[thedufer]

> You could certainly offer general "advice", but this will never be a substitute for seeing a doctor.

No, and I don't think anyone is arguing that. But surely its better than doing nothing, which is the alternative for people who can't afford to visit a doctor?

[pak]

The increasing inequality in access to care is something that concerns me greatly because I see it all the time (I work for a free clinic that supports local residents without insurance) and I fear that it contributes to growing frustration and distrust of the American healthcare system. It is this very frustration that fuels desperate solutions like CoinMD, sketchily marketed natural remedies and insurance supplements, political bickering over healthcare.gov and the ACA, medical tourism, semi-legal internet stores for prescription drugs, ... it goes on and on.

As a commenter below put it so well, all of these responses are "a symptom of how we think about these kinds of problems being badly broken..."

Furthermore, I disagree that something is necessarily better than nothing. Wrong or incomplete advice can be much worse than no advice. Telling somebody it sounds like they have the common cold while missing out on the possibility of tuberculosis because the doc can't do a chest XRay, a PPD (skin test), run cultures, or listen to the lungs, is downright dangerous to that person and the people that they come in contact with. If a doctor then recommends the wrong drug to somebody based on incomplete information, the long term outcome can reduce or end a life.

This is why (1) medicine is already so heavily regulated (2) malpractice is such a prevalent concern among doctors and (3) it would only confuse healthcare consumers to endorse a second tier of medical care where the advice they receive might be "less right" than that of the first tier.

Here are some reasonable parallels to the dilemma you bring up:

- Plenty of people in the US can't afford to buy a car. Is it surely better to let them all buy cheaper used cars from foreign countries with crappy brakes, no seatbelts and no airbags?

- Plenty of people can't afford to buy meat as often as they'd like. Is it surely better to let them buy cheaper meat from unknown sources which hasn't been USDA approved?

[sithu]

The reality is that there is already, and will always be, wide variation in quality between providers and institutions. No one should expect perfection from an online service, or anywhere for that matter.

It is this kind of thinking, the fear of missing that 0.01% chance of something serious, the fear of colleagues low opinions, the fear of lawyers and persecution- that perpetuates the current culture of doing as much as possible regardless of probability, adverse events or complications of those actions. You can't cough in an ER these days without getting radiated. You can't be a little short of breath without getting a chest CT. Surely there is a line to draw.

I agree with your overall premise that there should be a minimum quality level and regulations on any service. But I am not convinced that an online doctor (or even Watson) would be any more of a 'quack' than seeing a nurse practitioner/PA in a tiny clinic in suburbia.