“And that isn’t worth something? Prescribing better treatments?”
“Hmmmm,” she said, picking at her fingernails. “Not directly. Of course I always have the best interests of my patients in mind, but, you know, it’s not like they’ll pay more if I prescribe Lexapro instead of Zoloft. They won’t come back more often or refer more friends. So I’d sorta just be, like, donating this money if I paid you for this thing, right?”
I had literally nothing to say to that. It had been a bit of a working assumption of mine over the past few weeks that if you could improve the health of the patients then, you know, the doctors or the hospitals or whatever would pay for that. There was this giant thing called healthcare right, and its main purpose is improving health—trillions of dollars are spent trying to do this. So if I built I thing that improves health someone should pay me, right?
I spend quite a bit of time in healthcare improvement circles. It isn’t really a knowledge deficit problem, and pay-for-performance programs don’t seem to work either. They have a hell of a time getting doctors to use Choosing Wisely/Cochrane Reviews, and those are free. Changing the behavior of physicians and patients is actually really hard.
I mean for one, yes professional autonomy is important to the professions. Seen in that light, healthcare analysts trying to tweak incentives to induce practicing doctors to act as desired have the same moral coding as assistant deans subjecting full tenured professors to evaluation schemes looking to bend their teaching in line with grand administrative plans.
For two, as a matter of survival that’s a strong instinct. Homeboy created a technology for synthesizing the sum of accumulated medical knowledge, patient demographics, and side effect considerations into recommendations for treatment! We have something in that role already! It’s a doctor! Even self-diagnosis tumblr couldn’t generate dose-response curves untrained.
Like, I could absolutely see the political coalition that would allow, say, nurse practitioners or pharmacists using this sorta thing with insurer-approved protocols to prescribe most drugs, with doctor-only limited to the stuff you really need regular evaluation while on, it’s not a boon to “physicians” understood collectively, it’s a threat