Automating Health Care Provision

 Dealing with COVID has stimulated some thoughts about the current state of health care and where it is likely heading under the influence of Artificial Intelligence and Large Language Models.

The day after we arrived home from our Portland adventure I started an effort to see what treatment options were available.  I found out that COVID emergency procedures had been shut down and the only option which seemed available was my regular doctor at the Presbyterian Health Services clinic.  

The phone listed under my doctor's name did not work, so I dialed the main clinic number and got put on endless holding music.  I then sent the following message to the care team:

I tested positive on Tuesday evening for COVID.  I have some congestion and fatigue.  My temperature is normal.  I would like a recommendation for treatment.  

Mike Connealy

Two days later I got a reply:

Hello Mr. Connealy,  

 We received your MyChart message and due to the symptoms you have reported, your message has been sent to a Team Registered Nurse (RN). 

 We will make our best efforts to address your concerns and determine the next steps in your care within 4 business hours...

Fortunately, in the meantime I had come across another option on the Presbyterian web portal called Online Visits.  I clicked the link, and up popped a questionnaire asking for symptoms and health history which I completed in about ten minutes.  An hour later I got a thorough emailed summary of the "online visit":

Good morning— I’m prescribing Paxlovid for you, but I wanted discuss the interaction that it will have with your levothyroxine... 

Diagnosis - COVID-19 infection

My name is ALEXANDRA CARTER, MD, and I'm a healthcare provider at Presbyterian Healthcare Services. I've reviewed your interview. Based on your responses and recent positive COVID-19 test, I see that your symptoms are caused by a COVID-19 infection.

Since you tested positive on a self-test, you don't need another test. A positive self-test means that the COVID-19 virus was detected, and you very likely have a COVID-19 infection.

Most people with COVID-19 have mild to moderate symptoms and can rest at home until they get better...

As it turned out, my regular nearby Walgreens Pharmacy did not have Paxlovid in stock, but they sent me to another branch up the road where I got the prescription at no cost.

Margaret went through a similar process with her doctor, so we also used the online visit feature to get her an immediate response and prescription.  Both her doctor and my doctor's care team expressed irritation that we had sped up the diagnosis and prescription process by doing an end-run around their usual bureaucratic procedure.

So, it seems most primary care physicians are going to have to up their game with the regular inclusion of an automated process of diagnosis and treatment.  Not every condition will be as simple to deal with as our COVID experience, but progress in AI medical care provision  will surely make it relevant to treatment on a broad scale.  

The Online Visit process in this case is perhaps best characterized as AI-lite, but it was quick and effective.  While a lot of the content in the visit summary was boiler plate, it clearly took into account my responses in terms of symptoms and health history, and it was reviewed by "ALEXANDRA CARTER, MD".  (I'm assuming she is a real person.)  I wonder if reviewing AI-generated diagnoses and treatments is a full-time job and how Dr. Carter feels about doing it.

I am also wondering about how the big health care corporations like Presbyterian are going to assimilate AI, and to what ends. While speed and accuracy are likely targets, quite a lot of motivation is also likely to involve profit maintenance and enhancement. There is no guarantee that patient benefits will be on a par with bottom line considerations.

The doctor will see you now.