Thread by @amywebb

1 - My dad is in the hospital, again, for the third time in four weeks. The reason? Various "problems" diagnosed by various specialists. Here's my diagnosis: the guys is on 14 different medications, prescribed by 4 different doctors, who aren't looking at the bigger picture.

2 - Somehow in America, this is what we've allowed to happen:

• The standard of care has been to forego rigorous discovery--determining why, specifically, someone is sick--for piling on more meds. (Argue with me all you want, but show me evidence I'm wrong.)

• We've elevated specialists and disincentivized GPs. If you're not at a teaching hospital, it's unlikely you have a quarterback with a game plan who's thinking through all the possible plays. (3)

4 - At the moment, my dad is at a small community hospital with a chronic prostate infection, but a cardiologist admitted him. While there is a urologist and a nephrologist involved, the cardiologist is calling the shots. And guess what?

5 - Last night, the cardiologist prescribed yet another blood pressure medication (that brings him up to 4) and yet another diuretic (he's now on 3).

6 - This is what happened next.

Me, to the cardiologist: WTF?

Cardiologist: the body is complicated.

Me: so are you taking him off the other meds?

Cardiologist: maybe

Me: When will you know to recalibrate?

Cardiologist: ¯\_(ツ)_/¯

7 - My other half is an optometrist. He's the kind of eye doc who manages disease, and he researches how technology helps people see better (or makes their vision worse). If he needs to cut into the eyeball, he refers patients to an opthamologist who does surgery...

8 - But if he refers a patient out to specialists, he stays in the loop and co-manages all the care, and he's the person who works with the patient to coordinate. That makes sense.

I'm quickly learning that in the rarified field of American medicine, that's rare.

9 - His GP "doesn't do rounds at hospitals." There is a "hospitalist," but that person has to defer to the admitting doctor, who in our case is a specialist overseeing a problem in a different part of the body. There is a "patient advocate" mostly deals with payments.

10 - How do I live in a country with one of the largest economies on earth... a country that sent a car into space... a country that is home to the most influential and important companies anywhere...

and yet America's system of health care is so profoundly screwed up?

11 - We've engendered a system in which docs don't really talk to each other long enough for any serious analysis or insight. They certainly don't have time to talk to patients or their caregivers in a meaningful way.

So instead, medications and more medications.

12 - Meds are a stand-in for the hard work of thinking.

13 - If docs are concerned about the emergence of AI, they ought to be worried about their jobs. Because an AI system, with access to lots of data, can run circles around four ego-driven specialists who aren't really talking to each other.

14 - Precision medicine and AGI for healthcare can't get here fast enough. I'm done with humans.

15 - I realize this thread is full of typos. I'm tired and I'm pissed.

16 - Last thing. My dad isn't elderly. He's in his early 70s.