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Health industry group: Replace psychiatrists with vending machines

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Altostrata

Health industry group: Replace psychiatrists with vending machines
Measure to reduce health care costs

1 April 2014 Health Insurance Times (Dubuque, Iowa) A health care industry thinktank, US Health Insurance Consortium on Cost, advocates replacing psychiatrists and other doctors with vending machines to prescribe and dispense antidepressants.

"We believe this will cut the cost of psychiatric services significantly," Uli Arnowsky, spokesperson for USHICost, said. "Our studies show the diagnosis and prescription process can be automated, with no loss in quality of care. Specialist costs are just not necessary for this type of treatment, and psychiatrists are overworked anyway."

USHICost based its Psychiatric Diagnostic Screening Questionnaire (PDSQ) on the new psychiatric diagnostic manual DSM-5 and psychometrics research by Drs. David J. Kupfer and Robert D. Gibbons. It plans to make the PDSQ available online to health plan members. Answers would be captured in a database and analyzed to produce a recommendation for a prescription. A psychiatric nurse reviews the recommendations and authorizes the prescription, which is then attached to the patient's electronic medical record.

Vending machines, in convenient medical center locations and on a secure network, would be stocked with the most common generic antidepressants.

"We prefer the generics," Arnowsky said. "They're part of the cost-cutting. Our studies show they're just as effective as the name-brand drugs."

According to Arnowsky, to get a prescription filled, a patient would input a health plan ID and a password at a vending machine. The machine would look in the database, dispense the authorized prescription, and charge the co-pay to a credit card on file in the patient's health plan record.

"We really like the way this system keeps electronic medical records, too," Aronowsky said. "It's a win-win-win for all concerned."

Patients reporting side effects would be advised to see their doctors, who could then adjust the prescription if needed.

"There's a lot of trial and error in prescribing antidepressants already," he said. "This system is no more error-prone than present prescribing practices. In fact, we put fuzzy logic in the system to rotate prescriptions among the antidepressants, because we've found doctors prescribe them in an almost random fashion. We built the human element right into the system -- it thinks just like a doctor about these drugs."

He stated that USHICost's studies had shown diagnosis by PDSQ was at least as accurate as by doctors, including psychiatrists. "This will take a big burden off primary care physicians, too, who are bearing the brunt of prescribing antidepressants," he noted.

Edited by Altostrata
updated

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Neuroplastic

Oh, my god.... For a moment I thought it was r _ _ l. :blink: Great one! :D

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Healing

What do you do if your quarters get stuck?

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summer

What do you do if your quarters get stuck?

 

You curse like mad and put in more quarters.

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Healing

You curse like mad and put in more quarters.

 

And then you need an additional medication for your anger problem. And now you need more quarters!

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summer

The sad thing is that there are some caring, compassionate pdocs out there... you just have to hunt them down. I think you have to find someone over 60 who has no use for pdocs who just hand out scripts. I know they are in the minority, but they are out there.

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Healing
That all changed in the 1980s.

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Neuroplastic

Oops! So sorry, Healing - wanted to quote you, but instead went into the editing mode by mistake in your post above. :blink: Seems like I may have erased part of it. :huh:

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Neuroplastic

That all changed in the 1980s.

 

So true, Fluoxetine made it to market in 1988, and from then on it all went ever more absurd.

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Healing

Ha! Erasing my posts, are you?!

 

What I said (before I was so insidiously erased...) was that summer's comment about age 60 makes sense because psychiatric training in the US used to be more focused on psychoanalytic psychotherapy. But then behaviorism came into fashion, and then there were "advances" in pharmacology. So, now US psychiatric training is psychopharmacology.

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stan

1 April 2011

Dubuque, Iowa

Health Insurance Times

 

Health industry group: Replace psychiatrists with vending machines

Measure to reduce health care costs

 

 

and the software of the machine could say (vocal voice) : < you have a lack of serotonin , it is not addict, you can stop when you want, >

and the next year with your history : < you need it for life as diabetes insulin , you need double dose, you need another added, choose between these five, ...>

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Healing

...and the next year, the voice would say -- your two antidepressants are not working. You need to add Abilify.

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Altostrata

Oops! So sorry, Healing - wanted to quote you, but instead went into the editing mode by mistake in your post above. :blink: Seems like I may have erased part of it. :huh:

 

I've made that mistake myself! Gotta do something about that edit button (available only to admins and mods).

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Rhiannon

...and the next year, the voice would say -- your two antidepressants are not working. You need to add Abilify.

 

and the year after that you would get a new diagnosis: Bipolar disorder type II with mixed states. You need a mood stabilizer.

 

I think we should get a patent.

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compsports

In rereading the thread, this is pretty much what goes on when a doctor hands you a psych med. There is no more thinking that what you would get with an interaction with a machine.

 

Experiencing side effects from the med? Oh, that must be because your illness is worsening. Increase the dose. There isn't any analysis of what the med is really helping vs. causing harm.

 

Anyway, going through a machine would be alot cheaper.

 

CS

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cinephile

***NOTE: I had to spell the acronym for health maintenance organization as "HMoh" because it was getting censored for some reason***

 

Eegads. I just don't like this at all. God, this country is so obsessed with saving time we don't realize how important it is to take time with certain very important things (like health). I honestly think that this virtuwell thing will just be another "innovation" that seems great on the surface (that is, it cuts down patient wait times and hassle) but in hindsight will be criticized for allowing greedy insurance companies to whittle health care down even more. Hell, we're already in a society where we pay more than anyone else in the world for wham-bam 10-minute doctor's visits which can easily lead to misdiagnosis, and now some people are in FAVOR of "virtual" care? I'm sorry, but my mind and body deserves better. And so does my wallet!

 

I was honestly very surprised to read how well-received this was on the thought broadcast blog. Even Jackie, the blog's resident "armchair physician" (her term!) is loving this, and thinks that it could even work for psychiatry! She thinks it could work for "simple" cases that can be treated with monotherapy. I think this opens up the possibility of people who are needlessly drugged on psych meds to just keep merrily -- and mindlessly -- refilling their prescriptions and absolve their prescriber of any responsibility. And ideally, the whole point of a psychiatrist following a patient long-term (with more than 15-minute med checks) is so they can monitor their patient's symptoms and side-effects. And we all know how insidious the onset of side-effects can be for psych meds. Often it would help to have a third party point out to us that our personality has changed.

 

I can't help but see this as another step in the wrong direction: a step further towards social isolation where we're tricked into thinking we're getting more for less, when it's really the other way around.

 

And some of the statements are just perplexing. I honestly don't know if they were made tongue-in-cheek or seriously, such as this passage below from SteveBMD (the blog owner and psychiatrist):

 

In psychiatry—a specialty in which treatment decisions are largely based on what the patient says, rather than a physical exam finding—the implications of web-based “office visits” are particularly significant. It’s not too much of a stretch to envision an HMoh providing online evaluations for patients with straightforward complaints of depression or anxiety or ADHD-like symptoms, or even a pharmaceutical company selling its drugs directly to patients based on an online “mood questionnaire.” Sure, there might be some issues with state Medical Boards or the DEA, but nothing that a little political pressure couldn’t fix. Would this represent a decline in patient care, or would it simply be business as usual? Perhaps it would backfire, and prove that a face-to-face visit with a psychiatrist is a vital ingredient in the mental well-being of our patients. Or it might demonstrate that we simply get in the way.

This is just such a strange line of reasoning. First, haven't we learned the hard way that HMOh companies are not the physician's -- or patient's -- friend? Can't anyone see that what we gain in so-called convenience of a web-based "diagnosis" (done entirely with a computerized algorithm and not even with a physician via a webcam or something) we lose in nuance and clinical judgement which is essential for medicine? And can't we see that such software as Virtuwell is music to *** companie's ears because it allows them to slash their costs even more to rake in even more profit, regardless of the impact on our health care outcomes? Didn't we learn how broken the HMOh companies' promises were after the honeymoon period ended? That is, once our doctors' visits became whittled down to almost nothing and the system became unsustainable?

 

Also, it's surprising for a psychiatrist to be so forthcoming in admitting how unsophisticated so much psych diagnosis is and that it can be so readily outsourced to an online computer algorithm where a patient with "straightforward complaints of depression or anxiety or ADHD-like symptoms" (uh, what exactly constitutes straight-forward? And don't tell me the DSM has the answers) can get their meds directly from a pharmaceutical company by answering an "online mood questionnaire." It's just so strange he's saying this in defense of virtuwell because it's largely at the expense of psychiatry: it makes psychiatrists look like what we've known them to largely be: credentialed pill pushers who largely engage in guesswork and rely on corrupted pseudoscience. Am I the only one who sees how wrong all this is? YIKES!

 

I have issue with Steve's logic here too:

 

When I worked in community mental health, I know that some of my fellow MDs saw 30-40 patients per day, and their interviews may just as well have been done over the telephone or online. It wasn't ideal, but most patients did just fine, and few complained about it. (Well, if they did, their complaints carried very little weight, sadly.) Maybe it's true that much of what we do does not require 8+ years of specialty education and the immense knowledge that most physicians possess, and many conditions are fairly easy to treat. Virtuwell is simply capitalizing on that reality.

I think part of the reason why the interviews for those patients "may just as well have been done over the telephone or online" is because the doctors had 30-40 patients per day. That's not medicine -- that's an assembly line. Of course the interview is going to be superficial and could carry over a telephone line if it's only 10 minutes long. But that doesn't get to the core of the problem that a patient deserves more than a ten-minute interview. Now, I'm not saying every patient has to have an hour-long consult with their doctor (certainly those with a simple infection or a sprained ankle wouldn't), but what about those poor souls that DO have complex and murky symptomology? Or what about those who have problems (chronic fatigue, sleep apnea, vitamin deficiencies, low testosterone) that can only be teased out and properly treated over the course of half-a-dozen longer visits? In this current model of care, the opportunity is ripe to misdiagnose and over-prescribe (which is, of course, music to big pharma's ears). How many MORE people will be needlessly dosed on SSRIs when a five-minute "online mood questionnaire" determines they're depressed, when really they just have sleep apnea, or a poor social situation, or have low testosterone, or have a crappy diet? Of all the medical disciplines, it's my opinion that the mental health specialties (psychology and psychiatry) are the ones closet to an art because it takes an extraordinary amount of insight, clinical judgement and sensitivity to diagnose properly due to the murky nature of the symptoms. That simply can't be done through the impersonal chill of a computer program. I should also mention that many patients don't know what they need and many doctors know this very well when a patient walks in and demands to be put on a prescription med they saw advertised on last night's evening news. A responsible doctor may tell them that it's nonsense for them to want to be on this drug as it's not indicated for their symptoms. Or, perhaps a patient's true needs will spontaneously, epiphanously surface in a moment many doctor's visits down the line. All of these situations largely can't play out with online care. And I should also point out that most of this country's illnesses are lifestyle illnesses like diabetes, obesity, and mental health which require far more personal attention and diligence than a computer program or online nurse practitioner can provide.

 

I guess proponents of virtuwell would counter by saying that such complex medical issues would be reserved for traditional doctor's visits, but I'm not so sure. I'm not so sure because I know how insatiable human greed is, and HMOs are largely run by greed. At first there may be a honeymoon period (similar to when HMOs first got started) where everyone plays nice and online treatment is only reserved for cut-and-dried medical problems. But slowly but surely, more and more complex medical issues will be grandfathered into this new online paradigm of "care" when the *** companies realize how much it will balloon their profit margins. I can even see how this could play out: you could be forced to pay more for a plan that allowed you to see a doctor in person for all your problems, similar to how you have to pay more now for a PPO plan versus an HMoh if you want more choice in which physician you can see. The scary thing is I don't think I'm being paranoid or a conspiracy theorist: I've based these arguments on what I've observed first-hand when buying insurance and, of course, being a health care consumer in this country.

 

But I guess what I object to, above all, about this stuff is our underlying belief in technology as a panacea. We use it for EVERYTHING these days, even when the studies often scream that the best treatments for complex mental disorders aren't pills but the eternal things like diet, exercise, meditation, and social interaction. Greedy companies know the average person is entranced by technology and thinks it can solve most problems. Case in point: here's one last quote from Steve:

 

For example, this week also saw the introduction of the "Skin Scan," an iPhone app which allows you to follow the growth of your moles and uses a "proprietary algorithm" to determine whether they're malignant. Good idea? If it saves you from a diagnosis of melanoma, I think the answer is yes.

Here we go again, jumping on the tech bandwagon. Who knows how reliable this skin scan is? Who exactly designed this "proprietary algorithm"? Was it qualified doctors? And which doctors? In fact, the collusion of doctors with technology like medical apps could be a new conflict of interest waiting to happen: doctors could be paid handsomely by app developers to lend their knowledge and research to the apps, even if the final product isn't a very accurate clinical tool. In fact, such apps may be a new revenue stream for big pharma. And what if there's a glitch or bug in the software and someone gets "misdiagnosed" by the software? The consequences could be dire. Hell, my brand-new plasma TV (less than a year old) is already glitching out, which is indicative of how touchy and sensitive all this new technology is these days (even though I'm not into my 30s, I can still remember the days when you could buy a piece of consumer electronics and it would be built well enough and be designed well enough that you didn't have to worry about it breaking within a year). In fact, I'm glad I bought the extended two-year warranty which, as recently as my childhood, was considered largely a rip-off because electronics were built to last, but now are basically necessary (and need to be added into the final price tag, reducing the "bargain" you get) because of the widespread shoddy worksmanship and complex technology that is rushed to market before it's thoroughly tested. That's how quickly we've fallen.

 

All of this just doesn't inspire confidence in me about Virtuwell and similar trends to "outsource" medical care via technology. Hell, it's maddening enough for me to try to get tech support from some guy in India. I sure as hell don't want to do something similar with a health problem. Every American deserves better.

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Altostrata

I read Steve B.'s remarks about automating psychiatry as sarcastic.

 

Just ignore Jackie, another anonymous person talking through an orifice.

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cinephile

I read Steve B.'s remarks about automating psychiatry as sarcastic.

 

Just ignore Jackie, another anonymous person talking through an orifice.

I hope you're right! I would actually welcome it being a sarcastic post and thus invalidating my arguments because I really, really don't want my arguments to turn out to be true some day lol.

 

Again, the post just struck me as strange. I think it's truly amazing that it really is difficult to know if such ideas are sarcastic or serious. It's just a sign of the absurd times. It's similar to when Summer thought that Onion article I posted about youthful tendency disorder was true! Or when I honestly can't tell if an ad is for the latest romantic comedy, a medical procedure, or Viagra!

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Jemima

Oh, wow...and all this time I thought my shrink was a vending machine.

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Altostrata

bumping

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