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Comment by AnIdiotOnTheNet | Hacker News Reader

> The doctors were completely dismissive of and uninterested in the symptoms -- it really shook my faith in medical practice.

I had a similar experience as a child, where a textbook case of a reasonably common disease went undiagnosed for 2 years by doctors before a toll booth worker at an airport diagnosed me. She recognized the symptoms because her dog had it. Sure enough, after my mother brow-beat a doctor into running the absurdly simple blood test she was proven right.

On the one hand, I want to chalk this up to them being like everyone else: 90% of them are just shit at their jobs. On the other hand, I have it on good authority from nearly every nurse I've ever met that doctors are indeed arrogant, dismissive, and often mistaken.

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> On the one hand, I want to chalk this up to them being like everyone else: 90% of them are just shit at their jobs. On the other hand, I have it on good authority from nearly every nurse I've ever met that doctors are indeed arrogant, dismissive, and often mistaken.

I think there's an extra layer. Any public facing jobs tend to take a toll on you, too. Some more than others. With doctors patients lie to you constantly, for a variety of reasons. Some drug seeking, some simply not wanting to admit it.

Yea, i imagine they're like everyone else (shit), but i also imagine it is very easy become very dismissive in that line of work.

It's a fine line to know what to filter and what to ignore, i imagine.

I think the issue is more that the healthcare industry makes doctors gatekeepers to healthcare, which can breed tremendous amount of resentment between doctors and patients. A doctor is pressured/forced to provide service to patients, and patients are not legally allowed to seek healthcare from other types of professionals, like biochemists for example, which often have a much better understanding of some diseases than doctors.

When there is so much coercion and lack of consent, people get very frustrated.

>brow-beat a doctor into running the absurdly simple blood test

I feel like I see this story all the time: "a simple test found the issue that they denied I had".

What we should be examining are the incentives for the doctor to resist running tests. Are they too invasive? Some can be, but blood tests certainly aren't. Are they too expensive? Ah, there's the ticket. The doctors are either losing money on tests that find nothing, or they are getting berated by the managers for wasting money on tests that find nothing, or the insurance company is saying no when they ask to run tests.

We have the technology to have proactive medicine. We could be catching cancers in early stages all the time with some standard sets of annual tests. But the economic incentives are all out of whack, and we're waiting until the last minute to do these tests.

Many tests are simply not that good. It's not that simple, like pay $1 for a test that with absolute certainty tells you if you have disease X or not. It would be good if that was the case because then it WOULD have been just a question of money.

But if you have a test that is wrong 20% of the time, and you take this on all your patients every year, you will end up with a huge amount of mental suffering or possibly physical side-effects (unnecessary biopsies, or even surgery). You might end up giving people long runs of unnecessary meds. OTOH, you might end up missing some diagnoses if you don't do some tests. Balancing all of this is difficult.

Of course this is not news to the medical profession, this is a big input to the standard flowcharts. And you can always find anecdotal edge-cases that think their particular case was crystal clear and should have immediately been diagnosed. But don't assume that medical diagnosis and treatment is as trivial as doing a blood test and some googling.

> Many tests are simply not that good. It's not that simple, like pay $1 for a test that with absolute certainty tells you if you have disease X or not.

I will note that in my case the test is routine and reliable and has been since before I was born.

Sure you can't take every test at face value. How you approach the results of something that isn't 100% accurate is important. A potential false positive should mean a follow-up test, not a full diagnosis. Or even just holding onto the information until it can be part of a bigger picture with presenting symptoms. You don't even need to tell the patient what the results MIGHT point to, so you don't encourage hypochondria.

> We have the technology to have proactive medicine. We could be catching cancers in early stages all the time with some standard sets of annual tests.

I often wonder why such an expensive device as an MRI machine isn't utilized 24/7. I'd gladly go in for a scan at 3am if it meant paying even as little as 20% less.

The really strange thing about tests is even if you pay out of pocket you still have to get a doctor to sign off on it, which dramatically increases the friction and price for testing.

It's just information about your body. You shouldn't need a doctor's approval for that.

Doctors operate in an environment of extreme uncertainty, because human biology is so complex and so poorly understood.

At the same time, doctors are rewarded for acting as though they are certain.

Not unlike internet commenters rewarded with karma for condemning doctors across the board with certainty.

Humans crave certainty in an uncertain world.

The consequences of being wrong in the comments section is significantly less, imho. Plus, doctors are paid a lot for their expertise. It's really not about craving certainty. It's a question of a system that disincentivizes thinking through a problem that doesn't slot well into the diagnostic framework taught in medical schools to students selected for their ability to think inside the box, with little requirement, or really, possibility, to be very deep in biochemistry, pharmacology, research science, or a host of other inputs. Oh, and they're often very arrogant.

Doctors do save many lives but I fully agree a whole lot of them are indeed terrible at edge cases and what's worse is the arrogance they display when one tries to explain the symptoms clearly. Some of them go as far as recommending a psychiatrist when it is really not called for (sure, there are instances of hypochondriacs but how about the rest who aren't? ).

> 90% of them are just shit at their jobs.

As the joke goes, "What do you call the person who graduated last in his or her class in medical school? Doctor."

Funny joke but I really don't believe a good test taker does make a good doctor. It might in fact make for more arrogant doctors.

Real life impact of Dunning Krueger indeed.

Out of curiosity, was it Parvovirus? Somebody I knew dealt with a bout recently and I never realized how common it was.

Well done, tollbooth worker!

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