You can't rely on asking the customer. When they're upset (they often are in these calls), they'll lean towards the negative regardless.
I don't know how well these AIs evaluate, but if they're even a little bit good, it makes sense to use it to screen for outliers, then have a human listen to those outliers and judge.
Patient or customer? I even struggle with that, but I guess that’s what people are in a privatised healthcare system.
I definitely want to be a customer.
If you outsource that work to customers/patients, you'll end up with the car dealership model, where the sales rep begs you to give a 10 on every single question including on the interior design so they don't get fired.
That's the part most of this discussion misses. Supervisors exist for a reason. Congrats on your flat org structure, you fucked up an important feedback channel.
Oh yes, and the nurses did employ strategies like that pre-LLM (don't know if they still do). They had to be very strategic about it (you can't just say "Rate me a 10.")
Repeated unprofessional behavior with no discernible change after trying to address it. My take is that the Kaiser nursing org has a serious discipline and customer (patient) focus problem.
The necessity of teaching nurses that doctors orders are not sacrosanct comes from the bitter experience of doctors giving orders that are wrong.
Asking for clarification is great, but doctors can be very reluctant to hear. The bottom line is that the nurse must not do certain things and the certification exam is there to make sure they know it.
Think of it in relation to the “anybody can stop the assembly line” part of quality control.
You can ask the customer enough times that unreasonable customers or surveys are averaged out.
A good question might be "why are you upset?"
A significant fraction of the calls they answer are patients shouting at them because of:
- Long wait times
- They don't like their doctor
- They don't like the advice they're given (sorry, but we're not going to book you as a high priority appointment if all you can tell me is you have a headache. Sorry, we're not going to prescribe a narcotic for a scraped knee.)
- Several reasons that have nothing to do with the nurse, but the customer will still blame the nurse.
I'd guess most people have had a situation where there's a corporate problem, the support person you talk to literally doesn't have the tools or the agency to fix it, but then you're asked to rate their performance on whether or not they solved the issue, with no option to say "Actually they did their best but this isn't their fault."
In this case, the lack of such an option is obviously a flaw in the assessment system.
How to fix that? Major political issue, I suppose.
I suppose it is political because these companies rarely want accurate assessment of their labor to begin with. They want any justification needed to lay anyone off at any time while minimizing legal liability.
Can’t believe nobody noticed this was a joke
How would you want yours rated? By someone you have communicated with, or some data centre somewhere?
I suppose you could do that with the survey as well. It'd be an interesting study to see which is more reliable.
By a knowledgeable/skilled person who listens to the call. (Which the AI solution provides).
We don't know, so let's not pre-judge.
Are you saying that the AI is the same as a knowledgable/skilled person?
Sorry, I parsed this as claiming ‘the AI solution provides a quality of results the same as a human.’
Are you actually saying that the AI solution should provide a human with the calls it identifies as needing a human review?
Hospital systems are incentivized to avoid the real problems with healthcare. People want timeliness and they want quality care which hospital systems are not incentivized towards in the US. The incentives are profit, which given budgets means corners cut.
Triaging is an opaque system to the patient. It's an important process to doll out finite resources but it also very frustrating to be told, "soon" when you've been waiting 15 hours to see someone. Frankly, if I were King for a day, the first thing I would do is break up the monolithic hospital systems and build out more urgent care.
I would also try to find a way to facilitate transferring less critical patients from ERs to urgent care centers. Right now a hospital won't take the risk, especially if you are sitting in waiting room because beds are full. You can't easily punt a patient because them leaving would be against medical advice.
Get the doctor to assess the nurse. Or the head nurses if you don't trust doctors. The nurses have managers, and if none of the doctors or head nurses can be trusted with a simple matter like assessing whether nurses are doing their jobs then you got bigger issues.
Oh no, the boss might play favourites if it's not an objective measure! Oh the injustice /s
But stupid rules or KPI also allow favourites. You can use an officious 30 point checklist and play favourites while ticking boxes. You can even rig "objective" data by controlling other factors (e.g. giving someone difficult customers do deal with).
Yeah, data driven would be nice, if you have good data. But data driven is a power tool. You don't measure SLOC or reward token use in software because of perverse incentives.
But evaluating tone and empathy? Great, now every nurse is gonna be wasting their time and energy making sure to recite the best canned, optimized text-adventure incantations for the KPI every time they enter the room instead of using their brains to see what the patient actually needs.
"Hello Mr. Smith our patients are our top priority at Kaiser and your nursing staff here at Kaiser Raccoon City are here to make sure you are cared for, comfortable, and safe. If you have any concerns or are feeling anxiety be sure to press the nurse button and we will be happy to assist you, we appreciate the trust you place in us and are eager to celebrate your recovery with you." < nurse now realizes Mr. Smith has been choking and losing consciousness while she was reciting that spiel >
Definitely don't do this. I know doctors. I know nurses. Plenty of doctors view nurses as their slaves.
And besides, doctors aren't qualified. These are different roles.
It’s not even been five years of AI, and we’ve already arrived at the point where the human is wrong and the AI is right.
Mind you this is in an area where the benchmark is the opinion of the human ! So if the customer is saying you’ve shown enough empathy but AI says you haven’t, then you take opinion of the AI?
Soon we’re going to have a situation where the patient is breathing, but the AI says he’s dead.
It’s somewhat the point of democracy to maintain a limit on rent seekers’ and wealth extractors’ power on the political process. It should come as no surprise that the individuals who have grifted and extorted their way into power are also fiercely antidemocratic. The xenophobes and bigots that have hitched their wagons are equally deplorable.
but if you can't see the stark difference in pro-mega-corp policies and blatant pay-to-play corruption in the last 1.5 yrs with the previous 4 years, you're clearly not paying attention
the fact that BigCorp couldn't wait to get rid of Lina Khan, and found a willing ally in Trump, is just one tiny example
But the similarities stop there. The party platforms are in stark difference, and the GOP is now literally a cult of personality run by a mob boss. The naked corruption is off the charts.
In fact right now Trump is working to cancel or refusing to acknowledge mid-term elections and acts as if he were king.
I say this as someone who used to be a Democrat but left in disgust when Clinton remade the DNC into pro corporate puppetry. Partisan politics is a cancer on the citizenry and may very well be the end of what we call democracy in the United States.
I've tracked presidential politics since watching the Watergate hearings and what is happening today is beyond the political pale.
My pushback is that now is not the time for both-sides-ism. It needs to be addressed but most voters are poorly informed or vote their emotions and that talking point needs to go in the back pocket for later, if there is one.
I get your point, and the other one stating that Democrats are not "the left", but they are the the least worst option that a 2 party system offers.
The game is rigged, but this quote nails it:
On Undecided Voter s: "To put them in perspective, I think of being on an airplane. The flight attendant comes down the aisle with her food cart and, eventually, parks it beside my seat. “Can I inter est you in the chick en? ” she asks. “Or would you prefer the platter of shit with bits of broke n glass in it?”
To be undecided in this elect ion is to pause for a moment and then ask how the chick en is cooked.” ― David Sedaris
Actual US identity expression "issues" (visible drag queens, actually trans people, sports questions) seem to be small number small beer problems that should fall under US principles of "We let Nazi's march, so why not Furries" ?
"woke" has been a goldmine for the Right. Who needs policy when fear, panic, and anger get the voters in those booths? After all, drag queens and trans people are scary -- think of the children!
That phrase gets used a lot, I'm curious what you mean by that.
If you mean "woke", then you're probably missing the irony of how that is actually used politically. Based on the phrasing of your question, I'm guessing you might have an irony deficiency. But please go on.
Political discussion here is frowned upon because it usually devolves into partisan name calling -- which justifies it not being tolerated.
But if you want to discuss policy or "hacking society", please do. I am of no political party and am more than happy to acknowledge the foibles of those I might associate with, as well as any of my own because everybody makes mistakes, no?
I ask because as an outsider I overwhelmingly see US identity politics issues being raised by the new "Republicans" and to a lesser degree by the old Republicans.
> if you materially make peoples lives better they will vote for you.
This doesn't explain the last election in the slightest unless relaxed to "if you pinky promise to materially make peoples lives better..."
The idea that there are any significant number of people out there deliberately hurting themselves for hate's sake is a complete myth. People reach for it because it feels good to imagine that your opponents are hate-warped idiots, but there is not a shred of evidence to support such a claim. When you actually talk to people (and not just assume you know what's in their heads), you find out that they, like you, are just trying to do good in an imperfect world.
Of course nobody's going to vote for a candidate who doesn't promise what they want. But if the promises are lies and never honored, and instead the winner does things that leads to making things worse for them, they have effectively voted against their own interests.
Very little of what Trump promised was related to the common voter's best interests:
* lowering prices and inflation
* ending the war in Ukraine (in one day, to boot!)
* "fix" US trade
Most of the other stuff was ideological red meat, much of which he actually has done, but I'd argue that it wasn't in the interest of the common person in the end (tariffs fucked up US manufacturing and businesses, and in the end was revoked because it was illegal).
Meanwhile, he started a new war with no clear way out, has ballooned the national debt, destroyed the US's relationships with our allies (likely permanently), etc. In the interest of brevity I'm just putting some relevant nuggets, but the list is quite long.
If you look at his promises and platforms, a majority of it was a revenge and hate spree, and the hunger for that hate was actively indoctrinated into his base.
If you read through any of the DNC talking points of any given campaign, you're not going to see much on social issues until you maybe get to Kennedy. It's just not really something that's a pressing issue for a presidential run.
And honestly, I can't think of any social policies in the last 50 years that was seriously pushed by a sitting president. They at best pay lip service by painting a rainbow on some building, often years after the actual legal and legislative battles were won.
----
Now, to directly answer your question: I'd rather not rely on deplorables to vote progressive. the nature of how they approach life simply won't allow that, even if they are otherwise in full agreement with every point. We need to energize the entire 3rd of the country that took one of the most important elections in the past 60 years and simply shrugged, staying home. We need to give them someone who will fight for them.
Of course, and that line of reasoning has consistently failed at the polls since it was deployed as a readguard attempt to bolster Clinton's failed presidential campaign. Like, how many times does the DNC have to stick a fork in this particular outlet before it becomes transparent that this line of rhetoric simply doesn't produce the desired results?
Not only is it absolutely time, it is well and truly past time to underline the functionally identical economic policies of both parties, how the economic turmoil this causes drives identity politics and political division in this country, with a clear eye towards bringing an end to all of that through any means available.
A two party system is a rigged game. Period.
The Democratic party absolutely needs to be taken to task and none of their bullshit should be tolerated or defended, ever, except one small exception: election day, in the general election -- because we can't fix the government if it's no longer a democracy.
We are in violent agreement in all but this: I refuse to reward the Democratic party for putting a gun to my head. If they as a political organization are willing to literally risk our democracy when the alternative is assembling reforms that clearly address the imbalances in our society then we can all burn together because I refuse to continue to reward their brinksmanship.
I want to point out that there were enough viable voters for Harris to win (but I am in the camp that believes there was actual election fraud done by Trump supporters).
The anger at blessing Harris without a proper primary, the genocide in Gaza, and the "everything's fine in the economy because the market is doing great!" -- none of that should be tolerated, and I recognize the anger leading to not voting for her because of that.
But by not voting in that unpalatable compromise we have an administration that is as evil, corrupt, and anti-democratic as could be. It's not clear if we can ever wrest control again. I'm frankly terrified.
We have to be strategic in our opposition, but that involves all of us reading from the same script -- a power that the Right excels at and the Left seems incapable of doing.
Case in point: "wokeness". It's been artfully weaponized by the Right and is the Achilles heel of the Left. It's the GOP's golden ticket to victory.
One of the superpowers of "wokeness" is that it's definition is never acknowledged on the Right other than "shrill libruls trying to boss everyone around and make everybody transgender and gay". That vagueness is intentional. To the Right it's an opaque blob of hate that requires no thought, no reason, other than "I hate that shit".
As "woke" was really about becoming aware of the institutionalized racism of the US I would call myself "fully woke" in that regard. But as it's more of a amorphous entity now I'd call it "human decency".
That said, I believe the Dems need to bail on "woke" and follow the model of the Tea Party, where a subgroup can espouse the more "extreme" stuff, and the main party can say "oh those silly people, that's not us, we're the serious party of populist economics and foreign policy"; then once that is framed in the public's eye, to go "oops, the extremists made me do this".
Politics means 2 distinctly different things: tending to the rules of governance, and tribal warfare. It's the latter that makes people hate talking about it.
This is all a game, a very important game, and a very strategic game. The rules used to be more clear but now its Calvinball.
Our only viable choice is to play the game the best we can, and recognize and act on what will help us "win".
Disclaimer: while I shit on the GOP, I recognize the value of "conservatism" and would love to see a GOP that existed to be the check and balance of any follies that the Dems enage in. If we're stuck with a two-party system, that would be our best bet for the country to survive, let alone succeed.
There is nothing sweeter to the oligarch constitunecy than the idiots who can't see shades of grey.
But the real crime is that the left never exploited that. If I was in charge, I’d have mountains of draft legislation vetted, proofread, run by every lawmaker, and printed out years before any potential majority just in case it ever came about. Whoever was in charge of the DNC in 2009 should feel ashamed of letting a generational advantage largely go to waste.
Fillibuster is a senate procedure rule. That's about the weakest a thing could be. At any point Democrats could have gotten rid of the filibuster with a 51 majority.
Democrats would much rather let congress do nothing than do something. It's hurt their reputation so much.
I like the idea of the filibuster, but like most things it degraded from a way to force the stand to consider your ideas at all costs, to a blatant stalling tactic, to a lazy button to push against anything you disagree with. I'd rather throw it out these days than keep it, but ideally we'd completely revamp it to close such obvious loopholes and bring back some skin in the game.
development of power can be based on all sorts of things, it depends on the framework.
a nurse who is utterly incompetent will be fired quickly.
after a certain threshold though, obviously, competition won't be about 'ability' so much - but there are baseline ability and professionalism thresholds.
Most of the replies are large pop subReddit level junk.
Where has all the empathy gone? And common sense? :(
Contrary to popular belief, I don't think common sense has gone away. It just has been deprioritized at the altar of profit. It'll be visible loud and clear the very instant if/when the lives of the assholes chasing profits was on the line.
> Contrary to popular belief, I don't think common sense has gone away. It just has been deprioritized at the altar of profit.
Or perhaps it has been left to starve due to apathy and an unrelenting pursuit to reduce the difficult job of leadership into a much simpler one based on arbitrary numeric values which are defensible to those higher in the managerial food chain.
Defensible on account of discharging their relentless duties of generating shareholder value within legal limits... i.e. profit.
The fact that it is done in a lopsided way at the expense of everything else is just sign of societal decline due to deification of money and letting the tiger of capitalism roam without boundaries.
> A company spokesperson said, "Kaiser Permanente does not use Average Handle Time to assess agent performance"
So uh, average time wasn't raised as a concern, calls beyond a certain threshold was. I wish this semantic discrepancy was better highlighted in the article.
They claim they do not use average handle time, but it is very common to get called into meetings to discuss why they spent a lot of time on some calls. The nurses get defensive (by definition - they have to justify the time used - it is a defense).
They also do get called into meetings if their average handle time is large.
It may still be true they don't use it for evaluating performance, but they absolutely do utilize it to "coach" the nurses.
I highly doubt it. If this is the reason your manager knows who you are, you are absolutely going to be judged on it. It doesn't really matter what the policy says.
And the nurses absolutely feel like they are being punished for it. Just like having to consistently remind HR that your "absence problem" is due to covered FMLA leave - they know who you are because they've had to talk to you about absenteeism. In a call center of 500 people, it isn't likely they remember that you had issues because of their faulty systems.
This is true for any job. I was unfairly fired from a job because somehow the manager got a perception of me being incompetent, because he often talked to me about problems in my work - most of those conversations ended with him saying "Oh, now I see why you did it that way."
But, just purely semantically, the statement Kaiser gave in response was worded in a precise smug corporate America style to dodge the main concern raised. I think it's important to call out weasel words.
I know nurses. And I know their unions. Kaiser can be extremely clear and tell the truth, and they'll still say "We don't believe you!" without any evidence other than being called in to talk about it.
I'm not anti-unions - I've benefited from them. But it's well known that distrust goes up when you have (or need) unions. It typically degenerates from "We" to "Us vs them".
Let me ask you this: Are you saying they shouldn't monitor the time at all?
Again: A tidbit of inside information: A number of Kaiser patients get such long wait times that they're issue isn't addressed when they try to call (i.e. they are told they'll be called back, and they're called back some other day). I don't know the percentage - likely small - but from a healthcare standpoint, it's unacceptable.
Another bit of information (likely not inside): Kaiser has a serious budget problem. They already pay amongst the top salaries for nurses, and they can't simply solve the problem by hiring more.
So: How would you solve it?
We're liberating them from work so they can focus on what matters
Also, California has a high cost of living.
I shouldn't really have referenced "replace" at all, but rather "optimize". And not targeting middle management but the whole non-medical structure above. This is where I think most of the waste in our modern US medical system lives.
But I understand it is still mostly a half-baked concept. We'd need a revolution far outside of just some management system. I believe it's the whole enclosing system that is rotten and driving medical costs away from the actual encounter costs. Profiteering, risk management, regulatory capture, etc.
I woudl argue there was a point, long ago, where these things have taken on a life of their own and no longer serve the need of improving care outcomes and the actual medical cost-benefit tradeoff we should be optimizing in a just and caring society.
> Another nurse speaking on condition of anonymity said “AI did not understand our job and would grade us wrong all the time.”
It's always worth remembering Goodhart's law https://en.wikipedia.org/wiki/Goodhart%27s_law - "When a measure becomes a target, it ceases to be a good measure."
In theory AI could usher in the first time in history where one can escape from this trap - because qualitative judgments can be made at scale, from an unbiased and universal baseline. In this situation, for instance, rather than collapsing call transcripts and reports into metrics, it could evaluate whether red flags are encountered in the context of a call, and allow for qualitative guidance on improvement, across a comparative corpus of situations that are themselves chosen qualitatively.
But very few managers are empowered to take this kind of approach; they're evaluated by their ability to report quantitative metrics, and thus they must implement regimes of quantitative metrics. And leadership instructs them to use AI to build that regime more quickly.
If you want to see an "AI native" organization, it's one where leadership actively fights this tendency, and sees managers as product designers who make the end-user experience a beloved and empathy-driven one, as opposed to a gear that turns accountability into a single number on a screen.
So stupid. If you had ever made a phone call to a patient, or their family member, you’d soon realise how bad this is.
You need to talk to the patient and something a family member too. Be too hasty and you cause more harm than good.
About 14% of Americans think AI is moving us towards a better world. About 17% are creationists. About 26% believe in Telekinesis.
0 people that I know are in all three. Pretty confident about that.
For the any two of three cases where [A] includes creationists and those favorable to AI; [B] includes creationists and those who believe in telekinesis; [C] includes those favorable to AI and who believe in telekinesis.
[A] 0 ; [B] 0 ; [C] 0
Considering people that I know who could be part of one of the three groups now is an interesting question. I am pretty sure that two relatives are creationists based on interactions over the years. I haven't ever heard anyone I know talking about telekinesis so I probably have to say that this could be a non-zero number. If it is a non-zero number then [B] could end up being non-zero. AI is universally hated or even feared by those that I know who are being forced to use it or whose employer is adopting AI tools in their workplace.
So based on my own recollections I have to say that there are only 2 people that I know who belong to one of the three groups you identified. Interestingly enough, the children of those two creationists are not religious as adults. I think they had all they could stand growing up in that environment and as soon as they went to college they 'rebelled', leaving the parents disappointed that the kids didn't want to tote all that baggage in their own lives.
Sample size is small though since I don't know many people.
It’s going to be very improbable that these statements are true.
Where and how is that determined? I.e., any references to back that up?
And you can't in one breath say they have the best healthcare but then say their employees' reports of their experience are unreliable.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8032167/
Their secret sauce is their ability to standardize protocols throughout their entire organization.
https://healthy.kaiserpermanente.org/northern-california/pag...
There’s no best healthcare for everyone but that doesn’t change the fact that Kaiser is objectively one of the best.
If you have a choice of hospital networks, research carefully. Kaiser might be fine for many people's needs, it's not fine when it comes to intensive care.
But it doesn’t change the fact their protocols are top notch as reflected by their quality metrics.
Plus, a quick Wikipedia glance shows they have a fair share of controversies, including major fines due to poor COVID protocol adherence.
In the Northwest (Oregon + Washington), it's pretty high. Not sure about other locations (Hawaii, etc).
But again: Customer satisfaction doesn't mean best outcomes...
Their goal isn't to provide high quality care. Their goal is to increase profits. It's not hard to imagine how improved quality would lead them to spend more money. (faster diagnoses of serious illnesses and recommending expensive care)
Truth is most nurses care for people having the worst day of their lives. =3
How can UHC use AI in the same way? They're an insurance company. They're not administering the actual healthcare?
UHC, the HC stands for Health Care, does have a field operation that handles home health care evaluations for those who live in rural areas with minimal access to medical facilities. Those patients are visited regularly by field personnel, trained nurses, who evaluate their conditions and insure that they have access to appropriate treatments for their conditions. Part of the evaluation of appropriate treatments has recently been pushed off to an AI-based system which uses various inputs to determine eligibility for treatment options.
I hate to break it to you, but "non-profit" doesn't mean what you literally think it means.
https://en.wikipedia.org/wiki/Kaiser_Permanente
Also, KPMGs are indeed "for-profit" while Kaiser Permanente as a whole is constituted as a "consortium" of both types.
And here is why: I guarantee you that the nurses are working in the "for-profit" units, and also, that still betrays ignorance of what "non-profit" actually means, which is the load-bearing topic of this thread.
This doesn't seem like a money-saving measure exactly. The main AIs the article talks about is making sure nurses on their nurses' lines aren't being assholes. I guess this used to be spot checked before so you save on that? Maybe? It seems like they are trying to solve the problem of some of their nurses staffing their nurses' line not treating their patients the way they're supposed to.
Increasingly health insurance companies and healthcare providers are intertwined. So they may spend 80% on healthcare, but then a big chunk of that could go to the urgent care clinics that they own.
And even if they don’t own the provider, they don’t have much incentive to lower total cost because 20% of a larger number means more total profit.
Kaiser is an HMO. They are the insurer and try to have their employees, such as these nursing lines, perform almost all of their care. Shifting from one line of business to another is purely internal and can't game Medical Loss Ratio like your scenario.
> they don’t have much incentive to lower total cost because 20% of a larger number means more total profit
There is some bad incentive here for sure. That being said, insurers do compete on price so they lose customers if they charge more than other insurers. Also, regulatory rate review can decide whether they can raise premiums a given amount.
> That being said, insurers do compete on price so they lose customers if they charge more than other insurers.
Yeah but that’s a second order effect. Most companies are incentivized to cut costs because they will directly realize the profit. Insurance companies are incentives to cut costs only to grow market share.
I understand the point of the profit limits, but I don’t think it works very well in practice. I think it would probably be better to just have private companies without that profit cap and add a government insurer to compete with them.
>Maybe healthcare shouldn’t be primarily for profit?
Which is a far larger topic than what the article was about.
Given how healthcare is one of these sectors that seems to relentlessly resist efficiency increases and is the prime example of Baumol's cost disease, I think any developed country with a costly healthcare system needs to do these AI experiments. The current versions will be shit, but the only way out is through if you still want to provide affordable care.
I honestly have no doubt that AI going forward will be able to do a good job at triaging via calls and also being empathetic about it. But of course it needs careful experimentation.
People started hating tech right around the time metrics became popular. I don't think it's a coincidence. AI just accelerates the trend.
The problem is the misidentification of AI as the issue. As long as we don't understand the real issue, we won't solve it. AI is just a tool. It's being used in a way that denies human agency.
Our cultural values need to shift away from safetism that demands centralization. And shift toward valuing human agency. That starts with talking about the core issue.
"To the man with a hammer, everything looks like a nail." [1] There is no such thing as "just" a tool.
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Now, like many tools, the majority of those selling AI to make money off of large enterprise sell its ability to increase productivity, efficiency, compliance. Either to make money or to minimise risk. And so like you say, they just become tools to make these metrics move or report them at higher granularity. And often there is either a lack of imagination or a willful ignorance of the perverse outcomes with relationship to humans because they are in service of the organisation not it's employees.
But that same AI could cause those companies to no longer exist.
The AI I'm happy about allows people without much tech knowledge create small apps to do exactly what they want. And, for those that know just a little more, use it to help them extend open source software for their niche use case.
This makes computing more personal and gives back agency to the computer operator.
Mix that with the rise of much more competition in much more custom software, and you'll see that a future can exist, if we want it, where software becomes more personal and humane.
The software vendor will capture less value, though - the margins will be thinner. Instead that value will be captured (in non-money terms) by the end users.
That also means that software companies, unable to capture so much value, must shrink and become more boutique. The software that contributes to our centralized world would lose a lot of power.
That's the future I can see. The only way it doesn't happen is if a cynical narrative wins out and manages to lock it out through regulatory capture so that only licensed operators can use or provide AI. The anti-AI narrative helps the cynics.
They will vocally rationalize it.
I did it. "I'm more productive work from home." But then I do dishes, take an hour break, paid.
Foucault says that when people are observing them, power is placed over them.
If you are a worker you should hate this.
If you are a customer or owner, you should like this.
But I certainly won't be automatically believing people under surveillance who make claims it makes their quality worse.
Some of the tech is pretty scary. One big vendor's solution [0] can provide not just AI agents but also use AI to snoop on calls in progress, evaluating sentiment from both sides [1], verifying phrases are said - pretty dystopian in theory. From experience, these things tend to go downhill based on the attitude at the top - is the mission to slash costs or take care of customers? A 1000 decisions follow from this one, and like Jira, it can be a useful tool or a prison-like hell.
[0] https://www.cisco.com/c/dam/en/us/products/collateral/contac...
[1] https://www.cisco.com/c/en/us/products/contact-center/webex-...
If it's to do something normal you could do through the website there was no need for AI - a website or app suffices - provided it isnt terrible.
Capital definitely thinks it can save costs here but capital is getting increasingly delusional these days.
A good 90% of call center humans are flesh interpreters for support scripts. They are being paid to act like they don't have free will.
if it was easy enough for an AI responder to solve I would have solved it myself
<s>
Hey, company's AI can help a lot in stealing its service's user passwords, which you usually cannot do yourself _that_ easy:
https://news.ycombinator.com/item?id=48350239
Think of AI as a tool... for data leaks. </s> (not 100% sarcasm)
"You wouldn't believe how much of a relief it has been. In your last visit, you saw me typing everything you were saying, right? I don't have to. I can listen to you and take very specific notes as necessary as opposed to focusing on both typing and listening to you at the same time. It has bought my stress levels down to here." (Indicated by his hand lowering)
They're amazing in a support role, but not equipped as well for primary care roles.
If you present with anything other than healthy and fine, the ones I have had to see are less than helpful.
They simply do not have the depth or breath of training as a doctor. They're very good at executing a plan as part of a care team, and even making changes to that plan based on patient need. But they just simply aren't as good as doctors.
There's a reason they're replacing doctors. . . They're cheaper. That's it.
Which is great, because anyone suggesting AI should replace clinical judgment and work is an idiot.
Too many AI tools are built hastily for me to give my doctor’s (visibly awful) software the trust.
It's a shame, if they had an AI transcription tool that kept everything in-house I'd be much more comfortable with it. Or perhaps some kind of zero-knowledge cloud-based product where I hold the keys.
On the one hand, pre-LLM there was plenty of software out there for medical use, and they had to be HIPPA compliant, etc. I've worked with people who used to write that SW (they hated the job because HIPPA was so strict). The rational side of me is saying I shouldn't be biased against these, and that there's no way they would relax the requirements.
On the other hand, the emotional side of me screams: It's LLMs! Huge privacy concern!
I try to let the rational side win. I've always given consent. Especially because I liked my doctor pre-LLMs, and it seems silly to suddenly mistrust him and go to a doctor I don't know at all.
I made a single presumption: that the PCP's use of AI for this situation is not mandatory. Is it mandatory or is it not?
In 2024 when the AI empathy snakeoil machine was inflicted on the nurses, the nurses had no choice in the matter. And management has already established that they may do something like this again.
Your situation is completely different. It's a doctor overseeing their own tool. If the AI makes a mistake, the doctor is responsible and would presumably take responsibility. Who is responsible if an AI tool makes a mistake in a performance evaluation of an employee? The employee! The employee is guilty until proven innocent. But the employee gets no choice in whether that AI tool is used against them (absent a union agreement which dictates how AI tools can be used).
The reason I fear the misuse of AI is because it is so useful.
I've seen summaries that implied the opposite of what was actually said, and even the transcripts themselves often contain egregious errors. I can so easily imagine these tools summarizing "I drink coke often" to "I use cocaine often", as a random simple example. All nuance gets lost, all context gets lost and unless you're vigilant and looking out for these types of errors it's so easy to slip by the cracks.
The loser, as always, is the patient's quality of care.
This is not a decrease in quality of care - this is your provider having actual evidence of the care needs they discussed with you when they close their note, hours or days after seeing you.
what significant improvements to society or humanity have come about as direct result of AI, that wouldn't have been achieved without it? faster protein folding is the only one I can think of and that more a matter of "faster" than "impossible without AI"
I think at some point there's going to be some version of the Butlerian Jihad
FWIW my wife works for Kaiser and finds a lot of value in the the medical LLM tools available to her. She tells me being able to do live translation, summarize notes, and quickly get comprehensive answers save her time and help her give better care. Her older patients also frequently come in bringing AI-powered alerts from their apple watches that detected cardiac events.
It's annoying that we use broad terms to describe a set of technologies that in some ways can be problematic and in another ways are very beneficial. We gotta evaluate each of these as they come rather than talk about blanket bans.
Ive actually moved primary care physicians over this once already, found the oldest guy I could who barely knows how to use a laptop but spends a bunch of extra time with me.
For example, a 60 yo doctor would have been born before the first heart transplant, the recipient lasted 18 days. Now 5000 are performed each year and after 5 years 80% of recipients are alive.
Too bad for me, it’s a real mixed bag. I need a doctor who is an AI-using LLM skeptic, I guess.
- will not see a “provider”. A doctor (MD/DO) only please.
- will not see a doctor who uses LLM tools (or therapists for that matter)
- Make it abundantly clear that if you do then we’re not a match.
- Will pay significantly more/go out of my way for for this.
We all have our biases.
Better the devil you know ...
A paint conveyer belt is not a robot. A sprinkler system is not a robot. A CnC machine might be a robot. A conveyer belt that sorts items might be a robot. A roomba is a robot. And all of these function just fine.
> It would have been, 20 years ago.
No, it would have been called what it is both then and now; an asynchronous message emitted by a device having sensors capable of detecting when to do so.
This isn’t exactly the same, but nothing in the book Paradigms of Artificial Intelligence would be considered AI today.
Microsoft now calls everything AI (actually mostly "Copilot"). YouTube now calls everything AI (including genuine LLMs and generative features, but also everything it used to call machine learning). Google now calls everything AI (including everything it used to call machine learning). Apple is seemingly the only one immune.
My argument is not that no one ever used "AI" to refer to a product that utilized machine learning, but rather that the term of art in the industry for machine learning itself was actually "machine learning", not "AI", until LLMs took over and made it "AI".
You would not pull a library off the shelf for "AI", it would be for machine learning. You would not implement and perform "AI", but machine learning. Even central parts of the AI ecosystem like PyTorch advertise as being for "deep learning", which is a subset of machine learning. Not "AI".
Machine learning was AI. The specific wording was a branding choice, because "AI" was a deeply stigmatized brand. ( https://en.wikipedia.org/wiki/AI_winter ) But there was not a conceptual division.
There's a close analogue to how modern genetic researchers are happy to tell you that your genome is not informative as to your "race", but it is informative as to your "ancestry".
You should listen better. The University of Edinburgh had an entire Department of Artificial Intelligence when I was an undergrad there in the 1990s, and one of the things it researched was machine learning.
Someone who was truly on the ball on this matter might’ve observed that Edinburgh in the 90s was so balkanized by internecine personality conflicts that most research that might later be strictly labelled “machine learning” actually took place in adjacent units and not directly under the DAIry. But I suppose you haven’t heard that, either.
Exactly what do you think my argument is? It's not "I didn't hear of [anything], therefore it doesn't exist / is not admissible". It's roughly "I didn't see machine learning referred to as 'AI' for years, until LLMs happened, at which point most companies that used to say 'machine learning' started calling the same things 'AI'".
You don't have to be snarky about it. I've heard it's okay to not know things. Is that wrong too?
Also:
> desperate compulsion to litigate hair-splitting category distinctions.
All I'm saying is that neither one is a strict subset of the other. Even though AI and ML are incredibly related to the point of even mostly overlapping in practice, they're not the same thing! AI is an outcome and ML is a mechanism. You can use the mechanism to achieve the outcome, or you can use a different mechanism to achieve the outcome, or you can use the mechanism to achieve a different outcome. That's all. If that's a hair-splitting category distinction to you, then so be it.
So machine learning became the marketing.
There's a book from 1995, called Artificial Intelligence: A Modern Approach, by by Stuart Russell and Peter Norvig, which gives the definition "AI is the study of agents that receive percepts from the environment and perform actions." but doesn't define intelligence.
https://aima.cs.berkeley.edu/2nd-ed/preface.html
If we go with that, though, I'd say AI is anything that uses a model to make decisions instead of hand written "if" statements.
> If we go with that, though, I'd say AI is anything that uses a model to make decisions instead of hand written "if" statements.
Hand-written if-statements are a model though...
I would say AI is anything with the intention of performing as a human does. In my opinion, LLMs are AI because they're designed to either perform a human role, or be addressable like a human to a user. (In general I do not agree with implying intelligence by humanity or that it is exclusive to humanity, but it is genuinely the easiest way for me to explain this here.)
Even LLMs that are used as part of harnesses or backend services would count for this, because you could technically replace the model with an equivalent human and they would be able to read and write in its place.
And pre-LLM AI would also count for this, because the whole selling point of AI is that it's like a human in some way or could perform as a human does in some way. Even if it's purely for entertainment value or whatever, if the entertainment value includes that it seems like a human.
But uses of ML that have nothing to do with this would not count, like for example camera image enhancement. You could say a human could sit there and work through some algorithm manually (like from a book, etc) but that's not what image enhancement algorithms are doing. Now if you let an LLM have access to human-UX-ful photo editing tools and let it iterate or etc. then that would be AI but that's another thing.
It's difficult to define precisely exactly what this definition is though. Different people have different ideas of what "performing as a human does" means. If the ML algorithm is executing machine code instructions to perform a task then could a human execute the same machine code instructions by hand to prove that it's AI? No, because the human has to be in place of it, not emulating it. The human would have to take its inputs and give its outputs, without depending on its definition. So, then, it depends on where you define the boundaries of the system. LLMs typically output in tokens, so would a human have to think in tokens? No, because the use of tokens is as a text encoding, and humans are perfectly free to use tools in their work, etc. A human being able to read and write text in English would still prove that a language model that reads and writes the same but in tokens is AI as long as they would be more or less interchangeable.
Of course, today's LLMs are not really true replacements for humans but I'm not talking about performance here, just where they can be positioned. AI to me is more of an intention than a technology -- any technology can be AI depending on how you use it. ML however is a technology, no matter the intention.
The textbook definition of AI is a system that solves problems that are difficult for humans. Whether the approach uses formal logic, machine learning, neural networks as a special case of machine learning, optimization, search problems, etc. does not matter.
The rising LLM = AI equivalency is unfortunate.
"All machine learning" is not AI, as k-means clustering and linear regression, amongst others, are very much ML without qualifying as AI algorithms.
There's overlap and edge cases, though: Maybe you have a program that summarizes texts. One could argue that's no different from a passive filter. But can you then ask questions about the text? That's unquestionably AI.
As it is taught literally every single AI/machine learning course on the world, machine learning is very much part of AI completely since inception.
I don’t completely understand why it is this important for you to argue against this completely defined fact.
Also, 'every single course' is perhaps an overstatement - a course that I co-authored tries to get it right from the first principles.
For example, if you pick them manually, decision trees can be AI but not ML. Video game character behavior is a trivial example.
Eliza for example is also not ML, but could be called AI.
Likewise, there is ML that is not AI. Such is debatable, because you could always argue that using machine-learning on anything results in intelligence. The way I see it, things like image enhancement or voice replacement are not artificial intelligence at all. I probably could not define a hard line where it becomes artificial intelligence though.
I will instead pick at this latter part of your claim. What is an example of something that is AI but that is not ML..?
[1]: https://en.wikipedia.org/wiki/Artificial_intelligence
Ctrl-F Machine Learning. Apple Watch alerts are Machine Learning
I would expect companies to blend shit metrics with AI systems, if not at Kaiser then at other places. People lack imagination and using AI to monitor your workforce has to be one of the possibly worst ways to use it. Alternatively some dickhead will "lean startup" their way into measuring "performance" in such a way with the "help" of AI that they will do something even worse.
Are there no actual problems with what it promises/how we're expected to use it at work/how it is used against us by people who use it at work? Is it just anxieties and feelings, that aren't actually grounded in anything? Everything's getting better for everyone, no downsides?
I think OP is a good case in point where people are blaming AI but really the issue here is the human in the loop, the person implementing these abhorrent policies that happen to be powered by AI.
I don't care if the torture nexus itself is not at fault, now that it has been created, it has enabled its owner to do a bunch of novel bad things, and it deserves a large part of the blame.
Or are the providers just pocketing the difference?
Given that prices are definitely not going down, I'm not sure how this makes my life any better.
Well instead of staring at a computer the whole time now they can actually make eye contact with you. IMO that alone makes my life quite a bit better
As executives and analysts increasingly use the "AI" craze to push automation and computerization (and layoffs) generally, even aside from AI proper, it should not be surprising that the individuals and groups opposing those moves also use the same labels.
The lack of precision in language here sucks. It sucks for the discourse and it also sucks when it comes to focusing anger and productive energy on the core problems (obfuscation of human responsibility, erosion of human agency, declining institutional flexibility, deprofessionalization, etc.). But it doesn't begin with the critics of AI.
It's a feature. Or at least, a perk. If they want to claim this new shiny rock is AI and people buy it, then of course it's in their best interest to keep the black box mysterious. Being subterfuge for muddying the discourse of critique is just a nice side bonus.
Yes, it makes sense that the confusion aligns with their interests, and they are unavoidably a big part of the conversation. But it remains a problem for the non-overlapping group of people who actually value the social contract, and for us finding a solution which helps take one more step to defeat the scammers remains valuable.
X, Open AI and Anthropic, to name three
Do you have anything I could read to understand your reading better? I would love to be able to dive back into one of my favorite books with a new lead.
I remember the novel relating similar themes more generally, which has shaped how I even think of the title after reading the book. Being "closer to the machine" isn't just about working at a lower level; it's about the way working with computer systems reshapes the people developing for them and the people using them. It's about how even "cushy" software companies lean into, hire for, and draw out obsessive, dissociative traits: the included lunches, the laptop you can bring home and continue to work on, the places to nap or crash on-campus.
Maybe a very dark reading, and certainly colored by some of my own experiences in tech and where I was at in my career when I read it. But for me there's absolutely this sense that the need and desire to be "close to the machine" is also something that lures us away from ourselves and from each other.
And I think this is a big part of the problem. Being a shell of a human does not lend yourself well to empathy and solidifies your ego and that you are “worth” more than others, reinforced with a lucrative salary, praise, and those perks you mention.
Surely these are “good old-fashioned AI” (statistical learning) and not LLM, though.
I just want to be clear that the “medical LLM” tools are the new ones, and the Apple Watch alerts aren’t.
I work in a bank and a can tell you that the customers absolutely hate ML when it rejects their loan application. Over the pond in the US, I have an impression that the fico score is not exactly popular either, but I have no first hand experience.
Black box automatic decision making is much more problematic.
For home mortgage lending, FICO scores are now being partially replaced by VantageScore.
As evidence, let me cite the “computer says no.” sketch from 2004
Nor is this a trivial decision. AI has the potential to change society and economic relations as profoundly as the industrial revolution, or the invention of the printing press.
These boundaries are also contested, as interests which benefit from a particular application are different from those whose interests are harmed. Society needs to identify which usages have a net benefit.
It also needs to define which usages cause "absolute" harms which is will consider unacceptable regardless of benefits to some parties. Such as, potentially, reductions in personal autonomy, increased leverage or dominance by government or private interests.
Not only that, but data and models which were collected/ built for one purpose can easily be adapted for others.
This is also basically now happening all at once in many domains.
In short, you can expect there to be tension over these boundaries for some time. It's not realistic to expect that others will agree with your personal perception of which applications are "obviously" unproblematic.
I totally get it. I think few years, if some company said they record and transcribe every meeting/interview they take, it would be concerning. Now, its somewhat a norm for people to use these AI meeting tools which record everything you say and then go back to recording and exactly what people said. I'd call it surveillance than AI
Relying on LLM to summarize things for you has one more issue. To outsiders, this seems like a tedious process, but is actually very important part of the thought process. Wording your thoughts and writing these down helps people to discover new aspects of the problem. It's how people learn.
At the moment consensus is that it must not be banned, but also not mandated in any way - people must take responsibility, and they must be able to decide for themselves where and when the LLM use is justified and where it is not.
while being bombarded with articles like "AI makes things worse", "AI consumes all the water" and the like
What I’d personally be most concerned about would be the risk of bad models instead of SOTA being used which would be especially error and hallucination prone.
If you’re gonna do it, do it right. Otherwise don’t bother at all.
How is this not a good thing for everyone?
"fun" fact, a number (some? many? all?) of the LLM speech to text models will editorialize or hallucinate words for you, to make your speech fit the pattern it expects.
I don't think it's appropriate to use a model that can editorialize in a medical transcription setting. I feel that crosses a huge number of ethical lines.
> At the moment consensus is that it must not be banned, but also not mandated in any way - people must take responsibility, and they must be able to decide for themselves where and when the LLM use is justified and where it is not.
I have a really hard time understanding how supposed experts in their field, have been taken in so perfectly and so completely. You're a trained and certified medical/healthcare worker, responsible for the health, safety and well being of other humans, and yet willingly turn over parts of the process that exists to protect the safety and health of others, to a machine that you know can and will make mistakes you wouldn't or even couldn't ever reasonably make. You're supposed to make sure it works and is safe for everyone you're responsible for before you start using it... but then, I prefer healthcare that doesn't move fast, and break humans.
I'm sure someone will try to play devil's advocate and suggest it's a good thing to ration care, and that you have to acknowledge that you can't save everybody, faster is better after all But no, I'm angry enough about it that if a licensed person suggests that, I'll gladly complain to your licensing board (rhetorically speaking, I'm not gonna try to doxx anyone). You can't ethically argue for rationing care, and letting a machine known to make errors in ethics or care decisions, that you have been trained not to make. (Advocating for a reduction in the standard of care in order to increase profits.) (Yes, you're correct, if you're in a state of triage, you're required to, and in those cases, using an imperfect machine is possibly preferable, and probably ethical, but still objectionable. I currently refuse to believe that the US is in a state of emergency, but perhaps that's where I'm wrong) Part of your licensure you promised to prioritize patient care above personal gain. You can't then make decisions to experiment with systems you cant prove are safe.
I can understand in when SWEs ignore the best interests of the humans they're working for. But Doctors and Nurses? I guess I expected better from my former colleagues?
Yes, surely it’s not you. It’s all the experts that are wrong and being hoodwinked. Why can’t they just see what you can?
Most humans use a default trust model for life; they've been lied to. That's part of why I'm angry, if you trust other people; why would you look for it? This entire article is about the fallout from not looking for it, and the resulting harms to pt care. So, it turns out, it was a mistake to adopt the new tech quickly; you know, as evidenced by the harms to patients?
So I don't know, why do you think they couldn't they predict the harms that I thought were obviously predictable, and then happened?
A medical scribe isn't just taking dictation, they're doing some level of interpretation and often entering structured, coded data directly into an EHR. This is a more complex role and requires some clinical skills. There are some new LLM products that automate this to an extent, but ultimately the licensed clinician is still legally accountable for what goes into the patient chart.
I can absolutely ethically argue for rationing care. All healthcare systems ration care although the means vary. Demand is effectively infinite, especially from older patients with complex or terminal conditions. Resources are finite.
Since then pt has had to re-explain to multiple doctors how the ER report was incorrect, to their usual MD skepticism. So, for now, I figure LLMs are for shite. Maybe in another 15 years...
And it pays to read everything on a medical report before leaving the facility.
https://sohl-dickstein.github.io/2022/11/06/strong-Goodhart....
This is a well understood phenomenon.
That tool was a trial that they put away (but may come back).
The rest of the stuff all existed pre-LLMs and isn't even machine learning (time per call).
I wondered why they zip in and out of the rooms, when just a few years ago they would spend fifteen to twenty minutes in each room. The patient load hadn't grown. The number of nurses has gone up, not down.
So I'm blaming the stupid metric on their evaluations for a worse standard of care.
Healthcare utilization, number of unique patients, amount of care per patient has all gone up.
American has a massive overutilization problem driving cost but is unwilling to be honest with itself about it.
Although Kaiser tends to repel such patients (they'll happy say "No" and tell you to find some other provider). The bulk of complaints I've heard about KP in California boil down to "They wouldn't give me a referral to a specialist".
That being said, more than one (female at that) doctor has told me in confidence and based upon their observations during residencies, etc. that if I'm ever admitted, be very careful how I modulate my interactions with nurses. They're not all Florence Nightingale and Mother Theresa and there exist those who will @#$% you up on various pretexts or are just plain sloppy and negligent.
Despite all the moralising fluff, it's just a job, not some saintly vocation. Some safety oversight is needed, just as it is for any other work function. Still, can bet that anything 'Corporate' has mandated will be Goodharted up the wazoo.
> Mother Theresa
I read a good chunk of the criticism against Mother Theresa as either willfull misunderstanding and/or just repeating the same literal three quotes from Hitchen's book (seriously, they're always there). I cannot say whether she was a good person or not, but I can say: if you ask "which evidence is there which doesn't lead back to a man with a personal vendetta?", the list gets significantly shorter.
[edit] preemptively, if you're going to claim "but this isn't art so irrelevant" then I claim bull fucking shit. It's the same problem no matter how you slice it whether it be engineering, support, art, or medicine. Get real. Look inward. Touch grass. If you think AI is a good thing for your profession--whatever that profession might be--you're probably a delusional psychotic. It's OK, you'll thank me later.
The problem has always been pharmaceutical prices, liability costs, and inadequate supply of healthcare.
The government does not want to decrease the price of medicine by funding trials so medicine is in the public domain and cheaper, the government does not want to increase the number of matriculating doctors and bring down their time/money/stress costs, and the government does not want to enact tort reform so every step of the healthcare chain is spending inordinate amounts of time and money to prevent litigation.
In the US, you should always be double checking what your provider (or guidelines or whatever) is telling you to ensure that the information is maximizing your benefit instead of minimizing their liability.
The sad thing is that there are many issues, but the study didn't really address them. One would hope for more effective critics.
The AI application I'd like to see would be to identify the elective hyper-utilizers (so we could try to demotivate them by addressing what's really bothering them). That would improve quality of care for them and quality of life for providers, and create time for outreach to the under-utilizers who need preventative care.
Do these idiots not know how intelligent assholes work? If you make this a policy, everyone who has a gripe will eventually learn to delay a call to 14 minutes and then make an absurd ask.
I'm sure he doesn't think AI is making his job worse.