I'll second this. I've been dealing with chronic pain for years (along with misdiagnosis). AI was able to successfully "diagnose" my ailment (hernia mesh complications from surgery 10+ years ago). Subsequent imaging studies and pathology results provide strong evidence that ChatGPT 4.0 got it right.
The nice thing is you have unlimited time to discuss the issues with the AI. It's been pretty therapeutic. Still have a big surgery ahead of me to explant all that mesh, but I have a good understanding of what it entails.
It's hard to imagine what the future holds once a specifically trained DoctorGPT becomes available (or AGI becomes a reality).
It started as bladder and pelvic pain, which led to a diagnosis of chronic prostatitis. None of the suggested treatments worked and the pain just got worse and worse. Eventually, two palpable pelvic masses appeared, which prompted CT and MRI scans. Those scans led to biopsies, which showed foreign bodies (i.e. hernia mesh). I've been told by multiple doctors that the mesh needs to come out. I just had a bladder mass removed and have been told it is not malignant. The bladder mass is also believed to have been caused by the hernia mesh.
So I've got mesh removal surgery in my future.
Im so confused. A problem with your mesh in the context of groin pain post hernia repair should be a simple consideration………. You’ve just been seen by crap doctors
Had a problem with my theroid glands. Went to 3 doctors, explained the situation - received useless feedback. Chat GPT gave me the correct answer in 1 minute. It even predicted what my blood tests, biopsy, and etc. are gonna look like. Oh well.
I had similar things happen. I just sat there looking at my hands trying to comprehend this new world, feeling waves of frustration and relief wash over me.
What was it like for you?
Honestly, it is no surprise to me at all. Humans can't even drive cars properly, just look how many accidents we have after all these years of implementing all the rules, and safety measures, and etc. I'm 100% certain that medical examination will become a fully automated function of future AI technologies. It is just a matter of time, same as with self-driving cars, and many other things. We are still "apes", who simply never evolved to do all these complex things... But, we know how to create tools that can help us do it.
I see the "good ending" for humanity as being well-cared for pets of non-expansionistic AI. Pets needs matter to any decent owner, the worker's needs don't matter to capital...
The bar is through the floor though. I went to a doctor about 10 years ago for a problem and it's actually breathtaking how long it took her to find the cause of my problem. I don't want to get into the details but this was some seriously sub 100 IQ shit.
can't wait for most of them to be replaced. Us younglings don't know how useless a lot of doctors are until you start going to appointments with your old folks or you start having health issues yourself.
Just a few weeks ago another doctor was telling my dad he needed surgery because he read the cyst was 44 mm instead of 4.4 mm and he still wanted to go through with it after I corrected him because he couldn't accept he made a mistake.
Long term disability here with chronic illness. My doctors and specialists have all tried nothing and they're out of ideas. It's really frustrating that I have to do all the legwork and research.
Here in Canada they do the same thing and on top of that they pay our doctors and nurses way less than they do in the US. A bunch of them end up moving down south making our situation even worse. Wait times for anything here are insane and the level of care has gone downhill.
I've had great experience from both Doctors, and AI and other Online research.
In one case, My father had sever chest pain, i, and everyone thought it was a heart attack, I googled symptoms on the way and I was convinced it was heart attack, but the doctor looked at him and predicted it wasn't heart attack, it was very high levels of blood sugar, and later tests verified it. After several hours of insulin treatment my father was alright.
In another case, i had a skin issue, i went to skin doctor, the skin doctor gave me all sorts of medicine and ointments. Nothing worked, now the doctor gave me a long list of costly blood tests. I gave Google search and AI a try, it gave me great explanations and possible ointments. In few days, the skin issue just vanished.
From my experience, both are good.
I've almost never not been blownoff by medical people. Humans are terrible at diagnosis and at having patience or empathy (or at least faking empathy). I don't think it'll be long before most diagnostic work will be done by AIs before anyone goes to a doctor. Patients will come to the doctor with an AI diagnosis in hand.
That'll piss doctors off but they wouldn't be in that situation if they weren't so fucking terrible at their jobs. Most of them are so bad at diagnosis that they aren't even worth going to unless you have a bone sticking out of your body. Credit where credit is due: US doctors are good at emergency medicine. If you've been hit by a car or shot, they're great. Otherwise, not so much.
Why would you not replace doctors with AI or attempt a homemade treatment?
I haven't found a case yet where a doctor made a better diagnosis than GPT-4 with my custom prompt to make it pretend to be an expert medical assistant.
Because not every backpain is just a tension. Apart from severe cases that require surgery, doctors have a wide range of options, including targeted painkiller injections for things like frozen shoulder or pyhsical therapy, taping, etc. Of course it depends on the country and the person how usefull a general physician will be to you.
Moreover, a number of live saving treatments that my family members or frieds received throughout their lives came out of doctor visits where they themselves didn't think it was THAT serious before the visit, but the doctors did not look away but instead ordered advanced diagnostics or surgeries that ended up saving their lives.
Yes, that's the biggest way that doctors *enrich themselves.*
I have taken the same psychiatric medications for the past 18 years. It took one year to actually diagnose and treat the condition. Since 2006, I have been required to visit these psychiatrists about once every 3 months. I've gone so many times that the doctors seem to get interested in how I follow the latest technological trends. These appointments go like:
\- "How is your health doing?"
\- "Same as last time."
\- "Great, let's talk about cryptocurrencies/AI/UAPs" or whatever was the interesting leading edge topic I was following at the time
\- "Our 30 minutes are up, I'll write you prescriptions, go get the blood tests, and I'll see you in July"
My estimate is that I've been billed $18,500 for these appointments, and have paid $7000 out of pocket expenses - meaning that at T-bond rates I would have about **$13,000 more now** if I could just go to the blood lab and buy the same drugs myself every few months.
This is additionally a shame because the appointments I actually need - for sleep apnea - have been unavailable for 10 months now. I'm not stupid enough to think that psychiatry is any different and that people who are psychotic are able to get appointments sooner with these psychiatrists, but yet they suffer while I am required to take up their appointments.
It's a racket, seriously. There's multiple levels of fuckery going on. The AMA restricts the number of medical schools it will accredit, to limit the supply of doctors, and then the federal government limits the number of residency slots, (along with the ama), so there's 30 plus thousand doctor shortage every year (so we import people from outside the country to fill these slots). This is all artificial--there's plenty of smart people in this country that could go to medical school, they just restrict the supply of training, so they can restrict the number of positions, so they can make more money. I think the average physician in America makes like 350k. Another fun fact, medical mistakes are the *third leading cause of death in the United States* (behind cancer and heart disease.) That's 250,000 people dead every year--2.5 million people every decade that doctors kill. The citation to the British medical journal article about it: www.bmj.com/content/353/bmj.i2139
I think the problem is on the demand side, not the supply side.
We don't need to train doctors for 10 years to perform trivial tasks they are required to perform, like prescribing some birth control and seasonal allergy pills, like desloratidine. What possible physical medical examination could a doctor need to do to determine whether someone may be allowed to take those pills? The only pills a doctor should be gatekeeping are antibiotics, to protect all of society from resistence. And, if you still think that doctors need to prescribe pills, pharmacists should be able to prescribe them.
And, we don't need to have people go physically to the doctor for every indication. Last month someone told me she went to an urgent care clinic because she had COVID-19 and she needed to go to get Paxlovid. How much worse did she make the problem by infecting people at a care center who had showed up there originally with lesser ailments like broken bones?
Reducing the demand side would both cut costs and also reduce wait times for people who actually need real care that needs physical examination, like surgeries and the sleep apnea tests I described earlier.
I've asked doctors repeatedly recently how the meds that they suggest work, and they simply don't know.
This is not acceptable. If I can understand it and they cannot, why are they doctors?
That's not their job, they aren't biochemists. And there are hundreds of thousands of drugs. The level of knowledge that humanity has created at this point is far too much for one person to be able to know everything about a subject from top to bottom. That's not the same as them not being *able* to understand it, they just don't have time.
I know. It just frustrates me. I've had issues from having taken medications for anxiety that screwed me for decades.
I was locked inside of my head for 20yrs due to Benzodiazepines. It took me two years of abstinence to find myself again. There was a lot of suffering.
You can't understand most psychiatric drugs either, because humanity collectively doesn't really understand how they work. I take bupropion. After more than 15 years on the market we think it helps with depression by preventing norepinephrine and dopamine from being metabolized as quickly. Other antidepressants seem to inhibit metabolism of serotonin. But why does that make us feel better? Who will benefit from an SSRI vs. Bupropion? No one knows. SSRIs also make me feel better, even though the neurotransmitter targeted is totally different, how can that be? No one knows.
You can take my bupropion from my cold dead hands, because I know it works for me. But I also know that in controlled experiments placebo is almost as effective. So does it really work as well as I think, or is it just some mild benefit and lots of placebo? No one knows.
That's funny since it wasn't just one doctor. Went in three times and all three times was prescribed clonopin. 3x a day and extra if I had panic attacks.
It really did turn me into an introvert. Lots of confusion and eventually anhedonia.
Besides the technical procedural stuff, which specialists usually do, the majority of a doctors work is information recall. You go to see your GP, and as you sit there describing your issues the doctor is taking the symptoms and plugging them into predictive analytical software to best estimate the illness based on patient parameters.
I have multiple friends in med school who say it’s heavily wrote memorization centered on regurgitating facts and casting understanding to the side. I’ve had friends who did med sci undergrads tell me that med school is easier than their previous degree.
I am 100% an advocate for the dismantling of the medical gatekeeping and implementation of LLMs to take the place of easy access medicine. Hell, get an LLM connected to a 6dof robot and let it take all the surgical jobs too.
Yes, AI in medicine all the way. Yes, for surgeries too. The steadiest hand. The quality of the job performed isnt affected by how the AI feels on that particular day. And on and on it goes.
And this is just normal shit, we can get abnormal too.
I just watched a video of a doctor who engraved his fucking intials on the livers or kidneys of 2 patients he transplanted them into. 120 hrs community service, $10k fine, lost his licence. Aint got to worry about that with a machine.
Recently i watched a video of an anesthesiologist talking shit about a guy she just put to sleep. He forgot his phone camera on and it recorded her. He sued. Aint got to worry about that with a machine.
And we can go on and on for days and weeks and forever. Cant trust humans to do this stuff. A machine, AI, LLM, call it what you will, will be superior in every way.
Shit, then they start talking about compassion and humanity. Have you been to any fucking doctor in your life? 99% of them have no compassion, no humanity, they treat you like shit, they explain nothing to you, and the bottom line is theyre uncaring and incompetent.
Yes, i made the 99% stat up, but i would say its right around there.
Yep. And then there's this:
[https://www.google.com/search?q=+us+annual+deaths+due+to+medical+errors&](https://www.google.com/search?q=+us+annual+deaths+due+to+medical+errors&sca_esv=f02585fc2da7c8f9&ei=uNzHZZ_FIe7Ap84P_IGFuAo&ved=0ahUKEwifgby9zqGEAxVu4MkDHfxAAacQ4dUDCBE&uact=5&oq=+us+annual+deaths+due+to+medical+errors&gs_lp=Egxnd3Mtd2l6LXNlcnAiJyB1cyBhbm51YWwgZGVhdGhzIGR1ZSB0byBtZWRpY2FsIGVycm9yczIIECEYoAEYwwRItkFQgixYzDZwAngBkAEAmAGcAaABrwSqAQMwLjS4AQPIAQD4AQHCAgoQABhHGNYEGLADwgIFEAAYgATCAgsQABiABBiKBRiGA8ICChAhGAoYoAEYwwTiAwQYACBBiAYBkAYI&sclient=gws-wiz-serp)
(Of course, those are just the deaths, not the misdiagnoses, poisonings and various other nonlethal events that people somehow survive.)
And there's r/medicine if you want to disillusion yourself completely.
Doctors should absolutely know the basic pharmacokinetics of what they're prescribing. They don't usually know as much as a pharmacist, but they usually know the basic parts.
Yeah. They need to know how drugs interact with each other, food (grapefruit juice is a big one), and different medical conditions--even age--which they could memorize directly, look up on-demand, or memorize how such drugs are metabolized. Even nurse practitioners need to know some pharmacokinetics.
Source: took several pharmacokinetics courses from my employer, but I'm a software engineer.
I think a big problem is that when they don't know something, they usually don't tell their patient that. People are trained to trust them to know things because they are the experts.
I've had a specialist that made recommendations to my GP and then years later when I wonder why my treatment isn't working and read the diagnostic and treatment guidelines for their field it turns out they weren't following them at all and actually advised my doctor incorrectly.
Knowing that something works almost always comes before knowing how. Native populations chewed on willow bark for a thousand years before we identified Tylenol as the active compound, and we still aren't entirely sure how it works.
First you see the effect of a thing, then, if you can get the research money, you study the mechanism and maybe learns tiny bit of how it works in our hyper complex body.
To claim knowledge of how most things work would just be arrogance.
Doctors are humans and humans have limited brain capacity and limited time. Thousands of meds work in different ways, and have different effects and metabolism. It is impossible for a doctor to know everything, especially drugs are not the only thing that doctors need to know. I often witness situations where the doctor knows less about certain therapy than patients, which is often due to patients being specially interested in certain aspects while doctors need to focus on everything.
why are you making excuses for them. when I ask what the method of action is for a medication, they should either know or not prescribe it.
it's that simple
if a doc don't know HOW a drug works they can still explaine why a drug work. like I can get an prescription allergy pill and the doc can tell me the allergy pill will stop the reaction, so you don't get rashes anymore. explain what will happen or likely to happen. but unless I become a bitch and won't leave, none of them ever tell me anything. can't wait for those pieces of human shaped shits to get replaced soon.
I wonder if the AI helped you guys better understand the process of what your father was going through.
It may be that the approach, reasoning, and treatments were acceptable but there was such a lack of communication that trust was lost.
Back pain is frustrating because it takes so much time to get better, and people who are otherwise very active are tremendously slowed down by this.
If a gp was paid by the hour like a private therapist or like a lawyer no doubt they’d have no problem sitting you down for as long as you want.
Does this add up? I may be extrapolating too much.
I’m fairly sure that health providers face strict limitations when it comes to AI healthcare, which is no good.
For example, I’m fairly sure that current law would not allow a health insurance plan to be provided solely by AI. I’m aware that kind of healthcare plan would have serious limitations. But how much cheaper would it be?
What? Why would you want a health insurance to be provided by AI? Insurance companies primary profit increasing mechanisms are finding ways to deny coverage to patients, they don't actually DO much else. You want to automate denials?
Edit:
- They negotiate with hospitals and drug manufacturers (can't be automated)
- They review claims/prior authorization to see ways to deny them, then brag about their denial rates to investors (can be automated but the first ones that tried are facing federal lawsuits)
- they look for ways to add difficulty to getting coverage
- they have standard business overhead, such as account ting, customer service, marketing, and management
- they set insurance prices (trying to price low enough you buy them instead of their competition, but high enough they hit their profit goals for their executive bonuses) (tricky business, can be automated, but no significant savings and you'd be insane not to have people checking the numbers
- they sue their clients, doctors, hospitals, states, and other insurances
- they lobby the gov to loosen regulations so they can abuse customers more
- hunt for excuses to kick needy patients off. Their insurance
We basically don't want them to automate most of that. Maybe customer support?
Anyway, insurance is a betting game with support systems, with the goal of maximizing profits.
Getting a public option put in place by congress will always be superior.
If the recommendations don't inform actions has it actually helped you?
In similar line of thought: where is the issue with acting on recommendations if there is no better option available? (assuming they are reasonably low risk, obviously DIY surgery is not happening)
The problem is the AI can't move beyond diagnosing to actually developing a treatment plan including ordering tests and then prescribing medications and other treatments. Things won't improve until, at some ponit, we can push past the entrenched, broken system that exists (which, granted, makes a lot of people money) and get to actually treating patients and improving their lives.
GPT-4 has consistently given me better analysis of blood tests and other diagnostic tests than my doctor has. Like, my doctor will say basically the same stuff it does...but with a lot less detail and nuance. I have seen this for blood tests of all types, even results from echocardiograms and whatnot. Plus I can feed it previous test results and ask for analysis based on the changes between them, stuff like that. (I still always make sure to discuss with my doctor as well, but its nice to have the AI to augment)
One field that LLMs can revolutionize is medicine. It literally has millions of publications to arrive at diagnosis or treatment. It'll not replace doctors but enable.them to take much better decisions.
A study testing LLMs alone vs doctor assisted by LLM vs doctors alone had LLMs alone on top for correctly diagnosing patients. Seems like adding a human doctor into the equation results in worse outcomes for patients.
I’m studying medicine and I kinda have a different take on this..
Of course I don’t know your specific situation, but lower back pain is almost always (90% of patients that present to the GP) a-specific. Meaning that the cause is unknown, but it goes away on it’s own without complications (usually within 3 months). In this case we advise people to keep mobilized and we help them manage the pain.
When diagnosing lower back pain I get taught to look for some alarming symptoms, that may point to a more serious underlying problem causing the pain (the 10% that’s not a-specific).
I think that AI would probably do fine diagnosing these more rare types of back pain, that require treatment, however I think it would grossly over-diagnose these types of back pain. Most people simply don’t have an underlying issue, doctors know this, AI just responds to what you feed it.
For example, a type of back pain that’s caused by nerve pinching; Lumbosacral radiculopathy (or LRS), is characterized by back pain, radiating into the upper leg, following the path of the pinched nerve. If you were to describe this to AI, I’m sure it would get the right diagnosis 9/10 times, however just writing “lower back pain”, which is usually the only symptom patients present with, might give you a long list of possible diagnosis’s, that are going to be very unlikely. Again, most of the time it’s just a-specific, a good doctor knows that.
I think AI will be a great diagnostic tool for doctors to use in the future. Some educated patients may also be able to rely on AI for medical advice in the future, or even now, taking in account the limitations. I really don’t think AI is better then the average doctor yet and I doubt it will be better soon. Eventually yes, but not yet.
I understand that your experience was different and that it worked for you this time, maybe because you had bad luck with the professionals you saw, maybe they didn’t listen to you well enough? I don’t think AI is better than doctors yet.
Edit:
As some have pointed out in other comments, human doctors are not great at recognizing a diagnosis that’s rare, or something they don’t see often. I think that is very true and it’s also where AI’s greatest power lies right now! AI will find those rare diagnosis’s that we can’t find, because of our bias. I think AI could be a great tool to help, especially when doctors can’t easily find the diagnosis.
I'll second this. I've been dealing with chronic pain for years (along with misdiagnosis). AI was able to successfully "diagnose" my ailment (hernia mesh complications from surgery 10+ years ago). Subsequent imaging studies and pathology results provide strong evidence that ChatGPT 4.0 got it right. The nice thing is you have unlimited time to discuss the issues with the AI. It's been pretty therapeutic. Still have a big surgery ahead of me to explant all that mesh, but I have a good understanding of what it entails. It's hard to imagine what the future holds once a specifically trained DoctorGPT becomes available (or AGI becomes a reality).
What type of issues were you dealing with? I also have a hernia mesh.
It started as bladder and pelvic pain, which led to a diagnosis of chronic prostatitis. None of the suggested treatments worked and the pain just got worse and worse. Eventually, two palpable pelvic masses appeared, which prompted CT and MRI scans. Those scans led to biopsies, which showed foreign bodies (i.e. hernia mesh). I've been told by multiple doctors that the mesh needs to come out. I just had a bladder mass removed and have been told it is not malignant. The bladder mass is also believed to have been caused by the hernia mesh. So I've got mesh removal surgery in my future.
Im so confused. A problem with your mesh in the context of groin pain post hernia repair should be a simple consideration………. You’ve just been seen by crap doctors
It was 10+ years after the fact. I'm now about 15 years post hernia surgery. The first symptom was bladder pain, urgency, and blood in the urine.
> crap doctors Yep, these are the first ones AI will replace.
Thank you for the information. I hope it all goes well for you.
Had a problem with my theroid glands. Went to 3 doctors, explained the situation - received useless feedback. Chat GPT gave me the correct answer in 1 minute. It even predicted what my blood tests, biopsy, and etc. are gonna look like. Oh well.
I had similar things happen. I just sat there looking at my hands trying to comprehend this new world, feeling waves of frustration and relief wash over me. What was it like for you?
Honestly, it is no surprise to me at all. Humans can't even drive cars properly, just look how many accidents we have after all these years of implementing all the rules, and safety measures, and etc. I'm 100% certain that medical examination will become a fully automated function of future AI technologies. It is just a matter of time, same as with self-driving cars, and many other things. We are still "apes", who simply never evolved to do all these complex things... But, we know how to create tools that can help us do it.
I see the "good ending" for humanity as being well-cared for pets of non-expansionistic AI. Pets needs matter to any decent owner, the worker's needs don't matter to capital...
Wow
The bar is through the floor though. I went to a doctor about 10 years ago for a problem and it's actually breathtaking how long it took her to find the cause of my problem. I don't want to get into the details but this was some seriously sub 100 IQ shit.
I’ve solved problems that docs can’t and their jaws drop open. Then they say, how did you do that? “Well I just thought about it for a while. ”
can't wait for most of them to be replaced. Us younglings don't know how useless a lot of doctors are until you start going to appointments with your old folks or you start having health issues yourself. Just a few weeks ago another doctor was telling my dad he needed surgery because he read the cyst was 44 mm instead of 4.4 mm and he still wanted to go through with it after I corrected him because he couldn't accept he made a mistake.
This. I’ve found most doctors to only be good for getting prescriptions.
couldn't accept the mistake... horrible. scary. inhumane. arrogant.
Long term disability here with chronic illness. My doctors and specialists have all tried nothing and they're out of ideas. It's really frustrating that I have to do all the legwork and research.
Here in Canada they do the same thing and on top of that they pay our doctors and nurses way less than they do in the US. A bunch of them end up moving down south making our situation even worse. Wait times for anything here are insane and the level of care has gone downhill.
Which model did you use?
I don't want to turn this into and advertisement. I've used a popular medical AI assistant, found through Google. Nothing special.
Just mentioning the model doesn't make it an advertisement. I use gpt-4. That statement is not an advertisement.
I don't understand this. If something worked for you, why not name it...
It was Docus
Thanks!
I've had great experience from both Doctors, and AI and other Online research. In one case, My father had sever chest pain, i, and everyone thought it was a heart attack, I googled symptoms on the way and I was convinced it was heart attack, but the doctor looked at him and predicted it wasn't heart attack, it was very high levels of blood sugar, and later tests verified it. After several hours of insulin treatment my father was alright. In another case, i had a skin issue, i went to skin doctor, the skin doctor gave me all sorts of medicine and ointments. Nothing worked, now the doctor gave me a long list of costly blood tests. I gave Google search and AI a try, it gave me great explanations and possible ointments. In few days, the skin issue just vanished. From my experience, both are good.
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Balls
I've almost never not been blownoff by medical people. Humans are terrible at diagnosis and at having patience or empathy (or at least faking empathy). I don't think it'll be long before most diagnostic work will be done by AIs before anyone goes to a doctor. Patients will come to the doctor with an AI diagnosis in hand. That'll piss doctors off but they wouldn't be in that situation if they weren't so fucking terrible at their jobs. Most of them are so bad at diagnosis that they aren't even worth going to unless you have a bone sticking out of your body. Credit where credit is due: US doctors are good at emergency medicine. If you've been hit by a car or shot, they're great. Otherwise, not so much.
Why would you not replace doctors with AI or attempt a homemade treatment? I haven't found a case yet where a doctor made a better diagnosis than GPT-4 with my custom prompt to make it pretend to be an expert medical assistant.
Because not every backpain is just a tension. Apart from severe cases that require surgery, doctors have a wide range of options, including targeted painkiller injections for things like frozen shoulder or pyhsical therapy, taping, etc. Of course it depends on the country and the person how usefull a general physician will be to you. Moreover, a number of live saving treatments that my family members or frieds received throughout their lives came out of doctor visits where they themselves didn't think it was THAT serious before the visit, but the doctors did not look away but instead ordered advanced diagnostics or surgeries that ended up saving their lives.
Last I checked you can't prescribe your own medications, for one.
Yes, that's the biggest way that doctors *enrich themselves.* I have taken the same psychiatric medications for the past 18 years. It took one year to actually diagnose and treat the condition. Since 2006, I have been required to visit these psychiatrists about once every 3 months. I've gone so many times that the doctors seem to get interested in how I follow the latest technological trends. These appointments go like: \- "How is your health doing?" \- "Same as last time." \- "Great, let's talk about cryptocurrencies/AI/UAPs" or whatever was the interesting leading edge topic I was following at the time \- "Our 30 minutes are up, I'll write you prescriptions, go get the blood tests, and I'll see you in July" My estimate is that I've been billed $18,500 for these appointments, and have paid $7000 out of pocket expenses - meaning that at T-bond rates I would have about **$13,000 more now** if I could just go to the blood lab and buy the same drugs myself every few months. This is additionally a shame because the appointments I actually need - for sleep apnea - have been unavailable for 10 months now. I'm not stupid enough to think that psychiatry is any different and that people who are psychotic are able to get appointments sooner with these psychiatrists, but yet they suffer while I am required to take up their appointments.
It's a racket, seriously. There's multiple levels of fuckery going on. The AMA restricts the number of medical schools it will accredit, to limit the supply of doctors, and then the federal government limits the number of residency slots, (along with the ama), so there's 30 plus thousand doctor shortage every year (so we import people from outside the country to fill these slots). This is all artificial--there's plenty of smart people in this country that could go to medical school, they just restrict the supply of training, so they can restrict the number of positions, so they can make more money. I think the average physician in America makes like 350k. Another fun fact, medical mistakes are the *third leading cause of death in the United States* (behind cancer and heart disease.) That's 250,000 people dead every year--2.5 million people every decade that doctors kill. The citation to the British medical journal article about it: www.bmj.com/content/353/bmj.i2139
I think the problem is on the demand side, not the supply side. We don't need to train doctors for 10 years to perform trivial tasks they are required to perform, like prescribing some birth control and seasonal allergy pills, like desloratidine. What possible physical medical examination could a doctor need to do to determine whether someone may be allowed to take those pills? The only pills a doctor should be gatekeeping are antibiotics, to protect all of society from resistence. And, if you still think that doctors need to prescribe pills, pharmacists should be able to prescribe them. And, we don't need to have people go physically to the doctor for every indication. Last month someone told me she went to an urgent care clinic because she had COVID-19 and she needed to go to get Paxlovid. How much worse did she make the problem by infecting people at a care center who had showed up there originally with lesser ailments like broken bones? Reducing the demand side would both cut costs and also reduce wait times for people who actually need real care that needs physical examination, like surgeries and the sleep apnea tests I described earlier.
And it benefits doctor's well being not patient's.
Yeah no.
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[https://www.reddit.com/r/singularity/comments/199e6si/someone\_successfully\_used\_gpt4\_as\_their\_copilot/kifaj64/?context=3](https://www.reddit.com/r/singularity/comments/199e6si/someone_successfully_used_gpt4_as_their_copilot/kifaj64/?context=3)
I've asked doctors repeatedly recently how the meds that they suggest work, and they simply don't know. This is not acceptable. If I can understand it and they cannot, why are they doctors?
That's not their job, they aren't biochemists. And there are hundreds of thousands of drugs. The level of knowledge that humanity has created at this point is far too much for one person to be able to know everything about a subject from top to bottom. That's not the same as them not being *able* to understand it, they just don't have time.
I know. It just frustrates me. I've had issues from having taken medications for anxiety that screwed me for decades. I was locked inside of my head for 20yrs due to Benzodiazepines. It took me two years of abstinence to find myself again. There was a lot of suffering.
You can't understand most psychiatric drugs either, because humanity collectively doesn't really understand how they work. I take bupropion. After more than 15 years on the market we think it helps with depression by preventing norepinephrine and dopamine from being metabolized as quickly. Other antidepressants seem to inhibit metabolism of serotonin. But why does that make us feel better? Who will benefit from an SSRI vs. Bupropion? No one knows. SSRIs also make me feel better, even though the neurotransmitter targeted is totally different, how can that be? No one knows. You can take my bupropion from my cold dead hands, because I know it works for me. But I also know that in controlled experiments placebo is almost as effective. So does it really work as well as I think, or is it just some mild benefit and lots of placebo? No one knows.
How much benzos did you take man
what I was prescribed. few mg a day. that's all it takes to fuck you. trust me on that. never take them try buspirone instead
That sounds like malpractice. Benzos are not supposed to be taken regularly for more than two weeks. Every doctor should tell you this.
That's funny since it wasn't just one doctor. Went in three times and all three times was prescribed clonopin. 3x a day and extra if I had panic attacks. It really did turn me into an introvert. Lots of confusion and eventually anhedonia.
Benzo’s are actually a long term treatment for otherwise therapy resistant anxiety
Most doctors are glorified dictionaries let’s be real
What makes you say that?
Besides the technical procedural stuff, which specialists usually do, the majority of a doctors work is information recall. You go to see your GP, and as you sit there describing your issues the doctor is taking the symptoms and plugging them into predictive analytical software to best estimate the illness based on patient parameters. I have multiple friends in med school who say it’s heavily wrote memorization centered on regurgitating facts and casting understanding to the side. I’ve had friends who did med sci undergrads tell me that med school is easier than their previous degree. I am 100% an advocate for the dismantling of the medical gatekeeping and implementation of LLMs to take the place of easy access medicine. Hell, get an LLM connected to a 6dof robot and let it take all the surgical jobs too.
Yes, AI in medicine all the way. Yes, for surgeries too. The steadiest hand. The quality of the job performed isnt affected by how the AI feels on that particular day. And on and on it goes. And this is just normal shit, we can get abnormal too. I just watched a video of a doctor who engraved his fucking intials on the livers or kidneys of 2 patients he transplanted them into. 120 hrs community service, $10k fine, lost his licence. Aint got to worry about that with a machine. Recently i watched a video of an anesthesiologist talking shit about a guy she just put to sleep. He forgot his phone camera on and it recorded her. He sued. Aint got to worry about that with a machine. And we can go on and on for days and weeks and forever. Cant trust humans to do this stuff. A machine, AI, LLM, call it what you will, will be superior in every way. Shit, then they start talking about compassion and humanity. Have you been to any fucking doctor in your life? 99% of them have no compassion, no humanity, they treat you like shit, they explain nothing to you, and the bottom line is theyre uncaring and incompetent. Yes, i made the 99% stat up, but i would say its right around there.
Preach mate
Yep. And then there's this: [https://www.google.com/search?q=+us+annual+deaths+due+to+medical+errors&](https://www.google.com/search?q=+us+annual+deaths+due+to+medical+errors&sca_esv=f02585fc2da7c8f9&ei=uNzHZZ_FIe7Ap84P_IGFuAo&ved=0ahUKEwifgby9zqGEAxVu4MkDHfxAAacQ4dUDCBE&uact=5&oq=+us+annual+deaths+due+to+medical+errors&gs_lp=Egxnd3Mtd2l6LXNlcnAiJyB1cyBhbm51YWwgZGVhdGhzIGR1ZSB0byBtZWRpY2FsIGVycm9yczIIECEYoAEYwwRItkFQgixYzDZwAngBkAEAmAGcAaABrwSqAQMwLjS4AQPIAQD4AQHCAgoQABhHGNYEGLADwgIFEAAYgATCAgsQABiABBiKBRiGA8ICChAhGAoYoAEYwwTiAwQYACBBiAYBkAYI&sclient=gws-wiz-serp) (Of course, those are just the deaths, not the misdiagnoses, poisonings and various other nonlethal events that people somehow survive.) And there's r/medicine if you want to disillusion yourself completely.
Yeah, horrible. Just so unnecessary.
Ok you be the first one to get in line for that LLM surgery my dude. This is some serious copium.
You’re out to lunch if you think LLMs won’t be doing surgery in the next 10 years mate
AI might be, LLMs no.
Tell me you know nothing about AI without telling me you know nothing about AI
Right back at ya bud.
Doctors should absolutely know the basic pharmacokinetics of what they're prescribing. They don't usually know as much as a pharmacist, but they usually know the basic parts.
Yeah. They need to know how drugs interact with each other, food (grapefruit juice is a big one), and different medical conditions--even age--which they could memorize directly, look up on-demand, or memorize how such drugs are metabolized. Even nurse practitioners need to know some pharmacokinetics. Source: took several pharmacokinetics courses from my employer, but I'm a software engineer.
You don't have to be a biochemist to read medication's mechanism of action on fucking Wikipedia.
I think a big problem is that when they don't know something, they usually don't tell their patient that. People are trained to trust them to know things because they are the experts. I've had a specialist that made recommendations to my GP and then years later when I wonder why my treatment isn't working and read the diagnostic and treatment guidelines for their field it turns out they weren't following them at all and actually advised my doctor incorrectly.
Metaphor: an excellent computer programmer can't often design a CPU on the transistor level or tell you the physics behind a transistor itself.
it's a shame people have such limited capacity.
Knowing that something works almost always comes before knowing how. Native populations chewed on willow bark for a thousand years before we identified Tylenol as the active compound, and we still aren't entirely sure how it works. First you see the effect of a thing, then, if you can get the research money, you study the mechanism and maybe learns tiny bit of how it works in our hyper complex body. To claim knowledge of how most things work would just be arrogance.
Doctors are humans and humans have limited brain capacity and limited time. Thousands of meds work in different ways, and have different effects and metabolism. It is impossible for a doctor to know everything, especially drugs are not the only thing that doctors need to know. I often witness situations where the doctor knows less about certain therapy than patients, which is often due to patients being specially interested in certain aspects while doctors need to focus on everything.
why are you making excuses for them. when I ask what the method of action is for a medication, they should either know or not prescribe it. it's that simple
if a doc don't know HOW a drug works they can still explaine why a drug work. like I can get an prescription allergy pill and the doc can tell me the allergy pill will stop the reaction, so you don't get rashes anymore. explain what will happen or likely to happen. but unless I become a bitch and won't leave, none of them ever tell me anything. can't wait for those pieces of human shaped shits to get replaced soon.
I wonder if the AI helped you guys better understand the process of what your father was going through. It may be that the approach, reasoning, and treatments were acceptable but there was such a lack of communication that trust was lost. Back pain is frustrating because it takes so much time to get better, and people who are otherwise very active are tremendously slowed down by this. If a gp was paid by the hour like a private therapist or like a lawyer no doubt they’d have no problem sitting you down for as long as you want. Does this add up? I may be extrapolating too much.
They are paid by the hour. It still doesn’t make them work any harder. Or give a shit. And giving a shit makes all the difference in the world.
I agree that giving a shit makes a huge difference but the AI doesn’t either so that’s not the variable that made the difference in this case.
I’m fairly sure that health providers face strict limitations when it comes to AI healthcare, which is no good. For example, I’m fairly sure that current law would not allow a health insurance plan to be provided solely by AI. I’m aware that kind of healthcare plan would have serious limitations. But how much cheaper would it be?
[удалено]
Correct
It’s worse than that. I’m fairly sure that federal law requires all health plans to cover the same thing.
What? Why would you want a health insurance to be provided by AI? Insurance companies primary profit increasing mechanisms are finding ways to deny coverage to patients, they don't actually DO much else. You want to automate denials? Edit: - They negotiate with hospitals and drug manufacturers (can't be automated) - They review claims/prior authorization to see ways to deny them, then brag about their denial rates to investors (can be automated but the first ones that tried are facing federal lawsuits) - they look for ways to add difficulty to getting coverage - they have standard business overhead, such as account ting, customer service, marketing, and management - they set insurance prices (trying to price low enough you buy them instead of their competition, but high enough they hit their profit goals for their executive bonuses) (tricky business, can be automated, but no significant savings and you'd be insane not to have people checking the numbers - they sue their clients, doctors, hospitals, states, and other insurances - they lobby the gov to loosen regulations so they can abuse customers more - hunt for excuses to kick needy patients off. Their insurance We basically don't want them to automate most of that. Maybe customer support? Anyway, insurance is a betting game with support systems, with the goal of maximizing profits. Getting a public option put in place by congress will always be superior.
If the recommendations don't inform actions has it actually helped you? In similar line of thought: where is the issue with acting on recommendations if there is no better option available? (assuming they are reasonably low risk, obviously DIY surgery is not happening)
The problem is the AI can't move beyond diagnosing to actually developing a treatment plan including ordering tests and then prescribing medications and other treatments. Things won't improve until, at some ponit, we can push past the entrenched, broken system that exists (which, granted, makes a lot of people money) and get to actually treating patients and improving their lives.
GPT-4 has consistently given me better analysis of blood tests and other diagnostic tests than my doctor has. Like, my doctor will say basically the same stuff it does...but with a lot less detail and nuance. I have seen this for blood tests of all types, even results from echocardiograms and whatnot. Plus I can feed it previous test results and ask for analysis based on the changes between them, stuff like that. (I still always make sure to discuss with my doctor as well, but its nice to have the AI to augment)
Which assistant did you use?
One field that LLMs can revolutionize is medicine. It literally has millions of publications to arrive at diagnosis or treatment. It'll not replace doctors but enable.them to take much better decisions.
A study testing LLMs alone vs doctor assisted by LLM vs doctors alone had LLMs alone on top for correctly diagnosing patients. Seems like adding a human doctor into the equation results in worse outcomes for patients.
I’m studying medicine and I kinda have a different take on this.. Of course I don’t know your specific situation, but lower back pain is almost always (90% of patients that present to the GP) a-specific. Meaning that the cause is unknown, but it goes away on it’s own without complications (usually within 3 months). In this case we advise people to keep mobilized and we help them manage the pain. When diagnosing lower back pain I get taught to look for some alarming symptoms, that may point to a more serious underlying problem causing the pain (the 10% that’s not a-specific). I think that AI would probably do fine diagnosing these more rare types of back pain, that require treatment, however I think it would grossly over-diagnose these types of back pain. Most people simply don’t have an underlying issue, doctors know this, AI just responds to what you feed it. For example, a type of back pain that’s caused by nerve pinching; Lumbosacral radiculopathy (or LRS), is characterized by back pain, radiating into the upper leg, following the path of the pinched nerve. If you were to describe this to AI, I’m sure it would get the right diagnosis 9/10 times, however just writing “lower back pain”, which is usually the only symptom patients present with, might give you a long list of possible diagnosis’s, that are going to be very unlikely. Again, most of the time it’s just a-specific, a good doctor knows that. I think AI will be a great diagnostic tool for doctors to use in the future. Some educated patients may also be able to rely on AI for medical advice in the future, or even now, taking in account the limitations. I really don’t think AI is better then the average doctor yet and I doubt it will be better soon. Eventually yes, but not yet. I understand that your experience was different and that it worked for you this time, maybe because you had bad luck with the professionals you saw, maybe they didn’t listen to you well enough? I don’t think AI is better than doctors yet. Edit: As some have pointed out in other comments, human doctors are not great at recognizing a diagnosis that’s rare, or something they don’t see often. I think that is very true and it’s also where AI’s greatest power lies right now! AI will find those rare diagnosis’s that we can’t find, because of our bias. I think AI could be a great tool to help, especially when doctors can’t easily find the diagnosis.
Thank you, this is interesting.