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Comment by tdrp | Hacker News Reader

Dealing with some specialists feels like dealing with automated bots. They almost sound like they follow a script down to the letter. If A then prescribe B, then C. And almost never look at the big picture. And every symptom that happens they tend to shoehorn into their own specialization, and not realize that it might be an indication that the problem lies elsewhere.

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In medicine there is a lot of emphasis placed behind evidence-based approaches. The alternative is an experience-based approach (the more fluid approach you're describing). The problem with experience-based approaches are that they're hard to evaluate since it's impossible to standardize, and they may open the provider up to risk of litigation. As a result, an evidence-based mindset may result in the algorithmic behavior you describe. We don't have a good codified way to standardize the practitioner's balance between evidence-based and experience-based, so it's a bit up in the air right now. Medicine is really, really hard to do well.

Love to hear from anyone with a different take.

This is going to sound harsh but I feel it is true and inevitable. If you are not using an experience-based approach you are not doing your job. People seek doctors precisely because they are supposed to have experience. Medical school is many years long precisely so you can build that experience. If you just execute algorithms based on evidence you are a prime target for automation. Those in my profession (software) will automate your role away and do it better and faster and more available and more reliable. Because you make it easy for us. We may be cursed to solve only 80% of any problem but if you solve even less, we still end up ahead.

My point, all of the interest and investment in AI diagnosis (IBM Watson comes to mind, but the field is decades old) is caused precisely by the poor practices in the medical field. It is of course naive to think we will solve medicine with software. But we only need to be better than average just like self driving cars are not aming to be perfect, just better than average.

Be a HUMAN doctor and we will need AGI to replace you. Be a robot and you will be replaced by an actual robot.

(note: I do not believe technology is the solution here. I am just a bit pissed after a doctor prescribed stuff without even touching or looking at an acquaintance.)

Not saying I disagree with your sentiment, but the idea behind evidence-based medicine is that it's effectiveness can be demonstrated through a randomized control trial.

Experience-based medicine cannot.

So, it's tricky because we want to identify those treatments that actually work based on objective clinical data, as well as those that clinicians have anecdotally found effective based on experience.

And do we want treatments that have been demonstrated to work, or treatments that are based on a provider's best judgement? That's not an easy question to answer.

The benefits of demonstrated effect are balanced with those you describe of the experience-based approach.

It's a gray area.

You just can't AI-away an ER doc (at least not with current tech). Something's got to interview, intubate, suture, palpate, and prescribe all those bleeding, festering, diabetic masses flowing into the ER like the tide of the Thames. Note the downside, an ER doc is a very exhausted, burned-out human, prone to error.

I'm sorry about your acquaintance, I'd be pissed too. You definitely have a right to be!

And after a few minutes they start signaling that the conversation is about to end.

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