Hacker News Reader

Patients with a serious, chronic condition are frequently more knowledgeable about it than most doctors they deal with. Yet if a patient tries to talk about that online, you can count on some ugly beat down accusing them of being nutcase antivaxxers or similar slurs.

It is also difficult to assess because as someone with a chronic illness I also know that there a lot of people who think they are more knowledgeable than doctors while they in reality most likely are overestimating single studies or don't have the full picture.

It's possible to admit you have no idea if what they say makes sense without launching into ugly and dismissive attacks based on a presumption that they can't possibly know what they are talking about. But people rarely meet that standard and typically default to asserting that whatever is currently generally accepted must be correct.

That's not at all how actual science works. Actual science admits "This is our best understanding currently. Feel free to improve upon it."

Shouldn't we be well past the abusive treatment doled out to Galileo for daring to dissent? He was eventually determined to be correct, but it was well after his death, so it did nothing to remedy his troubles.

It should be "feel free to improve upon it, if you've mastered the current understanding and know what to improve and what evidence would be required to validate that improvement."

Otherwise any joe shmoe with a youtube following can start encouraging nursing mothers to have a glass of pigs blood before bed or some other nonsense.

It's tempting to imagine expertise as something that should be equitable, but it's hard to beat the foundational knowledge of someone who had four years of biology coursework, four years of medical course work, for years of residency, then however many years still in the field, still thinking about the same problems and how to solve them, vs. someone who spent 2 hours searching google or struggling through pubmed articles and are looking to best the person providing them care.

Galileo was a university trained physicist and astronomer with over 30 years in the field, he wasn't a layman at all. In fact, a little more on Galileo.

He wasn't condemned for 'daring do dissent,' his theories had merit and supporters. Galileo just critiqued people's theories so throughly and aggressively in his letters that he pissed a lot of people off in academic italy by just dismantling their work. Eventually one prick got the inquisition on the case, the pope asked galileo to write a detailed book to set the record straight with his theories, and while galileo did that he did it by making the pope a character in his book, portrayed as complete idiot, circulated the book all over catholic Europe, and shit naturally hit the fan. Apples and oranges.

"Doctors" are an enormous field of work. Are you talking about primary care physicians, which are widely being augmented/replaced by nurse practitioners? Are you talking about specialists who are able to work out treatments plans for conditions you have that are definitely more complex than you can self treat, or are you talking about surgeons, who have an insane amount of training and stress in their job and you definitely cannot perform your own surgery.

I would posit that GP doesn't know what they're talking about at all, and therefore chose to broadly slander "doctors" as if it's one single field.

This is crock.

The reason you see the same treatments and basic medicines and panels each time you go to the GP is because your problems are pedestrian compared to what doctors actually train for. Most likely, you're not even being seen by someone with an M.D. - casual checkups are often beneath their paygrade.

Doctors undergo a decade of specialized training in order to diagnose and treat issues far beyond anything that you can Just Google. Determining the factors affecting which treatments to apply, considering the tradeoffs, and making the right call are skills that AI will not achieve in our lifetime, no matter how many VC-funded tech-bro AI startups try.

If you could spend a day in the shoes of an aspiring medical resident, working 80-hour weeks and studying for board exams at the same time, you'd count your lucky stars that we don't license the software profession like we do medicine. Maybe we should.

Mostly the reason you see the same treatments is because there is no useful treatment, but they provide one anyways. Or they run a battery of tests, partly because they need to, to cover their ass from malpractice law suits, but also because its profitable for the hospital to do so.

Take the case of someone having a psychotic episode for the first time, with no prior history, who goes into the ER. The doctors will instantly put them on an anti psychotic medication. This decision will usually stop the psychosis, and means that they "fixed" the patient. But the ramifications of being put on these drugs prior to a proper diagnoses could be that the patient is never able to successfully get off them, a lifetime of drug dependence due to a split second decision. (Getting off these drugs often causes psychosis in itself, which creates a vicious life long cycle).

The medical institution bears no error in this case, they gave "treatment". Not putting the patient on medication is a risk to them, so they do it every time. The patient is uneducated in this matter, does not know that they will damage their brain, lose IQ points. The list goes on and on, it happens every day.

I hope you're not a medical professional. If an individual has a problem (mental or physical), it is never pedestrian, beneath a paygrade, or reason to avoid a personalized treatment plan. If you feel this way, go into research and do not interact with another patient ever again. Sickening attitude.

Let me be clear: there are conditions that are routine, and whose treatment is deferred to roles that are not as specialized as a doctor. That does not mean that the provider/patient interaction is any less personable just because the treatment is standardized.

Treating the sniffles does not require a personalized care plan in the majority of cases. You'll get the bog standard treatment of the symptoms, which is actually the best we can do. It would be an institutional waste to personalize that kind of care for each patient and provision an M.D. each time -- you'd actually be putting other patients at risk, with more complicated problems, who critically need that doctor's experience instead.

The father of a childhood friend of mine was diagnosed with a peptic ulcer and died of stomach cancer about six months later. The stomach cancer that actually wasn't just a peptic ulcer was only diagnosed a few weeks before his death once he was hospitalized because he was dying.

Surely, differentiating between a garden-variety peptic ulcer and stomach cancer can be difficult given the symptom overlap but that's why doctors undergo a decade of specialized training, right? Alas, all the doctor he scheduled a casual checkup with could see was that this patient's pedestrian problems were beneath their paygrade. At least as far as I was told, his symptoms were dismissed out of hand and he was diagnosed with an ulcer and sent on his way without any sort of workup being done. Presumably the doctor felt that spending time diagnosing someone with such common symptoms was not what they trained for.

I guess VC-funded tech-bro AI startups don't have a monopoly on making the wrong call. (Or on hubris!)

This post sounds hyperbolic but I’m not that far off from agreeing.

A family member went to the doctor to get a work up on a rare disease. The work up basically followed a flow chart from a specialist center that was easily accessible online.

I’m sure there’s some additional confidence from experience and knowledge of the first principles that vastly outweighs my judgement, but on the surface it didn’t seem like the doctor had obtained a skill set that should command a 2x-3x training and schooling premium.

They knew enough to know upon assessment that the standard flow chart process was appropriate, and additional follow-up or referral to the specialist was unnecessary. That is the kind of skill and training core to the profession.

IT doesn't reprovision your work laptop after you accidentally deleted a file, they follow the appropriate process for the task ("they just pulled up the system restore flow chart, what am I even paying these guys for").

You should have been far more concerned if they didn't follow the workup protocol. There's little decision making in the workup phase, it's basically gathering information.

It sounds like you're speaking from a place of pain and I hope it's taken care of. Nevertheless, this can be said about any profession with the internet nowadays. Becoming an expert in an obscure topic is not hard, and made even easier with a very clear vested interest in one's own health.

Its true, this can be said about any profession, but the difference is that other professions do not have peoples lives in their hands. Claiming absolute authority on a topic that is a matter of life and death, and then providing potentially mediocre or worse outcomes or an incomplete picture of the possibilities is inexcusable in 2019.

The industry as it currently is, with restricted supply of doctors, memory based entrance exams, etc makes no sense

> Very few drugs we have do anything at all but cover up the symptoms.

Isn’t that akin to “Treating the symptoms”? Eg. In case of most common viral infections, you literally can’t do anything but treat the symptoms.

> They prescribe the same thing to the same set of symptoms basically every time, without much capacity to take in the nuances of some condition.

Could it be because statistically “trivial cases that they, in their practice, have treated numerous times” occur more frequently than rare cases? (I’m speculating).

I do not fully agree with your claim but the medical profession along with a few others, like lawyers, are self-regulating industries that set their own rules, including the rules to admission to the club.

I really dislike the idea of a club with legal powers over you, such as doctors or lawyers, that both set their own rules and control entrance to the club.

It strikes me as feudalistic and undemocratic. Oppressive. As an American I find it vaguely un-American!

One issue I take with the general practitioners I frequently come in contact with is their usage of the word "average".

In the broadest sense, there are two types of things in the world: things that tend toward (or cluster around) some kind of “natural” value, and things that don’t.

Often times, you are not briefed on the distribution of the graph which the very "average" is being derived from, viscerally it is being surmised that it follows a “Gaussian” distribution by the patient which then makes significant medical decisions based on such bits of information.

Therefore, I'd advise caution for those who'd base their medical decisions on arbitrary "averages", instead you are much better off if you were to take a look at the graph to see if the word "average" carries any meaning at all in such distributions.

A man with a PhD in Chemistry once told me "The average human would have one tit, one nut and a three inch weiner."

(As best I can remember, those were his exact words. No, I'm not cleaning it up to be more PC.)

Someone with a PhD in math might remind them that modes and medians are averaging techniques too.

“Average” is a very vague term.

Most people mean mean when saying average.

It stuck with me because it's a nutshell version of the book "How to lie with statistics" in a humorous and highly memorable form. Someone with one breast, one testicle and a little penis would be a bizarre statistical outlier for the human race, but "mathematically" speaking, it's an accurate description.

It speaks to a lot of common errors of logic and it's pithy.

I'm sure this is true in your case, but seems overly broad. Sort of like saying 'No managers care about quality, and all are useless'.

Not sure, but I wonder if more nuance in statements like this would make them more persuasive. For some reason absolute certainty kind of turns me off.

Medical student here. It sounds like you can do the job of a doctor, but I can't be sure yet. Case vignettes are the medical equivalent of the coding interview. Let's start with an easy question. If someone comes to you with a fever and a cough, what is your approach to their history and physical exam? What labs or imaging do you need, if any? Do they need treatment? How do you decide? If so, which drug and how long and why? How does your approach vary if the patient is 29 or 89? Or if the patient has HIV? What if the patient smoked for 20 years?

In all of these cases, I do what I laid out above, I start googling and reading multiple sources about whatever ails me. I may spend a week or so doing research to determine whether my condition is serious or not, I read all of the literature, making sure to understand when possible ailments could be really bad, but also to ground myself and understand the probability distributions of ailments taking a massive turn for the worse. Once I determine that I probably need someone to run some kind of test, or write some kind of medication, I call the doctor.

You arent some kind of high priest, I am allowed to question and understand medicine. I am also not afraid of academic publications, and attempts at belittling me for doing so come from a place of insecurity on your part.

All of that knowledge in your head is on the internet.

Love it. Ok- then do some reading and answer my question!

knowledge is obsolete

I am loving the troll-y nihilism! <i>Knowledge</i> and experience are the basis for prioritizing information, efficiently handling a patient's complaint(s) without doing a week of reading, and accessing reference sources when needed.

And then when you leave doctors or nurses will roll their eye and say "Dr. Google"