Let's face it, Doctors are busy and things do slip through cracks. In your example, the patient care was lacking because she was concerned and no one in her care team mentioned the change in her lab results (now patients can see all results and that 'abnormal ' flag is prominent! ) It is hard to know patients temperaments, who trusts implicitly or who will question yor advice. We are not perfect! I take all the extra help (relatve docs, neighbors, CHAT!) I can get. And I tell anyone who asks for a curbside consult, that my advice is free and..you get what you pay for! It's worth nothing without knowing the whole picture.
I am FP, now in direct primary care (thank Goodness) but even when I was in the usual FFS world, I had many patients actually pay their copays to see me after they saw their specialists so I could “translate” for them, re-explain, and see what I thought of the specialist’s plan, so almost the opposite of the curbside! I have caught many instances of two different specialties working at cross purposes and was able to call them both and work out a compromise plan. I worry that there is less chance for patients to do this holistic look at things with a primary provider due to availability/ cost etc. I feel healthcare is getting so piecemeal and that can be dangerous. We in the community do not see our specialists much anymore and those curbsides are harder to come by.
More than anything else, I think this example shows the overwhelming minutiae involved in medical care and a place where AI screening, sifting, and direction would be imminently useful! The fact that an 85 y/o with a mildly elevated TSH received a call from her physician and is having a repeat lab test in 6 weeks is wildly attentive and detailed! The amount of data coming at a primary care physician at any one time is astronomical. To have the physician be intimately involved with each and every.single.decision is not reasonable or should be necessary in this day and age. Why are we having to wait so long before AI will take this over?? sifting the lower level, non life-threatening results so that only the very important ones rise to the doctor-level. Flooding any human with results - some of which are exceedingly important and acute, others of which are low-level or of uncertain (and low likelihood importance) - is just asking for errors.
We keep hearing that AI will "soon take over medicine! Doctors will be out of a job!" Really? Can we just get some help here first?
I’ve gotten burned with curbside consults by doctors who document our conversation in the chart. I worry this could expose me to liability because my recommendations can be deemed to violate the standard of care since I didn’t do a formal evaluation. Your thoughts?
My most frequent extra-clinical curbside consult request from friends and family usually begins, "My Cardiologist just asked me to schedule my routine, annual nuclear stress test. . ."
It has affected me in my scope of practice. I've worked with the specialist who has developed a pathway of treatment which I then carry back to my patient only to be subterfuged by Google. It appears that Google has higher standing than a specialist in his field and a nurse whose been around the block for a very long time. On occasion there has been a "hollywood" TV doctor who knows best also. It's like being blindfolded and having to pin the tail on the donkey. Now what do I do? I wait until the donkey spills it's candy and then and only then I must come along and pick up the pieces.
I am but a lowly former CNA with several years' experience working in geriatric memory care. I find it flabbergasting how often friends and family members ask me for medical advice. If it's a question of basic bedside care I will gladly give tips and pointers. If it's dealing day-to-day with a family member with advancing dementia or spates of delirium, I will gladly give a few tips and pointers but always with the caveat that this is what I found helpful in X situation dealing with a person in X state. However, when they get into more complicated territory I can't advise and folks don't always take that for an answer. I can generally recognize a brewing UTI from a mile away and will always take note of an elder's gait for indications of balance issues. Lab results? Latin to me. Why can't others recognize that I'm just a former tech with a gait belt (emphasis on former).
It's probably because of several factors. The general stress of having to visit the doctor. The inability to understand medical vocabulary. The "Trust Me" salesmanship of the current medical/industrial complex in the face of the care actually given to the individual leading to deep distrust. Yes, the practice of medicine must be very difficult and I know I couldn't bear that burden myself. I stepped away due to burnout and to protect my mental health. I don't know the answer, but clear communication between patient and care team is where it has to start. It's scary when one doesn't understand and one's life is on the line.
I try to be cautious in commenting on third hand renditions of medical questions that friends and acquaintances often pose. I was always open and frank when a colleague would ask my opinion on a case or medical situation where I could be fairly sure that the information I was hearing was correct. On the other hand, I will not hesitate to give even casual acquaintances my opinion on medical questions about which I hold firm opinions---i.e. I think calcium scans are worthless, I always advised patients to avoid statin drugs, etc.
I guess all of us get the same thing (even though I'm retired). I even run a diabetes support group in my Florida community that meets once a month (that was my schtick when I was in practice). I have a group of regulars who like it and others who come in sporadically. I fancy that what I do is give information rather than advice but in reality I think it's both since it's not unusual for me to be able to amplify on what their PCP is prescribing. I'm always careful to add that "I'm not your doctor." So far, I haven't had any bad feedback and in fact most of it is good, with some reporting that their docs followed my advice. My wife worries that I don't have malpractice insurance but I poo-poo that.
A flaw in (the Canadian system) seems to be that a GP can't just phone a specialist and get a quick response they can pass along to the patient. Only my experience but having seen two specialists for the same problem, the specialist in question could have just sent me a very brief email. The problem is they don't get paid for this. Instead you GP has to do some amount of paperwork, put you on a waiting list, then the specialist writes up (or does some copy paste) a brief report of the visit that your GP will only share with you if you book another visit. I changed GP's through the process and the second specialist was someone my GP personally knew.
Adam - Here is my REBUTTAL for you to consider: In theory, an intelligent and diligent patient benefits greatly from gathering information from reliable INTERNET sources (AHA, Cleveland Clinic, NEJM, Mayo Clinic, X AI) and knowledgeable individuals (nurse aunt, paramedic neighbor), synthesizing it into tentative solutions, and presenting it for SDM with their doctor. This enhances health literacy, empowers advocacy, and aligns with SDM’s collaborative model. However, patients must filter information carefully, acknowledge its limitations, and present it collaboratively to avoid misinterpretation or physician resistance. When done thoughtfully, this approach positions patients to make informed choices in partnership with their doctor, maximizing the benefits of SDM.
“patients must filter information carefully, acknowledge its limitations, and present it collaboratively” In other words, the patient must be trained as a physician to be able to “synthesize” the medical information he receives from a multitude of conflicting information sources into a “tentative solution” to present to his doctor.
Contrary to your belief, physicians do not inherently possess superior analytical or problem-solving skills compared to others, nor do they necessarily have better judgment. Their expertise stems from specialized knowledge in a specific field. Once that information is acquired—whether through research or an AI platform—others can achieve comparable competence.
I understand that your original proposal spoke only to “an intelligent and diligent patient,” but that’s not most patients. As George Carlin once said, “Think of how stupid the average person is, then realize that 50% of them are stupider than that!”
You and I (not a doctor, but spent 23 years doing drug research and writing books for allied health professions) may be in your “intelligent and diligent” cohort, but every one of my family and friends (in their 70s and 80s) are in the “Whatever you think best, doc” cohort.
Physicians, as a group, are further along the analytical and problem-solving skills bell curve than patients, as a group. Yes, of course there are exceptions in both groups, but before COVID, I defaulted to trusting a physician’s judgement. After COVID, I question the judgement of physicians who promoted and received the shots (almost all them did), especially since it has now been shown that mRNA shots interfere with cognition and brain function.
Not related to the subject at hand but it's the first time I come across someone saying mRNA vaccines interfere with cognition and brain function (negatively, I suppose, and to an extent as to incite doctors to stop recommending them immediately). Since it's not the expert consensus as far as I know what makes you believe that?
Thanks for the question. Happy to help. Most of the research on the mRNA shots focus on adverse cardiovascular effects, such as myocarditis, polycarditis, and coagulopathies. And frankly, those are the ones that are likely to kill.
“The more doses you get, the sooner you die.” — Japanese study.
It has also been hypothesized that Joe Biden’s cognitive decline was accelerated by the COVID shots he received. This article also talks about the increased incidence of stroke subsequent to the shots.
The correlation between mRNA shots and brain injury is not 100%, of course, just as there are anecdotal reports of life-long smokers NOT dying of lung cancer, heart disease, etc. due to smoking. And there is some evidence that, when Pfizer and Moderna could not keep up with demand, they filled the “vaccine” vials with saline so as not to reduce government payments. If true, this would confound any correlation studies.
Randy, it seems you and I are more aligned in the way we see this issue than I originally thought. I would add that Carlin's principle applies equally to physicians who are just average people that spent time in school and then OTJ training being told what to think by other average people. So we (collectively) all need to start disabusing ourselves of the notion that doctors always know what is best for us.
How sure are you, really, that she has no lingering symptoms of hypothyroidism that might indicate revisiting her dose? Did you ask her or just assume she was stable because she always had been and probably missed some pills because 80??
My long time primary care MD had brushed off my repeated concerns. Ignoring his scorn and listening to a relative's MD instead, I ended up in the ER just in time (with sepsis).
As your footnote states, you have colleagues who need checking. Many, in my experience.
I am a nurse and when people ask.me, I often encourage them to call their provider .Many patients are reluctant to ask questions. I let them know that I think their questions are good and try to build their relationship . If a provider will not answer questions, I find that to be a red flag
Thanks Susan. I have spent months inpatient for a long series of cancer treatments. Nurses are terrific for many reasons… one is that they are not haughty as many specialists are. You mention another: they listen to patients and in my experience, never counter the clinician’s or attending’s actions. That said, nurses provide a safe team member with whom patients can share their doubts and anxieties.
Patients have doubts and anxieties when receiving long term clinical care. Maybe a big dose of humility from the doctor would be helpful.
Let's face it, Doctors are busy and things do slip through cracks. In your example, the patient care was lacking because she was concerned and no one in her care team mentioned the change in her lab results (now patients can see all results and that 'abnormal ' flag is prominent! ) It is hard to know patients temperaments, who trusts implicitly or who will question yor advice. We are not perfect! I take all the extra help (relatve docs, neighbors, CHAT!) I can get. And I tell anyone who asks for a curbside consult, that my advice is free and..you get what you pay for! It's worth nothing without knowing the whole picture.
I am FP, now in direct primary care (thank Goodness) but even when I was in the usual FFS world, I had many patients actually pay their copays to see me after they saw their specialists so I could “translate” for them, re-explain, and see what I thought of the specialist’s plan, so almost the opposite of the curbside! I have caught many instances of two different specialties working at cross purposes and was able to call them both and work out a compromise plan. I worry that there is less chance for patients to do this holistic look at things with a primary provider due to availability/ cost etc. I feel healthcare is getting so piecemeal and that can be dangerous. We in the community do not see our specialists much anymore and those curbsides are harder to come by.
More than anything else, I think this example shows the overwhelming minutiae involved in medical care and a place where AI screening, sifting, and direction would be imminently useful! The fact that an 85 y/o with a mildly elevated TSH received a call from her physician and is having a repeat lab test in 6 weeks is wildly attentive and detailed! The amount of data coming at a primary care physician at any one time is astronomical. To have the physician be intimately involved with each and every.single.decision is not reasonable or should be necessary in this day and age. Why are we having to wait so long before AI will take this over?? sifting the lower level, non life-threatening results so that only the very important ones rise to the doctor-level. Flooding any human with results - some of which are exceedingly important and acute, others of which are low-level or of uncertain (and low likelihood importance) - is just asking for errors.
We keep hearing that AI will "soon take over medicine! Doctors will be out of a job!" Really? Can we just get some help here first?
I’ve gotten burned with curbside consults by doctors who document our conversation in the chart. I worry this could expose me to liability because my recommendations can be deemed to violate the standard of care since I didn’t do a formal evaluation. Your thoughts?
My most frequent extra-clinical curbside consult request from friends and family usually begins, "My Cardiologist just asked me to schedule my routine, annual nuclear stress test. . ."
It has affected me in my scope of practice. I've worked with the specialist who has developed a pathway of treatment which I then carry back to my patient only to be subterfuged by Google. It appears that Google has higher standing than a specialist in his field and a nurse whose been around the block for a very long time. On occasion there has been a "hollywood" TV doctor who knows best also. It's like being blindfolded and having to pin the tail on the donkey. Now what do I do? I wait until the donkey spills it's candy and then and only then I must come along and pick up the pieces.
I am but a lowly former CNA with several years' experience working in geriatric memory care. I find it flabbergasting how often friends and family members ask me for medical advice. If it's a question of basic bedside care I will gladly give tips and pointers. If it's dealing day-to-day with a family member with advancing dementia or spates of delirium, I will gladly give a few tips and pointers but always with the caveat that this is what I found helpful in X situation dealing with a person in X state. However, when they get into more complicated territory I can't advise and folks don't always take that for an answer. I can generally recognize a brewing UTI from a mile away and will always take note of an elder's gait for indications of balance issues. Lab results? Latin to me. Why can't others recognize that I'm just a former tech with a gait belt (emphasis on former).
It's probably because of several factors. The general stress of having to visit the doctor. The inability to understand medical vocabulary. The "Trust Me" salesmanship of the current medical/industrial complex in the face of the care actually given to the individual leading to deep distrust. Yes, the practice of medicine must be very difficult and I know I couldn't bear that burden myself. I stepped away due to burnout and to protect my mental health. I don't know the answer, but clear communication between patient and care team is where it has to start. It's scary when one doesn't understand and one's life is on the line.
I try to be cautious in commenting on third hand renditions of medical questions that friends and acquaintances often pose. I was always open and frank when a colleague would ask my opinion on a case or medical situation where I could be fairly sure that the information I was hearing was correct. On the other hand, I will not hesitate to give even casual acquaintances my opinion on medical questions about which I hold firm opinions---i.e. I think calcium scans are worthless, I always advised patients to avoid statin drugs, etc.
I guess all of us get the same thing (even though I'm retired). I even run a diabetes support group in my Florida community that meets once a month (that was my schtick when I was in practice). I have a group of regulars who like it and others who come in sporadically. I fancy that what I do is give information rather than advice but in reality I think it's both since it's not unusual for me to be able to amplify on what their PCP is prescribing. I'm always careful to add that "I'm not your doctor." So far, I haven't had any bad feedback and in fact most of it is good, with some reporting that their docs followed my advice. My wife worries that I don't have malpractice insurance but I poo-poo that.
A flaw in (the Canadian system) seems to be that a GP can't just phone a specialist and get a quick response they can pass along to the patient. Only my experience but having seen two specialists for the same problem, the specialist in question could have just sent me a very brief email. The problem is they don't get paid for this. Instead you GP has to do some amount of paperwork, put you on a waiting list, then the specialist writes up (or does some copy paste) a brief report of the visit that your GP will only share with you if you book another visit. I changed GP's through the process and the second specialist was someone my GP personally knew.
Adam - Here is my REBUTTAL for you to consider: In theory, an intelligent and diligent patient benefits greatly from gathering information from reliable INTERNET sources (AHA, Cleveland Clinic, NEJM, Mayo Clinic, X AI) and knowledgeable individuals (nurse aunt, paramedic neighbor), synthesizing it into tentative solutions, and presenting it for SDM with their doctor. This enhances health literacy, empowers advocacy, and aligns with SDM’s collaborative model. However, patients must filter information carefully, acknowledge its limitations, and present it collaboratively to avoid misinterpretation or physician resistance. When done thoughtfully, this approach positions patients to make informed choices in partnership with their doctor, maximizing the benefits of SDM.
“patients must filter information carefully, acknowledge its limitations, and present it collaboratively” In other words, the patient must be trained as a physician to be able to “synthesize” the medical information he receives from a multitude of conflicting information sources into a “tentative solution” to present to his doctor.
Randy,
Contrary to your belief, physicians do not inherently possess superior analytical or problem-solving skills compared to others, nor do they necessarily have better judgment. Their expertise stems from specialized knowledge in a specific field. Once that information is acquired—whether through research or an AI platform—others can achieve comparable competence.
Bruce,
I understand that your original proposal spoke only to “an intelligent and diligent patient,” but that’s not most patients. As George Carlin once said, “Think of how stupid the average person is, then realize that 50% of them are stupider than that!”
You and I (not a doctor, but spent 23 years doing drug research and writing books for allied health professions) may be in your “intelligent and diligent” cohort, but every one of my family and friends (in their 70s and 80s) are in the “Whatever you think best, doc” cohort.
Physicians, as a group, are further along the analytical and problem-solving skills bell curve than patients, as a group. Yes, of course there are exceptions in both groups, but before COVID, I defaulted to trusting a physician’s judgement. After COVID, I question the judgement of physicians who promoted and received the shots (almost all them did), especially since it has now been shown that mRNA shots interfere with cognition and brain function.
Randy,
Not related to the subject at hand but it's the first time I come across someone saying mRNA vaccines interfere with cognition and brain function (negatively, I suppose, and to an extent as to incite doctors to stop recommending them immediately). Since it's not the expert consensus as far as I know what makes you believe that?
(I'm not an immunology expert but I am an M.D.)
Thanks for the question. Happy to help. Most of the research on the mRNA shots focus on adverse cardiovascular effects, such as myocarditis, polycarditis, and coagulopathies. And frankly, those are the ones that are likely to kill.
“The more doses you get, the sooner you die.” — Japanese study.
https://slaynews.com/news/japan-releases-bombshell-data-millions-vaxxed-citizens-more-doses-sooner-you-die/
But other studies have tracked cognitive changes after the COVID vax, best summarized here (with extensive links):
“We Now Have Proof The COVID Vaccines Damage Cognition”
https://www.midwesterndoctor.com/p/we-now-have-proof-the-covid-vaccines
It has also been hypothesized that Joe Biden’s cognitive decline was accelerated by the COVID shots he received. This article also talks about the increased incidence of stroke subsequent to the shots.
“Is Joe Biden's Brain Vaccine Injured?”
https://www.midwesterndoctor.com/p/is-joe-bidens-brain-vaccine-injured
The correlation between mRNA shots and brain injury is not 100%, of course, just as there are anecdotal reports of life-long smokers NOT dying of lung cancer, heart disease, etc. due to smoking. And there is some evidence that, when Pfizer and Moderna could not keep up with demand, they filled the “vaccine” vials with saline so as not to reduce government payments. If true, this would confound any correlation studies.
Thank you for your answer.
The conclusions from the first link you provided, on the Japanese study, are misleading.
Here is why:
https://science.feedback.org/review/inadequate-analysis-japan-data-false-covid-vaccine-mortality/
And
https://www.reuters.com/fact-checnk/japanese-study-does-not-report-explosion-deaths-among-covid-vaccinated-2025-04-24/
In general, quality evidence comes from peer reviewed journals, not from video livestreams and anti vaccine sites like SlayNews.
Randy, it seems you and I are more aligned in the way we see this issue than I originally thought. I would add that Carlin's principle applies equally to physicians who are just average people that spent time in school and then OTJ training being told what to think by other average people. So we (collectively) all need to start disabusing ourselves of the notion that doctors always know what is best for us.
How sure are you, really, that she has no lingering symptoms of hypothyroidism that might indicate revisiting her dose? Did you ask her or just assume she was stable because she always had been and probably missed some pills because 80??
My long time primary care MD had brushed off my repeated concerns. Ignoring his scorn and listening to a relative's MD instead, I ended up in the ER just in time (with sepsis).
As your footnote states, you have colleagues who need checking. Many, in my experience.
As per usual, I agree with Adam, and it is a frustrating scenario to say the least.
My only addition to this excellent article is that most of these unwanted consults don’t come from the curbside,they come from “Dr. Google“
Ben Hourani MDMBA
I am a nurse and when people ask.me, I often encourage them to call their provider .Many patients are reluctant to ask questions. I let them know that I think their questions are good and try to build their relationship . If a provider will not answer questions, I find that to be a red flag
Thanks Susan. I have spent months inpatient for a long series of cancer treatments. Nurses are terrific for many reasons… one is that they are not haughty as many specialists are. You mention another: they listen to patients and in my experience, never counter the clinician’s or attending’s actions. That said, nurses provide a safe team member with whom patients can share their doubts and anxieties.
Patients have doubts and anxieties when receiving long term clinical care. Maybe a big dose of humility from the doctor would be helpful.
“Those of us in healthcare should be cautious about the recommendations we make when we are outside the clinical setting…”
Yes - and the advice with which you finish this paragraph is essentially what I have always strived to follow!
And - yes - I tend to get a little worked up about coronary artery calcium scans.