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Comment by nahikoa | Hacker News Reader

PubMed is an incredibly useful resource. I've found that it is fairly common for my psychiatrist and GP to be relatively unaware of the latest studies and treatments.

Of course, reading through abstracts and papers requires a critical eye into the statistics, methodology, and funding. The Cochrane Reviews are similarly awesome.

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Medicine moves fast and it’s impossible to stay up to date on everything. In general I do not incorporate the latest discoveries into my daily practice unless the evidence is absurdly overwhelming, which rarely happens. Usually new therapies have marginal evidence to support them. I prefer to wait until multiple studies support a treatment before it becomes my standard of care, and by that time it’s likely going to be summarized in a Cochrane Review.

Should a patient come in with a preference for a treatment they read about on PubMed (which has never occurred in my practice) then I would likely accommodate their preference unless I thought it would put them at serious harm. A patient knowing more than I do about a particular disease happens more than you’d expect, especially if they have a rare chronic disorder. This does not diminish my ego or confidence in my knowledge base.

You are a very unusual doctor. I wish there were more like you.

Doesn't seem unusual to me. I could have written the same thing myself. Most of my doctor colleagues would be similar. Maybe you live in a different part of the world where doctors jump on every latest trend/study, but I'm not sure where that would be. Most of us like to let the water settle first.

Not jumping on the latest fad is very common, and something I expect of a doctor. However, I wish more doctors I've met fit in with the latter part of the grand parent comment, though.

A friend of my family met 15 different doctors for a period lasting years because of agonizing headaches, they all sent her home thinking it was nothing unusual. She died of a brain tumor the size of a tennis ball. We often think about what would've happened if one of those 15 doctors would've shown some humility.

To be clear, I work in tech, we have more than our fair share of big egos too. I don't think this is anything particular about doctors.

15 doctors and none ordered a scan of her brain? Well I'd say that's very unusual and the exception rather than the rule. In my experience doctors are more likely to request imaging purely to demonstrate to the patient that there's nothing visible, even if imaging isn't indicated.

Some more context; she didn't ask for 15 different opinions, she lived in the country side and her nearest hospital used relay doctors. So, it was more a case of being sent home and told to return if it didn't get any better, and when she did return, her previous doctor was long gone and had been replaced. All the next doctor had was whatever the previous doctor left them to work with in her charts. I'm not a doctor, so I don't know how much that would be in a case of a piercing headache.

It is not the first paragraph that makes the OP unusual, but the second.

That also doesn't seem unusual to me. I'd say most doctors recognise their limitations.

Not to their patients in my personal experience.

I understand that 99% of patients are clueless and that most providing information are likely misinformed by whatever they read on google, but every so often you meet a patient that actually knows more than you about their problems. The experience for this rare patient is almost always very poor.

Same here. It’s pretty shocking how many different opinions you’ll get from doctors. I end up doing my own research quite a lot via public.

And same here too (in the UK), at least within the NHS - it seems doctors train, start working, and then don't spend any time learning about new developments within their field. It's very disappointing.

I'm sure it can't be like that for all doctors, but it's been my (unfortunately vast and varied) experience.

Doctors have to show continued professional development every year for Revalidation of their license. It’s hard to keep on top of all the research, there is so much of it. Much of it of arguable quality, and contradictory making it hard to interpret. Generally people follow guidelines and advice from experts unless they are the expert in that are due to this. And doctors are culturally quite cautious, preferring proven treatments/ideas than new ones, partly from being burnt by previous “great” ideas (e.g. thalidomide), and due to the risk involved.

In my experience as a patient trying to deal with a chronic illness. Doctors, like many professionals, seem to have a strong preference for methods that seem to work for them.

Crucially I don’t think there’s a strong feedback loop for specialists. I was frustrated with my urologist. I just got a 2nd (and 3rd) opinion. But the information of “what you were doing hasn’t been working for me” didn’t make it back to my doctors. In part because it takes months to schedule an appointment. They also probably assume if they don’t see me, it just got better. This is partially because medicine is hard and there’s so much subjectivity in patient experiences. Crucially these specialists are in high demand, so they will find work, even if they really are just marginally effective.

Maybe there’s more “feedback” than I see, but That’s just my 2 cents from the patient perspective.

What you say is also true. Often, if patients don’t return we assume it has resolved itself, partly because it sometimes does (especially minor complaints) and partly as pragmatically its hard enough to keep up with current workload. I agree doctors do what works for them, and think both of what’s good for the patient and what they could be sued/penalised for and how to avoid that harm too. I think this sometimes leads to worse outcomes but you have to work in the system you are in. I guess part of the difference between a good doctor and a great one is knowing when to pry more, find out things aren’t working and try something different. Sorry for your bad experiences. I think there are more good doctors than we think out there, it’s just the system and workload ruin it for everyone.

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