Diagnosis

My concern goes like this: In the early days, X rays, funny biochemical tests, and other sophisticated gadgets are meant to help clinicians, not to replace them. Two key roles of physician emerged in those days were selecting the appropriate diagnostic tests and, when the results are available, interpret them. Senior physicians used to laugh at their juniors when the latter used a shotgun approach and ordered a whole panel of (to the former, useless) tests. Any investigation, as simple as a tiny finger prick or X ray, involves risk, discomfort, and, above all, cost, and should only be ordered when there is a reasonable indication.

For example, when a man has tummy pain, he can have a CT scan to find out what's wrong. If that costs HK$5000, and, the alternative for him is to consult a doctor (who could also tell him that much), the doctor could - by simple economic analysis - also charge the patient for the same amount. (In theory, the doctor should charge slightly higher because exposure to radiation is avoided, and, more importantly, there is a human touch - a factor we should take aside for the time being.)

But time has changed. If the cost of a CT scan comes down by 80%, interpretation could be outsourced to some exotic country (see Thomas Friedman's The World Is Flat) or even automated by artificial intelligence, the consultation fee of that poor doctor should drop by the same extend. To be even more drastic, if the doctor always asks for a CT scan after clinical assessment (exceedingly common nowadays), he really adds no value on this tummy matter what-so-ever - all he charges now covers the cost of medico-legal responsibility and the provision of a human touch.