In a very meaningful way the line between physician and non-physician had been blurring anyway.
There's a software called Epic which is used by virtually all large healthcare centers, and while most know it as a database system to store patient history and health records (problems and conditions they've been diagnosed for, lab work results, medicine they're currently taking or have taken in the past), it also has a little tab where a healthcare worker can put in some keywords, e.g. the symptoms a patient has, and Epic guidelines gives the health-provider an action plan for that patient, as well as guiding them with differential diagnoses for non-simple issues.
Of course for common ailments a nurse practitioner knows as much as a primary care physician anyway and their treatment plans wouldn't differ, but the thing is a physician basically effectively will also only follow one script that the healthcare/insurance system in-place allows for, that Epic will spit out also.
In the same way some of us see the task of building a CRUD app as something fairly unremarkable (owing to existing frameworks, existing 'best practices' etc), a physician's day-to-day work is really not challenging, and a "people-person" non-physician equipped with Epic software could arguably work to deliver equal or if not better healthcare outcomes.
Having worked in healthcare IT, and as a prehospital provider who has seen and interacted with many EHR systems, including Epic, Meditech, and ESO (moreso for prehospital)... the sooner Epic dies in a fire the better.
Keyword-driven differentials should be, if anything, the baseline, bottom rung, pattern matching to inspire and drive critical thinking, focused assessment, and diagnostic skills. Not to "easy mode" the path of least resistance.
Epic very much is poised to take over and every week it appears a new large healthcare center makes the switch to it.
I think the hard lesson everyone must learn eventually is that they have to take control of/become deeply involved with their healthcare as much as possible, because dragons are everywhere. For the average person acute care is not needed when they're thinking of reaching out to the doctor, and they shouldn't because elevating level of intervention can quickly result in shit: got a headache or a hip injury? The doctors will give you a plethora of CT scans and you end up with cancer. Got pain? They'll give you opioids so you end up with crippling addiction.
Indeed, of paramount importance for us is to learn how to take care of ourselves by going back to the basics (avoid processed diets, increase fibre-intake, etc, exercise (for the strength gains, for the endorphins and cardio/conditioning, for better bone density so that the body can whether through injuries better), cultivate your link to a positive community so it is there for you in your time of need). And download Epic and learn about healthcare/medicines and take charge as much as possible of your own fate. But when faced with a truly acute problem, see a specialist doctor and follow their commands.
Can you really just download epic? Like it’s free? I thought it was super specialized and you had to have some kind of business relationship to get access to it. I tried to find it online but didn’t see anything.
Epic is basically enterprise-grade software. And every hospital, forget health care systems, is an enterprise. Which makes it very difficult to break that moat.
Only planning for the common case is an insane thing to do in healthcare. We don't train doctors for 12 years so that they are faster or more efficient at diagnosing the common cold, we train them so that they have a wide breadth of knowledge, experience, and skills. People already have difficulty getting satisfying diagnoses from MDs with 12 years of training + Epic, imagine how much worse it would be if the person had no clue illnesses other than what Epic spits out even exist.
Exactly. Not everything is a zebra, plenty of horses, but...
When I teach new EMTs, there's a common topic that comes up. For clarity, EMTs undergo about 200 hours of training, for what is called BLS (basic life support) - essentially non-invasive processes. Generally they can only administer about 5 medicines (oxygen, aspirin, epinephrine, glucose, nitroglycerin). Paramedics undergo up to 1600 hours of training, for ALS (advanced life support), and can start IVs, administer ~40 medications, and do a variety of invasive procedures.
So our local EMS protocols say that if you administer a caloric supplement (i.e. glucose) for someone with hypoglycemia, you must "upgrade" that call to ALS and have a paramedic respond.
"But what if the patient is getting better?" As expected, as hoped. And if the hypoglycemia is really just that, then 99% of those patients won't need, or want, further care/transport. And for 99% of that 99% (arbitrary, but very high, percentages), it's probably entirely reasonable. "So if they're getting better, why do we want a higher level of care?"
For the zebras. For the person with endocrine issues, or for whom hypoglycemia isn't a simple diabetes-related thing, but actually symptomatic of early organ failure, or other things, to get a deeper review to make sure we don't say "Sure thing, Mrs Smith, just stay home and have your husband make you a PB&J or two for some complex carbs" to the patient who has something more serious going on.
A few years ago I saw a young doctor and all she did was put stuff into an iPad that told her what to do next. I could not run from her fast enough. Medical care by iPad app is not the way to go
There's a software called Epic which is used by virtually all large healthcare centers, and while most know it as a database system to store patient history and health records (problems and conditions they've been diagnosed for, lab work results, medicine they're currently taking or have taken in the past), it also has a little tab where a healthcare worker can put in some keywords, e.g. the symptoms a patient has, and Epic guidelines gives the health-provider an action plan for that patient, as well as guiding them with differential diagnoses for non-simple issues.
Of course for common ailments a nurse practitioner knows as much as a primary care physician anyway and their treatment plans wouldn't differ, but the thing is a physician basically effectively will also only follow one script that the healthcare/insurance system in-place allows for, that Epic will spit out also.
In the same way some of us see the task of building a CRUD app as something fairly unremarkable (owing to existing frameworks, existing 'best practices' etc), a physician's day-to-day work is really not challenging, and a "people-person" non-physician equipped with Epic software could arguably work to deliver equal or if not better healthcare outcomes.