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851 points swyx | 1 comments | | HN request time: 0.222s | source
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nickjj ◴[] No.25826835[source]
That was a fun read. I wish the author mentioned how much he was trying to sell the service for. It could have been $59 a month or $599 a month and with doctors you could potentially expect the same answer.

I'm not a psychologist but some of the author's quoted text came off extremely demeaning in written form. If the author happens to read this, did you really say those things directly to them?

For example, Susan (psychologist) was quoted as saying:

> "Oh sure! I mean, I think in many cases I'll just prescribe what I normally do, since I'm comfortable with it. But you know it's possible that sometimes I'll prescribe something different, based on your metastudies."

To which you replied:

> "And that isn't worth something? Prescribing better treatments?"

Imagine walking into the office of someone who spent the last ~10 years at school and then potentially 20 years practicing their craft as a successful psychologist and then you waltz in and tell them what they prescribe is wrong and your automated treatment plan is better.

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GordonS ◴[] No.25832379[source]
> I'll just prescribe what I normally do, since I'm comfortable with it

This is actually something that drives me absolutely nuts about doctors in the UK (I presume they are the same elsewhere) - inertia.

It's like doctors leave medical school with "best practices" about what they should prescribe - like they are glorified, human decision trees - and then across their 40-year career, they never read a paper, never read any new guidance, and general never change.

Inertia seems to be a particular problem in the NHS, where doctors have a set list they are willing to prescribe. Why? Because it's what they've prescribed previously, so they are "comfortable" with it. You can see there is a bit of a "chicken and egg problem" with other medications.

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mattowen_uk ◴[] No.25832584[source]
There is also the 'NHS approved medication' list that they can only prescribe from, which restricts whats available to you, and it takes years for something newish to make it onto that list (for reasons...)

If you want better options, the only choice in the UK is private healthcare.

But yeah, I do still agree with you - GPs don't seem to even be up-to speed on the latest info with regard to a patients condition - surely their industry requires on-going professional learning like the rest of us ?

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DanBC ◴[] No.25835873[source]
None of this is true.
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1. GordonS ◴[] No.25852026[source]
It's not technically true, but there is a lot of truth in it.

There are lists of recommended treatments, and there are many restrictions on prescription of medications, expensive ones in particular.

At a national level, NICE[0] (or SMC[1] in Scotland) decide what medicines the NHS will pay for, and for what conditions. They determine what medications are licensed for different treatments. They also set guidance on what treatments should be used for different conditions, what the 1st line, 2nd line, 3rd line treatments should be, and what treatments they think should not be used.

At a regional level, there are "formulary" groups, which take the national guidance, and make some tweaks - for example, for monetary reasons, they often increase the restrictions on expensive medications, making them harder to obtain. An example of those restrictions might be that the patient has to have been suffering for longer, the impact of the condition has to be more severe, or the patient must have tried several other (cheaper) medications first.

For expensive medications, it's often not as simple as a consultant saying "I want my patient to have this" - at a regional or hospital level, there are quotas/limits on how many patients per year will be treated with sich expensive medications, and there are comittees that meet regularly to decide who is worthy.

Now, if we put aside those expensive medications for moment: yes, technically consultants are free to use their experience, knowledge and judgement, and prescribe what they see fit (even unlicensed drugs) - but in reality, within the NHS it is uncommon to prescribe outwith the regional formulary guidance, or/and outwith licensed medication uses. There are a number of reasons for this:

1. Consultants take on individual liability when they prescribe unlicensed medicines, and individual hospitals fear legal risk too

2. Consultants will have their balls broken by their department head when they prescribe expensive medications - dept heads have budget responsibility, and in turn they will have their balls broken by the board

3. Consultants regularly meet with others from their department to discuss difficult/unusual cases, and have to justify their decisions to the panel

4. Perhaps it's the workload, but (IME) NHS consultants often have outdated knowledge. I swear some have never so much as read a journal article since they left medical school 30 years previous :( Again IME, private consultants seem to be much more confident to think out of the box with treatments; perhaps it's the commercial competition?

[0] https://www.nice.org.uk [1] https://www.scottishmedicines.org.uk