Thursday, March 26, 2009

Box Doctor: A primary care doctor in every home?

431 words

I am nearly done reading John Geyman, MD, Do Not Resuscitate. He does an outstanding job of pointing out all the problems with the present medical insurance system. However his argument that a single-payer system would be better at holding down costs, while it may be correct, is less convincing.

One of Dr. Geyman’s complaints, shared with many other critics of the current system, is that we have far too few primary care doctors. I have long wondered if one way around this problem might be a kind of “doctor in a box,” software that we could buy (in a box!) and load into our computers.

The Box Doctor would be an expert system that we could run when we think something might be wrong with our health. It would ask us a series of questions and on the basis of our answers might do several possible things: It might tell us to eat a bowl of chicken soup, go to bed, and see how we feel in the morning. It might write a prescription for an appropriate medicine and print it out or e-mail it to our selected local pharmacy. It might tell us that we should go to an emergency room or immediate care center right away and print out its tentative conclusions for us to hand to the receptionist there. It might suggest that we consult our primary care doctor or an appropriate specialist. It might prescribe physical therapy and print out an order to that effect. It might tell us to have certain lab tests done.

A later version might even have a set of gadgets that plug into our computer’s USB port and report certain measurements for the Box Doctor to take into account----perhaps blood pressure, blood sugar, urine tests, pulse, and so forth.

In a word, the Box Doctor would serve as a pre-primary care doctor, and in some cases as a primary care doctor. It could save immense amounts of money and of time and travel, of missed work. It could allow prompt attention to a problem when we might otherwise procrastinate about doing something about it because of the inconvenience of scheduling and going for a doctor visit.

Designing such an expert system would be an interesting challenge for a team of physicians and software engineers. A larger problem, however, might be insuring the software against malpractice lawsuits! Any company seeking to create and market a Box Doctor will need to have a very good legal department as well as top notch doctors and engineers.

It sounds like a job for Google!

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