The future of medicine

Squeezing out the doctor


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‘Speciality rationing’ is a term that springs to mind in how best doctors might use their time most effectively, whilst delegating other tasks routinely performed by them to other members of medical staff.

Economies of Scale to be found within wards and medical surgeries will go some way in revamping health care systems that cannot, at present, meet rising demands on doctors’ scarce and valuable time. The concept of using smart phones and other forms of digitisation with the patient is becoming common in the UK, alleviating patient travel time to medical centres and reducing costs and wastage in the process. For example, type 1 diabetics might exchange blood sugar readings rather than attending clinic saving on surgery time for the clinician and travel time for patients. In Scotland, for instance, travelling time for patients who live geographically rural to see a specialist in Edinburgh or Glasgow can take many hours before returning home. The use of electronic gadgetry might not always be the most appropriate form of contact but it is a start in the right direction as to how best scarce resources within health care systems are being arranged to meet with priority needs.


Doctors and barbers are two professions where absolute trust is required to avail their services.

For medical profession, I see lot of cases where this trust is breaking down slowly.

For the barbers - not so! I still don't mind his steel on my throat.

Strange world we live in ... Barbers 1, Doctors - 0

Jacob Chacko

I agree that doctors are often too highly trained for basic symtomatic management that takes up so much of the GPs time (and makes a large chunk of his money). To train a health care provider in fewer years and with less money seems sensible, but the challenge would be to integrate it with the current system so that they have an efficient referral system.
As for the argument regarding technology replacing doctors....well IMO anyone who'd rather go to a machine for his treatment rather than coming to a doctor is more than welcome to do so.

teacup775 in reply to Jacob Chacko

Diagnosis is mostly a matter of sorting through a giant list of statistics on facts and fitting them to a patient's condition. You could have a nice human face to take your vitals interact with you, then querry an expert system -- a computer-- to report back the set of ailments which fit the criteria. So what to you want to to rely on, a computer system or some guy or gal who spent 20 years trying to retain and recall information a computer will do without error, or prejudice?

guest-iiinasj in reply to teacup775

It's very hard to program a computer to exercise real judgment. Before I enter an exam room I look at the patient's name and recall the major history over the 20 plus years I've been caring for that patient. I also recall the idiosyncrasies of that patient's personality that would influence how they present their symptoms and how they manifest their physical signs. I also remember the things that have and haven't worked in the past for that patient. Finally, after seeing a patient I base my recommendations on the past 30 years of medical experience I've had as a primary care physician.

These are the things that personal physicians do every day. Try getting that service from a computer or a "doc in the box."

Anon1658 in reply to teacup775

teacup, that is absolutely NOT what diagnosis is. Seriously. You shouldn't be commenting on things you don't know anything about out. A computer will not be able to replace a human physicians, not now, not in a 100 years, and maybe not ever. A computer knows only algorithms and is incapable of exercising proper, accurate clinical judgment. As any physician (or any other health care worker) knows, algorithms break down quite frequently in the hospital/clinic. Commonly, patients present in an uncommon way. The computer will be wrong a lot of the times in these cases, whereas the human physician with years of training and experience will be much less likely to be wrong.

We get it. You're on a personal vendetta against physicians. However, don't mislead others with false information.

Nuijel in reply to guest-iiinasj

I understand your point, and I am entirely willing to admit that we are a long time from algorithmic diagnosis.
However, from the examples you give, I see nothing that, IN THEORY, an algorithm could not do more reliably. Even the idiosyncrasies of misreporting symptoms could be modelized from past behavior.
But we need smart physicians to do that. They need to be the engineers of the healthcare process, not its groundworkers.

teacup775 in reply to guest-iiinasj

"It's very hard to program a computer to exercise real judgment."

The tech world is moving fast. Heard about Watson or the Google car project (related to the DARPA Grand Challenges, you know DARPA the people that brought you the internet)?
And a "Watson" could also do the same tasks, without fail and over all patient populations remembering every last detail, compiling statistics on outcomes, without any ego involved in the process. You concept of computers and what they can do are 20th century.

Even 30 years ago, I met research a scientist who had automated pathology examination, but while he could prove his system was more reliable, he acknowledged the AMA wouldn't ever accept it. This is in addition to other outcomes from projects dealing with diagnosis and treatment of ailments in areas where Drs are in short supply -- where minimally trained staff + paper flow charts for God's sake, resulted in better outcomes than physicians.

Let's put it this way, for any instance of all the things you do, or say you do, here is a short list of my own experiences:

1) as a child I was prescribed a course of antibiotics for a non existent condition because my parents wanted me to be treated with them and the Dr just went along with it. Intro into the world that Doctors treat without illness.

2) In college, a train of Dr kept administering the same tests over and over again for a complaint, yet I was only lucky later to have an internist recommended to me that actually figured out what the issue was. Intro to the idea that the bulk of physicians mindlessly apply tests.

3) Mid 30s, presenting classic symptoms of an ailment, I had urgent care Dr basically assume I was fishing for narcotics, and dismissed me after a perfunctory test came back negative. A week later, after finding a good internist. I demanded a copy of the radiologist's report. I was so mad about the 5mm "non existent problem" for which I had surgery for, I wanted to find that Dr and stuff the report down his throat. Intro to the idea that Doctors can harbor preconceived attitudes about people entering urgent care.

3a) Some time later, after entering ER for a sporting accident, the attending physician blithely referred to my right side as my left side and the x-ray technician wrenching around a broken limb in order to make his image acquisition "easier".

I've had a few sporting injuries. In *all* cases ER or urgent care staff can't be bothered to administer R.I.C.E without me harping on them -- thus prolonging my recovery and worsening my pain.

4) Rinse and repeat for other people I know who had other conditions, and for whom had repeated CT scans (with the lovely 400x radiation dose of a simple x-ray) because the Dr/Radiology dept couldn't be bothered to scan at the appropriate resolution to accurately determine the size of the feature being scanned. [CT is another area of medical image processing I've been involved in].

5) Yet other people I am acquainted with speak with annoyance that their doctors appear to want to push pills on them for anything.

6) Are "we" aware which community has been prescribing antibiotics for viral infections, thus encouraging the rise of resistant bacteria strains?

Speak all you like about 30 years of experience, but unless you have a scientifically/statistically based track record of outcomes of your specific treatments, I'll withhold judgement.

teacup775 in reply to Anon1658

"A computer knows only algorithms and is incapable of exercising proper, accurate clinical judgment."

Thus spake the individual that knows what about computers? My attitude doesn't come from the air, but from -researchers- who have developed automated systems for which physicians replied "you mean a trained monkey can do what I do?"

to which the researcher says "yes, AI works well in narrow and deep knowledge bases".

Anon1658 in reply to teacup775

teacup, where's the data that current technology can replace physicians? Link me a randomized, controlled study with one arm being a Watson-like machine and the other arm consisting of physicians that compares outcomes. Show me the data. Cite any well-designed study that states that machines can replace human beings in the most complex field known to man. By the time physicians have to worry about being replaced by machines, nearly every other job in the world will have already been taken over by machines. Fact.

Anon1658 in reply to teacup775

Also, considering that I work in a very tech-savvy field of medicine, I would be willing to bet that I know a LOT more about technology and it's use in medicine than any computer engineer without any medical training does. I also have a pretty solid understanding of limitations of technology, especially in the complex world of medicine.

I don't really care how many "researchers" you've talked to. I'm a researcher myself (though it's in medically-related topics and not computers) and I guarantee that no machine will be replacing physicians in the next 100 years, let alone our lifetimes. Even something as "simple" as image recognition in radiology is nowhere close to being able to take over for a radiologist. This again comes down to the enormous variability from one individual to another. A computer cannot account for the variability found in every single human being and adjust accordingly. That's where human judgment comes in.

As I mentioned earlier, if technology is so far advanced, you should be more worried about keeping your job. A nurse is much, much, much more likely to be replaced by a machine before a physician will ever be. Most professions in the world will be replaced by machines before medicine ever will be. That is absolutely a fact based on simple analysis of the complexities of human physiology and body function.

So, I ask again: Show me the data. Where is this extensive body of data showing that machines can replace physicians? You've repeatedly failed to provide any data that I've asked for, so I can only assume that you're making things up (as you have so far regarding so many other aspects of the practice of medicine).

Also, quick question: when the machine makes an error that leads to patient harm, who's going to be held liable? Will saying "Oh the machine is usually right. Just not when a patient does not present in a textbook manner" work in a courtroom? Even then, who's going to be at fault? The machine manufacturer? The tech who's running the machine? The machine itself? People tend to put a lot of trust in machines. But the moment a machine makes a mistake, will the general public be okay with it and risk their lives to a cold machine that only sees them as data points and confidence intervals and treats them based on simple probabilities without context or judgment? Is that ethical?


Dare I suggest it is time resources were put to doctors to review sick living and working environments, to prevent the continuing levels of service demand, as our population ages. Fumes and noise from increasing road traffic stress everyone exposed. Where are planners allowing schools and childcare centers to be located? There are jobs just waiting to shore up defenses in so many sites. Doctors could start the rush by declaring action on identifying and initiating demand for constraint public health risks.

No Mist

For routine healthcare duties, doctors are too overqualified. It is possible to have a array of trained professionals who are not legal doctors but still can treat most of the routine medical ailments. And they would then refer the patient to a doctor if the situation is complicated. India is to be lauded for making efforts in this direction. And the way forward is definitely private enterprise. Kudos to the private hospitals of India.

At the same time, doctors are behaving like the craftsmen cartel of 18th century. A strong political will is necessary to make required legal changes. A task where India singularly fails.

No Mist


Very impressive !

How many CEOs can do open heart surgery ?

SET Sail

Back in UK I used to call the GP, have the visit and most of the times prescribed the medicaments with no need of further analyses. I survived pretty well all those years.

Now in the US I call an admin, get a call back for the appointment, get another call back just in case I forgot, and when check in at the family doctor I am getting all sorts of pretty useless routine checks that consume other people's time...hence money. I'm certainly getting pampered, but am I getting better medical treatment ? Arguably not.

Am I spending more ? Way more in time, more in money too. The moral is that the health system improvements are not based solely on the number of docs available, but on lean processes being applied. And good old common sense remaining at centre stage.

Liveinhope in reply to SET Sail

SET sail

we differ in our experience and our opinion.

My mother , an 86 year old managed to fracture her leg some 5 years ago, went to the doctor, who told her to ho home to bed and that there was nothing wrong with her.
She spent the next 3 months with her daughter recovering from the intense pain and obvious discomfort.
Cam back home again and went to see the doctor. The locum was suprised.
He asked her ' Why did you not ask for some treatment, with an obvious crack in your leg? '

another incident : The same lady had a slight T.I.A some 2 years ago.
My UK qualified brother-in-law who is NOT allowed to be her doctor and who used to come to her house regularly every week, did not diagnose her symptoms about 5 days later ( she does not really self-diagnose).
The diagnosis was left up to my own brother 2 weeks later, whence the symptoms were still immediately obvious !

needless to say that He was furious !
You may well focus on costs and easy procedures, whereas I continue to focus on outcomes!

V3w79vgN38 in reply to SET Sail

Yeah, notice the difference between your experience and Liveinhope's experience is that you were not sick and Liveinhope's rels were sick. You don't need a doctor if you are not sick, basically. If you are sick, then you need good health care and it costs. The problem is that it is not obvious if you are sick or not. If it was obvious then a) there would be far fewer health horror stories and b) being a doctor would be MUCH simpler. Once you have a diagnosis, all you have to do is look up a book, unless a procedure is required. The differential diagnosis is the heart of medicine. And for this there very little electronic decision making assistance available, and a doctor AND an nurse practitioner will be better than just a doctor.


There is a striking similarity between the conclusions that we published in Health Affairs 10 years ago (in a paper urging action to alleviate the coming physician shortages) and The Economist's conclusion today (with shortages now at hand).

Cooper, Getzen et al, Health Affairs Jan/Feb 2002
Faced with shortages, it seems likely that physicians will be drawn to those complex areas of specialty medicine that demand their attention most and redefine themselves in ever more narrow scientific and technological spheres, while other disciplines evolve to fill important gaps.

The Economist, June 2, 2012
Resources are slowly being reallocated. Nurses and other health workers will put their training to better use. Doctors, meanwhile, will devote their skill to the complex tasks worthy of their highly trained abilities.

It seems clear that the roles of physicians are being redefined. Tomorrow's physicians will be specialists and consulting generalists in a workforce that includes a range of other professionals. All will carry out tasks commensurate with their abilities and worthy of their training.

Richard (Buz) Cooper, MD
Director, Center for the Future of the Healthcare Workforce
New York Institute of Technology

Nightscroft Squire Maldunne

Hospitals and Insurance companies eat up a great deal more of healthcare expenditures than do doctors. Blaming shortages of medical care on doctors is like blaming food shortages on farmers. The idea that by devaluing medical credentials and empowering the less educated, skilled, and life-dedicated, health care can be made
more affordable and accessible, is insane. Highly intelligent people
choose a career in medicine out of a genuine desire
to help others. There are many careers that are more lucrative and require far less time
and work than medicine. Its clear that the person who thought that enabling fly-by-night charlatans to make critical and expensive medical would save money decsions never went to medical school.

"Highly intelligent people choose a career in medicine out of a genuine desire to help others. "

I can't agree. I have directly dealt with idiot doctors and I know people that have as well. Misdiagnosis, bad treatment selection, lazy attitude, indolence.

Also to declare anyone who wishes to work in medical care a charlatan because they aren't an MD is the most vile slander.

Anon1658 in reply to teacup775

teacup, you clearly have no clue what you're talking about. The vast, vast majority of us who went into medicine did so because we genuinely wanted to help people when they are at their most vulnerable (ie. when they're sick). Many of us, myself included, have put aside our 20s to study in libraries, work 80 hours a week in hospitals, be woken up at all times of the night, etc. And we do this because we love what we do. No amount of money can ever make up for all the moments of life that I missed during training, the relationships that I've had to cast aside since there are only 24 hrs during the day and most of my time is spent learning medicine, and the sheer amount of determination and hard work it took for me to get to where I am. Countless times I've had to miss birthdays, weddings, and deaths of loved ones so I can take care of complete strangers in the hospital and help them recover their health.

Medicine is quite possibly the most complex thing that man currently knows of. The general public, I think, is spoiled by medical dramas where everyone seems to solve every problem on the first try. Coming up with a diagnosis is not an easy thing to do. There's an incredibly complex algorithm going on in our heads as we listen to our patient's history and decide what's relevant and what isn't for our decision making. Add to that the fact that there's so much variability from one person to another, you add another layer of complexity to an already difficult process. Bad treatment selection? Sure, that occasionally happens. What's a lot more common is that a treatment that works for a lot of others might not work for you. That again comes down to individual variabilities in physiology and body function/response. If a certain drug has worked for 99 of my patients with a particular condition, I'll probably choose that same one for the next patient unless something suggests it won't work.

I don't think any physician is declaring any health care worker a "charlatan" as you put it. What we ARE saying, however, is that there is no shortcut to becoming an excellent clinician. Physicians go through a minimum of 7 years of rigorous training, which includes tens of thousands of hours of clinical training, before we're allowed to practice independently. Now, you have people who have a fraction of that amount of training (NPs/DNPs often graduate with 500-1500 hours of clinical training, less than 10% of what full-fledged physicians receive). So, when someone with such little training claims that they're equal to someone who's put in a decade of training before practicing independently, of course it's going to rub us the wrong way. And the fact is that midlevels do not function at the same level as attending physicians do. At best, they function at the level of a 1st or 2nd year resident. And that's fine because that's what their trained to do. They don't receive the comprehensive training that physicians receive. And I can absolutely tell you, the people with less training will almost always make more mistakes than someone with more training and experience.

Just to clarify, these "idiot doctors" you're complaining of have had a minimum of 7 years of rigorous training and likely have more than 15000 hours of clinical training alone (which doesn't include classroom learning of the basic sciences). If such a vast amount of training still occasionally puts out an "idiot doctor," do you really think someone with a fraction of that training will make fewer mistakes, misdiagnoses, bad treatment selections, etc?

teacup775 in reply to Anon1658

A: I am speaking fro direct experience of doctors misdiagnosing me or people I know. Only about one doctor in five or six seems to not be an idiot. I've also dealt with the medical instrumentation business and I'll tell you, your luninaries are mostly ego and hot air.
B: It has been long established that personnel trained to take vitals coupled with AI performed signifigantly better than a full MD. This is because medical knowledge is narrow and deep; where AI excells and is not prone to silly sympathies and ego of doctors.
C: hours of devotion on your part does not mean that you will out perform automation. Last I saw giving up on a relatives birthday doesn't make you more intelligent or remove human failings.
D: The medical profession is one of the few industries that does not subject itself to QA. Physicians have rebellled against scientific research into effectiveness for decades. This flies in the face of the attitude of manufacturing or software.
E: You've been brainwashed about the nature of the complexity. Such is the nature of a priesthood, which in fact is the mythology of the profession.

Teacup, there are only two reasons someone interested in healthcare would not become a doctor:

1)They aren't smart enough and couldn't do well enough on the MCAT or maintain a high GPA.

2) They are lazy and are not willing or committed enough to dedicate many years of hard work to the profession.

Anon1658 in reply to teacup775


A: The plural of anecdote is not data. You make claims based on minimal experience and you present it as fact. I'm sorry you and your friends experienced misdiagnoses. I doubt every single misdiagnosis was a genuine mistake made by an "idiot doctor." As I already explained, and as you've clearly ignored, the process of coming up with a differential diagnosis and, ultimately, the final diagnosis is extremely complicated. Not even the best physicians in the world will be able to diagnose everything 100% accurately. There's too much variability for that to be possible.

B: It has actually NEVER been established that "personnel trained to take vitals coupled with AI" perform better than a physician. I've never even heard anyone suggest that until your post. And I've been in academia for more than a decade, so that alone says a lot. Where's the data? Only recently, with Watson, are people considering incorporating some computer-based algorithms into helping with the differential diagnosis. Even Watson will never be able to replace a resident, let alone a board-certified physician. Why? It's simple: algorithms always break down. If every patient presented exactly like what's written in a textbook, then yes, computers can take over medicine. Unfortunately, patients commonly present with uncommon constellations of symptoms. Medical knowledge is NOT narrow and deep. It's extremely broad and deep. Again, if it was so narrow, we wouldn't need such a lengthy training. That's the truth. Medicine is not easy. I don't know why you seem to think it is. It's dangerous thinking like yours that leads to patient endangerment: people who think they know everything are the ones most likely to make mistakes. This is especially true in medicine.

C: Actually, I (and my physician colleagues) will ALWAYS outperform an automaton. Being humans, we have one thing that a machine does not have: clinical judgment. That alone guarantees our superior performance over machines. A computer may be able to spit back data more effectively than a clinician, but it doesn't have the capacity to look at the patient history in context to develop an accurate differential diagnosis. My point in my previous post wasn't that missing birthdays made me a better physician. My point was that the decade of rigorous training, which was so rigorous that I frequently was unable to even take a day off for something like a loved ones' birthday, makes me an excellent clinician. You clearly missed the point that I was getting at.

D: The medical profession DOES subject itself to QA/QC. Where in the world did you get the idea that it does not?! We have weekly-to-monthly M&M (Morbidity and mortality) conferences where we discuss errors that have occurred in patient care and what steps must be taken to avoid such errors in the future. We have multiple QA/QC meetings to ensure that everything in the clinic runs smoothly and to minimize any possible errors. If we didn't have QA/QC, we'd be opening ourselves up for getting sued left and right! QA/QC is one of the most important things for a practicing physicians. Heck, a lot of us even keep our own database of patients we've individually treated in the past, with thorough history, assessment, treatment data, etc, so that we can assess any areas where we can improve ourselves. My own patient database is quite extensive and I frequently delve into it (and work with med students to mine that data for retrospective research projects) to improve the quality of care I provide. And "physicans have rebelled against scientific research into effectiveness for decades?" Hah. What are you talking about? The mantra of modern medicine is: evidence-based practice. You do realize that physicians are the lead investigators in the vast, vast majority of clinical trials designed to test the effectiveness of current treatments right? Why would we be running clinical trials if we weren't interested in researching the effectiveness of treatments?

E: Clearly, I've been brainwashed. You must be some sort of genius who knows everything about human physiology, pharmacology, pathophysiology, pathology, microbiology, etc, and the clinical application of each of those basic sciences. And I guess you come up with the right diagnosis, based upon a myriad of clinical symptoms, 100% of the time. If you are, kudos to you. 99.999999% of us aren't geniuses and we find medicine to be extremely complex. Guess we're all wrong and you're right.

In summary, you are clearly not part of any healthcare field. If you were, you'd realize how silly some of your statements are. What you have is a hatred for the medical profession, due to your bad experiences in the past, and you're using that emotion to drive you toward making unsubstantiated and blatantly false statements. Nearly everything you've written so far is completely wrong and not at all reflective of the practice of medicine.

That would explain the intense hatred for physicians. He/she likely didn't get into med school and decided to pursue nursing. And ever since, he/she has harbored an intense hatred for the people who were successful in getting accepted to med school. I've come across quite a few of these types of individuals over the years.

Full notice: I have nothing but the utmost respect for those in the nursing or other allied health fields! Their value in patient care is immeasurable. My response was aimed particularly at teacup, not the nursing profession in general. I know that the vast, vast, vast majority of nurses choose their profession because they genuinely wanted to be nurses. My post is based on the amount of vitriol and blatantly false statements that teacup has made.

teacup775 in reply to Anon1658


50 years ago, I suppose pilots would have said the something of flight. 50 years ago, computer scientists figured they'd have AI driving cars in 10 years. The got schooled by reality. Humbled they had to hunker down and do some hard work. A lot of research into cognition has taken place in that stretch of time. A lot of *that* research reveals just how limited our vaulted "reasoning" is.

The physician field is filled with tradition -- a lot of which is only that.

"The mantra of modern medicine is: evidence-based practice"

Yes, it took you guys aeons to get with the program and still medical staff have to be reminded to wash there hands to prevent the spread of infection. Like over a century ago, Doctors still refuse to soap and water.


Simply put, you don't get AI.

"My point was that the decade of rigorous training,.."

And my point is that years of rigorous training does not necessitate any meaningful result or imply that an automated system couldn't end up doing it faster and more reliably.


And I am to assume that somehow my experiences are a statistical anomaly? Or when *similar* anomalies show up in other people, it's just a fluke?

Anon1658 in reply to teacup775

Flying a plane is a LOT easier (relatively) to diagnosing and treating a human being. Every plane of the same model is the exact same. Every human body is different. Sure, maybe AI can take over the jobs of pilots (I still see pilots all over the place though, so I guess not). But you can't say the same for medicine.

teacup775 in reply to Anon1658


And see, this is why I dislike physicians so much. You get a falsehood into your heads and you run with it. Never ***ever*** had any desire to deal with your profession.

Keep taking that Nexium for ulcers guys, 'cause we know ulcers are caused by "excess acid", right?

Anon1658 in reply to teacup775

Again, show me the extensive body of data that suggests machines can take over every job on earth. Since medicine is one of the most complex fields, due to the amount of variability and complexities involved in the human body, it's unlikely to be the first field to be taken over. Nearly every other field will be taken over by machines before medicine will even be touched.

So, where's this data that we've been asking for? Where are these studies? You "talking" with someone doesn't equate to peer-reviewed, scientific data. So, where's this data? I'd like to see citations, especially since you make it seem like there are thousands of studies out there that suggest this.

Anon1658 in reply to teacup775


You DO realize that the relationship between H. pylori infections and gastric ulcers has been established for a while right? And that there are also separate conditions where there genuinely is an excess of acid produced that causes ulcers?

I find it really hard to believe that you're a nurse. Surely any nurse that graduated from a US program knows even this basic concept.

teacup775 in reply to Anon1658

"But you can't say the same for medicine."
That in itself is an assertion without basis. You are assuming today's technology and extrapolating into the future.
Every day the sky is a different place.
Amusingly, within the general aviation community, physicians have the worst reputation. Apparently something about the mindset leads to a higher incidence of accidents, if you believe private pilots. And no, I am not in their number either.
20 years ago an automated car would have seemed outlandish, and now things seem different. 20 years ago robotic systems to perform joint replacement surgeries were not available. How long will it be before they are standard? Computers calculate radiation therapies, and produce visualization aids for plastic surgery. CAD has replaced scores of drafts people, and made it possible for untrained individuals to design systems. And you assume that there won't be autodocs?
Researchers work assiduously to develop technology to automate discovery and diagnosis of disease from CT/MRI and sonograms. Automated pharmacy systems track contradictions in medications -- instead of filling your head with endless lists of outdate information on drugs.
The list goes on and on. Yet you want to believe that somehow people are *so* complex that only the high holy order of doctors will be able to practice it.
Pilots don't much fly the aircraft. They run through the check list, interact with the air traffic control and punch in flight parameters for the auto pilot. There are there for monitoring and to take control in extreme circumstances. Most commercial aircraft can fly themselves from takeoff to landing.
*ALL* I am a saying (with a lot of invective because yes, there are a lot of individuals in your profession that perform outrageously badly) is that a huge portion of medical practice operates under a huge premium paying a physician to do things that don't require that much skill or involves tasks subject to automation.

teacup775 in reply to Anon1658

I am not a nurse. You are taking hearsay from another physician as fact.

Is this an example of your fine clinical reasoning?

AND surely you know that for the longest time the running theory was excess acid caused ulcers. That is what Nexium was developed to treat. It was one of those money makers for Big Pharma.

One Australian doctor fought tooth and nail with established medical theory, going so far as to infect himself with the germ, contracting ulcers, then curing himself with a course of antibiotics thus proving his theory correct. Or are you that short on medical history?

Nexium now is sold over the counter as what? Mostly for acid reflux and as an adjunct to antibiotics with peptic ulcers.

teacup775 in reply to Anon1658

"Again, show me the extensive body of data that suggests machines can take over every job on earth."

A fine exaggeration, doctor. I just hope you don't indulge in the habit at the office.


Didn't suggest that. It is you who need to dig. The simple fact is the studies and developments are out there. The developing world will probably lead the way, because they don't have the time or the resources to indulge in a spoiled profession.

Anon1658 in reply to teacup775

So, if I'm understanding you correctly, you have absolutely no data to back up your statements? Okay, got it.

When someone makes a claim, it's up to the person making the claim to show data supporting that claim. It's not up to others to disprove it or dig around for data. That's how science works. Since you've been throwing out words like "scientific research" so frequently, there is no excuse as to why you don't understand this concept of burden of proof. The burden of proof rests on you, the person making the claims, to provide data supporting your claims.

That fact that you're incapable of providing any such data and have to resort to saying that "the studies and developments are out there" tells me that you have no studies to back up your statements. This is common problem we see in people who back themselves up into a corner by making ridiculous claims and then are asked to show the data that they claim exists.

So, just to be clear, you have absolutely no data whatsoever to back up your claims. Good to know.

teacup775 in reply to Anon1658

I can hunt it down, but I'm not going to bother with it, in the same way as I related to you about the history over the clinical history of the cause of ulcers.

And you and your "learned" colleague can still fantasize that I am nurse. Please go ahead and keep the mantra up. You can even start teaching it as received wisdom in your clinics.

teacup775 in reply to Anon1658

Just to give you some idea, here's what a simple Google search turns up here,
here and taste.

Gee look at those flowcharts. And guess what, they are developed after analysis of clinical treatment effectiveness. But of course, analysis could never get even more sophisticated than that...

The robots are coming for your job.

Certain bacteria and many plant species have larger genomes than humans....

maybe some of that complexity is just due to the limitations of un-augmented human research and a backwards rent-seeking profession.

Teacup, if you're not a nurse (though I'm sure I remember you saying you were), how did you become such an expert on healthcare and gain a basis for all of these remarkable insights?
There is nothing wrong with nursing, by the way, though it does seem to explain some of your opinions.

Anon1658 in reply to teacup775

How did either of your examples show that "robots" are coming for my job? The first one you linked to was a guideline for care of acute bronchitis. And that's all it is: a guideline. It's not a foolproof method of treating every single person with acute bronchitis. Haven't I explained enough times already that algorithms ALWAYS break down in medicine? How have you not understood this simple concept yet? Guidelines are not, and have never been, meant to substitute for clinical judgment. The majority of patients I treat have no real guidelines to follow. You know why? It's because clinical studies assess effectiveness, etc, in well-defined populations. And the majority of my patients do not fall within the parameters of the major studies used for a lot of guidelines. So, I have to extrapolate data and use clinical judgment (ie. my knowledge base of basic sciences and clinical sciences) in order to diagnose and accurately treat my patients. Your second link won't open for me for some reason.
I don't know why you keep thinking that guidelines and algorithms are foolproof. They're very far from being foolproof. Quite frequently, following guidelines can actually hurt a patient because, like I mentioned above, guidelines are based off of studies on selected sets of populations. The data then has to be extrapolated to each individual patient you encounter. And again, like I've mentioned many times, most professions in this world will be replaced by machines before physicians will be. As it stands, physicians are the "gold standard" in providing medical care. Whether you like it or not, whether you agree with it or not. It's simply because we receive the most amount of training out of any field in diagnosing and treating disease. So, I'm sorry to tell you, but we're here for a looooooooooong time. If I ever have to worry about losing my job to a machine, you'll probably already have been unemployed for years by then, whether you're in the health-care field or outside of it (you're even more vulnerable to be replaced by a machine if you're not in healthcare). It may be shocking to you but most people do not want to put their lives in the "hands" of a machine.

guest-iiweiml in reply to Anon1658

"Many of us, myself included, have put aside our 20s to study in libraries, work 80 hours a woken up at all times of the night."

"is quite possibly the most complex thing that man currently knows of. "

Funny thing is that perfectly describes my work, as well, but I'm no physician. In fact, I think this describes the experience of lots of professionals. Actually, I went to school and trained longer than you to make less money, but we don't have to talk about that. I've actually taught budding physicians; their overinflated egos and overvaluing of their work starts quite early in their career.

No, I have relatives that were. And to note, these are my opinions not theirs. Although the one with the nursing background (graduating with honors in the accelerated 1 year course for RN degree, -- while-- working as an LVN BTW) for some reason maintains a very tight leash on the doctors she'll deal with, as you might expect from somebody having to deal with rheumatoid arthritis, and the medications and surgeries that inevitably follow.

My cohort (geeks/nerds/engineers) find themselves reading publications like Cell or Nature for giggles and kicks. Some exposure comes from growing up in a university town that sports one of the major (medical) universities with friends and relatives dating research scientists doing things the AMA doesn't like cause it takes doctors out of the picture or are professionals themselves.

I developed such a strong negative attitude from experience. I say 4 out of 5 doctors I've interacted with have resulted in bad diagnosis or troubled treatment because that's the track record. I lost all patience over a few incidents (such as the doctor who decided I was fishing for narcotics when I came in displaying classic symptoms of gall-stone attack, for which his test came back negative and I was dismissed from his office, and for which 2 weeks later (after finding a competent internist and a quick sonogram), I exited gall bladder surgery for a 5mm stone.)

Couple this with the medical experience of both friends and relatives (5 of 8 suffered surgical "complications" or had doctors ignore them when they reported on their own physiological idiosyncrasies and for which the doctors had to eat crow) -- the worst of which involved my father languishing with a septic infection from a probably a botched suture for a colectomy. The problem I had with it was fecal matter was seeping into his abdomen for over a *month* with him becoming ever more delusional as infection took hold. The doctors just fobbed it off on him having dementia because of his medical history.

And who made the stunning Holmesian observation? A friend of the family, one with ABSOLUTELY NO MEDICAL EXPERIENCE, caught him fainting while being weighed, while the medical staff simply ignored him passing out, and complained. Only then did they test him for infection, and about 4 hours after receiving antibiotics for *some* reason his rationality was greatly restored.

Doctors who offered competent care, I have no issue with. The appear to be in the minority. So why bother with them, when they do nothing more that ape the recipes drilled into their brains by "years of clinical experience"?

Also I have developed software for medical instrumentation and been involved with automated analysis digital image data (what the medical profession so quaintly refers to as 'film-less'). I've seen the semi-frankenstienish insides of the medical profession's intersection with technology up close and personal like. I get twitchy when friends of mine have CT scans that under report the size of things... all because for some reason the scan settings were set at a lower resolution than was required for exam accuracy.

Couple this with news reports of glaring cost, error rate (oops we amputated the WRONG limb), the fact that tens of millions of people lack coverage, the medical establishment's reported idiocies, the cessation of autopsies and the questions it raises over QA,
hospital screw ups and inefficiencies (I heard plenty about the deficiencies of hospital automation), and reports of the success of programs delivering medical services in poor rural areas in the third world with non MD staff.

Lastly, and not least, dealing with the private insurance market.

So basically now, if I break an ankle, ask the attending ER physician's assistant to see the x-ray or MRI, while asking the staff for ice, elevation and compression, and if the fracture has no displacement and is the fibula (non weight bearing doncha know but I cross my fingers that the talus isn't involved), find my way home, take the crutches out of storage, apply my own immobilization, pain management, and inflammation control, stay off the limb for standard 4-6 weeks, and perform my own PT which I probably have enough practical to sit and get a certificate. I get full functionality back without the $20K price tag.

If I sprout a third arm, I might go to doctor about it, but maybe not.

Anon1658 in reply to teacup775

Oh, so you're not using science at all. Got it. You're extrapolating from a handful of doctor experiences to the entire profession as a whole. That alone shows your complete ignorance of the scientific method and basic statistics.

I'm sorry you had bad experiences and I'm sorry your family had bad experiences (if at all they experienced true surgical complications -- considering that you're speculating and that you have no medical knowledge base whatsoever, based on your posts so far, I'm going to go ahead and assume that your family members had a few bad outcomes and you're automatically placing blame on their physicians -- keep in mind that a bad outcome is not even remotely close to being the same as making a mistake or committing malpractice).

Either way, your ridiculous extrapolation of a very, very small number of experiences to the entire medical profession is straight-up wrong and unscientific. The simple fact is that doctors who are incompetent are very much so in the minority, not the majority. Why? It's because truly incompetent doctors are extremely easy targets for malpractice lawsuits. And due to these lawsuits, they will eventually lose hospital privileges, malpractice coverage (or ridiculously high premiums), and licenses. No one can protect truly incompetent doctors from their own incompetence.

Btw, when you complain about medical errors, keep in mind that it's extremely, extremely rare for an error to be caused by a single person, whether it's a physician or not. An entire system often has to break down before an error is committed. Medical error? A mistake could occur anywhere in the chain between physician, nurse, pharmacist, pharm tech, and many other players on the healthcare team. And the fact that tens of millions of people don't have insurance coverage has absolutely nothing to do with physicians. Physicians are not responsible for what insurance companies do or what the government does. So I don't know why you're attributing those issues in your hatred for physicians again.

That's great that you've developed some medical instrumentation. It's absolutely useless to us though unless you test it in a randomized, controlled trial compared to the current gold standard. So, run your large clinical trial comparing your method vs. a CT and if it ends up being superior to the CT, great. If not, honestly, you have no room to complain since you have no data whatsoever claiming its superiority over the current gold standard.

Here's a suggestion for you: next time you or a loved one get seriously sick or injured, don't go to a physician. You clearly know better. Seriously. Surely that'll teach us. And, like you said, you'll avoid having to pay for any medical service. Of course, you'll run the risk of serious, permanent damage or, potentially, death. But according to you, it'll be safer than seeing a doctor right? Btw, just an FYI, but a lot of your scenario regarding an ankle break doesn't make sense. Throwing around anatomical words in a very poorly designed clinical scenario (which doesn't make sense at all) further confirms your lack of basic medical knowledge and treatment management. I'd advice you to not rely on this shaky foundation you have over that of clinicians but, then again, I'm only just a physician. You probably know more than me, right?

V3w79vgN38 in reply to teacup775

Solution? LESS training? LOWER standards?

A real solution is a nurse practitioner AND a doctor. Having people look over your shoulder increases your standards. That is one of the reasons that there are two airline pilots in a plane - 1.3 mistakes per flight on average.

Also, too few doctors means less competition which lowers standards.

Ian Welch

We all run across the exceptions and for a time being many of us will live life as an exception.

It was pointed out to me by an acquaintance; “Look at that elderly couple, they are eating hamburgers and fries and they are at least in their 80′s.”  We often encounter the story regarding the 3 pack a day smoker that lives into his 90′s.

My response is always the same; 1 out of 3 of us will have no issues with health.  The flip side, 2 out of 3 of us will die from a chronic disease; heart disease, cancer or diabetes. 

Nearly 1 in 2 Americans (133 million) has a chronic condition. “Chronic Conditions: Making the Case for Ongoing Care”. 

90% of seniors have at least one chronic disease and 77% have two or more chronic diseases.  The Growing Burden of Chronic Disease in Americans

You always see that elderly couple eating burgers and fries because you never see the other couple, the couple that did not make it into their 80′s.

Our lives are defined by the daily precautions we take to avoid death.  We look twice when we cross a road, we wear our seat belts, we avoid bad parts of town, we don’t swim after big meals and never ever swim in the ocean at dusk.

However, the odds of dying by the actual disasters we spend so much time avoiding,  is statistically insignificant.  The odds of dying from flesh-eating bacteria is zero, but we are all aware of the possibility and sure as hell not going down any zip lines in Georgia anytime soon.

As a society we are fascinated by increasing the odds to our favor.  To gain an edge and increase the probability of success.

One year odds of:

Dying by shark attack: 11.5 million to 1

Dying in a plane crash: 11 million to 1

Struck by lightning: 6.2 million to 1

Walking across the street: 48,500 to 1

Drowning: 88,000 to 1

Murder: 16,500 to 1

I suspect if we allocated the same amount of time a day to eating healthy as we do to avoiding statistically improbable accidents we would see immediate health benefits.

Start equating your daily food decisions to the same type of instinctive behavior you use to fasten your seat belt.  Making the right choices regarding Nutrition is very similar to not being hit by lightning.  During a lightning storm you would not run over and hug the nearest flag pole; you would find shelter.

Logic dictates that eating a diet full of fats and processed foods is the equivalent of hugging a flag pole during a lightning storm.  You are not swaying the odds in your favour.

The point is:

A vast majority of chronic disease can be prevented and reversed by simply changing your nutritional input.  We have scientific, peer-reviewed evidence that supports a Plant Based diet increases your odds of dying from old age, not from a painful, disabling disease.

The House always wins because the House has a statistical advantage.  From time to time, an exception, will beat the House… but it is the exception. 

Statistics are meaningless when you regard yourself as an exception.  Unfortunately for many of us, it is not until you are a statistic that you realize this.

Ian Welch


Replacing primary care doctors with nurse practitioners and physician assistants will not do anything to control costs. I guarantee that mid-levels will generate more referrals to specialists than a good doctor would, thus increasing money spent on specialists.

The system in the US has to change, but fewer medical practitioners are required not more mid-level ones as there is a problem of supply induced demand. In the US unnecessary interventions are common, caused by unhelpful incentives and asymmetric knowledge. I bet that in rich countries outside of the US there have been improvements in doctor productivity.


Awesome, lets go ahead and create two health system: Uninsured/underserved populations will see nurse practioners and physician assistant that have poor understand that the much complex mechanism underlying even the commonest disease and middle upper class will be given the privilege of being assisted by adequatelly trained professionals. Who are you gonna be willing to see when you need? It is true that most chronic condition can be managed more guideline than thinking basic, and a midlevek trained professional would be helpful with that. But the skill of first seeing a patient, deciding if that person is or is not sick, creating a differential diagnosis and a treatment plan, that you cant get without lots of study and rigorous training

Lets go ahead and put the health of those that needs the most on the hands of professionals that didnt meet the credentials to go to medical school (which is fairly accessible for anyone who works har enough)

And if I may, let me clarify something: I certainly met doctors in my careers that overuse tests and procedure, but I nnver, ever met any that is willing to people to keep sick so they can have broader market, that clearly comes from someone that has no insight in medicine practice. We have jobs and market regardless, that wont change. And the healthier the patients are the better! More rewarding

I definitelly agree that helathcare costs needs to be cut down, and using medical aid professional for performing some tasks that would make doctors job more efficient is highly welcomed

And lastly, for the gentleman that mentioned regarding EMR, if you work with that you should be aware of the HIPPA legislation that utmost makes exchange of information between hospital the most complicated and improductive process in the world

Again, if you are sick, what medical care do you want?

teacup775 in reply to jufatsilva


And this is based on what scientific evidence? And how does this training compare with AI that can quickly sift through millions of statistics on probabilities with given conditions and offer up the results for the patient and their care giver to consider?

In this day and age most people I know Google to find out what set of issues they may be facing before going to the doctor. Often times they have to lead them by the nose to the problem, and I'm not talking wishy washing stress related complaints but things like gall stones etc. that those decades of training don't catch.

Doctors fantasize about the proficiency, yet never submit themselves to the rigors of QA in the field, so they never pay much attention to their mistakes. After decades of indoctrination and natural human ego, they like any other professional group believe all too much in their snowflake brilliance.

Anon1658 in reply to teacup775

A lot of patients do look up things on Google or WebMD before coming to see a physician. They're almost always wrong. In all my years as a practicing physician, I've seen exactly 2 patients come to the right diagnosis from doing web searches before coming to see me.

Computers cannot exercise judgments. They cannot put a patient's history into context. They cannot do a physical exam (or even a focused physical exam), which is an extremely important clinical tool. So no, a computer will not be able to outperform a human clinician. There is lots of scientific evidence that the decade of intense training is necessary to put out competent physicians. In fact, currently, there's talk of even extending the number of years of residency in many fields because there have been so many advances in medicine over the past decade that there's even more information to learn.

And, again (as usual), you're completely wrong about what the medical field is like. Medicine is subject to rigorous QA/QC. In fact, being a profession where mistakes can kill or permanently maim human beings, medicine probably has the MOST RIGOROUS QA/QC out of any profession in the world.

So, again, if you're going to attack the medical profession, at least use some accurate information. Cite your statements with studies that back up what you say. Otherwise, you just sound like another person who's angry at physicians because he/she did not get accepted to medical school.

V3w79vgN38 in reply to teacup775

If electronic decision-making assistance was available beyond drug interactions, I would grab it with both hands. The doctors would be the first to use it. An example of this is reading an ECG. This takes real skill to do properly, unless you have an ECG machine. I am happy to take the ECG machine's word for it. The problem is that the idea that there is decision making support is just pure fantasy. If there was such support, doctors would be the first to use it.

Scott Brzygot

It is of utmost importance for the medical community in the US to begin to understand the need for non-physician activity in many areas of the medical practice. Utilizing physicians for truly complex and necessary cases and others with highly skilled medical training to relieve these physicians of their time in more basic areas is of utmost importance for the US to meet the needs of an aging population. This was a well written article from the Economist on a highly topical and fragile issue.


I absolutely agree with many of the points made in this article. One of the most important ways to reduce healthcare costs will be using the skills of each healthcare worker to their fullest. There is no reason there should be waste in the form of restricting what certain medical workers can do to protect special interests. One thing that was talked about was the lack of managerial skills of physicians. Instead of just assuming that is the way it must be, I believe that one of the best ways to make medicine efficient in the future is to encourage doctors to gain managerial intuition. Doctors are always going to be paramount in medical leadership, so there might as well be a subset that is trained to do this most efficiently through managerial training via MBA programs or other routes

Adam Onge

Medical doctors are overrated and overpaid in most Western countries. They google things they don't know anyway, so for most of the stuff they do,there is no need for such a costly and specialised education. Besides, why should all these nerdy kids with good grades go to med school and law school? A good doctor needs a completely different set of skills, like how to smile nicely so that the patient feels taken care of. I don't go to a doctor to test his/her IQ (I'm not going to talk to them about Higgs bosons or dark energy or stuff like that!). I go there, when I'm not feeling well, for treatment and comfort. That's basic human psychology and they should know.

I don't know where you go your information about how doctors work, but it is completely false. As a son of two doctors and having shadowed doctors many, it is evident that taking care of the human body (arguably the most complex system known to man) takes a high level of intelligence. If you go to the doctor with what looks like a benign disease, but is actually life threatening, you want a doctor intelligent enough to recognize that not just make you "feel better."

A typical, rather arrogant response of medical doctors (even of their children?) about their profession. By the way, even if a dumb worthless human being like me dies, the human species will still survive for quite some time into the future (so don't worry about me "feeling better"). In fact, the human population has increased quite a bit since the "advent" of modern medicine, thanks to the "super-intelligent" medical doctors who can cure almost all the diseases we have (even though wars still kill people and so generals and politicians need not be as intelligent as medical doctors I assume lol)

ZM5 in reply to Adam Onge

You have to realize that when a doctor looks something up on google and reads it, there is a qualitative difference in their understanding of the read material than in yours. Two people can both read something and understand it differently-the years of training for a physician allow them to read information and place it an appropriate context. It's something you can't see happening-you just see the doctor reading the screen, so in your layperson mind you see it as "oh, the doctor has no clue, he's just looking it up," when in actuality he's doing a lot more. That's just one of the little things you take for granted. You think when the doctor is looking back at you smiling, he's a very simple person, when in actuality he is thinking light years ahead of you with respect to what's actually going on in your body. You're just too dumb to realize it.

Anon1658 in reply to Adam Onge

You clearly have had a bad experience at some point with a physician and are using that to make ridiculous, unsubstantiated statements.

If medicine is so easy, why does it a take a minimum of 7 years of training to become a full-fledged physician? There are very few professions that require that amount of training.

Adam Onge in reply to Anon1658

I went to University for longer than 7 years, but that's because being such a p-brane, I kept failing my classes and it took me quite a while to get a job. No wonder medical doctors look down upon people like me (although I do admit writing a reference letter or two for some students applying to med school many years ago, but maybe they didn't get in, I don't remember!)

teacup775 in reply to ZM5

The way you describe a doctor is a good description of a relational database. I'll take the database.

Also you could apply the same description to priests, which is why they've proven to be so much more moral than regular people. Just ask the kids placed in their care.

NHS Surgeon in reply to Adam Onge

Typical and disturbingly popular comments. Made, of course, when Adam is well. Not when he has just shattered his tibia and ground grass into the muscles cut to shreds through a massive gash in his shin. And relies on the nerdy kid with good grades to make the knife edge decisions right now that will determine whether he keeps it or not. Or the 34 yr old executive with a life-threatening psoas abscess who is going into septic shock under my eyes and I have to decide the timing of surgery vs a few more hours of massive doses of intravenous antibiotics and then surgery when, if, he gets better. [We delayed surgery, he did improve, we operated at the safer time and he is on the mend]. Or the unexplained aggressive possible necrotising fasciitis of the arm in a previously well 50 yr old man that was so fulminant he needed inotrope support in ITU. And we agonised whether he would need aggressive debridement of necrotic tissue or whether the anaesthetic would kill him. Fortunately the antibiotics worked and he is also [slowly] on the mend without losing anything more than a large patch of skin on the inside of his upper arm. Real cases this last week Adam. Yes, I used Google a few times: but I know how to put what is there into context, not blindly follow what could be sheer gibberish. So, if I smiled nicely enough, all these patients would be OK? It is the self-obsessed worried well who need the kind of 'doctor' you describe. Not really that physically ill, they just someone to suck out some sympathy, like a leech. I am not saying that a bedside manner, sympathy and all of that is not important: it just amazes me you think it is the most vital ingredient. Did it ever occur to you that the basic psychology all good drs learn as they progress through their careers also makes them able subliminally and instinctively pick up the negative and disparaging attitudes your post reveals. It is a self-fulfilling prophecy: drs will react defensively to the prickly smart alec you are and then you smugly say to yourself 'thought so, drs are all the same'. The problem, mate is with you.

V3w79vgN38 in reply to Adam Onge

Well, I do google stuff all the time. The difference between me and my patients is that I am able to put the googled knowlege in context. If a lawyer, or you, what every your profession is, googled something, then you would be able to learn from it or reject it in a way that I could not. As for just going to seek treatment and comfort, working out the correct treatment is not easy. If it was easy, there would be adequate electronic decision support, and ther is none, beyond Google and interaction software.

teacup775 in reply to V3w79vgN38

Rethink your search criteria.

The problem with doctors is that they think they are the _only_ ones who can put things in context, or more significantly, they are the only one who should be able to.

The largest problem with the medical profession is the culture, which has generally been an impediment. As a researcher said to me many decades ago, "I can prove my system is more reliable, but the problem is the AMA will never accept it". This from a researcher from one of *the* major medical institutions.

The issue is will not feasibility in this day and age.

Also, I find it interesting that while some here have seen fit to bait me about positive proof, they ignore the logical antithesis, which is are there any papers proving doctors are any better than computer guided diagnosis? If the answer is no, all of you have no rational basis to argue that *you* are by definition better than an expert system+human staff trained differently than the typical MD regimen in general or for a range of applications.


Everywhere medical costs will be driven down, except in the US, and as our economy continues to bloat with these overheads it will continue its drive to uncompetitiveness.


Answer to rising health cost in US- deregulate, deregulate, deregulate. One medical license for all the states. Make most of the medicines available over the counter. Do away with certificate of need. Take the power away from state health agencies- they are their to save their jobs in the guise of patient safety. Let the market economy work.

Concerned CM in reply to TheNeo507

I'm sorry but this is just plain idiocy. Health care needs regulations and structure. The U.S. has the most expensive health care system in the first world, yet it serves the least percentage of its population. It'll be prudent to see how other first world countries are doing it. The insurance system is driving up its cost, by having bureaucrats hired to "say no" to patients; that is not health care.


A large province of Canada now has a committee to address the demand for services from an aging population. So why did they put a doctor at its head?

In a recent interview he identified the same problem situations that have been identified repeatedly for the past 15 years .. as if he just discovered them. His solution is to add geriatric training for all doctors. He indicated no appreciation that change is stymied by politics.


Interesting to see the chart on number of doctors per population. However nobody mention the fact that in developed and developing countries , when you have a problem you have to see a lot of specialists. In 2009 I had a cancer near the amigdala, on the right side of my neck. I needed to se my doctor, see a troat specialist, a quimotherapist and a radioterapist, and dozen of nurses and operators.They all added to the bill. It is not too much?


What really needed at the times we are in is not tech- medicine but life style changes in populations. Bit of fresh air, bit of exercise, bit of less calorie intake will go a long way to a healthy societies. I feel all the govts worry & want is to spend less on health so that the economics dictate our well being not the individual responsbilty.The govts needs to spend more on life style changes.

teacup775 in reply to sadoshah

Quite agree. As much as killing off the medical priesthood is a Good Thing, all these cost saving measures do nothing to remove the profit incentive from treating illness. And that still benefits from sickness.

Deebles in reply to sadoshah

Persuading more people (aside, obviously, from the small minority who are underweight etc.) to adopt more exercise and less calorie intake is a very worthy goal. And I fully agree that it needs more time, money, thought, and even political investment.

However, so far as I am aware, no country in the world has yet succeeded in deliberately reducing its obesity prevalence (ignoring famine situations in failed states). Some have got fatter much faster than others, it's true; but the trend appears to be upwards everywhere. Barring some new magic bullet (and all anti-obesity drugs so far trialled have been highly disappointing), reversing this trend is going to be a very long, slow battle of persuasion; and in the meantime, the world's population is inevitably going to need a lot more healthcare.

OLS in reply to sadoshah

I think your statement about what is needs is "life style changes in populations" is on the right track but the solution requires far more than a "bit of fresh air, bit of exercise, bit of less calorie intake".

The Industrial revolution reorganized social structures from rural and agrarian to urban centric which then led to the emergence of social institution such as K-12 schools, hospitals, and social welfare instituions. To support these centralized institutions bureaucracies were born and government expanded in step.

Now however, we are beyond the adaptations to the Industrial Revolution. The information age and the advent of the WWW has diminished the Industrial paradigm need for centralization, uniform processing characteristic of factories, schools, hospitals and bureaucracies.

A new paradigm also means that we can consider, as a whole, what are the necessary conditions for healthy human development throughout the human life cycle and organize our societal systems on a scale of change like that of the Industrial Revolution.

If we did so, I do think we'd have a better chance of creating health and happiness for larger numbers of people than by focusing on treating chronic disease in a globally aging population with shrinking resources.

If you are interested in hearing more and commenting also I am developing these idea in greater detail at , a blog/website we will launch in the next few days.
Ely Zimmerman, M.Ed., M.P.H.



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