AI in Medicine

[cwbullet]

Securing an appointment to see a doctor in the United States is exacerbated by soaring health care demand and fewer doctors. Many specializations are increasingly affected by this trend, but primary care and emergency medicine are among the hardest hit.

The average wait time to see a doctor has increased since 2017 and continued to rise after the demand spike brought on by COVID-19. A survey conducted by AMN Healthcare in 2022 of 15 large metro markets revealed the average time to see a physician was 26 days—an 8 percent increase from 2017 and a 24 percent spike since 2004. Heck, my wait to see a neurologist was 6 months.

I did a survey of providers in the local area. The average age is 47 and 75% plan to retire or change professions in the next 10 years. The schools cannot make them quick enough.

How do we fix this system and encourage young folks to go into medicine or do we just switch to AI as our medical workforce? How you accept an AI clinician?

 

[blackwing94]

Hell yes!!!! My daughter is a primary care physician. I would trust a (really good) AI over my daughter any time. Hell, she's just a kid. (and always will be )

In my vision of a future, talking to an AI doc that has access to a world of information, would be the same as talking to several specialists, all from different fields, all at the same time. No going to an ENT only to get referred to a neurologist only to get referred to..... you get the idea.

And just think of the wonderful bed side manner an AI doc would have. It would not get tired, suffer allergies, call in sick so you have to reschedule.

Plus you can pester it with questions about the research behind it's decisions.

This AI is sponsored by Bayer. Take two aspirin and come back tomorrow.

 

[darrenf]

It's a double edge sword right? On one hand, AI could be the best method for diagnosing and creating a treatment plan, having all medical knowledge available at all times, but on the other hand, if it's controlled by the wrong people, it could eliminate our ability to make well informed decisions. It's coming though, either way.

 

[Antares JS]

I find the idea of AI practicing medicine dubious at best, ever since I heard of the lawyer who tried to use AI to write a brief, and the AI made up precedents from cases that didn't exist. The lawyer ended up in huge trouble over it.

We need to understand why so many doctors are leaving the profession and why so many don't encourage kids to go into medicine, and mitigate those root causes. I have a feeling it has to do with so much of their time being taken up dealing with insurance companies and bureaucrats.

This applies to a few other issues I can think of as well. Too many people want to slap a band-aid on problems rather than investigate root causes and actually solve problems.

 

[NTP2]

I find the idea of AI practicing medicine dubious at best, ever since I heard of the lawyer who tried to use AI to write a brief, and the AI made up precedents from cases that didn't exist. The lawyer ended up in huge trouble over it.

We need to understand why so many doctors are leaving the profession and why so many don't encourage kids to go into medicine, and mitigate those root causes. I have a feeling it has to do with so much of their time being taken up dealing with insurance companies and bureaucrats.

This applies to a few other issues I can think of as well. Too many people want to slap a band-aid on problems rather than investigate root causes and actually solve problems.

This is my view as well, I encourage @cwbullet to go and ask a large language model (eg GPT) a medical question and see how long it takes before it’s completely wrong.

why so many don't encourage kids to go into medicine,

I can answer that one, it’s because it’s extremely hard to get into medicine, a bunch of college and med school is very expensive and it takes a lot of smarts, and you’re rewarded with a job that is damaging to your mental health. The sort of people who are smart enough to be doctors are smart enough to get hired by Silicon Valley and make more money with less college and less health impacts.

 

[cwbullet]

I can answer that one, it’s because it’s extremely hard to get into medicine, a bunch of college and med school is very expensive and it takes a lot of smarts, and you’re rewarded with a job that is damaging to your mental health.

It is gettign easier and easier to get into medicine. When I applied, 99% of applicants had ateast a bachelors if not a masters or PHD. I have two bachelors and I was working toward a third when I applied to grad school and medical school at the same time. Now, some will accept students with only 2 years of udnergrad.

Medical school is hard work but not difficult. It takes a strong work ethic.

 

[Antares JS]

I can answer that one, it’s because it’s extremely hard to get into medicine, a bunch of college and med school is very expensive and it takes a lot of smarts, and you’re rewarded with a job that is damaging to your mental health. The sort of people who are smart enough to be doctors are smart enough to get hired by Silicon Valley and make more money with less college and less health impacts.

It is gettign easier and easier to get into medicine. When I applied, 99% of applicants had ateast a bachelors if not a masters or PHD. I have two bachelors and I was working toward a third when I applied to grad school and medical school at the same time. Now, some will accept students with only 2 years of udnergrad.

Medical school is hard work but not difficult. It takes a strong work ethic.

It sounds like it's the same problem as teachers - even if you have the ability to be a teacher, there are other options that are far more lucrative and less mentally taxing, so why be a teacher?

 

[astronwolf]

How do we fix this system and encourage young folks to go into medicine or do we just switch to AI as our medical workforce? How you accept an AI clinician?

We've all seen AI art. There are defects and strange features that are easy for people to identify, but difficult for an AI. That's your AI doctor.

 

[darrenf]

Everyone pointing out AI's deficiencies right now seem to have no idea how quickly it is advancing, and it already has a large number of people unable to tell the difference between AI generated video and real life.

Here is a good little primer on where we were a year ago versus today, and the improvements are only going to accelerate.

 

[dhbarr]

I don't need my AI doctor to be better than every human doctor. I only need it to be better than the average human doctor.

Fundamentally I view machine learning as an augment for skilled humans, relieving them from minutiae and allowing them to focus on their specialty.

Expressed differently: use the machines for things they're good at.

 

[SDramstad]

Having a doctor that can be hacked or manipulated by pharmacology companies to prescribe their products is something I wont be comfortable with

 

[darrenf]

Having a doctor that can be hacked or manipulated by pharmacology companies to prescribe their products is something I wont be comfortable with

That is already an issue with human doctors though, has been for years. We have no way to know what influences our doctors now. Like I said, a double edged sword for sure. We live in interesting times for sure. The Chinese curse is upon us.

 

[NTP2]

Everyone pointing out AI's deficiencies right now seem to have no idea how quickly it is advancing, and it already has a large number of people unable to tell the difference between AI generated video and real life.

Here is a good little primer on where we were a year ago versus today, and the improvements are only going to accelerate.

Ohhh I know, I know a guy who was doing AI before it was cool, but it has its limits namely that it doesn’t know what it doesn’t know, it always thinks it is 100% correct even though it’s obviously not true. Go ask it a couple questions about something you’re knowledgeable about and see what happens.

 

[NateB]

Expressed differently: use the machines for things they're good at.

AI tools used by physicians and other providers is great. Machines can find patterns with labs and other test results and compare them to confirmed diagnoses to help guide a provider. I don't think AI can ever replace the compassion and emotional support which is also essential to helping patients.

 

[darrenf]

Ohhh I know, I know a guy who was doing AI before it was cool, but it has its limits namely that it doesn’t know what it doesn’t know, it always thinks it is 100% correct even though it’s obviously not true. Go ask it a couple questions about something you’re knowledgeable about and see what happens.

Again, that is not unique to AI. We all know doctors who think they are infallible. Who knows, maybe AI will be a way for us to reign that in in a way we were never able to with people. Time will tell, I have no doubt we are going to see the best and the worst very soon.

 

[NateB]

How do we fix this system and encourage young folks to go into medicine

Tough question, and there are many layers of problems with a health care system which makes in unappealing.

I've seen a transition where the focus on care has shifted to quantity rather than quality. Hospital administrators want rooms turned over as quickly as possible. Even our department gets comments from a VP that about if we move 100 patients the day before, lets make it 110 today. This might reduce wait times in the lobby, but it makes it easier to miss important things when you are rushed treating someone.

What do we do about low reimbursement rates preventing the funds to keep rural hospitals open, let alone pay staff and repair or replace equipment? Reimbursement rates being tied to readmissions and satisfaction score is making things even worse. Why enter a field or move to an area where you worry about the doors getting locked or always working with aging or broken equipment?

NTP2 mentioned the mental health. I think people can either handle it or not. Everyone deals with tragedy and grief differently and it is a hard skill to teach. I don't know how medical schools are, but EMS classes do okay preparing people to handle grief and trauma, the schools don't do as well talking about other stresses of the job not directly related to patient care.

 

[prfesser]

Professions such as medicine, dentistry, pharmacy, and teaching have several commonalities. They require a commitment to the profession itself, they require a lot of education, they put the individual in a hole financially. And today they are increasingly stressful due to restraints placed on them by people who have no earthly business making those restraints.

[Imagine if auto repairs were in a situation similar to medicine. $300 for an oil change, $40k for a transmission rebuild. People get auto repair insurance that brings costs down to today's levels, but no policy covers everything, deductibles for this and that, and there are weird loopholes. Mechanic diagnoses a problem but has to submit it to insurance personnel who know nothing whatever about automobiles, etc.​

​

Pharmacists and pharmacy techs are leaving the profession in droves because of the stress. The insurance is equally incomprehensible to pharmacists, techs, patients, and the insurance reps. By design IMHO.]​

To get more students to enter such professions and to keep those who are already there, start by removiong the stress produced by unnecessary interference in the profession.

 

[NateB]

To get more students to enter such professions and to keep those who are already there, start by removiong the stress produced by unnecessary interference in the profession.

Very well said. I often tell people I'd have the best job ever if they just let me fly around and take care of people. It's everything else that's the problem.

 

[NTP2]

It is gettign easier and easier to get into medicine. When I applied, 99% of applicants had ateast a bachelors if not a masters or PHD. I have two bachelors and I was working toward a third when I applied to grad school and medical school at the same time. Now, some will accept students with only 2 years of udnergrad.

Medical school is hard work but not difficult. It takes a strong work ethic.

I don’t know that!! Maybe they would get more applicants if they advertised that.

NTP2 mentioned the mental health. I think people can either handle it or not. Everyone deals with tragedy and grief differently and it is a hard skill to teach. I don't know how medical schools are, but EMS classes do okay preparing people to handle grief and trauma, the schools don't do as well talking about other stresses of the job not directly related to patient care.

Honestly I was more thinking about being waked up in the middle of the night, if I was a doctor I’d hate that the most (I felt so bad for the poor doctors who had to be dragged out of bed the one time I had a emergency surgery) but your correct it probably takes a toll working in trauma like you do.

 

[NateB]

Honestly I was more thinking about being waked up in the middle of the night, if I was a doctor I’d hate that the most (I felt so bad for the poor doctors who had to be dragged out of bed the one time I had a emergency surgery) but your correct it probably takes a toll working in trauma like you do.

I used to work 24 hour shifts when I was on a 911 ambulance at a firehouse. You never sleep well waiting for calls. It is hard going from sleep or boredom to periods of high stress in seconds or minutes.

Our hospital is generally on 12 hour shifts. Some specialists and certain surgical teams are on call after hours and either sleep in rooms at the hospital or have contracts that they have to live within certain distance away. Some smaller hospitals have to keep people on call after hours. There are some in our area where the ED doctor might be on a 24 hour or longer shift and might be the only doctor in the building after normal hours.

 

[ksaves2]

It is gettign easier and easier to get into medicine. When I applied, 99% of applicants had ateast a bachelors if not a masters or PHD. I have two bachelors and I was working toward a third when I applied to grad school and medical school at the same time. Now, some will accept students with only 2 years of udnergrad.

Medical school is hard work but not difficult. It takes a strong work ethic.

Huh? When I applied in '77 it was an absolute "witch" to get into any med school. Got in and had to study my arse off.
Don't know how hard it is to get into now. I was in a state school and the tuition was cheaper than the private Catholic
college I attended for undergrad. It was the time of capitation grants. In fact I had money saved up to cover two of the years.
I started working in a business my father owned at age 10 so had a nest egg. Child labor laws didn't apply to a family owned
business.

 

[prfesser]

A step that physicians might take is to have a dedicated AI server/web page/whatever, constrained to consult only peer-reviewed medical literature, physicians' diagnoses, relevant peer-reviewed science journals, and other reality-based material. A team of MDs, dentists, and pharmacists elected by their peers would oversee selection of input (term limits on team members to avoid all manner of problems).

[Letting my brain freewheel here] Online patients could input their symptoms. AI's diagnosis is not available to the patient. MD or other medical professional looks at AI's diagnosis and either concurs or looks for more input. An alert system for other MDs' input if AI's diagnosis is unusual or even controversial.

There would be many details to consider, obviously, and it would be imperfect. But there has to be a way to screen out most of the trash and anecdotal material, and base diagnoses and treatment on the best possible objective information, while reducing the load on the medical profession and its ancillaries.

 

[boatgeek]

I would be very uncomfortable with an AI doctor. I am OK with a doctor assisted by an AI trained to detect certain things or a doctor using AI to process lists of symptoms. As an example of the latter, a friend does AI work, and he made a system that looks at EKGs and detects anomalies. His system was far better at catching stuff than GPs, about on par with top cardiologists. That sounds great to me. Along the lines of what @prfesser said, it was trained by looking at a lot of EKGs and how top cardiologists read them, so it was trained by the best.

On the other hand, I have high triglycerides. My GP flags them every year since they're over 150. But then she says that considering the rest of my health and lifestyle she's not really worried unless they're over 500. I think that kind of nuance is hard to get with an AI with any sort of confidence.

 

[prfesser]

Huh? When I applied in '77 it was an absolute "witch" to get into any med school. Got in and had to study my arse off.
Don't know how hard it is to get into now. I was in a state school and the tuition was cheaper than the private Catholic
college I attended for undergrad. It was the time of capitation grants. In fact I had money saved up to cover two of the years.
I started working in a business my father owned at age 10 so had a nest egg. Child labor laws didn't apply to a family owned
business.

My experience over the last decade or so of teaching was that med school was somewhat harder to get into than dental school, and vet school was much more difficult than either. A respectable fraction of the incoming pre-med students taking chemistry---perhaps a fifth or so---got into med school. Conservatively, not more than five percent of the pre-vets made it to vet school; three or four out of 120 chem students wasn't unusual. And yes, you still work your behind off, from what students told me.

 

[NTP2]

I would be very uncomfortable with an AI doctor. I am OK with a doctor assisted by an AI trained to detect certain things or a doctor using AI to process lists of symptoms. As an example of the latter, a friend does AI work, and he made a system that looks at EKGs and detects anomalies. His system was far better at catching stuff than GPs, about on par with top cardiologists. That sounds great to me. Along the lines of what @prfesser said, it was trained by looking at a lot of EKGs and how top cardiologists read them, so it was trained by the best.

That guy I know also did that sort of work in grad school, it found cancer by looking at MRIs it wasn’t very accurate since it was looking for colon cancer which is hard even for a human expert but it got better than 50/50, impressive for 1980s.

 

[ksaves2]

Tough question, and there are many layers of problems with a health care system which makes in unappealing.

I've seen a transition where the focus on care has shifted to quantity rather than quality. Hospital administrators want rooms turned over as quickly as possible. Even our department gets comments from a VP that about if we move 100 patients the day before, lets make it 110 today. This might reduce wait times in the lobby, but it makes it easier to miss important things when you are rushed treating someone.

What do we do about low reimbursement rates preventing the funds to keep rural hospitals open, let alone pay staff and repair or replace equipment? Reimbursement rates being tied to readmissions and satisfaction score is making things even worse. Why enter a field or move to an area where you worry about the doors getting locked or always working with aging or broken equipment?

NTP2 mentioned the mental health. I think people can either handle it or not. Everyone deals with tragedy and grief differently and it is a hard skill to teach. I don't know how medical schools are, but EMS classes do okay preparing people to handle grief and trauma, the schools don't do as well talking about other stresses of the job not directly related to patient care.

Get rid of computers period! Major reason I retired at age 64. Turning M.D.'s into keypunch artists is the biggest waste of their time! I dictated my paper medical records based on my hand written crib notes so anyone could read my paper medical records clearly. I could page through my records and see clearly what I did to a patient in the past. Saved me a lot of time. Sure beat "scroll click, scroll click, scroll click" chit.
If I was filling in for another M.D. that didn't dictate and their hand writing was illegible, it was a "beech" to figure out what the heck the doc was doing.
Asked the head hospital administrator if he minded if I dictated all my hospital notes in the hospital system when I went to work at the local clinic I stayed at for my entire career. H&P's and discharge summaries were expected to be dictated. He said it was fine to do all my notes dictated. They would appear on the paper charts the next day and I'd sign off on them before "everything" became computerized.
When computers came online, records now occupy most of a primary care M.D.'s time and make primary care so dissatisfying. Was so glad I was able to
retire and get out when I did. I have no regrets. The student docs coming out now are too stupid to realize how good it was years ago.
Computers for lab work I have a different opinion of. Was happy with that as I could access lab work hot off the press and didn't have to wait for the "hard copy".
Oh, I had many a phone call from an itinerant E.R. doc for a patient admit of mine and received many compliments from the doc as they were reviewing the
patients' past medical records and they could "READ" everything I did in the past in the old records.
I DO NOT recommend to any young person to go into medicine anymore. It's a waste of time. It was so much more efficient in the days of old with dictated paper records. It's nearly impossible to do office work, hospital work and take call in primary care anymore due to the current system.
If one is in an "office only" practice with income based on production only, it's impossible to produce enough if one has a bunch of elderly complex patients to see. They take more time and hence production is down. Plus if one isn't involved with the care of a patient in the hospital, they are clueless once they're
discharged. Can follow with the specialists if they're needed and be familiar with what is going on with the patient before discharge.
Nowadays in the next big city over, primary care docs aren't allowed to see patients in the hospital anymore. That has been going on for
years now. There are "hospitalists" who never see the patient outside of the hospital and are "clueless" as to what is going on. Continuity of care
has "gone to hell".
I recommend to go into another field. O.k. some specialties are better than others but that would take another long post to go into. Kurt (used to M.D. for a living now retired)

 

[ksaves2]

My experience over the last decade or so of teaching was that med school was somewhat harder to get into than dental school, and vet school was much more difficult than either. A respectable fraction of the incoming pre-med students taking chemistry---perhaps a fifth or so---got into med school. Conservatively, not more than five percent of the pre-vets made it to vet school; three or four out of 120 chem students wasn't unusual. And yes, you still work your behind off, from what students told me.

Comment here: There are more med schools than vet schools. There was only one vet school in Illinois at the time. At my med school U of Ill. there were many classmates who turned to and were accepted into medicine as they couldn't get into vet school!
It was funny when I lamented with one of my classmates on his situation he replied, "That's o.k. I'll just ask the patients to moo, meow or bark for me!"
I got a good laugh out of that reply. I think the vet schools get so many "straight A" students who worked with animals, they can just draw their names
out of a hat and have a good class.
Malpractice is probably cheaper for vets so that lowers their overhead. Might be that they don't even carry it unless they practice on "high dollar" animals.
Kurt

 

[Peartree]

At the very least, AI should be trained to navigate the paperwork and red tape of filing the insurance forms. And something must be done on the other end as well. In our experience, often, even when the providers get it right, and file the insurance claims exactly as instructed, the insurance company screws it up, or has made unannounced changes to the process, or announces changes to a process that didn't actually change, all resulting in claims that are declined/refused. How much extra do we pay, and how much time is wasted on the part of clinicians and staff, because the insurance companies have F'd the whole process.

As for doctors, it is a) academically rigorous, b) time consuming, c) crazy expensive. You graduate from med school and still face a period of an internship, followed by a residency (and more than one if you want to specialize), then finally start at a decent, but not fantastic, salary but are already hundreds of thousands of dollars in debt. Now working, you have ridiculously high malpractice (and other) insurance payments, plus the burden of paying for staff (many of which spend their time arguing with insurance companies), plus the overhead of maintaining the rent and other expenses of your practice, and after all THAT, both your patients and the government bitch that everything costs too much and blame it on doctors' salaries.

Yeah, who wouldn't want to do that? (But I'm really glad that some people do.)

Full disclosure, I seriously considered it, and even went as far as changing my major to a double major in Electrical Engineering and Pre-med... right up until I got slaughtered in chemistry. I was good enough for engineering but everyone said that wasn't going to be good enough to get into med-school.

 

[boatgeek]

Rather than considering how to integrate AI, maybe we need to ask about how to deal with how we pay for medical care. AIUI, part of the hassle of providing medical care is that the process for getting paid is incredible hard to manage with dozens to hundreds of insurance plans and multiple billing specialists in an office. It wouldn't surprise me if that's also part of the drive to computerized records--it makes it easier to pull things out for billing. If the billing process was simpler, the overhead that now goes to billing could go to actually, you know, providing care.

I recognize that this is much harder to deal with than getting AI bots into the exam room computers.

 

[NTP2]

Full disclosure, I seriously considered it, and even went as far as changing my major to a double major in Electrical Engineering and Pre-med... right up until I got slaughtered in chemistry. I was good enough for engineering but everyone said that wasn't going to be good enough to get into med-school.

I don’t suppose you’re teacher had a habit of complaining that there students couldn’t multiply?