Paleo Diabetic

I consider infectious disease specialists to be, in general, the smartest non-procedural medical specialists. They are often called in to consult on a hospitalized patient who’s already been evaluated by three or four other doctors, but just isn’t responding to treatment and may have an underlying atypical infection.

Dr. Mark Crislip is a retired infections disease doc who is highly intelligent and a good writer. I don’t know him personally but have had the pleasure of working with a few like him throughout my career (shout out to Dr. Kara Asbury). Here’s what he thinks of the intrusion of AI – artificial intelligence – into medical practice.

I really think we are heading into a world where doctors are going to be mediocre at best. There are many articles about how kids today (remember, I am an old geezer) are unable to read books or even sit through a whole movie. You wonder how they are going to master, yes, master, the immense amount of information, all in dense, dry, complicated, technical textbooks, required just to get through medical school, much less become proficient in whatever medical specialty field they choose.

Now? All the cognitive processing will be offloaded into AI. And people will take the path of least resistance, in the process acquiring only the facade of understanding. And if the AI hallucinates? They are not going to know enough to recognize it.

So there will be three kinds of doctors slowing evolving into one.

A few old geezers like me who will mostly avoid AI. I say mostly. I wouldn’t mind if AI generated my billing codes. But that is it. But their medical mind will remain sharp and be wielded like a samurai blade.

Most current MDs will take the path of least resistance, use AI and their mind will be increasingly rusty and dull and at some point be useless.

And those brought up on AI? Their minds will be plastic sporks. Enshittified from the start.

I recommend you read the whole thing, especially if you’re a physician. Plus he takes a few jabs at EMRs (electronic medical records).

—–Steve Parker, M.D.

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Jose Alberto Nino outlines the plan at The Unz Review:

On a December evening in 2020, [President Donald] Trump granted clemency to Philip Esformes, a South Florida nursing home operator serving a 20-year sentence for orchestrating what federal prosecutors called the largest individual healthcare fraud scheme ever prosecuted in American history. The commutation freed Esformes from prison after he had served just over four years, though it left his conviction and roughly $44 million in financial penalties intact.

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The first warning signs emerged in 2006 when Esformes and associates connected to Larkin Community Hospital reached a civil settlement with federal and Florida authorities. The $15.4 million agreement resolved allegations involving kickbacks and admitting patients for medically unnecessary treatment. Though the settlement required no admission of wrongdoing, prosecutors later pointed to this episode as evidence that suspicious conduct continued unchecked.

A decade later, federal authorities brought criminal charges that painted a portrait of systematic fraud on an unprecedented scale. In July 2016, prosecutors indicted Esformes on multiple counts related to what they described as a roughly $1.3 billion scheme to defraud Medicare and Medicaid. The government’s case detailed an intricate operation designed to maximize profits by manipulating patient care and gaming federal reimbursement rules.

According to court filings, Esformes orchestrated a system that moved beneficiaries among hospitals, skilled nursing facilities, and assisted living centers in carefully timed patterns. These transfers satisfied Medicare eligibility requirements such as mandatory three-day hospital stays and 100-day skilled nursing limits, allowing facilities to restart billing cycles regardless of whether patients actually needed the care. Prosecutors alleged that medical decisions took a back seat to financial calculations.

The scheme allegedly extended beyond unnecessary services. Federal authorities claimed Esformes paid kickbacks and bribes to physicians and physician assistants who referred patients to his network. These illegal payments flowed through intermediaries and were disguised as legitimate business expenses. Some payments were allegedly hidden as charitable donations, prosecutors said, while others appeared in fake contracts and invoices designed to conceal their true purpose.

Parker here. That’s just one way to get filthy rich in the healthcare industry. I wonder how much money Esformes got to keep in exchange for his four years in prison. I wonder if Esformes paid a substantial “donation”in exchange for his clemency.

I quit running my own medical practice in 2001 because I couldn’t make a decent living at it while following the rules.

—–Steve Parker, M.D.

PS: This Unz article illustrates the power we’re up against in trying to reform healthcare.

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