The Futility of Doctors
Why you shouldn't expect a human doctor to diagnose your health problems very well (or at all for that matter).
Why is the medical industry so inefficient?
I don’t say that lightly.
I understand not every doctor will be like House M.D.
Human labor has its limits — not every doctor will have more than 15 minutes to figure out what’s wrong with you.
Given these time constraints, I understand doctors cannot (with godlike precision) say what’s wrong with you after every visit.
I understand that.
I get it.
Still, I think the modern conception of doctors is wrong. We think of doctor’s as miracle workers, but the modern day doctor is closer to an office drone going through the motions than Sherlock Holmes.
There’s no eureka moment; no sense that a doctor is helping another person solve their problems. There’s only a top-down pressure to type in the right words, in the right places in a spreadsheet so managers can tell their investors, “We’ve made a 1.2% increase in the sale of Ibuprofen this quarter.”
Nowadays, doctors make more eye contact with their computers than with their patients. And that wouldn’t be a problem if computers were actually useful (although that begs the question if the computers were that useful, why does the patient have to be there? You could just diagnose patients from the comfort of their home.)
But unfortunately, the computers are a farce. Next time you go to the doctor’s office, pay attention to what they’re doing. Doctors will ask specific questions so they can check off specific boxes in their spreadsheets. They’re not thinking about what could be wrong with you. They’re going through a routine that rarely changes day-to-day.
To be clear, I’m not against medical institutions making money. But there is something odd about how doctor’s solve people’s problems nowadays: There’s always this pressure to diagnose problems and if you can’t find it in a textbook in less than 30 seconds, just call it anxiety and prescribe a pain reliever. Why?
If you’re wondering why doctors prescribe drugs like Ibuprofen so often, it’s because it’s their “Get out of jail” free card:
It gives you the illusion they’re solving your problem.
Prescribing Ibuprofen won’t bring any lawsuits against them.
It covers up their lack of knowledge with your specific problem.
To be fair, sometimes Ibuprofen is the best solution for a problem. But sometimes it also serves a lesser purpose: A way for medical organizations to make money without actually solving your problem.
And to be even more fair, doctors are stuck in a local minima they can’t get out of. Even if a doctor knew what was wrong with you, they couldn’t offer any useful advice. They would be punished for it.
Why?
Because the medical industry is set up to punish doctors who take risks and reward the ones that stay in the status quo. Hospitals don’t want to be sued. Not even a little. That’ll interfere with the business. It’ll interfere with the bottom line.
Maybe that’s the fault of the laws in America. Maybe the law disproportionately favors the patient against the doctor. I couldn’t say.
But I can see the effect: Doctors become unwilling to take any risk out of fear of losing their license — in the same way a cop fears going to prison, a doctor fears getting his medical license revoked.
It’s a terrible system because innovation requires some risk. Innovation happens at the edge of what you know to be possible. And sometimes you don’t know as much as you think you do. Maybe you offer a suggestion, but it doesn’t work. Should you lose your job for it? The asymmetry of the doctor-patient relationship means patients can’t get the help they need and doctors can’t offer it.
For that reason, the trajectory of modern medicine isn’t aimed at innovation. It’s aimed at preservation. At optimizing what’s already known.
The medical industry isn’t looking to eradicate Alzheimer’s. It’s looking for drugs that can slow down Alzheimer’s year by year while maximizing profits. Because that’s the safer route, the more familiar route.
And while profits aren’t bad, anything short of trying to completely eliminate Alzheimer’s isn’t a good enough goal.
We don’t want to find new ways of prolonging diseases. We want the trajectory to be aimed at getting rid of them entirely.
But that’s not the case. Not in this day, not in this age.
More questions than answers
Why do doctors still diagnose patients in their offices with tools from the 1810s?
Why are radiologists so critical of smart algorithms that can analyze X-Rays with precision, warning about the patient misinterpreting the data, as if that would be as dangerous as the cancer they’re trying to diagnose itself?1
Why are doctors so blissfully unaware of the impact nutrition has on a person’s health? Why do they recommend plant-based foods when study after study has consistently shown how bad the effects are?
Why do doctors still prescribe statins when their efficacy has already been proven to be less useful than a diet change?
Why do doctors have you go from department to department doing useless tests for problems you’ve never had?
There’s no push to solve these hard problems. There’s only a push to keep doing the same things. Companies spend their efforts on improving something marginally, rather than taking a risk to find a great new solution.
There’s a blindness towards the way medicine is run today. People yell about healthcare, but never stop to ask, “Is our healthcare even effective? Are the institutions actually set in place to solve our problems?” The answer is clearly no.
For that reason, the future won’t be in doctors diagnosing people. The ratio is just too imbalanced. There’s far more patients than doctors. The human capital just isn’t there. The incentives aren’t there. Eventually, these doctors will be replaced by machines, smart algorithms, and software. Or at the very least, augmented to the point that 95% of doctors lose their jobs and 5% provide useful work at scale. Because the current status quo isn’t effective and there’s so much low-hanging fruit.
And to some extent this has already happened. Google Searches, Reddit forums, and Amazon reviews all leave traces of a new paradigm; people sharing anecdotes, notes, and solutions after absurd amounts of trial and error now made possible because of the Internet. (If you’ve ever had a health problem, you’ll know this routine all too well).
And yet, given this eventuality, there’s no push to upend the medical industry in that direction. At least for now. Listen to an entrepreneur in the medical space, and you’ll hear them throw all sorts of words around, talking about optimizing this, optimizing that. They’re utterly focused on making doctors more efficient. But given everything about the current system, why would you want to make doctors more efficient? What does that even mean?
It means speeding up the number of people going through your clinic so you can prescribe more drugs. It means finding ways to squeeze every last bit of value, creating optimization functions to find the best locations to build medical centers to increase yearly revenues.
It means, ignoring the most fundamental aspect of a medical institution: The patient.
The patient has a health problem: “What’s the quickest, most effective, and cheapest way to solve their problem?”
That’s the paradigm the medical community should concern itself with.
And yet, it’s the least of their concerns.
Well said! Working on eliminating the 95% as we speak. Global Population Health Informatics = personal health, anytime and anywhere.... it will happen ... not fast enough bit the time is right!