IM Doc has been giving regular reports from the front, particularly on the accelerating crapification of medical care in the US. You may recall his horrorshow experience with AI, as in having it forced on him for the transcription of patient notes and having the output not simply have many important errors but even complete fabrications.1 He has a new report below about how his hospital plans to roll out sweeping changes implemented via the widely-used billing/records system Epic, that amount to turning diagnosis and care decisions over to AI.
This development is not just due to AI and total surveillance enthusiasm. A big reason for medical systems to go this route is the long-standing primary care physician shortage, and now, IM Doc indicates, is extending into other specialities.
IM Doc recounted the history of how this came about but I am not able to find the relevant e-mail. So I am pretty confident in the general trajectory but am a bit fuzzy on the timing and the institutional forces behind it. Anyone who can provide details and any needed corrections please pipe up.
Medical schools cut the size of their classes. I believe this started in the 1980s but it might have been as late as the 1990s. This may have been the result of an expected demographic decline in the US; experts were surprised that the 2000 census showed a population increase since a fall had been widely anticipated. The rise was the result of immigration and higher birth rates among Hispanics. But my understanding is the bigger driver was the expectation (or plan?) that rather than growing its own doctors, the US would increasingly rely on foreign-educated physicians.
The latter, as IM Doc explained, did not work out. Doctors who came to the US to practice in large measure went back home. Even with the inducement of attractive pay levels, they were put off by the time, stress, and risk involved in fighting with insurance companies. Word of their negative experiences got out quickly in medical communities in their home countries, so far fewer medical students there considered, let alone tried, practicing in the US as an option.
The part that is opaque to me is that when this foreign sourcing of doctors idea fell way short of expectations, why US medical schools did not start increasing their class sizes.
A big second contributor to the primary care and now specialist shortages is the corporatization of medicine. Outside New York City and concierge practices, most doctors seem to find it necessary to work with a big medical system. That means as an employee as opposed to a solo/small firm practitioner. That in turn means that they have lost control over how they practice medicine. The loss of autonomy and dealing with a money-driven as opposed to care-driven bureaucracy has resulted in quite a few doctors who are able to retiring early. 2
Now to IM Doc’s alert on changes planned with the many medical systems using Epic:
I was informed this week that in about 6-18 months our software will be updated. Oracle is apparently investing billions in AI as is Epic. It will take all incoming lab results for each patient and craft a pages long note with details about their labs and if they are normal or abnormal and what they need to do etc. It will be able to go through all of their entire chart – the arrays we have in the system as well as every single page of scanned pdf – and the national vaccine database – and put a paragraph at the very beginning of each communication discussing each and every deficiency in their health maintenance. In each terminal station, audio visual equipment will be set up and we will supposedly never touch a keyboard again. It will immediately alert us if there are billing issues on anything we are ordering. It will analyze each incoming voicemail and computer message from patients and craft a complete response with the current standard of care for the issues via up to date. If information is requested or required from any outside source – staring in 6-12 months Epic and Cerner and VA systems will all be interlinked and the system will go and gather all documents needed. If it cannot find it – it will automatically send Release of information to any doc in the USA.
What could possibly go wrong?
I have been repeatedly told this is all for two reasons. The absolute dearth of primary care MDs all across the nation. The entire “hospitalist” movement that has now come out as the clear and total victor has decimated the general internist cohort – almost no one straight out of training is going into outpatient medicine in internal medicine. This is on top of mass retirements and transition to concierge care causing a horrific deficit in outpatient internal medicine. (FYI – I am personally seeing 20-25 people every day with an NP seeing another 12-15. I see 2-3 new people a day. Most new patients are very complicated and require much attention. My next new patient scheduled visits are in FEB or MAR – and a routine follow up is in about 6 weeks. I routinely have people calling on the phone that my nurses can tell are deathly ill and we put them in as overbooks all the time. On this past Friday – I had an acute renal failure with Creat of 5, a new onset rapid afib, and a massive leg infection – all being overbooked. This was on Friday alone. 2 of these patients had been seen in urgent cares by NPs and had been completely misdiagnosed and mishandled and had sat at home for days with festering issues that could have killed them.) The family practice doctors were simply not trained to deal with very ill patients like I and my internist colleagues do every day.
Furthermore, the system is now being backfilled with NPs [nurse practitioners] and PAs [physicians’ assistants] and these AI systems are being set up in large part because of the extreme knowledge and practice and experience deficits in these types of providers. The AI systems are thought by the MBA crowd to be a failsafe and a very reasonable aid for these NPs and PAs who were never trained to be physicians. There is no other way to put it.
What was once a way of having NPs see overflow under the direct supervision of general internist MDs has now turned into a situation where they are all over this country all on their own. On their own except for the AI systems telling them what to do and how to answer patient questions.
The system is literally imploding because of this. Routinely every day I have 1-2 patient disasters in my office because of bad care that was given days or weeks ago by people who are simply not trained. The specialists are now overwhelmed with cases of all kinds of things that in the past had been handled by general internists. There are multiple sub-specialties that were already in dire shape numbers wise – but now are just absolutely torpedoed. This is most acute in endocrinology, rheumatology and neurology. But ENT and urology are close behind.
And they think this AI is going to help? And when will the day come that I can just sit in my office and read and let the computers do everything? – This AI and the absolute crushing case load is not what I signed up for in any way shape or form. This is not the medicine of decades ago when I started. And all the while, with all this crushing load, I am on the phone every day with insurance companies begging for care for my patients. All the while, patients screaming at me and my staff because we did not get back to them in a timely manner, etc. I must say – I was trained to be strong and resilient – but this is about to break me. I look forward to retiring soon.
It is not clear to me what might happen with this scheme, which depends on recording of patients, if they refuse. Some states that require all party consent for recording.3 I suppose the bureaucrats could say, “No recording, no treatment” but would that be an arguable breach of contract? And what about the unlikely event of unionized action by patients, say >25% of patients in thees states refusing? Unlikely but one can hope. Too bad the class action bar has, by design, become so hollowed out.
_______
.1 From a September post:
IM Doc later provided a horrorshow example of the hash it makes of transcribing patient notes. In one case, it invented multiple serious illnesses the patient had never had and even a pharmacy that did not exist. Extracted from his message:
This is happening all the time with this technology. This example is rather stark but on almost 2/3 of the charts that are being processed, there are major errors, making stuff up, incorrect statements, etc. Unfortunately – as you can see it is wickedly able to render all this in correct “doctorese” – the code and syntax we all use and can instantly tell it was written by a truly trained MD.
This patient actually came into the office for an annual visit. There was nothing ground-shaking discussed….
This patient is on no meds that are not supplements. There are no prescriptions – and yet we supposedly discussed 90 day supplies from Brewer’s Pharmacy in Bainesville. There is no pharmacy nor town anywhere around here that even remotely sounds like either one. A quick google search revealed a Bainesville MD, far away from where we are – but as far as I can tell there is no Brewer’s Pharmacy there – the only one in the country I could find was in deep rural Alabama.
The last paragraph was literally the only part of this entire write up which was accurate…
This is what I do know however
1) Had I signed this and it went in his chart, if he ever applied to anything like life insurance – it would have been denied instantly. And they do not do seconds and excuses. When you are done, you are done. If you are on XXX and have YYY – you are getting no life insurance. THE END.
2) This is yet another “time saver” that is actually taking way more time for those of us who are conscientious. I spend all kinds of time digging through these looking for mistakes so as not to goon my patient and their future. However, I can guarantee you that as hard as I try – mistakes have gotten through. Furthermore, AI will very soon be used for insurance medical chart evaluation for actuarial purpose. Just think what will be generated.
3) These systems record the exact amount of time with the patients. I am hearing from various colleagues all over the place that this timing is being used to pressure docs to get them in and get them out even faster. That has not happened to me yet – but I am sure the bell will toll very soon.
4) When I started 35 years ago – my notes were done with me stepping out of the room and recording the visit in a hand held device run by duracells. It was then transcribed by secretary on paper with a Selectric. The actual hard copy tapes were completely magnetically scrubbed at the end of every day by the transcriptionist. Compare that energy usage to what this technology is obviously requiring. Furthermore, I have occasion to revisit old notes from that era all the time – I know instantly what happened on that patient visit in 1987. There is a paragraph or two and that is that. Compare to today – the note generated from the above will be 5-6 back and front pages literally full of gobbledy gook with important data scattered all over the place. Most of the time, I completely give up trying to use these newer documents for anything useful. And again just think about the actual energy used for this.
5) This recording is going somewhere and this has never been really explained to me. Who has access? How long do they have it? Is it being erased? Have the patients truly signed off on this?
6) This is the most concerning. I have no idea at all where the system got this entire story in her chart. Because of the fake “Frank Capra movie” style names in the document I have a very unsettled feeling this is from a movie, TV show, or novel. Is it possible that this AI is pulling things “it has heard” from these kinds of sources? I have asked. This is not the first time. The IT people cannot tell me this is not happening.
I have no idea why there is such a push to do this – this is insane. Why the leaders of my profession and our Congress are all behind this is a complete mystery.
2 As this extract shows, what was intended was better fleecing of patients. But the bean-counters overlooked that doctors have agency and might not embrace the MBAs’ priorities. One example via a 2013 post, Coming Corporate Control of Medicine Will Throw Patients Under the Bus:
One of the most effective scare techniques employed to preserve our grotesquely inefficient, overpriced health care system has been to invoke the red peril of “socialized medicine”….
In fact, business freedom here increasingly means the God-given right to exploit the vulnerability of the public. The example slouching into view is more corporate control over the practice of medicine. And based on the previews, it will make the horrors falsely attributed to socialized medicine look pale….
I strongly encourage you to read this post from Whole Health Chicago (hat tip Lambert) in full. It shows how the future of American medicine is to fire the ones who are unhealthy. No, I am not making that up. The writer, Dr. David Edelberg, describes a recent presentation by a large insurance company. They’ve apparently been hosting similar sessions with physicians in the Chicago area in large medical practices. Here are the key bits (emphasis original):
The speaker at these evenings is always a physician employed by the insurance company. His/her title is medical director (I begin to think there must be dozens and dozens on their payroll) and he always begins by reassuring the audience that he was in clinical practice himself so he understands something of what physicians–especially primary care physicians–are facing. I view this physician more as a “Judas steer,” the animal that leads an innocent but doomed herd of cattle through the slaughterhouse corridors to the killing floor.
• The health industry hopes that individual medical practices and small medical groups will ultimately disappear from the landscape by being financially absorbed into larger groups owned by hospital systems.
And why do the powers that be regard this as desirable? Although the article does not stress this point, doctors have an established revenue stream. So the acquirers buy them out and impose discipline on those artistic, freewheeling doctors. The “practice style,” which used to mean the independence that doctors once enjoyed, is now an Orwellianism and includes hewing to corporate guidelines as to how to operate.
And here’s what to expect:
Physicians are expected to spend a limited amount of time with each patient, and are encouraged to see as many patients as possible during a workday. The insurance companies, sometimes with the token cooperation of a few physician-employees, create vast books of patient-care guidelines to which they believe their physicians must be “accountable” (remember this word, it will crop up again). These guidelines might mean documented Pap smear and mammogram frequency, weight management and exercise, colonoscopies for patients over 50, and getting that evil LDL (bad cholesterol) below 99 by any means possible…
If the chart audit system discovers that a physician, for whatever reason, is an “outlier”–that she’s either not following the guidelines exactly or not getting the results anticipated for her patient population—she’ll be financially penalized. A quick example of what might occur: if your LDL is 115, you may be on the receiving end of a statin sales pitch from your doctor, not because bringing it down to 99 will improve your longevity, but because your refusal to do so will impact her financial bottom line.
Now of course, you might say, “Well, in fairness, medicine is too much of a cottage industry. Look at how many doctors give unnecessary annual EKGs to patients in low risk groups. How else are we going to get to evidence-based medicine?” The problem is that what we as patients will get isn’t driven by best outcomes, it’s driven by profits. Edelberg explains:
…the subtext of “standardized” always includes the unspoken “spend less money on the patient.” Thus, a doctor might be financially penalized for recommending nutritional counseling to lower cholesterol (“counseling is expensive”) instead of writing a generic statin drug (cheap). Or recommending psychotherapy (“therapy is very expensive”) instead of generic Prozac (cheaper than M&M’s). Or referring patients for massage, acupuncture, or even chiropractic (“expensive, expensive, expensive!”) instead of pushing an over-the-counter antiinflammatory (free to the insurance company, as it’s OTC).
And I shudder to think what becomes of patients who don’t hew to standard templates: the person who had a high body mass but not due to dangerous abdominal fat (which is what creates the health risk) who is pushed to take the latest, greatest diet drug. What about people who don’t buy into the religion of getting your LDL down to below 100 (one reader argued that while it may lower your risk of heart disease, it increases your all-factor death risk by reducing your ability to fight MRSA)? Will they face penalties if they fail to comply?
No, you just will find it nearly impossible to get a doctor to take you:
• Let me close with a best-as-I-recall quote from an insurance company medical director. “We can no longer afford to pay for health care under the PPO model. Our plan is to phase out all fee-for-service care during the next few years. We’ll pay you doctors a finite amount of money to take care of a defined population. We tell doctors, ‘Don’t spend much money and you can keep the difference. Period. Don’t follow guidelines, and you’ll be leaving behind some serious money on the table and we’ll just take it back.’”
In case you think I overstated the implications, Edelberg recapped the discussion that ensued:
One physician piped up…. “But what about the non-compliant patients who won’t take the meds, don’t eat well, don’t have mammograms, continue to smoke? And what about super-health-conscious patients who want their vitamin levels measured and want referrals to acupuncturists?”
Another physician answered wearily for the medical director (who didn’t disagree): “You’ve got to fire patients like that. Get the non-compliant and the super-demanding out of your system. They’ll drag your numbers down. Hit your personal bottom line.”
Hey you, patient. Yes, I mean YOU. Pink slip time! Canned! Take your medical records and don’t let the frosted glass door hit you in the…on the way out.
3 All party consent states where even notification might not suffice. California is so big that large scale patient action might throw a spanner. But it is also the most tech-forward state :-(:
California
Florida
Hawaii
Illinois
Maryland
Massachusetts
New Hampshire
Oregon
Pennsylvania
Thank you for covering the state of medical industry in the US, it goes from bad to worse, and more frightening by the day. Orwellianisms by the dozen.
I have been sarcastically joking that my new “primary care provider” will be an AI bot, not a real person. Right now I cannot even find a PA or NP for primary care, let alone an MD who will see patients in person (rather than remote video). My former PCP retired.
The US already has the worst health outcomes in the “developed world”, and sometimes even worse than some global south countries. The US is already the most expensive “health care” in the world. As I always say, we don’t have health care, just extortion. It is tantamount to organized crime running a health care racket. (but at least the old Cosa Nostra was honest about their extortion rackets)
Physician employed by the insurance company… that should raise alarm bells, but conflicts of interest have been normalized.
The health industry hopes that individual medical practices and small medical groups will ultimately disappear from the landscape by being financially absorbed into larger groups owned by hospital systems.
Wow. And another rural hospital closed recently in Nor CA, and others will follow. Good times ahead eh.
The article is jaw-dropping. The degeneration of HC into simple and predatory business practice is an horror show. Go die!
Familiarity with a local company’s business process sets off an alarm on reading that statement. Epic is bought and paid for by a practice, what it’s going to be doing is analyzing your charts to identify defensible billing opportunities.
An I being unreasonable in the assumption that an AI use-case which involves such a sizeable investment by a user entity is not here to help me, the purpose of AI is to maximize profit for the entity paying for it.
Sounds right to me. “Stop hiring humans” = maximize profits.
https://x.com/AISafetyMemes/status/1867231103246864432
Totally reasonable if the system is that of the United States.
Possibly no if the system is elsewhere. Interestingly, the Chinese medical system, with a rather different ethos, is also wholeheartedly embracing AI. Perhaps over there, the tool may actually be beneficial?
Where I practice is south enough of the border that I have to regularly tell patients’ relatives they shouldn’t solely rely on witch doctor treatments.
Hearing horror stories like these always reminds me to be grateful that we have next to no pressure to practice according to the whims of big pharma/insurance, here.
The flip side is we barely have accessible health insurance (though it is a generally more reasonable beast than the ones this post describes). Unfortunately, that means patients have to fork over $10-20,000 for a consultation alone (about the price of 10 jars of peanut butter here, something 80% of persons can’t afford to lose all at once). If they can’t, then getting a six month appointment at the same largely nurse-run clinics, seeing 60-80 people a day (roughly 15 persons per 8 hours per healthcare staff when I worked at one) is their only option.
What surprised me the most in this post though is that, here, we actually have a massive amount of doctors graduating yearly, to help fill the gaps. Granted, the reward from those vacancies can be as low as 2 jars of peanut butter a day (which isn’t terrible, don’t get me wrong) but definitely pays lower than, for eg., the starting salary of a pharmacist.
Largely as a result of that, a sizable chunk of our new graduates disappear, only to surface after settling in the US medical system, having whole fists in peanut butter factory jars. Not to mention that a sizable chunk of the ones who didn’t fly off can’t say that it was for lack of trying.
In any case, I apologize for the terrible analogies.
TL,DR: The grass always sounds greener when the cows come home, at least to a good portion of the herd.
There’s only so many of us though, so it seems it’s still not enough to dent the paucity you guys are feeling. So far we’re stil hanging on to photocopied, blank, note-taking sheets so I will continue to pray that the witchdoctors work their magic, keeping the LLM virus away until the hype dies out.
The 2013 referenced article is already here in the North American Deep South. Many of the predicted outcomes are now manifest. My medica has “strongly suggested” statins for several years now. The doorways to exam rooms at a clinic Phyllis went to recently had fifteen-minute resettable timers attached to the outer frames. The doctor in attendance was obviously rushing the “consultation.” This younger woman became obviously bored when Phyllis started asking questions about various symptoms. Not just that slacked jawed look, but fidgeting about and looking at papers in her hand, as if she was reading something while Phyllis spoke. All of the data collection involved in the visit was gathered by a physician’s assistant before the doctor appeared. The most common electronic communication we have with the medical apparat now are billing demands.
The move of the more competent doctors to concierge practices is happening here as well. To my surprise, but I should have predicted it, many of the concierge practices are now subdivisions of the major regional medical trusts. The only really good internist that Phyllis could think of had entered such a concierge practice. They said that they did accept Medicare, but only after we paid the two thousand dollar a year per patient “membership fee.” Thus is American Medicine regressing to the model in force during the Dickensian Robber Baron Eras. This is nothing less than good old Calvinist eugenics at work. When personal value is measured in financial resources available, everything becomes a commodity, especially Terran human life.
Now, with AI, a misnomer if I ever saw one, in the mix, there is a new and potentially transformative force added to the practice of medicine, institutionalized chaos. I would suggest that chaos, when applied to automated systems, has one primary effect, the amplification of entropy. As the name implies, entropy is the handmaiden to death. My inner cynic sees this and sighs pensively.
In this “new and improved” social system, paranoia is a survival characteristic. The evidence shows that “they” really are out to get us. No wonder that Saint Luigi is the fastest rising young saint of our modern neo-liberal “best of all possible worlds.”
Stay safe. Fight hard.
Oedipus Rx?
If only our medico-finance cultists would put out their AIs, then the fates would be appeased.
Nailed it.
“Outside New York City and concierge practices, most doctors seem to find it necessary to work with a big medical system. That means as an employee as opposed to a solo/small firm practitioner. That in turn means that they have lost control over how they practice medicine”.
sorry, must disagree. it must be acknowledged that the MBA crowd is restrained,if at all, only by the law. even the law will not restrain their behavior unless there is a credible threat of punishment. certainly they have no moral or ethical restraints.
doctors, in contrast, despite abandoning the traditional oath, have a professional obligation that compels them to make their patients the top priority, not the cash. doctors are in a position similar to soldiers who are given unlawful orders or corporate employees who are instructed to falsify business records. resistance is obligatory, obedience is complicity. my advice to doctors? refuse to obey. the suits need you much more than you need them. to do otherwise violates your duty to your patients.
The suits don’t mind unprofitable physicians quitting medicine. Lots of FPs have been literally forced to quit normal medicine to do things like give Botox injections instead. The lucky ones are able to transition to the retainer model. The suits want more NP’s and fewer MDs now.
Let’s say that during the course of your life you see 100 doctors.
20 of them will help you and a few of those will prevent something that could have become chronic or catastrophic.
60 will be of no help at all, but won’t damage you.
20 will do an intervention (pharmaceutical or procedural) that will make your life worse.
And that is a BEST case distribution.
Some of us have very few medical interactions.
Some of us have WAY more.
If AI can improve the middle 60 by 10 more correct dx and treatment recommendations, that would be great.
If it reduces the 20 interventions that permanently damage you to 15, that would be great.
Most physicians (all specialties and Primary care) have a VERY limited knowledge relative to what is known. And have biases to jump to the most common and known (by them) explanations.
AI has tremendous potential.
But its research and applied uses will be subject to the same shortcomings of profit corruption as everything else.
Sorry, I do not agree at all. I have NEVER NEVER NEVER had a doctor give me a medication that harmed me. The one time I had a procedure turn out badly was when I sought out and got a non-FDA approved treatment.
I am sorry you have had such bad luck.
Having said that, I am not in a network so I can choose my doctor. My first PCP was great. I had a very good PCP in Sydney. When I came back I did have to shop a bit to find a good PCP.
Even if your made-up numbers were feasible, the idea that AI, unburdened by concern, empathy and guilt, would be an improvement over physicians is ludicrous.
The preparation for AI in medicine was the destruction of primary care and the cookbook one-size-fits-all application of “evidence-based medicine.” Intuition and patient-specific recommendations will never be replicated by AI.
You know who has a ‘VERY limited knowledge’? Not you?
Get ready for ‘baloney’ (below knee) amputations and ‘enemy trillium plants’ (endometrial implants) from AI transcription, Doc.
Great article, but scary. Former MT (medical transcriptionist) here.
I always check the Ars Technica site to see what the tech fanbois are concerned about. Today’s headline: “Should an AI copy of you help decide if you live or die?”
Well, gosh. Not sure how to answer that one…
Thanks for that Alex, had a good laugh. Tragic humor available in spades…
According to Association of American Medical Colleges, 1 in 5 U.S. physicians was born and educated abroad. Who are they and what do they contribute? They claim:
I recall Stoller fingered ObamaCare as causing a wave of consolidation in the healthcare system, as insurers and hospitals fought to build market power to offset each other.
The AHA has a three pager fact sheet on consolidation and physician practices:
Examining the real factors driving physician practice acquisition (PDF)
What was found
and
I was curious and looked and NBER looked at whether the HMO craze led to an earlier wave of consolidation. They claim no for that.
Did the HMO Revolution Cause Hospital Consolidation? (2005)
Whatever the reason (Ten Things to Know About Consolidation in Health Care Provider Markets)
Whatever it is, care quality has been declining quite a while now while costs have increased disproportionately to other western countries. A doubly negative outcome. Healthcare in America is a vast wealth extraction machine.
“The part that is opaque to me is that when this foreign sourcing of doctors idea fell way short of expectations, why US medical schools did not start increasing their class sizes.”
Indeed, opaque to a lot of us. No doubt it would be “too costly,” as always. But sending $20 billion (or is it now $40 billion?) to the Chainsaw Madman in Argentina, will sail through with nary a whimper. And how about another $20 billion to Israel, so more children can be slaughtered. Somehow, looking after our own citizens is viewed as another example of the evils of government. It seems that the best we can hope for is that this is all a dream, or nightmare, from which we will soon awaken.
If the negatives of being a practicing doctor are becoming worse and worse, one should see fewer locals wanting to join the profession. Why would one then expect US medical schools to start increasing their class sizes?
In ten years, decent hospitals will have disappeared from America. The wealthy will brag about flying to Europe on their private jets for medical treatment.
The stage was set for this nightmare even before the 80s. I was in college with many would-be docs, dead center of the baby boom. Med school slots were purposely kept as low as possible and getting admission was very difficult, and top scores in higher math courses were a handy filter to thin the herd. The idea was we wanted to prevent a glut of boomers becoming MDs, presumably this would keep practitioner salaries nice and high and prevent doctor unemployment. This was about the same time people were being urged to stop the practice of annual checkups that just ‘wasted’ scarce doctor time.
This ludicrous strategic plan has severely backfired. Boomers needed an extra cohort of docs especially in later years, not a shortage.
I have no idea what the AMA’s actual role or policy was in this, but it doesn’t look good for them.
I had a great primary doctor (internist) for a few years but she retired early because of her frustration working with EPIC. How many other older, experienced primary doctors will be looking for an early exit due to the crapification of healthcare? Perhaps it won’t matter as more and more people won’t be able to afford healthcare.
The link in # 2 above to Dr.Edelberg’s Whole Health Chicago post does not work.
A MAJOR reason for the shortage of PCPs is that primary care MDs are being phased out to be replaced by (much cheaper) nurse practitioners by the 3rd party payers. Family docs in particular have been livid about this for 15 years now.
Im Doc had his poker face the entire time and now he’s cracking. We are all cooked.
I had put in an application for EMT and then get ghosted by the time they scheduled phone interviews.
It might be a blessing. Its a brutal job. I still want to train. I’m just out of ideas on what to do next.
I’d trust you with an injury right now, more than any AI. Real skills. Education is caught in the same vortices as medical, get training while it’s worth something. Best of luck!
After reading all these comments one might pray for the health, safety and security of “Saint Luigi, Patron Saint of Healthcare Access for All“.
Sad times.
Here is a link that astonishingly speaks of the confessions being made by an AI engine in manufacturing a paper. Even if one does not read the article, the post script will suffice!
file:///var/mobile/Library/SMS/Attachments/97/07/D2C3F25A-7640-4D79-B6CC-DF862D7A7926/Use%20of%20Artificial%20Intelligence%20in%20Scientific%20Writing%20The%20Danger%20of%20Trying%20Too%20Hard%20to%20Please.HDI.pdf
Working link for the paper (I’m assuming it’s this one, based on the postscript):
Use of Artificial Intelligence in Scientific Writing. The Danger of Trying Too Hard to Please
Ps – The irony of having a “Schrödinger’s Notice” (this website is both alive and dead) at the top of the page only adds to the AI-saves-you-money theme:
One more thing lead to the death of primary care, the rise of the urgent care. Routine and urgent visits fled the primary care office in the name of convenience. Continuity of care was thrown under the bus. This siphoned off bread and butter visits and increased the office work of following up on a patient as records were elsewhere and needed to be obtained if possible, not to mention having to manage an episode of treatment, for better or worse, in midstream. Let’s also note the increase in overhead that each bit of SAAS has added to the expense of keeping the lights on. Article and commentariat are saluted here.
It sounds like they actually want to kill quite a few of us off through neglect and malpractice – but the kind of “cover your ass” malpractice where “they” are held unaccountable for destroying what should be genuine medical care.
My dad was a devoted physician – a surgeon – and even thirty years ago was fighting a system headed in this direction. He always prioritised patient care (and after care) and fought for his patients – at great personal cost. Like every rebel, those in power didn’t like anyone questioning their version of progress and “best practices.” I’m glad he isn’t alive to see AI contradicting his experience, knowledge, instincts and ethics. He was never in it for the money or even the prestige of the profession, but he would have been crushed to have had to practice medicine in these current conditions.
Thank you IMDoc and NC. We would never get this kind of thought provoking writing anywhere else.
Never heard of concierge doctors until last summer when we traveled to Texas and visited friends and family. After you reach a certain age, health usually becomes a topic of discussion. Both families (in different cities) we visited had concierge doctors, and neither seemed to think there was anything unusual about it. These were not wealthy people, but not struggling either.
Now, it seems to be a “thing” in the Chicago area. We are sort of looking for a new pcp. Mine retired at the beginning of covid, and my wife isn’t very happy with hers. We asked her bone surgeon if he could recommend any one, and he said “all the good ones do concierge now”.
Maybe I’ll make it out of here before things get too bad, but i worry about the world my kids will have to navigate.
Our kids and the kids’ kids will have to change it. We’re too old now. Ironic, ain’t it, that the average life expectancy of even our richest folks is now lower than the general life expectancy in countries with actual universal medical care and decent public health practices. It really proves that when we all do better, we all do better… but the rich will be the last to learn it.
We already know that AI, when faced with a problem, often concludes the best way is to cheat. So when faced with health problems but incentivized for profit, I would imagine patient health is not the primary goal.
When trying to describe the horrors of the American Health System to colleagues in China, they never really believed that I was telling the truth as it is so Callous. Impersonal. Bureaucratic. Inhumane. and set to get worse.
“It is not clear to me what might happen with this scheme, which depends on recording of patients, if they refuse. Some states that require all party consent for recording.”
I just had a routine checkup a few weeks ago and I live in a two-party consent state. My PCP began the appointment by informing me that AI would be recording or supervising or who knows what, I had to refuse multiple times before she relented. So at least for now in these very early days, they’re allowing an opt-out, but I don’t anticipate that will hold up for terribly long.
The hospital system I use is an Epic/MyChart org, and I would hazard a guess that if the managers get their way (which obviously they will,) AI care will be coming through that channel whether or not we consent to it, since you can still feed all the labs and history to the slop machine and get it to spit something back out.
I remember, when I first got into the medical field, I heard the advice to get your own personal medical care outside of the system that employs you, so that none of your colleagues can take a peek at your medical record, especially maybe psychotherapy or psychiatry or something reproductive. That made sense. But nowadays, I see in Epic that the medical records from outside facilities are being merged in with my facility’s own records, and all can be viewed. That is great from the perspective of a clinician wanting to know the whole story of a person’s medical care. But it seems to me that medical-care workers have even less of a chance at privacy.
“Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship. To restrict the art of healing to one class of men, and deny equal privilege to others, will be to constitute the Bastille of medical science. All such laws are un-American and despotic, and have no place in a Republic. The Constitution of this Republic should make special privilege for medical freedom as well as religious freedom.”
Benjamin Rush 1746-1813
Signer of the Declaration of Independence
Physician to General George Washington
Thirty years ago I covered a new concept, physician practice management companies, for a sell side research firm. The idea was that having firm PCPs refer patients to in house specialists would make the physician practice management firms a lot of money. In fact, they ran into the same problem that hospital owned practices had up to that time: when a practice was no longer owned by the doctors, the doctors didn’t work as hard.
Somehow, the hospitals have figured out a way around this in the thirty years since, perhaps through experimenting with rewards and punishments. None of this seems like a recipe for happy doctors.