[haldujai]

“Bullshit” is almost always a post hoc diagnosis. In the last 2 years I’ve seen 3 20-somethings with a few days of flu symptoms having used a virtual walk in clinic service before coming to the ER (this is Canada where primary care is mostly non-existent) that had APL (highly treatable) and ended up dying within a few hours from DIC and intracranial hemorrhage (not treatable and how they ended up in my neck of the woods).

There’s still something to be said for the physical exam and eyeball test.

Obviously there’s a large element of survivorship bias at play here but I don’t believe the solution for poor primary care is to accept it will always be shitty and substitute a LLM.

[tayo42]

I didnt mean it as primary care sucks so switch in an llm becasue it sucks as much.

But as away to free up doctors from low effort stuff, churn through lines quicker and get people who actually need focused attention the time with a Dr they need.

Maybe your right and nothing is truly low effort

[haldujai]

You’re right that the vast majority of the time it’s low effort but it’s hard to identify those cases with high specificity up front.

The issue in medicine is there is huge class imbalance, 90%+ of encounters are essentially “negative” or normal. It’s easy for something/someone to look accurate or safe because of pretest probability. The hard part is getting above 90% and why we spend so much time in medicine training.

I hate the word but there’s something in medicine called “clinical gestalt” which is the overall impression one has from certain things in history and exam and doesn’t fit into a decision rule or algorithm, until we find a solution for that I’m not keen on adopting something that distances the patient from the physician.

We’ve tried that with mid levels at my hospital and it didn’t really work out.