The big idea: Someone that tells you if you’re sick enough to go to the doctor

A big idea to feel better after getting some medical affirmation

I recently got norovirus, and it was horrible. After 14 hours of vomiting, I started to make contingency plans - when should I go to the doctor, or even the hospital? My wife, who grew up in a less neurotic household, told me I was being ridiculous and needed to stay home. This felt like the easier choice - going down a flight of stairs felt like a herculean effort, especially if it wasn’t going to help.

I eventually got better, but the experience got me thinking about health care. I didn’t want to go to the doctor and risk spending $200+ on a visit that wasn’t needed. And while CVS has a $59 video visit, it’s still a bit above my price range to essentially ask “should I go in person to get treatment.” I’d rather just ask my wife for a second opinion.

What if we productized this? Instead of talking to a nurse, you’d talk to just a person - at a lower cost - who tells you whether you need to go to the doctor. Introducing: GoSee (as in, should I GoSee a doctor?)

The healthcare industry is going down market

One of the biggest macrotrends in the healthcare system is a growing shortage of doctors. Despite an increase in medical school spots, constraints on the number of residencies means that there are fewer doctors than the healthcare system demands.

In response, more treatment is being given by nurse practitioners (25% of primary care visits as of 2023). If you do a virtual doctor visit, odds are you’ll be speaking to a nurse practitioner. Which is fine! They’re totally qualified to give medical care, especially for standard cases.

GoSee specialists are very much not qualified. We’re moving down market from a medical professional to a passionate amateur.

Why would anybody use this?

There really could be a market here! Healthcare is a black box in the US - even if you’re insured, there’s always a voice in the back of your head wondering if you’re going to get a surprise bill months or years later. People really don’t want to go to the doctor if they don’t need to - and for a small fee, those without a level headed spouse can buy psychological reassurance.

Now, usually that reassurance comes from someone that has some qualification. GoSee specialists explicitly don’t, so we’ll be hiring for trust. The ideal employee is probably a grandparent or retired teacher, who has dealt with lots of sick kids and has a nice bedside manner.

A responsible version of this probably includes some symptom checklists and a formal process. But I’d argue what people actually want is to be listened to. So it works pretty simply: the user starts the call and the agent listens attentively - the appearance of genuine listening is key - before giving an opinion on whether they seem sick enough to go to the doctor. It’s not scientific, but it is reassuring.

Uh, what about liability?

I don’t think many people would want to own this business when a patient is told they don’t need to see a doctor, then die a few hours later. Malpractice insurance is expensive - New York can be more than $27k per year. I’d charge way more than that if I was an insurer, these people are totally unqualified!

Legally, is saying “you’re probably fine” actionable? Can we write a liability release that covers this? Is this just entertainment? Some lawyer smarter than me will have to figure that one out.

It also (I am not a lawyer) might be illegal! Even with painful steps to clarify this isn’t a medical opinion, I imagine at least one state attorney general would disagree. Does anyone in power want amateurs giving their gut opinion on medical issues, even if it’s in demand? Will the American Medical Association sue us? Anything is possible!

Well, let’s assume it’s fine. Are the economics good?

Possibly! These aren’t medical visits, and probably shouldn’t take too long. The price also should be something that can be an impulse buy - you want to feel good about it whether or not you actually go to the doctor. So let’s say a visit is $15 and they take 8 minutes on average:

60/8 = 7.5 visits per hour

=$112 per hour per employee

For an 8 hour shift, that’s ~$900 per employee per day - $234k revenue per employee assuming 260 working days. Given that GoSee is explicitly not hiring qualified people, salaries are going to be lower than the telehealth competition.

Sure, there’s other costs - video call infrastructure, HIPAA compliance, the aforementioned insurance - but there’s enough meat on the bone that we can take this sort of seriously.

What if we were cynical?

On net, this service would probably lower overall healthcare usage for the people using it. That’s generally the core M.O. of an insurance company!

In a world where we have so much data, couldn’t an insurance company find the top 10% most neurotic people in their network and promote this to them? Reimbursement rates for urgent care can be as high as $150 per visit; if 12% of GoSee customers stay home, insurance companies come out ahead. And knowing how often I want to go to the doctor, they could probably interdict more than that.

I can already imagine the deeply cynical PowerPoint used to win this contract. Once insurers start sending their patients to GoSee, demand would go through the roof. I’m not looking forward to the growing pains when GoSee can’t screen their operators for “has a kind grandparent vibe.”

But there’s not really a barrier to entry

Even if you don’t get sued into oblivion, shut down by the state, can’t find an insurance partner, and get over the moral qualms of telling people not to get healthcare - there’s nothing really proprietary here.

You’re giving people a video call of someone offering their gut opinion, and maybe a nice brand. If you did manage to get any traction, expect to see lots of other entrants into the market that erode any profits. I’d imagine in our dystopian future, this very quickly starts to get replaced with offshoring - or even AI.

Wait…is this an AI company?

Maybe? People are already using ChatGPT to diagnose illnesses, and levels of trust in AI will only grow over time. You already see companies replacing or augmenting customer service with AI; it doesn’t seem that crazy to create a chatbot (or spooky AI avatar on a video call) that can tell you you’re probably fine.

Here’s where the incentives get extra bad - you have an AI bot that people are going to for health advice. The company paying for it is financially incentivized to say “you’re probably fine” if a patient is going to be ok. How do you set up their prompt? What level of certainty do you need to tell someone not to see a doctor? Could that change depending on your insurance plan and deductible? Will our GoSee overlords begin to accept a percentage of patients dying to meet its quota?

The first time that happens is likely to be national news. So even if you are going to be fine, you may start to think of your friendly GoSee agent as a harbinger of death. Not ideal! Meta got a lot of flack for their AI profiles; how much flack will Aetna get for their AI doctors (or rather…opinion givers?)

GoSee the future

An AI GoSee system will vacuum up health data - and since your insurance company is on the other side, they’ll be able to see your actual health outcomes. Over time, insurers can identify how often you go to the doctor against your GoSee advice.

Maybe there starts to be some price discrimination - known hypochondriacs get more scrutiny for reimbursement, or their premiums go up. People could start to fake being sicker than they are on these calls, leading to an exciting new industry providing makeup that makes the AI think you’re sick.

Please don’t start this company, I don’t want to write about the AI fake illness makeup idea next week.

Official idea rating:

2 out of 5 stars. If you can really bulletproof the liability piece, I think there is a real market to get cheaper validation that you need to go to the doctor. That said, I don’t love the idea of being the genesis of AI bots trying to talk you out of getting healthcare. For the time being, I think the hypochondriacs of the world just have to find a sympathetic friend, partner, or kind stranger to help soothe their neuroses.