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Comment by mangamadaiyan | Hacker News Reader

Something to think about: perhaps the problem is with the duration of the appointment, and the difficulty of getting one in the first place? Elsewhere in the world, doctors can and do spend more than 12 minutes figuring out what's wrong with their patients. It's the healthcare system that's broken, and it _can_ be fixed without resorting to chatgpt. That it won't is the reality, though

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Can't really compete with LLMs on duration of attention - SOTA LLMs can ingest years of research on the spot, and spend however long you need on your case. No place on Earth has that many specialists available to people (much less affordable); you'd have to have 50% of the population become MDs, and that would still cover just one sub-specialty of one specialization.

GP sessions being around 20 minutes is pretty standard in North American and European countries. You can't have standard hour-long GP sessions, as it'd become impossible to make a timely appointment, no matter which system.

Can confirm having experienced both the USA and Dutch systems now. In both countries is my visit only about 20 minutes + another 15-30 sitting in the lobby because they doctor is always running behind schedule.

In theory, the Dutch system will take care of your more quickly for "real" emergencies as their "urgent care" (spoedpost) is heavily gate kept and you can only walk in to a hospital if you're in the middle of a crisis. I tried to walk into the ER once because I needed an inhaler and they told me to call the call the hotline for the urgent care... this was a couple of months after I moved.

That said, I much prefer paying €1800/year in premiums with a €450 deductible compared to the absolute shitshow that is healthcare in the USA. Now that I've figured out how to operate within the system, it's not so bad. But when you're in the middle of a health crisis, it can be very disorienting to try and figure out how it all works.

Ever wonder why famous people and celbrities always seem so healthy? They have unfettered access to well paid doctors. People with lots of money can spend literal days with GPs, constantly trying and testing things based on feedback loops with the same doctor at the same time.

When people are forced to have a consultation, diagnosis, and treatment in 20 minutes, things are rushed and missed. Amazing things happen when trained doctors can spend unlimited time with a patient.

You make a good point, but the key here is that there are a lot less people with that kind of money. The lower volume of patients is why that's possible. There are a lot more people in the middle class. So sessions have to be limited to ensure everyone has fair, equal and timely access to a doctor.

And of course, GPs typically diagnose more common problems, and refer patients to specialists when needed. Specialists have a lower volume of patients, and are able to take more time with each person individually.

Ever wonder why famous people and celebrities seem so unhealthy with mental health and substance abuse conditions? I'm all for improving affordable access to healthcare but most people wouldn't benefit from spending more time with doctors. It's a waste of scarce resources catering to the "worried well".

While some people are impacted by rare or complex medical conditions that isn't the norm. The health and wellness issues that most consumers have aren't even best handled by physicians in the first place. Instead they could get better results at lower cost from nutritionists, personal trainers, therapists, and social workers.

Having worked in rare disease diagnostics in a non-US country with good public healthcare, most patients had to fight their way to the correct speciality to get their diagnosis. Without the persistence of family/specific doctors, its not possible.

AI might provide the most scalable way to give this level of access/quality to a much wider range of people. If we integrate it well and provide easy ways for doctors to interface with this type of systems, it should be much more scalable, as verification should be faster.

> Elsewhere in the world, doctors can and do spend more than 12 minutes figuring out what's wrong with their patients.

Where? According to "International variations in primary care physician consultation time: a systematic review of 67 countries" Sweden is the only country on the planet with an average consultation length longer than the US.

"We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians."

I was referring to a couple of countries in Asia.

The American Medical Association has long lobbied to reduce the number of medical schools, reduce the number of positions for new doctors, and limit what tasks nurse practitioners can do [1].

[1] https://petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-p...

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