VC legend Vinod Khosla believes that medicine will go mobile and most doctors will be out of a job

[tdram]

Bc they don't actually practice clinical medicine full time. They're more figure heads, thought leaders, etc.

So then the people who do practice clinical medicine should take it upon themselves to correct this, if they really do care about the future of healthcare in this country... Even if it means it's going to cost them some money. There's no reason they can't. There's enough of them and enough money between them to make it happen.

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[DermViser]

So then the people who do practice clinical medicine should take it upon themselves to correct this, if they really do care about the future of healthcare in this country... Even if it means it's going to cost them some money. There's no reason they can't. There's enough of them and enough money between them to make it happen.

They don't have the power. Just like AMA speaks for all physicians even though like 15% of physicians are part of the AMA.

 

[drhenPharmD]

Bc physicians have better things to do and bc either way docs will be demonized for "picking" on nurses.

Midlevels, including pharmacists, are definitely not practicing to the peak of their education and licensure. I wouldn't say incorporating them more deeply into healthcare would make it inferior.
I do agree, however, that physicians do not care about patient safety as much as they should. They are selfish and complain too much. I imagine this is the deeper reason that physicians don't publish studies to reinforce that they can achieve better meaningful outcomes.

 

[tdram]

They don't have the power. Just like AMA speaks for all physicians even though like 15% of physicians are part of the AMA.

What exactly is stopping them from getting the power? This is a lame excuse. If practicing physicians really cared to fix this, they could. They could take over the AMA. They could form a new group and organize a massive movement. They could put out studies showing that they can achieve better outcomes. At the very least they could educate their patients. They could take out ads on TV and on the web. There's so much they could do if they wanted to.

 

[DermViser]

Midlevels, including pharmacists, are definitely not practicing to the peak of their education and licensure. I wouldn't say incorporating them more deeply into healthcare would make it inferior.
I do agree, however, that physicians do not care about patient safety as much as they should. They are selfish and complain too much. I imagine this is the deeper reason that physicians don't publish studies to reinforce that they can achieve better meaningful outcomes.

You are free as pharmacists to do primary care visits (at least in California) and take the liability that comes with that. Hope you know how to do an H&P.

 

[DermViser]

What exactly is stopping them from getting the power? This is a lame excuse. If practicing physicians really cared to fix this, they could. They could take over the AMA. They could form a new group and organize a massive movement. They could put out studies showing that they can achieve better outcomes. At the very least they could educate their patients. They could take out ads on TV and on the web. There's so much they could do if they wanted to.

You'll see soon enough why by the time you're an MS-4 or a resident. The AMA gets more money from the govt. for it's CPT billing codes than from member dues. Thus it's no surprise they sold out doctors to Obamacare: http://www.forbes.com/sites/theapot...2-million-reasons-to-help-shrink-doctors-pay/

Many patients even say they prefer an NP bc they're "nicer" or "spend more time" with them. Any action on our part will just be attributed to jealousy and protecting the guild.

 

[drhenPharmD]

You are free as pharmacists to do primary care visits (at least in California) and take the liability that comes with that. Hope you know how to do an H&P.

I can't tell if that's sarcasm. Can they really do PC visits in CA? I know pharm associations are active in the CA legislature.

Anyway, diagnosing isn't and never will be a pharmacists forte. It's chronic disease management.

In CA, pharmacists go thru 4 yrs undergrad, 4 yrs pharm school and 2 yrs residency to become a primary care specialist. If I had to see a non-physician for my primary care, I'd see a pharmacist.

 

[tdram]

You'll see soon enough why by the time you're an MS-4 or a resident. The AMA gets more money from the govt. for it's CPT billing codes than from member dues. Thus it's no surprise they sold out doctors to Obamacare: http://www.forbes.com/sites/theapot...2-million-reasons-to-help-shrink-doctors-pay/

Many patients even say they prefer an NP bc they're "nicer" or "spend more time" with them. Any action on our part will just be attributed to jealousy and protecting the guild.

Just started MS4 two months ago. I think the real reason is that physicians today don't want to rock the boat. They like making money off of Pas and NPs, and they don't really care what's going to happen 10, 20 years down the line when every tom, dick and harry can practice medicine independently after an online course. Unfortunately by then it will be too late to do anything.

 

[tdram]

I can't tell if that's sarcasm. Can they really do PC visits in CA? I know pharm associations are active in the CA legislature.

Anyway, diagnosing isn't and never will be a pharmacists forte. It's chronic disease management.

In CA, pharmacists go thru 4 yrs undergrad, 4 yrs pharm school and 2 yrs residency to become a primary care specialist. If I had to see a non-physician for my primary care, I'd see a pharmacist.

It's not unheard of. In some countries, people skip the doctor all together for simple ailments and just go straight to the pharmacist. It's been going on like that for decades.

 

[DermViser]

I can't tell if that's sarcasm. Can they really do PC visits in CA? I know pharm associations are active in the CA legislature.

Anyway, diagnosing isn't and never will be a pharmacists forte. It's chronic disease management.

In CA, pharmacists go thru 4 yrs undergrad, 4 yrs pharm school and 2 yrs residency to become a primary care specialist. If I had to see a non-physician for my primary care, I'd see a pharmacist.

You are then free to see a pharmacist as your primary care provider in California. Hopefully you guys learned in pharm school how to do a history and physical. I will demand a physician. Thanks.

 

[DermViser]

It's not unheard of. In some countries, people skip the doctor all together for simple ailments and just go straight to the pharmacist. It's been going on like that for decades.

And pharmacists can take the liability that goes along with that.

 

[tdram]

And pharmacists can take the liability that goes along with that.

How does the liability work for, like, the CVS minute clinics. They can't be having the same malpractice costs as a physician, they don't even make that much.

 

[DermViser]

How does the liability work for, like, the CVS minute clinics. They can't be having the same malpractice costs as a physician, they don't even make that much.

CVS minute clinics are run mainly with NPs.

 

[drhenPharmD]

How does the liability work for, like, the CVS minute clinics. They can't be having the same malpractice costs as a physician, they don't even make that much.

Minute clinics are run by NPs. They cost less than residency-trained pharmacists.

 

[drhenPharmD]

You are then free to see a pharmacist as your primary care provider in California. Hopefully you guys learned in pharm school how to do a history and physical. I will demand a physician. Thanks.

Yes, we learned how to do an H&P. A semester of it. Like med school only gave me a semester of pharm.

Also, no pharmacist is asking to replace initially seeing a physician. They are trained to manage chronic diseases and complications post-diagnosis.

Of course, they would take the expanded liability that comes w/ expanded scope of practice.

 

[tdram]

CVS minute clinics are run mainly with NPs.

Do NPs have to pay the same malpractice as MDs if they are practicing independently?

 

[tdram]

Yes, we learned how to do an H&P. A semester of it. Like med school only gave me a semester of pharm.

Also, no pharmacist is asking to replace initially seeing a physician. They are trained to manage chronic diseases and complications post-diagnosis.

Of course, they would take the expanded liability that comes w/ expanded scope of practice.

Yes our school now has pharmacy students come to our clinical skills classes to learn H&Ps and stuff.

 

[DermViser]

Yes, we learned how to do an H&P. A semester of it. Like med school only gave me a semester of pharm.

Also, no pharmacist is asking to replace initially seeing a physician. They are trained to manage chronic diseases and complications post-diagnosis.

Of course, they would take the expanded liability that comes w/ expanded scope of practice.

Good luck with that. You'll be screaming later to throw the noncompliant patients back at the PCPs bc it will drive u nuts. Hope you guys learned how to use a stethoscope to listen to heart and lungs, ophthalmoscope, tuning fork, reflex hammer, sensory checks, etc.

 

[tdram]

Good luck with that. You'll be screaming later to throw the noncompliant patients back at the PCPs bc it will drive u nuts. Hope you guys learned how to use a stethoscope to listen to hear and lungs, ophthalmoscope, tuning fork, reflex hammer, sensory checks, etc.

Not really that hard...

 

[drhenPharmD]

Good luck with that. You'll be screaming later to throw the noncompliant patients back at the PCPs bc it will drive u nuts. Hope you guys learned how to use a stethoscope to listen to hear and lungs, ophthalmoscope, tuning fork, reflex hammer, sensory checks, etc.

lol

 

[DermViser]

Not really that hard...

It is for a pharmacist who hasn't learned it.

 

[tdram]

It is for a pharmacist who hasn't learned it.

even medical assistants know how to do that stuff.. not that hard to learn.

 

[DermViser]

even medical assistants know how to do that stuff.. not that hard to learn.

A medical assistant doesn't do H&Ps.

 

[tdram]

A medical assistant doesn't do H&Ps.

They do listen to heart and lungs, and do reflexes, tuning fork, etc. Doing it isn't hard, the hard part is knowing what to do with what you find.

 

[DermViser]

They do listen to heart and lungs, and do reflexes, tuning fork, etc. Doing it isn't hard, the hard part is knowing what to do with what you find.

Assuming u know how to interpret it in the first place. It's not part of Pharmacy training (doing an H&P).

 

[PL198]

How can they justify giving more and more free reign to providers of inferior care?

I mean if we're going to be truly conservative, then anything we think would be a bad idea, we'd say "sure go ahead and try it," and the issue would sort itself out. Critics of this would say " but what about the risk for patients?" In my opinion, that risk would be much better to have until the terrible idea is forever veto'd, rather than allowing it to continue to be thought by various parts of the country. Not really threatened by midlevel surge, I'm always going to be superior to them in terms of treating patients so if they take me out, I'll just take them out of their job and everything is as it was before relatively. Just like that note from wall street to the protesters. " We're the wolves, you're the teacher that makes 60k a year to basically have my kid in daycare all day, meanwhile I don't go to the bathroom for 8 hours straight so I don't miss a position. Guess what happens if you take me out? I come for your job, because you're a sheep and I'm a wolf."

As soon as midlevels actually start to threaten physicians, then the physicians will bite back, which is the last thing any of the midlevels ever wanted. That's the problem people don't understand. You don't take out the top group, you just push for a little more. However they all end up pushing too hard, pissing off the person on top, who when push comes to shove, will straight up own the person below them.

 

[KnuxNole]

First off I'm actually on your side. I'm just saying what the opposition argument is. They have studies showing good outcomes measuring a lot of different endpoints. We don't have studies showing that their approach doesn't work. The only thing we keep saying is that we know more. We need some real proof that knowing more actually makes a significant difference.

Unfortunately, that's the part we are missing. We don't have any evidence that their approach doesn't work, that can be presented to people. As we all know, the average American doesn't want to hear scientific words, they want to hear nice words. They don't want the doc who wants to make them lose weight with exercise, they want the easy diet pills.

 

[calvnandhobbs68]

Matter of fact is computer will have some part in medical decision making.

"As IBM scientists continue to train Watson to apply its vast stores of knowledge to actual medical decision-making, it's likely just a matter of time before its diagnostic performance surpasses that of even the sharpest doctors."

http://www.businessinsider.com/ibms...best-doctor-in-the-world-2014-4#ixzz3AOHfMD9K

What these articles don't understand (but I really think a lot of the Watson engineers actually do) is that machines are only as good as the data you can put in them to analyze. There are entire areas of medicine (oncology actually being one of the foremost) where there just isn't good data for a lot of the decisions we make because nobody has ever done the study you would need. You could have a computer that "learns" from its decisions like a person, sure, but that requires a person putting in all the data and outcomes for every encounter for probably years....so whats the point?

These types of machines will be much more useful in the way they can analyze and synthesize EXISTING data. Watson is extremely useful right now because it can comb through hundreds of plain language journal articles, compile the data for you and present it in an easily digestible manner to assist in decision making. It basically runs the world's fastest meta-analysis every time you use it. That doesn't make it a replacement for the person making the decision, it just makes it a very useful and complex tool.

 

[dadaddadaBATMAN]

lol

Sorry I'm leaping ahead here, and not reading the posts after this. I was just looking at a pharmD curriculum (I think Iowa?)...what kindof struck me was the absence of pathology, physiology, and anatomy/neurology.

You mentioned that medical school only gave you a semester of pharm...but it also gets incorperated into literally everything else (at least it does at my school).

So question #1
Do you guys take a similar approach to path/physio/various other basic sciences? As in, incorperating them into your various pharm. classes.

I have no doubt that pharmacists are extremely valuable. If I had to choose a non-physician as a PCP, I would probably feel most comfortable with a pharmacist.

Question #2
How comfortable are these residency trained pharamacists with the underlying pathology, physiology, etc. of diseases. Do they act mostly as consultants, or work with MD/Dos? Or are they purely stand-alone?

Thanks for your earlier messages, I learned a bit

 

[dadaddadaBATMAN]

What these articles don't understand (but I really think a lot of the Watson engineers actually do) is that machines are only as good as the data you can put in them to analyze. There are entire areas of medicine (oncology actually being one of the foremost) where there just isn't good data for a lot of the decisions we make because nobody has ever done the study you would need. You could have a computer that "learns" from its decisions like a person, sure, but that requires a person putting in all the data and outcomes for every encounter for probably years....so whats the point?

These types of machines will be much more useful in the way they can analyze and synthesize EXISTING data. Watson is extremely useful right now because it can comb through hundreds of plain language journal articles, compile the data for you and present it in an easily digestible manner to assist in decision making. It basically runs the world's fastest meta-analysis every time you use it. That doesn't make it a replacement for the person making the decision, it just makes it a very useful and complex tool.

I don't know too much about watson, I should probably work a little more on learning about it.

I'd imagine a tool like you described would probably have similar issues to meta-analysis: apples and oranges, garbage in and garbage out.

Somewhat derailing, but to me it seems like these devices are more of a threat to "algorithm heavy" professions. Medicine as practiced by physicians isn't particularly like this (at least, not according to the physicians I've spoken with or my limited experience).

It sounds like it could be a wonderful tool, if people get past the "sky is falling" aspects.

 

[PL198]

I don't know too much about watson, I should probably work a little more on learning about it.

I'd imagine a tool like you described would probably have similar issues to meta-analysis: apples and oranges, garbage in and garbage out.

Somewhat derailing, but to me it seems like these devices are more of a threat to "algorithm heavy" professions. Medicine as practiced by physicians isn't particularly like this (at least, not according to the physicians I've spoken with or my limited experience).

It sounds like it could be a wonderful tool, if people get past the "sky is falling" aspects.

I disagree. It's not like there's 1000 studies going on for each specialty every week that are groundbreaking or even good studies. I feel like most physicians are aware of the studies that actually change medicine. I'm not really anti-tech, but we have to realize when **** is become too technical. First time a drone delivers something to my house, will be the last time it delivers anything, that's for sure.

 

[KnuxNole]

I disagree. It's not like there's 1000 studies going on for each specialty every week that are groundbreaking or even good studies. I feel like most physicians are aware of the studies that actually change medicine. I'm not really anti-tech, but we have to realize when **** is become too technical. First time a drone delivers something to my house, will be the last time it delivers anything, that's for sure.

S0 when drones replace all pizza delivery boys, you'll never get pizza to your house? :O

 

[drhenPharmD]

Sorry I'm leaping ahead here, and not reading the posts after this. I was just looking at a pharmD curriculum (I think Iowa?)...what kindof struck me was the absence of pathology, physiology, and anatomy/neurology.

You mentioned that medical school only gave you a semester of pharm...but it also gets incorperated into literally everything else (at least it does at my school).

So question #1
Do you guys take a similar approach to path/physio/various other basic sciences? As in, incorperating them into your various pharm. classes.

I have no doubt that pharmacists are extremely valuable. If I had to choose a non-physician as a PCP, I would probably feel most comfortable with a pharmacist.

Question #2
How comfortable are these residency trained pharamacists with the underlying pathology, physiology, etc. of diseases. Do they act mostly as consultants, or work with MD/Dos? Or are they purely stand-alone?

Thanks for your earlier messages, I learned a bit

1) yea, path and physio are incorporated into the big chunks of 2nd and 3rd year called "therapeutics". At my school, we got anatomy for a semester 1st yr.
2) I've never met any stand-alone clinical pharmacists. Although they might be very comfortable w/ path & physio, I can't be sure since I didn't do a pharm residency (I went straight to med school). In my experience, they acted mostly like consultants in the hospital and chronic disease managers in the clinic setting (i.e. checking INRs, blood glucoses etc. and adjusting meds).

I'm not saying pharmacists should be sole providers of primary care. They are not qualified... but they are competent in what they're trained to do and can be used more efficiently.

 

[dadaddadaBATMAN]

1) yea, path and physio are incorporated into the big chunks of 2nd and 3rd year called "therapeutics". At my school, we got anatomy for a semester 1st yr.
2) I've never met any stand-alone clinical pharmacists. Although I'm sure they are very comfortable w/ path & physio, I can't be sure since I didn't do a pharm residency (I went straight to met school). In my experience, they acted mostly like consultants in the hospital and chronic disease managers in the clinic setting (i.e. checking INRs, blood glucoses etc. and adjusting meds).

I'm not saying pharmacists should be sole providers of primary care. They are not qualified... but they are competent in what they're trained to do and can be used more efficiently.

Definitely not saying pharmacists are unqualified . Thanks for letting me know, that mostly makes sense

 

[dadaddadaBATMAN]

I disagree. It's not like there's 1000 studies going on for each specialty every week that are groundbreaking or even good studies. I feel like most physicians are aware of the studies that actually change medicine. I'm not really anti-tech, but we have to realize when **** is become too technical. First time a drone delivers something to my house, will be the last time it delivers anything, that's for sure.

There is an unbelievable amount of literature out there. If I recall correctly, you were considering a meta-analysis a while back: did you ever do it? My experience has been that even very simple questions tend to have hundreds of results. My initial query has close to 10,000 hits, and I've only done one data base so far (PubMed). Even with my initial filtration, I still have thousands of studies to go through.

What makes literature "good" or "bad" often ends up being arbitrary criteria. Publication is ridiculously arbitrary: it skews effects upwards, selects for studies that ignite controversy, and often screens poorly. This is partially because people's careers depend on gaming the publication system, and partially because the publication system depends on subscriptions.

I agree that we shouldn't change our decisions on a daily basis.... I'm just saying it would be a useful tool, like uptodate.

S0 when drones replace all pizza delivery boys, you'll never get pizza to your house? :O

If a drone is delivering my pizza, at the same price as before, it will literally be the reason WHY I order delivery. Normally only get carry out.

 

[tdram]

S0 when drones replace all pizza delivery boys, you'll never get pizza to your house? :O

You don't have to tip a drone

 

[tdram]

First time a drone delivers something to my house, will be the last time it delivers anything, that's for sure.

I'm the opposite. I would only use the drone service. I order everything online if possible. If I have to go to a store, I much prefer the ones that have self checkout. I don't want to deal with people if I don't have to.

 

[KnuxNole]

You don't have to tip a drone

They might be equipped with anti tip guns! If they don't have a tip inserted, they are automated to fire you with an electric laser gun

 

[tdram]

They might be equipped with anti tip guns! If they don't have a tip inserted, they are automated to fire you with an electric laser gun

That sounds really cool.

 

[KinasePro]

I have to laugh anytime someone suggests that machines/computers will replace physicians. Hell, they haven't even replaced stethoscopes with better technology, which has existed since the early 2000's. Medicine as a whole is a very slow adopter to paradigm-shifting technology that works absolutely perfectly, let alone shoddy computer programs designed largely by non-physicians. It just won't happen in our lifetime.

 

[tdram]

I have to laugh anytime someone suggests that machines/computers will replace physicians. Hell, they haven't even replaced stethoscopes with better technology, which has existed since the early 2000's. Medicine as a whole is a very slow adopter to paradigm-shifting technology that works absolutely perfectly, let alone shoddy computer programs designed largely by non-physicians. It just won't happen in our lifetime.

Yes, physicians are notoriously slow to adopt anything new.

 

[KinasePro]

Yes, physicians are notoriously slow to adopt anything new.

It's not just physicians though, it's the healthcare system as a whole. Even the midlevel creep that we see in 2014 was set into motion more than 60 years ago.

 

[DermViser]

I have to laugh anytime someone suggests that machines/computers will replace physicians. Hell, they haven't even replaced stethoscopes with better technology, which has existed since the early 2000's. Medicine as a whole is a very slow adopter to paradigm-shifting technology that works absolutely perfectly, let alone shoddy computer programs designed largely by non-physicians. It just won't happen in our lifetime.

 

[KinasePro]

Portable doppler/US has definitely been around since early 2000s--- handheld doppler is available now and not absurdly expensive IIRC. Why try to listen for a murmur when you can amplify and/or visualize it? I bet they even have iphone apps for this. The stethoscope is just embarrassing IMO.

 

[tdram]

Portable doppler/US has definitely been around since early 2000s--- handheld doppler is available now and not absurdly expensive IIRC. Why try to listen for a murmur when you can amplify and/or visualize it? I bet they even have iphone apps for this. The stethoscope is just embarrassing IMO.

I agree, this should be the age of the ultrasound.

 

[TooMuchResearch]

They might be equipped with anti tip guns! If they don't have a tip inserted, they are automated to fire you with an electric laser gun

Something like 10 posts after this and no one commented on this post about tip insertion?

 

[TooMuchResearch]

I have to laugh anytime someone suggests that machines/computers will replace physicians. Hell, they haven't even replaced stethoscopes with better technology, which has existed since the early 2000's. Medicine as a whole is a very slow adopter to paradigm-shifting technology that works absolutely perfectly, let alone shoddy computer programs designed largely by non-physicians. It just won't happen in our lifetime.

Ultrasound. Diagnosed a sizeable pleural effusion with it hours ago. Identified a wall motion abnormality in a STEMI yesterday. Hydronephrosis 2/2 ureteral stone a couple days ago. Ascites before that.

Last time I did something incredibly useful with a stethoscope, other than generate a billable chart, was...don't know.

 

[Winged Scapula]

I guess it reflects my era: I read "VC" and immediately thought it meant "Viet Cong" because of older family members talking about their combat experience in Vietnam.

 

[Danbo1957]

"VC" = venture capital. (Hey, I'm an internist.)

 

[Winged Scapula]

"VC" = venture capital. (Hey, I'm an internist.)

Yeah I read the article and realized I was wrong. LOL