[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.