[sebmellen]

Don't get me wrong, I think checklists are great, and I use them all the time myself as well. I'm sure they are fantastic for emergency medicine (as outlined in that book).

My discontent comes more from the robotic tenor that checklists can engender. And, moreover, that checklists don't seem to be very good for preventative medicine. If a doctor takes no care for the patient's holistic situation (soul and psyche included), the steps and procedures advised by checklists can be hard to follow through on.

Consider obesity, for example. It's obvious our medical system is doing a horrible job at preventing the root causes of obesity. Yes, physicians often recommend the AHA guidelines on diet and exercise, and can provide some intervention like bariatric surgery if absolutely necessary. But for the most part, obesity is an untreated epidemic.

I think this has a lot to do with the cold and robotic feeling of checklist-style medicine. A doctor who is willing to engage with their patient to provide cures and remedies at the "level of the soul" is invaluable. Because everyone's situation is so idiosyncratic and peculiar, finding and fixing the root cause of someone's chronic ailments is much harder than running through a checklist.

To take obesity: any number of things could be the root cause, but they're hard to discover through a checklist, just because the realm of possibility is so large. Interacting with the patient on a human level might be the only way to really understand and solve these sorts of wicked problems.

[phobosanomaly]

Maybe this just isn't the type of problem we should be looking towards a physician to address? They spend at least seven years in school learning to handle certain types of problems that can be addressed with certain types of solutions.

Perhaps this type of thing (lifestyle issues) is more in the wheelhouse of a dietician or a lifestyle coach who has a different type of training.

If you have sepsis, a dietician probably wouldn't be the safest bet. If you have lifestyle issues with diet and exercise, maybe a physician wouldn't be the safest bet.

[sebmellen]

You raise a good point, and I don’t disagree.

This article is interesting to me because it portrays a version of medicine which treats the patient as an integrated unit.

I think a physician who can interrogate issues more deeply in addition to treating symptoms is invaluable. Maybe someone’s weight is not just a function of their lifestyle or diet, but is also due to undiagnosed, low-level hypothyroidism, for example. I don’t know that a dietician can be expected to have the knowledge and expertise to treat issues like this. Who knows, with the rise of smart medicine we might be able to replicate such a care team through technology.

Also, unfortunately, quality of treatment is in large part a function of time. And in most countries, the level of medical attention one gets is very dependent on how much they can afford. I mean, even in places like Germany that have socialized medicine, the privately insured get better care, more time with their doctors, less time to schedule an appointment, etc.

Knowing that, this might be an insoluble problem until we automate the checklist-style medicine with chatbots and ML, and then reserve doctors for the tricky cases where DDx falters.

[phobosanomaly]

> care team

You used this phrase, and I like it.

I see this as the core of the problem, and I might just be re-phrasing what you are saying.

I risk veering off into politics here, and I don't really want to, but I do think that the profit-centered healthcare system in the United States creates this separation of people who should really be consolidated into a single team. There should be a team of people working together: Dieticians, physicians, etc.

But, in my experience, everything is siloed pretty bad. Physicians work for one company, the dieticians work for another. Everybody is divorced from one-another. Nobody is part of a consolidated team.

Ideally, you would have both a PCP, and a dietician that you could consult, both of whom are part of a team, share the same medical records system, talk to each other over lunch, etc.

Let the doctors do the doctor part. Let the dieticians do the dietician part. Let them both work together for the benefit of the patient. But, integrate them into the same system.