On-board Diagnostics - The Daily PPILL #404

How our frameworks have to evolve as technology comes online

This post is sort of a rant about our healthcare system which is sick in itself. But it also attempts to be thought-provoking on how our frameworks, and even our society, have to adapt to what we do.

Let's start with the rant.

After we moved to Seattle, I did not have a family doctor who I could tap for anything, so I decided to go and get myself what we know as a “yearly phisical”, you know, your routine examination, bloodwork, etc. Most -if not all- private insurance plans cover these at 100%. So as long as you only do one of these each year, you don't have to pay. It kind of makes sense. The earlier some conditions are diagnosed, the easier they are to cure (read: less cost for the insurance company), and -in some cases-, a better chance to keep you alive longer (read: more “life-time revenue” for the insurance company). You would think the “system” would like to encourage these.

After a not-so-trivial process of finding a doctor of my liking who would be open to take on new patients, I made an appointment and the day finally arrived.

A surprisingly short wait, and I was having a conversation with my newly found “Chief Health Officer”. Review this history, measure that, listen to this thing, check on that; and then the doctor asked “anything else bothering you?".

Well, while I am grateful for my relative good health, I am past 50 long time ago, so of course there's HUNDREDS of things bothering me. I mentioned a couple of minor things to the doctor and he recommended a couple of tests “to rule things out”.

It happens to be, that I just uttered the wrong answer. Apparently, this made me come to the doctor's visit with a “concern” and now the insurance won't cover the visit.

What I find outrageous about this is that the doctor, when he or she asks you “is anything bothering you?“ is basically just tapping into your body's “on-board diagnostics system”. There are thousands of pain receptors and other indicators that are constantly monitoring your own body. You can emit “alerts” and “key performance indicators” without the need of any external instrument. Ignoring these would be foolish, right? After all, the first thing you do with any system is to run the internal diagnostics.

So if I go to the doctor, and I tell her that I have throbbing headaches and that my brain feels like a globe, I get charged. But if she just pulls out the sphygmomanometer, and detects high blood pressure, the visit is free. It seems that for our broken sick-care system, if the doctor uses an external instrument then it is OK to be sick, but not if the on-board diagnostics decides to turn on the “Check Engine” light.

This brings us to something we haven't lived with before. Many of us have wearables, and we are using them to track our exercise, sleep, etc. These devices collect actual, very useful health data that a physician could be able to leverage in their diagnostics. What's going to happen when your device alerts you of something and advises you to go see the doctor? Or even better, makes the appointment for you?

How will these be considered? Are these preventive? It was detected by an instrument. Or will these be considered diagnostics? Will the device's alert count as a “patient's concern”. What happens when AI gets factored into the mix and the device not only gives you an alert but emits an actual “opinion”?

We are ill-suited for the problems we have today, and we are not prepared for tomorrow's problems. We are creating more problems by getting in our own way. Get on the program folks.