History of medical decision making:

1900-1980 (post Flexner era): physician driven 

1980 to 2020 (employer based insurance growth/managed care boom):

Insurance/Institution driven decisions

2020 - present (post-COVID/GLP-1):

Patient-driven clinical decisions

Physician always trying to learn, passionate about healthspan and precision medicine.

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Not really to be blunt. 

Quite a bit I would say. 

I feel the 1% that are capable of understanding medical decisions and their implications are used too often as the reason to shift the balance away from paternalism towards autonomy. 

Because even with LLMs, you can say things to justify anything. If someone is having a headache, giving the right symptoms on the list can skew it to have it say take ketamine. Even if it was just sinusitis

Do you think the majority of patients are capable enough to make correct choices? 

How justified is paternalism based on your patient exp?

Factors leading to where we are today: 
- distrust of institutional medicine/credentials
- ROI on insurance is trash (left ppl hanging too many times)
- social media
- AI democratizing knowledge
- availability of DTC (byproduct of GLP-1 growth)

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This is also where the 2 tier health system is coming into full view.

Definitely more common to see with cash based things. Much much harder with insurance.

Peptides are probably the biggest one. Patients essentially hearing X peptide on Huberman then reach out, if one Dr can’t do it, they look for another one, and keep shopping until find someone that is willing to.

What are some examples where you're seeing patient-driven clinical decisions?

Feels like its still very emergent and its hard for patient-driven decisions to happen within the entrenched insurance/institutional paradigm

I hope the provider stranglehold on medications abates with the advent of AIs. Everywhere else I travel, there is a wide array of meds you can buy OTC from the pharmacy. You need a costly visit and Rx to get any new med in the US. It should be more democratized