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Comment by jazoom | Hacker News Reader

That's quite a lot you've taken away from one anecdote.

ACE-inhibitors are well-known to cause a cough but not like the one you're describing.

If I was to guess I'd say he had a respiratory tract infection that magically disappeared (as they do) not long after ceasing the medication. This is a common type of scenario where lay people get confused about correlation and causation, and is one of the reasons you need doctors to help you.

Even if it was the medication, like I said, this sounds like a somewhat unusual case.

You'll probably spend the rest of your life thinking the doctors didn't know what they were talking about, but in my experience with doctors (I have a lot of that since I'm a doctor myself), even the "median" ones are far better at diagnosing things than lay people.

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I don't know - if you're at all in a profession that requires problem solving, it can be quite jarring to work with a doctor.

For any given complaint, most will just tell you that your test results are in the normal range (don't get me started on this "normal range") and tell you there's nothing they can do.

I live in the bay area and have had a few GPs over the years, some from well known institutions.

Doctor's seem to put in the minimal amount of effort to get you out of their office in the allotted 20 minutes so that they can move on to the next patient.

I have multiple anecdotes similar to OP's - times where if it weren't for my insisting or my own inkling to visit a specialist I just would never have been helped.

Are there goood GP's? I'm sure there are - but to casually dismiss OP's statement is a bit ironic - since casually dismissing is part of the biggest problems as far as my own experience with doctors.

Your problem with doctors sounds like it's their time constraint. Why don't you pay a bit more to get a longer consult? You want them to work magic in 20 minutes?

I responded to OP's statement. Dismissing is quite different.

Las tdoctors visit I had I wanted to go through a list of 6 issues. I scheduled the longest available time slot, 45 minutes. I wasn't sure how long it would take, but assumed I'd be able to take as much time as I needed within those 45 minutes.

The doctor, after number 3 in my list and less than 15 minutes into the appointment said "Are you done?" After item 4 a couple minutes later he said "Is that it?" In a condescending manner.

Needless to say, I was pissed.

But, the thing is, it's not the doctors fault. He's working in a system that values throughput over all else...and this is Kaiser, a vertically integrated provider where you would think that would be less of an issue. So he was late to my appointment and saw my long appointment as a way to get back on schedule to ensure he saw the 40 patients he had to see that day.

The whole system is broken.

That's an unfortunate experience you had. Patients with lists can be a bit of a trial but at least you had the foresight to book a longer appointment. It's a shame the doctor saw it as a way to get back on schedule.

My father used to work for Kaiser - if he saw < 20 patients a day there would be some clearing of throats from management.

It's not possible to pay for a longer consult, in the same way it's not possible to pay for a 3 Michelin star meal in a McDonalds.

This is not meant to sounds harsh, all I am saying that from any business you can't buy a product they aren't in the business of selling.

I guess GPs where you are practice differently to GPs where I am. I can't imagine why they wouldn't book a double consult. How do they do more complex procedures and sort out patients with complex health problems?

Comparing this business model to McDonalds is a bit ridiculous. Maybe compare to a lawyer booking double time, or thousands of other professionals. But don't make the unnecessary jump to a fast food chain.

Spend more time than allocated on complex cases, then run late and short on others. More typical of specialists, but GPs do it too. Beyond that, incrementally, 1 appointment/billing code and a new test/intervention at a time. Until the patient gets better, worse or gives up.

Are you in US? Is double consult something insurance/government pays for twice for you? Or are you are talking about a different billing code? Or self-pay?

Australia. We have different billing codes for different length of time and different complexity of concern/procedure. We book double/triple/etc. appointments when necessary.

Doctors still often go over time.

Interesting. In US there are also different billing codes like that. But it's not something a patient has input on. However, it's safe to expect a provider to chose the maximum code that can be reimbursed at any given time by default.

So given that, a patient is likely getting the most expensive product a given doctor will deliver already. To get a better product simple options are specialists (much higher reimbursements, selection bias for more complex cases) and specialists at major teaching hospitals (even more of the above).

There are effective ways for a patient to hack the system by doing lots of work themselves (e.g. by maintaining his own clinical summary) but they are beyond what most patients will do.

Patients don't really have anything to do with choosing item numbers. They just may request a longer appointment or a specific procedure or test.

Why don't the doctors just tell him that they need more time to address his concerns properly, rather than dismissing his concerns?

Won't happen. Unlike engineers, doctors are trained to come up with a diagnosis given whatever subset of information can be presented to them and understood by them in the time allowed. The main source of their information is not even the patient, but prevalence (i.e. prior probabilities). It's a 80/20 sort of system, really more like 95/5.

It's a lot like YC office hours actually. Though doctors have less time than YC partners. And doctors get paid per appointment.

In general, it's not useful to think of doctors as engineers. The line doctors work is much more tech support - lots of similar highly repeatable cases, with a well understood script. The ones that are more like engineers are doing research in research hospitals and writing that script. They still see some patients as part of their work, but appointment reimbursements are not a profit center for them, but part of their research.

When making an appointment, my GP's assistant explicitly asks whether you've got multiple complaints, and if so, to list them; before explaining that in that case, they can reserve more time.

Then again, my previous GP said he had 7 minutes per consultation.

(FWIW, I’m in the Netherlands).

I don't know. Maybe they do? Maybe OP needs a different doctor who is more aligned with what he/she wants.

in Japan if you get more than 5 mIns with a doctor it is your lucky day.

> even the "median" ones are far better at diagnosing things than lay people

We aren't comparing doctors to "lay people" - we're comparing them to machine learning algorithms. I'd prefer the machine to many of the arrogant, but mediocre, doctors I've seen in my life.

Actually, OP was comparing doctors to his lay friend, who diagnosed the cough.

Edit: It seems "UCSF resident friend" is American for doctor. I suppose my statement was actually out of context then.

I think that a median doctor + a statistical classification scheme > a median doctor alone, though.

Sure. And most of us would be super keen to use that. In fact, ED doctors in particular use heaps of things like that. Maybe instead of rule systems we will eventually use deep learning algorithms.

This response makes me want to coin a new term: "doctor-splaining."

You're looking for "docsplaining"

Yeah, that's better.

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