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Primary Care Physicians are Incompetent. We Need More of Them.
Brief
Community responses in the same thread, however, do not uniformly engage the medical evidence. One explicit rebuttal (Antra Tessera, karma 9) says the thesis is “materially wrong” in failing to identify cohesion points and pivots the discussion toward AI alignment: they argue modern models have hidden coherence problems driven by training pressures and defense incentives, not necessarily the simple competence comparisons Hide makes. Other comments collected in the thread are largely off‑topic or focused on AI tooling and scale — lengthy reports of token consumption, named users (Liu Xiaopai, Rohit Krishnan), organizational metrics (SemiAnalysis, Cloudflare, Meta token counts), and debates about productivity theatre vs genuine gains (Kevin Roose, Nikunj Kothari). These responses extend Hide’s point about LLMs by showing widespread operational deployment and cost/scale considerations for LLM-driven workflows but do not directly rebut the clinical statistics or the policy prescription. The conversation thus splits: Hide presses for supply‑side reform and LLM-enabled substitution of routine PCP tasks, while at least one commenter insists the problem is more about alignment and interpretability of models; many other commenters provide empirical context about how rapidly LLM tooling and token usage have scaled, implying practical feasibility but also raising new social and regulatory concerns.
Why it matters
Hide (LessWrong, published 2026-05-02) argues median primary care physicians (PCPs) are ‘broadly, grossly incompetent’ and lists empirical failures: ~50% of rare-disease patients received at least one incorrect diagnosis and ~66% needed visits to ≥3 doctors; 30% waited >5 years for a correct diagnosis; a pediatric rare-disease survey found 38% saw ≥6 doctors and 27% had an initial wrong diagnosis.
Key details
- Physical exam performance cited: heart murmur detection sensitivity ~30–40%, lung “crackles” detection 19–67%, abdominal haemorrhage sensitivity ~30–40%; inter-rater kappa values for many exams fall in 0.18–0.45 (close to chance), leading Hide to claim removing physical exams would not reduce diagnostic accuracy.
- Communication and empathy failures: a 1984 study found physicians interrupt patients after ~18 seconds; a 2019 replication found interruption after ~11 seconds; surveys report >50% of US patients say symptoms were ignored or dismissed and physicians overrate their own empathy (inverse correlation with patient ratings).
- Hide claims clinician performance decays with experience: review of 62 studies shows >50% found decline with experience; cites a 2025 pulmonary/critical care fellows study where fellows scored worse than medical students on foundational pulmonary physiology. Average US PCP age is ~48, residency ends ~30 — implying ~20 years of post-training decline.
- Hide argues LLMs and CDSS already match or exceed PCPs: GPT‑4 is said to outperform median PCPs on metrics and LLMs exceed GPT‑4 on biomedical benchmarks; realtime LLM systems can transcribe visits and give diagnostic prompts, making much PCP triage delegable to software and automations (Zapier-style) for referrals.
- Policy proposal: massively lower barriers to entry — e.g., ~10X more PCPs, compress training toward ~1 year for the practical screening/referral role, accept lower incomes and more supply to reduce wait times and improve access; acknowledges cultural/political resistance due to doctors’ societal status.