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Comment by cryptonector | Hacker News Reader

I have a much lesser scare story of my own that taught me this: you just have to be your own [family's] diagnostician.

Fortunately in the age of the Internet and advanced search engines, you actually can be your own diagnostician.

You have to learn to decide when you must have medical attention, and you must not accept dismissiveness from doctors. Yes, you must also not be a hypochondriac -- that will cost you money and crowd out others who need the care. But this is why you must... become good at being your own diagnostician.

This is very much not what doctors want. It's not what the FDA wants. It's not what anyone should want. But the quality of care is so variable, and so dependent on someone noticing in less than the only five minutes they want to spare you, some detail that you have days to notice... that you just have to be your own diagnostician.

Arm yourself with knowledge before you get to the doctor's office or ER.

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When I first started my internal medicine rotation at the latter end of med school, I was quietly scandalized by how many diagnoses I caught that other doctors missed. These weren’t clever diagnoses to be proud of - given time and careful thought, the worst med student in the country could have done the same. I caught one diagnosis that had been missed by three other EDs in the past week, and just required asking the patient two questions beyond their chief complaint.

The doctors I was working under weren’t bad. They were, however, forced to run ragged all day without a break for a shit, allowed no more than a few minutes per patient. They didn’t like it any: they’d openly say “don’t emulate this,” while running to the next room.

The funny thing is, surgeries and pharmaceuticals and medical equipment are expensive. A doctor’s time? If he’s not a top renowned specialist, not much. But people have gotten so used to insurers playing the middleman retailer (buying healthcare services cheaply and reselling them to patients at a premium...), they’ve forgotten they can just -pay for the doctors time-.

It doesn’t require playing amateur medical sleuth. It just requires admitting that a highly skilled worker that had to train for a decade to do the job costs more than 20$.

It is basically the same problem business people get when hiring developers.

You just can't know if you are receiving competent service if you have no level of competence on practicing it.

It is very difficult to make such assessments. I don't think it's impossible, though the time to make an accurate assessment may take a while.

Solving a problem may be a useful guide. Find someone who can complete some specific task reasonably well, and even if you don't know how to do that task yourself, you may be able to make an assessment amongst various practitioners. This is easier to accomplish for simple tasks than hard ones (say: running a 100m sprint, or deadlifting 250 kg), but is the principle at the heart of, say, Jakob Nielsen's usability testing.

The problem is that there are domains in which tasks are complex, the time to determine successful conclusion is long, etc., etc. In this case, you may need to farm out the evaluation process, or look to evaluate institutions rather than individuals (say, in education, or medicine -- and there are reasons that the collective evaluation approach has validity for each, though also for adjusting for student population / case mix). The general problem of audits or programme assessment exhibits this.

My point isn't that assessments are easy, simple, straightforward, or not prone to their own issues. Only that there does exist a possibility in many cases for making valid assessments of service competence without specific competence in the service being assessed.

Yes, quite.

Ditto, say, accountancy. You have to have a clue.

I think this problem exists in just about every job. If you aren't cut out to do it, you can't do a good job. No matter if you clean a school or build bridges.

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