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You have to keep in mind that a relatively small fraction of the population (often with relevant diagnosis such as personality disorders, anxiety, illness anxiety disorder) are super utilizers of services, inappropriate users of services (such as misuse of mychart physician messaging) and are disproportionately the people complaining online (as well as misusing AI tools).
You see another version of this in the anti-psychiatry movement where people who can't recognize they have an illness because of the illness (ex: schizophrenia) are complaining about being forced into the hospital and take medication when that is the correct thing to do.
As for rationing the simplest example of this is as a good example of over utilization that many people fall into - suffering sometimes is part of life. If you have a viral illness you need to wait it out and take care of yourself most of the time, the doctor will not be able to do anything and rarely is it worth confirming which URI it is. Antibiotics will not do anything useful.
This does not stop people from emphatically making demands.
I can believe that. I guess what concerns me is that institutionally the same machinery has to apply to me and to Nutty Alice, and there seems to be a strong presumption that the role of a doctor is to constrain the patient and that a patient researching their own condition is essentially misbehaving. From there it's only a hop, skip and a jump to "people shouldn't be able to get medical advice from AI, and doctors should ignore it when they do".
Whereas instead we could work hard to make AI better at obtaining clinical histories and to make feedback loops with reality via diagnostics faster and cheaper. Maybe cutting Nutty Alice off if she exceeds some kind of monthly limit.
More broadly, and with what I hope is appropriate tact, I guess I see this as another skirmish in the long-running war over whether doctors should be respected servants or priests. It's simultaneously true that doctors have genuine expertise and it's often sensible "not to [flatter their patients' biases] due to the negative outcomes associated with that", while also being true that from the patient perspective doctors' anti-sycophancy training seems to be dialled so high that the relationship feels antagonistic. The default response to patients with their own opinions seems to be "no" rather than "yes, but".
To put it another way,
is true but doesn't seem to me to be striking quite the right attitude for a relationship that I conceive of as client and service provider.
A lawyer who tells you, "mate, it's not worth suing, even if you win the damages won't be worth it" or a plumber who tells you, "plastic pipes sweat a bit in the cold, it doesn't mean there's an issue" is worth their weight in gold. A lawyer who tells you, "all landlords steal your deposit, come back when you've got real problems" or a plumber who says, "pipes do that, call me when there's an actual leak"... not so much.
With respect to viral illnesses, I might have a better opinion of anti-virals than the doctor does, or I might suspect it's actually something else and want a test to check even if the doctor thinks I'm being silly, or I might just be really really interested in URI strains. In that scenario I think it's more productive to give me access to cheap good advice and make my wishes easier to fulfil than to litigate whether or not I'm permitted to have them. If Nutty Alice needs special accommodation I'd rather we tried to lay down some rules for her specifically than constrain everyone.
Caveats: some issues genuinely need gatekeeping, such as coordination problems like antibiotics or medical interventions with genuine health risks. I'm talking about a change in the relationship during diagnosis and exploratory treatment, not opening up the medical cabinet to all comers.
Caveats the second: I have experience with the British private system but not the American one (which might be quite different).
Intuition pump: debugging is usually the slowest and most annoying part of fixing any problem. Making each debugging attempt cost hundreds of dollars and take 20 minutes max and have a 25% chance of being refused outright is very inefficient.
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