of you out there, learn to measure your own BP. You can't leave it to an annual exam to find out it's getting high, and the BP taken in the doc's office may include the "white coat effect" (or as I call it, the "what will this cost me effect").

To be fair, I took that particular medication for over ten years before the crisis. So it's unlikely that the medication itself was the sole cause.

And when the symptoms started, I wasn't going to go to the chemist to start concocting home remedies for what I feared could be a mild heart attack. I went to the ER. Again, I don't know how old you are, but I'm old enough to have had friends my own age start dropping dead of heart attacks and strokes. Hence I decided to take the safest route.

I agree with you, but at least she was honest. Many others would say no for the same reason, but wouldn't be honest about it. A prospect who is honest about their true reasons for saying no is extremely valuable when you're pitching an early product.

I think in general, if you're building a business, expecting anyone to do something that isn't in their own selfish interest in some way is a recipe for failure, even if people in your target market might claim not to have selfish motivations. If you want someone to change their behavior (and/or their organization's behavior), you need to be able to clearly explain why it's a win for that specific person.

Or like a lot of GPs, she just prescribes whatever medication is top of mind after the last visit from the friendly pharma sales rep.

I'd like to imagine "laziness" isn't the reason doctors write the prescriptions they do.

"Laziness" is probably unfair - but there is a lot of evidence that everyone, doctors not included, will get stuck in their ways unless forced out of them.

There's much to be said for sticking with things we know work, rather than experimenting with new things that might work better. If a doctor has an effective treatment for a common condition among their patients, what is the cost of trying something new? Do you try it with all patients, or just one?

But "laziness" is something of a trigger word for me in health care discussions, just like "greed" is. It's so easy to attribute what we see as suboptimal outcomes to malice on the part of the person acting - even passive malice like laziness.

She basically just told him that if she treats her patients better they will visit her less. This is not laziness, this is malevolence.

Indeed. There's also concierge medicine and new models that are more concerned with patient outcomes, or at least the appearance of caring about them

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