What we lose with data-driven medicine(nytimes.com)
nytimes.com
What we lose with data-driven medicine
https://www.nytimes.com/interactive/2018/05/16/magazine/health-issue-what-we-lose-with-data-driven-medicine.html
50 comments
Nothing we lose nothing.
It's so frustrating...people LOVE to drum up fear about technology.
But technology is an enhancer!
It doesn't prevent anyone from doing anything they did before.
If you want to use a horse and cart go for it.
If you want to use a old fashioned rolodex instead of Facebook go for it.
Use the tech or don't.
The problem is people resist change even if it's for the objective scientifically proven better.
sorry, but this exhibits a complete disregard for (or lack of understanding of) the practice of medicine. Many of us love technology - some of us even read hn. But physicians have very little choice regarding use of this kind of technology, other than to leave medicine or go into private practice where we only take care of wealthy people.
And re EHR in particular: is this technology an enhancer as you claim? Because it sure isn't reflected in any objective measures of clinical outcomes.
I agree, but what if the ideal for EHR just hasn't been realized yet? Regulation or not, there must be ways to improve. We probably don't see those innovations because most hospitals stick to the juggernauts such as Epic for their software.
You poor thing, it must be really hard having so much job security and such inflated salaries, due to artificial constraints on the supply of doctors by the medical mafia. You're not going to get a ton of sympathy here on HN, where your job or startup will get replaced in the bat of an eye whenever someone / something comes along that's better / cheaper.
It's not ok to attack a fellow user like this on HN, and we ban accounts that do it, so please read https://news.ycombinator.com/newsguidelines.html and follow the rules from now on. That means posting civilly and substantively, or not at all.
> your job or startup will get replaced in the bat of an eye whenever someone / something comes along that's better / cheaper.
Anyone that works to eat is in the same boat.
Anyone that works to eat is in the same boat.
Exactly and it will remove the artificial physician monopoly and put them in the same boat with the rest of the world
I can't even fathom how EHR is not better for patients.
Having a patients entire history at your fingertips collected through their lifetime.
Being able to apply machine learning to their symptoms to find possible obscure issues
Being able to combine data from populations to find new symptoms for illnesses
Being able to identify outbreaks alot faster
Better ability to analyize complex data to prevent drug interaction
And so many more.
No I think primary care and internal medicine physicians are threatened by technology and are resisting it, because 95% of what their job consists of is exactly what computers are really really good at, crunching data to find statistically likely outcomes.
Tech is going to do to medicine what is already happening in Law. Put 90% of physicians out of business by making the few employed physicians infinitely more productive.
In a 20 years we're going to view having a physician diagnose you as primitive as having a physician bleed you with leeches.
Having a patients entire history at your fingertips collected through their lifetime.
Being able to apply machine learning to their symptoms to find possible obscure issues
Being able to combine data from populations to find new symptoms for illnesses
Being able to identify outbreaks alot faster
Better ability to analyize complex data to prevent drug interaction
And so many more.
No I think primary care and internal medicine physicians are threatened by technology and are resisting it, because 95% of what their job consists of is exactly what computers are really really good at, crunching data to find statistically likely outcomes.
Tech is going to do to medicine what is already happening in Law. Put 90% of physicians out of business by making the few employed physicians infinitely more productive.
In a 20 years we're going to view having a physician diagnose you as primitive as having a physician bleed you with leeches.
Those things aren't being done with the EHR data, at least in the real world yet. Those benefits aren't being realised yet (which is far more likely due to regulation of the data rather than EHR uptake). To doctors, an EHR is just a replacement for paper with a clunky, hard to use interface. It's hard to beat the flexibility of paper.
From what I've seen from EHRs and other related software, they're absolute garbage to use. I wouldn't want to use one either.
From what I've seen from EHRs and other related software, they're absolute garbage to use. I wouldn't want to use one either.
Yup. The article presents a luddite’s false dichotomy. Evidenced-based medicine and critical-thinking skills are complementary. Moreover,
I’d prefer automation and optimization of as much of the repetitious work as possible... checking drug interactions, CADx comprehensive differential diagnonsis symptoms listing, CADe in radiology as a second-opinion and more.
It is also annoying when professional “priests” commit what amounts to claiming only they have the mystical gifts to interpret what aren’t “tea leaves,” when it’s usually done out of fears of job security, special power and/or change of a legally-protected professional class.
It is also annoying when professional “priests” commit what amounts to claiming only they have the mystical gifts to interpret what aren’t “tea leaves,” when it’s usually done out of fears of job security, special power and/or change of a legally-protected professional class.
Exactly. Medicine is taking a set of data (symptoms) about an ill patient and determining the statistically likely problem.
It's a basic data analysis which is exactly what computers are good at.
No Tea Leaves involved.
This whole pushback by physicians is about status, jobs, wealth, etc.
In a 20 years we're going to view having a physician diagnose you as primitive as having a physician perform bloodletting or trepanation on you.
It's a basic data analysis which is exactly what computers are good at.
No Tea Leaves involved.
This whole pushback by physicians is about status, jobs, wealth, etc.
In a 20 years we're going to view having a physician diagnose you as primitive as having a physician perform bloodletting or trepanation on you.
Requiring technology means requiring capital investment, which means few solo practitioners (already happened) and practices controlled by massive bureaucracies.
This has benefits and costs.
This has benefits and costs.
Free and Open source software has existed in the medical sector for decades. E.g:
https://en.m.wikipedia.org/wiki/VistA
https://www.open-emr.org
FOSS software suffers from the same problems gaining a foothold in healthcare as it does in most sectors - namely a lack of money to spend on sales, and a malaise of FUD.
https://en.m.wikipedia.org/wiki/VistA
https://www.open-emr.org
FOSS software suffers from the same problems gaining a foothold in healthcare as it does in most sectors - namely a lack of money to spend on sales, and a malaise of FUD.
That's some of the issue. Also probably some usability and integration problems. Zocdoc tells some good stories about how hard integration with medical software is.
I use the same technology for my personal projects (AWS, Rails, C#) that my company does for it's enterprise projects.
My social worker friend already uses a SaaS for his billing and patient management.
I think technology will massively enable solo practitioners.
My social worker friend already uses a SaaS for his billing and patient management.
I think technology will massively enable solo practitioners.
Ask a medical doctor or dentist how much they pay for the various technology they use in their office. Even electronic medical records, as useful as they are, will have some negative effects for patients via the economics of medicine. EMRs are net positive, of course.
Perhaps some day, the medical field will experience the same boom in open source and inexpensive services. That day ain't tomorrow.
Perhaps some day, the medical field will experience the same boom in open source and inexpensive services. That day ain't tomorrow.
I don't trust physicians or dentists opinions on this subject, because they have a vested interest in preventing technology from disrupting their field.
Its better to be the oracle with the Tea Leaves garnering the accompanying salaries and status.
>> Perhaps some day, the medical field will experience the same boom in open source and inexpensive services. That day ain't tomorrow.
You're right it's today. There's a bunch of HIPPA compliant, reasonably priced SaaS's available to do just this. Google it.
The obstacle lies in getting medical professionals to give their status, cush jobs, and money over to a machine for the betterment of patients and the field, which is going to be a hard won battle.
I for one can't wait until a nurse with good beside manner takes my samples and symptoms, sends them to a lab/records them in an EHR, and a machine with zettabytes of data and years of machine learning diagnosis me with more accuracy than a human ever could imagine.
Its better to be the oracle with the Tea Leaves garnering the accompanying salaries and status.
>> Perhaps some day, the medical field will experience the same boom in open source and inexpensive services. That day ain't tomorrow.
You're right it's today. There's a bunch of HIPPA compliant, reasonably priced SaaS's available to do just this. Google it.
The obstacle lies in getting medical professionals to give their status, cush jobs, and money over to a machine for the betterment of patients and the field, which is going to be a hard won battle.
I for one can't wait until a nurse with good beside manner takes my samples and symptoms, sends them to a lab/records them in an EHR, and a machine with zettabytes of data and years of machine learning diagnosis me with more accuracy than a human ever could imagine.
> I don't trust physicians or dentists opinions on this subject, because they have a vested interest in preventing technology from disrupting their field.
You don't need to trust, but only use a little logic. Would a doctor prefer to reduce expenses and increase profits? Of course there's some interest in preserving status quo, but as that "Cult of the Root Cause" [0] article pointed out, there can be many system dynamics working simultaneously.
[0] https://news.ycombinator.com/item?id=17109114
You don't need to trust, but only use a little logic. Would a doctor prefer to reduce expenses and increase profits? Of course there's some interest in preserving status quo, but as that "Cult of the Root Cause" [0] article pointed out, there can be many system dynamics working simultaneously.
[0] https://news.ycombinator.com/item?id=17109114
I agree they would prefer to reduce expenses and increase profits however that's not what the long term outcome of medical automation is going to do. It's going to put them out of business.
Exactly, enabling the market to be controlled by a handful of large corporations, which has some negative consequences for patients (in addition to the benefits of technology).
Just consider all the conversations people have about Google. Life is just so much better with Google Search and YouTube -- learning things is so easy now. Yet, there are some nagging doubts about what we gave up to have that access to information.
Just consider all the conversations people have about Google. Life is just so much better with Google Search and YouTube -- learning things is so easy now. Yet, there are some nagging doubts about what we gave up to have that access to information.
It could go numerous ways.
It could be centralized, it could be a bunch of contractors working for a large corporation like uber health, or technology could do what it did for the record industry and enable the small provider.
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I'm curious, what examples did you see in the article that were indications we were "losing nothing"?
It sounds like the problem is in the people or procress then if they cut corners and aren’t thorough.
I didn’t see the computer or data failing in my hastey read through of the piece. It always contained what data the people entered.
I didn’t see the computer or data failing in my hastey read through of the piece. It always contained what data the people entered.
People make mistakes in communication all the time. Other humans can notice and interpret around those mistakes, but computers can't. Humans can infer things that are missing or implicit in the data. Computers can't. So if we build a computer system on top of data that we _know_ will be poor, incomplete, and sloppy, and if we force reliance on that system, then that's a major problem.
It's silly to assert "the computer didn't do anything wrong". The computer has no agency or will. It doesn't matter if we run perfect software against a bad dataset, or if we run perfect data through bad software. The only thing that matters are the results. The computer and the people are all parts of the same system.
It's silly to assert "the computer didn't do anything wrong". The computer has no agency or will. It doesn't matter if we run perfect software against a bad dataset, or if we run perfect data through bad software. The only thing that matters are the results. The computer and the people are all parts of the same system.
This is one of the really sad thing about medicine today. For those of us who remember how going to the doctor used to be, the experience these days is so disheartening. All that slavish tending to to the computers and data entry instead of spending time with the patients. Nurses and even nursing assistance have also been greatly impacted by this.
This is not an EHR problem. This is a poor bedside manner problem.
Lamenting documentation requirements is as old as Medicaid itself. With more and more oversight by governing bodies and the burdens of "quality-metrics", the personal connection with carers will be increasingly distant.
I love electronic records because I don't have to handwrite anymore, and all the data I need is just a few clicks away. The problem isn't the electronic nature of the records, but rather the reporting and documentation requirements that come with it. Why are there increased amounts of documentation required? Because it is a form of rationing: make patient care so time consuming that fewer patients can be seen, and less can be billed long term. It really is a pernicious way to decrease healthcare expenses, but it comes at the cost of depersonalizing patients, physicians, and nurses.
That, and also legal protections because lawyers exploit any "bad outcome" as negligence, even though no negligence occurred.
I love electronic records because I don't have to handwrite anymore, and all the data I need is just a few clicks away. The problem isn't the electronic nature of the records, but rather the reporting and documentation requirements that come with it. Why are there increased amounts of documentation required? Because it is a form of rationing: make patient care so time consuming that fewer patients can be seen, and less can be billed long term. It really is a pernicious way to decrease healthcare expenses, but it comes at the cost of depersonalizing patients, physicians, and nurses.
That, and also legal protections because lawyers exploit any "bad outcome" as negligence, even though no negligence occurred.
it does seem shameful that payers so frequently rely on denying care / making billing hard to cut costs when there are so many other things they could do that are harder but higher impact
Also, I'm only recently learning how pernicious the fear of malpractice suits is, and how this fear makes doctors reluctant to collaborate informally -- if you can't see a patient yourself or get their full chart, the perceived liability risk is high enough to prevent informal collaboration
Also, I'm only recently learning how pernicious the fear of malpractice suits is, and how this fear makes doctors reluctant to collaborate informally -- if you can't see a patient yourself or get their full chart, the perceived liability risk is high enough to prevent informal collaboration
Yes, doctors should focus on the patient and the family, not the computer. Technology should be scrutinized to be more supportive.
Yet a significant problem with this article is that it provides no comparison to other professions.
"A clinician will make roughly 4,000 keyboard clicks during a busy 10-hour emergency-room shift" -- I doubt that 4,000 "keyboard clicks" is unusual for any profession at present, even one where attention is moving across interactions with patients, colleagues, machines, and the computer. A page of text is about 3,000 characters.
(Aside: I'm actually not quite sure what is meant by a "keyboard click" is -- maybe the author is talking about mouse clicks or toggling checkboxes; elsewhere in the article the phrase is "4,000-key-clicks-a-day" -- if it's just 4,000 taps to keyboard keys, that's a pretty low number. I don't think that 4,000 checkbox or mouse clicks is even really such a big number. Answers here (https://www.quora.com/What-is-the-avarage-number-of-mouse-cl...) suggest between 5000 and 7000 mouse clicks/day. Another resources says a doc does about 2500 clicks/day -- http://www.healthcareitnews.com/infographic/infographic-one-... -- and that's for a 16 hour shift.)
In any case, is there something distinct about clinician work with regard to the use of computers, compared to what we're all doing? A claim that there is would strike me as special pleading. If there is an argument to be made, it must be made comparatively.
The author also claims that "Even if the E.H.R. is not the sole cause of what ails us, believe me, it has become the symbol of burnout" -- do doctors _really_ suffer from more burnout than other professions? _Doctor-authored_ studies may say so, but we need to have unbiased studies of burnout across the professions, and understand generally how being lassoed to a computer affects morale.
Yet a significant problem with this article is that it provides no comparison to other professions.
"A clinician will make roughly 4,000 keyboard clicks during a busy 10-hour emergency-room shift" -- I doubt that 4,000 "keyboard clicks" is unusual for any profession at present, even one where attention is moving across interactions with patients, colleagues, machines, and the computer. A page of text is about 3,000 characters.
(Aside: I'm actually not quite sure what is meant by a "keyboard click" is -- maybe the author is talking about mouse clicks or toggling checkboxes; elsewhere in the article the phrase is "4,000-key-clicks-a-day" -- if it's just 4,000 taps to keyboard keys, that's a pretty low number. I don't think that 4,000 checkbox or mouse clicks is even really such a big number. Answers here (https://www.quora.com/What-is-the-avarage-number-of-mouse-cl...) suggest between 5000 and 7000 mouse clicks/day. Another resources says a doc does about 2500 clicks/day -- http://www.healthcareitnews.com/infographic/infographic-one-... -- and that's for a 16 hour shift.)
In any case, is there something distinct about clinician work with regard to the use of computers, compared to what we're all doing? A claim that there is would strike me as special pleading. If there is an argument to be made, it must be made comparatively.
The author also claims that "Even if the E.H.R. is not the sole cause of what ails us, believe me, it has become the symbol of burnout" -- do doctors _really_ suffer from more burnout than other professions? _Doctor-authored_ studies may say so, but we need to have unbiased studies of burnout across the professions, and understand generally how being lassoed to a computer affects morale.
If anyone in this thread is a physician, and is looking for more autonomy in the way that they practice medicine my email is in my profile. We're working on fixing these problems at our clinic and what we've built could be of interest to you.
It's not like the doctors themselves are going to drive down the cost of healthcare. Machine driven medicine is the only way we can replace overpaid doctors who aren't doing anything much more intellectually challenging than car mechanics and yet are exploiting the American health care system for all it's got. At first the machines are going to be used for those without good health insurance, as those machines get smarter eventually even rich people will use them, and we can finally start to lower health care costs for everyone.
Exactly.
There are so many ideas here for how computer systems could be improved. It reads like an argument against the computer in a medical setting (or at least a move away from current, perceived, over-reliance) and yet systems could so easily fix 99% of these problems.
Yes, but - this is a highly regulated environment and barriers to entry are quite high. Very hard for new ideas to get a hearing.
The business of medicine in United States is about extracting reimbursements from payers while keeping regulators happy. Well-being and satisfaction of the patient is important only incidentally. Since most doctors would prefer to be in the business of helping patients, finding themselves in the business of billing insurance causes burnout.
Blaming the automation software for this fundamental misalignment is silly. Software is just a tool that optimizes for the needs of the business and the customer. And in American healthcare the patient is not the customer. Insurance companies and the government are the customer.
Blaming the automation software for this fundamental misalignment is silly. Software is just a tool that optimizes for the needs of the business and the customer. And in American healthcare the patient is not the customer. Insurance companies and the government are the customer.
I realized the other day we find ourselves increasingly influenced by algorithms. Intentionally or not people are forming their lives around arbitrary algorithms. The YouTube guy who reacted outrageously in a Japanese suicide forest was forming his life decisions according to YouTube's algorithms to generate views. Now doctors are making medical choices based on algos, what's next?
At what point does the hivemind merge with algorithmic ML to form a sort of distributed AI?
At what point does the hivemind merge with algorithmic ML to form a sort of distributed AI?
These EHR systems sound difficult and time-consuming to use. If they can't/won't be directly improved any time soon, why don't nurses and doctors have data entry specialist partners to do the clicking and typing? Why not take some people with a 2-year medical data entry certification and train them to use $INSTITUTION's customized EHR system? It seems crazy to make people who are qualified to actually diagnose and treat patients spend half their time on clerical work using cumbersome software.
Maybe people are worried that EHR quality would suffer if people with fewer credentials entered the data. According to the article EHR systems are already full of garbage data entered by physicians. Does it actually get worse if data entry specialists do the entry instead? This appears to be readily testable. You can have them do it in parallel with the physicians who enter their own EHR data now, and compare after a year.
Maybe people are worried that EHR quality would suffer if people with fewer credentials entered the data. According to the article EHR systems are already full of garbage data entered by physicians. Does it actually get worse if data entry specialists do the entry instead? This appears to be readily testable. You can have them do it in parallel with the physicians who enter their own EHR data now, and compare after a year.
The EHR systems I have seen in hospitals remind me of a lot of the typical enterprise software systems. Convoluted and really hard to use. Pretty much all the systems my company uses just plain suck.
I think it has to do with the fact that the buyers (decision makers) of the system are not the actual users so decisions are made based on everything but usability.
I think it has to do with the fact that the buyers (decision makers) of the system are not the actual users so decisions are made based on everything but usability.
I agree. I feel like this is an implementation problem not a problem with EHR in general. Just because a Ford Pinto is a bad car doesn't mean cars in general are bad.
As time goes on people will figure out new ways like you're suggesting of using the technology.
As time goes on people will figure out new ways like you're suggesting of using the technology.
They do, they’re called scribes.
That makes sense. Do you know why they aren't more common, to the extent that many doctors apparently spend much of their day on EHR data entry?
Maybe I'm just relying too much on this article plus a few similar complaints I've read in the past. Maybe most doctors don't spend much time on data entry but I only see the grievances of the few that are forced to.
Maybe I'm just relying too much on this article plus a few similar complaints I've read in the past. Maybe most doctors don't spend much time on data entry but I only see the grievances of the few that are forced to.
So I'm a medical student, as you can probably tell from my comment history. I once helped write a proposal for the American Medical Association related to medical scribes - individuals that record all the data from physicians into the EHR. The idea for these scribes were to allow physicians to focus on the patient care aspect rather than the documentation and billing.
Our proposal was approved almost unanimously by the student section of the meeting, but was argued extensively by the physician section, not on the proposals actual merit, but on the usefulness or lack thereof of scribes. Some delegates thought that they led to errors in documentation (our proposal was to study this), others thought they would be leapfrogged by newer technologies and thus unnecessary.
Long story short, I have two comments. The first, that having more scribes would be beneficial in letting doctors being doctors, perhaps being a simple solution to the problems demonstrated in the article.
The second is that doctors from all kinds of specialties probably agree on many issues affecting patient care and physicians at large. However, all I see are disagreements.
Our proposal was approved almost unanimously by the student section of the meeting, but was argued extensively by the physician section, not on the proposals actual merit, but on the usefulness or lack thereof of scribes. Some delegates thought that they led to errors in documentation (our proposal was to study this), others thought they would be leapfrogged by newer technologies and thus unnecessary.
Long story short, I have two comments. The first, that having more scribes would be beneficial in letting doctors being doctors, perhaps being a simple solution to the problems demonstrated in the article.
The second is that doctors from all kinds of specialties probably agree on many issues affecting patient care and physicians at large. However, all I see are disagreements.
I co-own a medical clinic and would love to talk with you about how we solve efficiency problems in our practice. (scribes are too slow/expensive) My email is in my profile.
The fact that you feel that additional personnel are necessary to document what another person does speaks volumes as to the unnecessary documentation requirements. We should pare back documentation requirements so that one person can do it without another person's help.
I don't see how that follows - especially given the point of documentation is for spotting errors and preventing malpractice. While much of the medical documentation is overly bureaucratic and poorly designed especially when billing and codes are involved it is completely possible that work could be assisted by a note-taker. Especially when their job is to make it readily understandable to those outside of the immediate context.
Not to mention that the notes are pertinent to goals other than patient treatment. A mechanic might replace every known bad part and could handle it himself by just noting the inventory changes but that would be discarding much of the engineering useful data like how the commonly worn out parts were damaged.
Anyway my personal opinion of the medical data systems are that they aren't unnecessary but awkward and poorly designed - perhaps due to having to serve too many disparate goals and having very complex systems to track in the first place.
I could see adaptive data charts and interfaces being useful in that context. A patient with one leg would have now irrelevant fields fields autofilled as "N/A - amputated" or similarly in their relevant contexts.
Not to mention that the notes are pertinent to goals other than patient treatment. A mechanic might replace every known bad part and could handle it himself by just noting the inventory changes but that would be discarding much of the engineering useful data like how the commonly worn out parts were damaged.
Anyway my personal opinion of the medical data systems are that they aren't unnecessary but awkward and poorly designed - perhaps due to having to serve too many disparate goals and having very complex systems to track in the first place.
I could see adaptive data charts and interfaces being useful in that context. A patient with one leg would have now irrelevant fields fields autofilled as "N/A - amputated" or similarly in their relevant contexts.
How is it any different than being a client of an accountant or lawyer? Or being an assistant to an executive?
Regardless, looking at the present, in my opinion having scribes available would provide a simple solution to a problem often bemoaned in medicine.
Regardless, looking at the present, in my opinion having scribes available would provide a simple solution to a problem often bemoaned in medicine.
You're confusing mid-level practitioners with scribes. Lawyers have paralegals. Physicians have PAs or NPs.
The existence of someone whose sole job is just following a clinician and documenting for them is absurd. Medicine in the past was fine with paper charts. Sure there was some inefficiency with collecting information. Medicine these days is actually less complex than in the past because answers are more readily available with diagnostic testing. Why is more documentation required today compared to the past?
We should all strive to simplify medicine, not facilitate ever increasing unnecessary complexity.
The existence of someone whose sole job is just following a clinician and documenting for them is absurd. Medicine in the past was fine with paper charts. Sure there was some inefficiency with collecting information. Medicine these days is actually less complex than in the past because answers are more readily available with diagnostic testing. Why is more documentation required today compared to the past?
We should all strive to simplify medicine, not facilitate ever increasing unnecessary complexity.
I wonder what the actual split of those two hours of EHR per one hour of patient care is actually targeted for _medical_ information vs cost accounting and risk management?
My experience (and resulting skepticism) in data collection for business suggests that “the business” side is the driver behind many or most of the inefficiencies.
My experience (and resulting skepticism) in data collection for business suggests that “the business” side is the driver behind many or most of the inefficiencies.
To the commenters claiming “scribes” can do this. It’s just not that easy. I was involved in developing a scribe system. It worked for a couple doctors. We thought we had the next big thing. The doctors were able to go in and actually talk to and look at the patient while a scribe sat in another room and listened to the conversation and watched a mirror of the doctor’s tablet (all with patients consent). By the time the doctor left the exam room, the progress notes were completed and prescriptions, follow-ups etc. were ready for order. The doctor just had to review and complete. System was great. Doctors were able to go home at a decent hour instead of spending 2 hours in the evening going over each patients encounter. When we tried to expand it failed. In hindsight it was easy to understand why. The scribes we initially used were CAs who had been working with these doctors for years and they could pick up on subtle verbal cues generating complete encounter notes just based on a few comments. In our experiment, it just didn’t work once we brought in scribes who had never worked with or around the doctors. I’m sure there’s a way to make this work and hopefully someone will one day. It would be nice to have a conversation with my doctor again. Anyway, just some thoughts. I see a lot of posts in here discounting the article and claiming the world is ready for computers to replace doctors, and it’s just the greed/ignorance of doctors holding us back. If you’re ready to put your life in the hands of AI and computers, I wish you the best of luck. I just want a system where doctors can actually be doctors again. The greedy people in our health care system don’t wear white coats. They run around with titles like “Hospital Administrator”, “Pharmaceutical Rep”, “Health Care Lobbyist”, “Senator/Congressperson” and “Insurer”.