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Comment by a_gnostic | Hacker News Reader

There are no solutions, only tradeoffs. The over-reliance on one size fits all "solutions" are what got us into this mess, and AI will prove just another bandaid with its' own problems, until we realize this.

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Yes and no - sometimes you need tailored complex care from a professional. Sometimes you need routine treatment, but it's going to take 3 months to get an appointment with the given specialist, or maybe in the case of rural areas there isn't even one within 1000km of you.

A lot of good can be done by extending "one size fits all" solutions for simple things there's just no capacity for

A naïve readthrough would lead one to that conclusion perhaps but the elephant in the room here is capitalism. Pragmatically, any "good enough" solution will be used to replace skilled care to improve patient throughput and thus the bottom line.

The problem is that "skilled healthcare" is essentially a cartel which uses artificial scarcity to increase the price. You can see the counter-example in Cuba, which has an incredibly high number of MD's per capita compared to other countries, and achieves very good healthcare results, especially in the context of other metrics of development and economy.

There are so pitifully few health care practitioners compared to what we need in most developed countries I don't think too many jobs are going to be at risk any time soon if AI picks up some of the slack.

What about nursing? That seems to be the flip side where there isn't the protection of the cartel around doctors, so wages get driven to the floor and we see scarcity due to cost of living and mismanagement.

Nurses might not get paid what they are worth in all cases, but they have amazing job security.

Ironically it's probably easier to replace a lot of what doctors do with AI than what nurses do.

We've already got NPs and PAs "picking up the slack" in the US. Prices are still outrageous for folks without health insurance and healthcare outcomes continue to decline. Adding another half-assed tool to the chain isn't how this gets fixed.

The US is not the only country with healthcare needs. There are plenty of developed nations with public health care systems which primarily suffer from scarcity rather than cost to patient, and AI could help with that.

What part of healthcare provided rote by untrained individuals at the behest of a LLM sounds like a solution to anything?

So for example, a treatment plan might look like this:

1. Go to a GP and explain symptoms 2. GP orders some tests based on symptoms 3. GP refers you to a specialist based on test results 4. Specialist orders more tests 5. Specialist analyzes results and orders more tests, or prescribes treatment plan 6. Check in with specialist in weeks or months to evaluate results and update treatment

It seems to me that for many common issues, 1-4 could plausibly be replaced by AI guided care with minor downsides.

If you are normally spending a lot of time waiting between steps for a practitioner to become available, then it's going to be a net win for many people.

"with minor downsides" ...

Artificial scarcity? Maybe. There aren't but so many households with children that fit inside the venn diagram of can afford med school, has the intellectual capacity and bloody-mindedness to actually finish med school, and is interested in going to med school.

Yes and no. No doubt the medical profession requires talent and rigor, but I think to some extent the hurdles which are placed in front of students who want to become doctors are artificially high to help justify the small number of graduates medical schools put out, which protects the artificially high salaries.

For instance, if you read up on the frankly cruel residency process which doctors are forced to clear in the US, the insane hours are in large part because one of the doctors who was influential in shaping the current practice was an abuser of stimulants.

So I think it's a bit of a "just so" story to assume that the version of the medical profession we have is the best possible version.

And indeed Cuba is a good counter-example to your argument. Unless Cubans are just a lot more clever and resilient on average than Americans for example.

Yeah I'm not convinced. I've worked adjacent to the healthcare and pharma industries most of my adult life and I can tell you the complexity of the human body beggars belief. You aren't going to run the equivalent of a coding bootcamp for healthcare and get good results.

Not all of medicine is dealing with the full complexity of the human body. A lot of it is applying wrote knowledge to essentially follow a flow-chart to map a set of symptoms and details about the patient to a diagnostic / treatment plan. Doctors are trained to not deviate from medical orthodoxy, and for instance it's been studied that if doctors are told another doctor has already come to a given conclusion about a diagnosis, there is a strong effect that they will confirm the diagnosis even in the face of contravening evidence.

I.e. I don't need "Dr House" to tell me to take 2 and call him in the morning. There is a whole large swath of routine medicine which AI could probably do.

And I am happy if you and your family have been lucky to be blessed with good health and good care, but many people have experienced having a mysterious medical condition, and going to several doctors or waiting months before it can be properly diagnosed. Human medicine is far from perfect.

Yeah. Would you like to review a graph over time of medical outcomes in the US based on this approach to healthcare (we see you minute clinic)? Hint: there's a reason we consistently rank dead last when compared to other industrialized nations.

> There aren't but so many households with children that fit inside the venn diagram of can afford med school, has the intellectual capacity and bloody-mindedness to actually finish med school, and is interested in going to med school.

That is the artificial scarcity he was referring to.

There is no reason to lump all medicine together in a MD degree /certification.

Why not have one certification for each common problem?

Why not? Symptom overlap springs to mind. Both anxiety and reflux can present 90% of the common symptoms of a heart attack. Get a reflux specialist when what you needed was a cardiologist and you're fucked. Labor costs also spring to mind. I can only imagine the look on some hospital administrator's face when the proposal to triple headcount comes across their desk.

Presumably you would structure such a medical system such that lower level practitioners would know enough to know when to escalate to an MD.

90% of medicine is stuff like people going to the doctor with the flu to get a sick note to stay home from work and instructions to rest and drink fluids. I don't think you need an MD for that.

We already have that structure to an extent. Much primary care for minor problems is delivered by a PA or NP. They are trained to escalate to an MD when necessary, although due to lack of training sometimes they miss things that an MD would have caught.

> due to lack of training sometimes they miss things that an MD would have caught.

It goes the other way as well. My aunt is an RN and she loves to tell the story about the time that a doctor was in such a rush one time she had to call his attention to the fact that his patient was dead.

Here's a fun question: would that be due to gross inattention on the doctor's part or gross overwork due to patient/provider ratios being skewed into bizarro world by cost-cutting measures on the part of the hospital?

Yes both of which could be helped by augmenting the healthcare system with AI to relieve practitioners from repetitive, menial tasks

You mean like how healthcare providers were relieved by advancing legions of PAs and NPs into general medicine? If that approach worked we would have seen improvements to healthcare metrics by now. We haven't.

You've literally described the current healthcare system in the US. Minute Clinic/NPs/PAs providing front line care. It doesn't appear to be working well based on how our country's healthcare system ranks against other industrialized nations.

I don't live in the US anymore, so it's hard for me to speak to the US healthcare system, but as an outsider it seems to me that the problems with the system stem from the incentive structure, and won't be fixed by any technology.

It seems to me the US healthcare system sits in this weird gap where it's not funded by private individuals, but it's also not publicly funded (excluding medicare/medicade/VA/tricare etc)

So it doesn't benefit from efficiencies of a single-payer system like the UK has, and it doesn't have to obey proper market forces either, since you have a bunch of for-profit entities in the middle, but the costs are obfuscated from the consumer unless you're unlucky enough not to have employer-funded health insurance.

So until you fix those core issues, I don't see how technological advancements are going to have much of an effect either positive or negative.

It's an orthogonal issue.

I don't disagree on any particular point except the notion that a medical AI represents an advancement. That claim would have to be studied extensively over decades.

Sending more students to medical school wouldn't help. Every year there are already students who graduate with an MD but are unable to practice because they don't get matched to a residency program. The first thing we need to do is get Congress to increase Medicare funding for graduate medical education programs (or find another way of funding those).

https://savegme.org/

< can afford med school

I mean arguably subsidizing med school would be a pretty sensible thing for a government to do if it wanted to increase the number of doctors. The other elements of the venn diagram can't be modified I agree, but affordability of med school doesn't have to be there

Cuba is hardly the example if their indentured servant doctors defect to Brazil.

Things must really really bad for someone to defect to Brazil

Exactly - it just shows how terrible the rest of the world is doing if Cuba of all places puts their medical system to shame, simply by training more doctors

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