My PCP Should Be a BOT

I like my PCP. She does her best, swimming against the tide of a dysfunctional healthcare system. And let’s be clear: if I had a serious medical condition, I’d want to be treated in the U.S. and nowhere else. 

So I have no time for yet another tear jerking expose of American healthcare! I mean, if that’s how you feel, don’t use it, and next time a loved one needs a complex medical procedure, feel free to head off to Canada, or the UK, or Sweden - wherever you think you’ll fare better; but as you travel, be careful not to bump into ‘medical tourists’ from those countries ‘sneaking’ across our borders to get their care in the U.S.

Not your cup of tea after all? Then shut it! (Full disclosure: I worked 40 years for a company I co-founded to provide health benefits to employees of mid-sized U.S. businesses. So caveat lector.) 

That said, enough is enough! Prior to 2019, my interaction with the healthcare system consisted of an annual physical and a monthly prescription for a beta blocker. In the most recent 5 years, I have been admitted (overnight) to the hospital a half dozen times, ‘incarcerated’ for a total of 40 days overall. Not fun! However, I was mainly well treated and the care I received was helpful, albeit minimal.

Then I stubbed my left big toe. I’ve been stubbing my toes since the age of 5. Painful but no big deal! This time, however, I damaged the nail and after a week or so it was clear that the nail was coming off, whether I liked it or not.

So I called my podiatrist…who could not see me for a month. No problem. I called my PCP and made an appointment for the next day. Her PA took one look at the toe and announced, “We can’t treat this here. You’ll need to go to Urgent Care (UC).”

Not a problem either! I’m a strong believer in UC; it has served my family well in the past. This time, however, the two closest UC facilities were ‘booked solid’ and ‘not seeing walk-ins’ that day; so much for ‘urgent’ care. Plus I needed an X-ray and neither had X-ray capability on site.

So my PCP sent me off to the ER…for a stubbed toe! They took me in right away (glad for the revenue perhaps), but 5 hours later, I was still there. Following an X-ray, my ER Doc proudly announced, “Your right toe has a small fracture…which BTW we don’t need to treat.” Ok, but it was the left toe I stubbed! Hmm…

In any event, I was sent on my way with a tetanus booster and an Rx for an antibiotic and a referral back to my Podiatrist who suddenly found he could ‘fit me in’ after all. So, all is well, right?

Not even a little bit! In a country where some folks have virtually no access to healthcare, I unintentionally and unnecessarily consumed thousands of dollars’ worth…for a stubbed toe. Plus, during my week-long ordeal, I noticed that my docs were more interested in ‘ruling out what isn’t’ than they were in ‘treating what is’. They were running through a check list; they were practicing defensive medicine. They weren’t really looking at my toe…or listening to me!

For the most part, I have benefited from the healthcare I’ve received over my lifetime but enough is enough. How can the system be made better?

Begin by transitioning healthcare generalists (PCPs, Pediatricians, Family Doctors) from their current ‘front line’ positions to an ‘oversight’ role on the model of a radiologist. Most current PCP functions would now be the responsibility of a new uber-doc, AI Bot, MD, first in his class at Harvard Med. 

Dr. Bot would handle patient in-take, conduct the initial interview, download my electronic health record, build my medical history, order appropriate tests, and offer a preliminary diagnosis along with any alternative diagnoses that ‘we can’t rule out’.

Each diagnosis would come with a full complement of treatment options, including the ‘null option’,  and prognoses for each. Only now, at this stage, would a human healthcare professional (PCP) review the data and evaluate Dr. Bot’s diagnoses and treatment options.

In most instances, the PCP will sign off and Dr. Bot will proceed as planned, referring the patient to the appropriate facility and/or specialist for treatment. Occasionally, a PCP may feel the need to see a particular patient face-to-face; no problem, Dr. Bot will schedule the appointment. Or the patient may have questions. Dr. Bot is on call 24-7 as is a human telehealth back-up. Still not satisfied, the patient may always schedule a call or in person visit with their PCP at any time.      

 Imagine if this system had been in place in time for my 2025 misstep! 

So what have we accomplished?

1. We have placed the patient back at the center of the healthcare process by providing information and treatment options every step of the way.

2. Patient centric healthcare has reduced providers’ need to practice defensive medicine.

3. Studies show that patients empowered with information and treatment options often do not choose the most invasive, or most expensive, course of care.

4. We have reduced our need for MDs – a good thing since we have an acute shortage.

5. We have empowered healthcare professionals to do what only they can do by eliminating myriad tasks that can be performed as well or better by someone or something else.

6. This greater efficiency will allow us to better compensate healthcare professionals at all levels, thereby attracting more people to the healing professions.

7. The need for legislation to protect the creators of AI software from malpractice liability may finally give us the boost we need to undertake overdue tort reform.

8. Last but not least, we will improve the quality of patient care. 

Today, 20 – 30% of all the care delivered in the US is not appropriate given the patient’s actual condition. This startling statistic includes contributions from defensive medicine, false positives, misdiagnoses, overtreatment, and less often, actual medical malpractice. I think it is reasonable to think that we can reduce that rate by an order of magnitude, i.e. to 2 – 3%, with better use of AI Bots.

Healthcare constitutes more than 15% of the US economy. To the extent that these expenditures are ineffective or even harmful, they represent a huge drain on GDP. Reducing waste by an order of magnitude, as I have proposed (above), would effectively pump 3-4% additional annual GDP into the national economy.

The future is AI and, for all our sakes, it can’t come soon enough!  

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Image: "The Doctor," oil on canvas by Luke Fildes, 1891. Located at the Tate Gallery in London.