[dax_]

I'm glad it worked out for your friend, but I can't help feeling extremely sad about this. What I mean is, why is the healthcare system so broken in the first place, that you need to take charge of your own diagnosis and treatment? AI in this case is a bandaid solution, improving something you shouldn't have to do all.

[pjc50]

I don't know if it was once different, but this seems to be a constant both in the US for-profit model and the UK not-for-profit one. After all, you are the person who knows you best, and has your own interests most at heart. So you need to advocate for yourself. Which can be extremely difficult in some situations, so you also need family who understand and are willing to help you.

[mandmandam]

> and the UK not-for-profit one.

The UK "not-for-profit" system has been systematically underfunded for decades [0], in the yacht-class' hopes that it can be privatized like the American system. Yes, it was once different.

Not that these things don't happen even in well funded systems, but the NHS isn't a great example of "not-for-profit" healthcare.

0 - https://www.ft.com/content/b593116d-f948-4757-b2fa-c74adadc8...

[arionhardison]

Im rebuilding both from the ground up for fun:

- no funding

- no ads

- etc... just an idea I had while locked up in SF county.

https://us.medicare.dev

https://nhs.dev

Its nothing that will fix healthcare or anything like that, but it's been fun learning about things like "Digital Twins", "FHIR" etc... and it actually works; meaning the Agent can help you achieve a desired health outcome (sometimes)

[pizzathyme]

Many people think that in the futuristic year 2025, the "system" of doctors and professionals and tests will be monitoring your body and health, keeping you healthy. It is nothing of the sort and possibly never will be.

We can improve healthcare systems, sure. But everyone needs to take personal responsibility for their own health. What is daily life-altering pain for a patient is just a JIRA ticket to a health care provider. No one is more incentivized than you to dig in and fix it.

[lemonberry]

"everyone needs to take personal responsibility for their own health"

Absolutely. I'm a caregiver to my father. He has many health issues. Some caused and/or exacerbated by poor lifestyle choices - smoking, poor diet, too much alcohol, etc. Granted his generation knew less than we do about these things today.

There's a popular myth today that doctor's just want to push pharmaceuticals on patients. Maybe this is true in some places or with some doctors, but I've been taking my father to doctor appointments for the better part of a decade. Every one of his doctors - primary care provider, nephrologist, cardiologist, and pulmonologist - emphasized the importance of eating better, quitting smoking, exercising, and drinking more water. It always landed on deaf ears.

After living one way for most of your life is very difficult. We also found out a few years ago that he brain damage from surgery to fix a leaking aneurysm in 1985. Both of these complicated his ability to make changes. Regardless, the doctors pushed pharmaceuticals as a last option.

I'm 50 now. I row almost every day, I workout with kettlebells, have a regular mobility routine, and walk outside often. My diet is pretty clean, I don't smoke anything, and do not drink. I could die tomorrow from any number of things, but it won't be because I didn't try to take care of my health.

All of that aside, I think it's important to not blame people for their health situation. It's easy to critique from the outside, but who knows what choices we'd make if we'd walked in their shoes and lived their life.

[voisin]

> why is the healthcare system so broken in the first place, that you need to take charge of your own diagnosis and treatment

Doctors have many patients and limited time. Patients have one concern (themselves) with many more available hours to think about that one case.

It is no different than lawyers, teachers, etc etc. you have to advocate for yourself because you have much more time to dedicate to your situation than they do. Think of professionals as conduits of expertise that you can rely on to a degree but are best used to augment your passion for your situation.

In other words, I don’t think this particular issue warrants calling the healthcare system broken (though there are many other reasons to do so).

[nucleardog]

The doctor's doing the equivalent of trying to diagnose and fix a bug where they're only given 10 minutes once a week to try and solve it (losing all their context in between) and can't directly check anything but the most superficial things. If they need more information, they have to refer the patient to somebody that can run check for one specific kind of issue in one specific place and will then provide a two sentence report back. Then they'll get another 10 minutes with that extra data point to try and come up with next steps. They can refer them to a specialist, and that person is going to only look at one small part of the context to try and come up with recommendations.

In this sort of setup it's _very_ easy to miss relevant information. Having somebody involved who is focused on the big picture and can surface relevant information and advocate based on it is really essential to getting the best outcomes.

And generally the only person involved to take on that role is... the patient. I don't think that makes the entire system broken, but it could definitely be improved.

The best solution I can think of is essentially to have someone with a medical background designated to take that role on your behalf. And apparently that's already a thing--a "case manager". (Though apparently in the US that term's been overloaded to mean "the person that works with your insurance company to do the wallet biopsy".) Though I haven't ever really run across anyone taking that role, and I'm certain wherever they are they're completely overworked and can't fulfill the role as effectively as we like.

I'm very much _not_ on the AI bandwagon and am really looking forward to all of this falling on its face so I can stop hearing about it and we can go back to finding solutions to problems instead of problems for solutions. However this does seem like one place where a LLM and adjacent developments could provide some benefit. A large part of advocating for yourself effectively is just knowing the right questions to ask and what information might be important to surface in the current situation. And all of this is being handed off to human experts, not being directly relied on or acted on by a laymen.

As a brief example: My wife developed a heart arrhythmia. The ER doctor was following the standard framework for dealing with this and was prescribing beta blockers and a blood thinner. While the ER doctor had a _lot_ of information in front of her face, what she didn't have was time to sit and dig through my wife's entire medical history. If she did, she would have found that the out-of-wack blood pressure readings she'd written off as "your heart's kinda fucked right now" were actually an on-going and previously diagnosed issue of low blood pressure.

In that moment I didn't need to understand everything or make any concrete recommendations, just make the connection "slower heart = less output?" + "already low output" = "problem?". Surfacing that information and asking the doctor whether we should be concerned didn't set the direction of her treatment, but it did change it. The doctor went to consult with a cardiologist before prescribing anything and came back with a different treatment plan.

It definitely seems like an area playing to an LLMs strengths (digesting a bunch of information and trying to relate it to the situation at hand) while avoiding the pitfalls. Ultimately everything is still in the doctor's hands, and the information it's giving is purely _additive_ and already being treated with suspicion. Even if it misses or hallucinates something we're not much worse off than we were without it.

[Groxx]

Even when everything is going well, ^this is still a reason for The Medical System to miss a lot of things.

It's full of people, and things can happen in an unavoidable rush with no prior context. It's not possible to have enough context and act quickly enough in many cases, regardless of intentions or money. So people do what people do: learn from past experiences where the effort/success line lies, and sometimes over-fit for the next case.

Personal attention is needed to adjust that line. Better tooling for personal attention does a lot to make that more possible. I do wish legitimate attention were easier to distinguish from hypochondria, and more doctors were willing to listen, but it's full of people - any pattern you can come up with will be wrong in both directions.

I dunno if LLMs are the current best option or not (they do have a huge benefit of understanding vague phrasing though), but I am definitely in favor of more tools. It has almost always led to better outcomes.

[cadamsdotcom]

This is in Australia.

Worldwide, doctors aren’t given the time to work through the issues properly.

[mapt]

We have a rather high overhead ratio in play. 1.1 million Physicians made a median salary of $239,200 in 2023, or around $263M.

U.S. health care spending grew 7.5 percent in 2023, reaching $4.9 trillion or $14,570 per person.

That's about 5% of healthcare spending going towards actual physicians. The logistic exigencies of dealing with insurance companies, seeking permission to treat, justifying, arguing, interacting with medical secretaries, is something on the order of an additional half of the typical doctor's time. They are strongly disincentivized from seeking out low probability explanations using tests which they need to seek permission to apply. They barely have the time to re-familiarize themselves with your chart.

We locked down the supply of physicians in 1997 via Congressional limits in how we fund medical residency slots. We further restrict physician time with problematically low rate setting in Medicare/Medicaid compensation, relative to market rates.

Everybody dies eventually. Everybody has healthcare needs.

A very large fraction of us will at some point suffer from some uncommon or rare condition, something that a physician doesn't see every day - a "zebra" rather than a "horse". There are enough of these conditions - tens of thousands now recognized - that the very low odds of having any particular problem adds up to high odds of suffering from at least one.

To recognize some of them, the doctor would need to synthesize an idea from half a dozen disparate pieces of information, two of which you've mentioned casually in a visit three years ago, two of which you've never told anyone, and one of which is in your chart, and one of which you mentioned casually to a specialist but who did not think it relevant enough to note down... And then they would need to do a differential against hundreds of megabytes of medical research. In five minutes allocated to your visit.

Doctors are trained with a certain degree of professional image to maintain, a sort of 'Wizard' status that must be kept to a tone of mysterious respect. Nobody wants uncertainty from a doctor, despite the fact that all of statistical reasoning and diagnostics is uncertainty, quantified. If they lose this image, it is felt, people start injecting bleach or suing them for malpractice or killing themselves over an innocuous granuloma that their doctor assures them is nothing. That is not a healthy environment to drill-down low evidence of probability outcomes.

Particularly if every test and treatment impoverishes you, and the impact of that poverty on your stress level and lifespan is dramatic.

While tripling the number of doctors would certainly help, AI and a great deal more population-scale diagnostics is just better suited to some of these limitations.

Is that what it will be used for? No. Initially, at least, it will actually be used to make everything worse, to automatically deny treatments, to argue with a doctor with the persistence of a chatbot.

And that's just for the stuff that's been medically recognized. Medical science has put comparatively little effort into researching ailments that cause chronic, non-contagious, non-fatal problems in your life, and less into resolving them. There is no agreement on how dandruff works, lower back pain was dismissed as psychogenic for decades, most headaches are undiagnosable, skincare is witchcraft.

A good doctor who sees you for a brief period every year is staring at your chart and furiously googling some of the things listed there to re-familiarize themselves for five or ten minutes before the visit, just to maintain an image of professional competency by not forgetting the words. Actually applying recent research... how?

[sarchertech]

You're right about most of that

>We locked down the supply of physicians in 1997 via Congressional limits

This part though is wrong. We temporarily limited the number of resident slots, but total number of residents has been growing for a while now. Not as fast as many people would like obviously.

Just looking at the numbers for recent years the total number of residents jumped from 134k in 2019 to almost 163k in 2024.

If you look at total number of physicians per 10k people, that number has been growing a steady rate since the 60s.

There are now 2x as many physicians per capita as there were in 1975.

https://www.cdc.gov/nchs/data/hus/2020-2021/DocSt.pdf