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Comment by xyzelement | Hacker News Reader

I don’t totally know where I fall on this question but the obvious (isn’t it?) counter is that cross-jurisdiction telemedicine makes certification very difficult.

IE if I am a New Yorker being treated via telemedicine by someone in Alaska or Nigeria, should New York be concerned that I can be treated by someone it would not consider a “real doctor,” and may not even be a doctor in the jurisdiction they are in?

You can argue that the market would sort itself out eventually because those who didn’t know how to find useful teledocs would die out, but it’s up you you whether you are comfortable with that.

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> cross-jurisdiction telemedicine makes certification very difficult

No, it makes certification by State governments very difficult. The solution to that "problem" is obvious: stop the monopoly that State governments have on certifications. Let patients decide based on whatever information they deem relevant whether a doctor is "certified" to treat them. There are already many private sources of information about doctors.

This would end up spectacularly badly, people are never informed to make good decisions on this

> people are never informed to make good decisions on this

Speak for yourself. I am at least as good as State governments at judging the competence of doctors to treat me. I suspect a lot of people are like me. I particularly suspect that a lot of people who have considerable experience dealing with doctors who were "certified" by State medical boards are like me. The question is not just how good or bad individuals are at it, but whether States are even worse.

But even if many are like you, I am not saying States cannot publish information about which doctors they think are certified. I am just saying that patients and doctors should not be restricted by that. Patients who want to rely on their State to do it can of course do that. But patients who want to make use of other information should be allowed to, and doctors should be allowed to treat them if the patients choose, without facing legal penalties.

The number of people who are capable of judging the competence of doctors is dwarfed by the number of people who believe in quackery. We have a very real problem of people feeding their autistic children bleach in the belief that it will cure them ("miracle mineral solution"). Regulations inconvenience people like you and me, but they save a lot of people who need to be protected from the consequences of their own poor decision-making abilities. I consider that a worthwhile trade-off.

> The number of people who are capable of judging the competence of doctors is dwarfed by the number of people who believe in quackery.

Evidence, please?

https://www.nbcnews.com/tech/internet/moms-go-undercover-fig...

<s> Dude, this is HN. Some FAANG libertarian developer guy is way smarter than a state licensing board. </s>

They are more often informed well enough to choose some endorsing body to delegate that decision to, and it's better that they have a choice of such endorsing bodies than a single one they may not agree with.

What goes horrifically wrong if there are multiple certifying authorities for medical practitioners, with varying criteria, and various meta-organizations making recommendations about which certifying authorities are better than others, and people make informed decisions accordingly? Some people will absolutely make ill-informed decisions, and those should still be their decisions to make. That seems preferable to the world in which someone can't see the specialist they want to see because they're in another jurisdiction.

How about we address problems with laws after we have a problem?

You’re using an edge case of a doctor in another continent to illustrate why we shouldn’t allow telemedicine appointment in the same country’s medical system across regions. That argument is classic false equivalence.

Ok. How about a doctor who loses their license in WA. Can they still practice telemedicine?

Because then you have microplastics in the most remote reaches of the earth, and still no political will to do anything about it.

Imagine if we were restrictive in the first place... The luddites could teach us a thing or two.

There is a group working on cross-state physician licensing already: https://www.imlcc.org/

Compact state licensure still requires you pay for other state licenses and go through their process, it’s just a lot faster since the states agree that your background check and data don’t need to be reevaluated from scratch. A doc would have to pay for every single state license in order to work nationally. But the VA and IHS already accept docs with any state license to work in their system at any site, basically creating a “national” license. It works just fine. It doesn’t increase risk of fraud, if someone is a fraudster they wouldn’t be able to practice anywhere after losing a national license.

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