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Comment by MarcScott | Hacker News Reader

My father was a GP, which obviously meant he didn't just see patients with symptoms related to a specific specialism he had studied intensely. He saw patients with a broad variety of symptoms that needed a diagnosis to decide if he could just administer treatment himself, or might require a referral to a consultant.

He was an excellent diagnostician, but when he was unsure or stumped by a set of symptoms he would outright just use Google. All the partners at the practice did. The skill was then sorting the wheat from the chaff in the search results, and then making the correct decisions for treatment.

Doctors don't just use specialist software to look things up, they often just use Google like the rest of us, it's bloody fast and with personalisation of search results, it often returns answers most relevant to you (or your profession).

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Edit: hospital dev if you are reading this, know that UpToDate.com must be 1 CLICK AWAY! :-)

The problem is more that:

1. speed is crucial in clinical medicine

2. UpToDate access is usually buried under several layers of corporate links or simply unavailable because too expensive

3. Google is inferior to UpToDate, but it's only a Ctrl+L away

Although really, we mostly rely on memory because looking things up isn't fast enough for the throughput we are required to keep up with. Web search is reserved for things where we really don't want to mess up.

UpToDate looks great.

How are we, as patients, can choose a doctor which has UpToDate and uses it ?

And how a patient, which can read the medical literature ,and use Google/Pubmed/Medical books, benefit from a subscription to your system to help validating a doctor's work(because they're human too, they sometimes make mistakes) ?

In all honesty and with the best of intentions from an academic doc, I think that trying to validate your doc's work other than from what you think of the result is a bad idea. Modern medicine is actually not that modern and still requires a massive amount of know-how that doesn't show in literary resources. For a trivial example, consider that UpToDate is really only valid for mainland US: an infection will be treated differently in Europe because of different resistance patterns. The list of such examples is infinite.

Of course, assessing results only has its limits. You can't know as a patient if you are treated optimally for a cancer that causes no symptom but that may kill you in 5 years. I think the only thing you can do to act positively on that is go to a big center specializing in your pathology. Notice that I say 'center' and not 'professor' or 'reputed specialist'. Modern medicine is a system, not an individual (as brilliant as he/she may be).

tl;dr: if you're not happy with the results of your current doc, find another one that suits you better.

Thank you for the recommendation to go to a specialized medical center.

That's the ideal.

It's possible in some cases(if you have a big medical issue diagnosed), maybe less possible in others(unexplained symptoms for example that your GP may not consider as important).

You. yourself, when someone in your family faces a medical issue outside of your specialty , do you sometimes do research on the subject ? do you talk with the doc about that research ?

No, I don't do research myself on issues that are not my specialty. Either the next step is obvious, or it's beyond my reach. Precisely because I lack the necessary experience and know-how to apply research results to the clinical problem at hand. For my family, I refer them to someone I believe is good because I've seen them in action and judged them to be good from my limited perspective, if possible.

Some docs have bigger egos and will do what you say and research and act outside of their specialty for themselves or their family. In my experience, this very often leads to subpar care (and even quite horrifying failures, sometimes).

Now, one can of course look things up to discuss them with their doc and learn why said doc chose whichever option they chose. That shows you're interested and your doc will usually happily oblige if he/she is not already overworked and completely burned out. If your doc's answer to that doesn't satisfy you, then maybe it's better to change.

A doctor doesn't need Uptodate to manage your run of the mill asthma and diabetes :). Best tip? Do your own research and take it to your GP. Either they appreciate it, or they dismiss it. That's the best way to differentiate between good+bad doctors.

As a doctor myself, I can assure you that it's possibly the worst way to differentiate capable from incapable docs. It's a good way to differentiate socially skilled docs from socially inept ones. This I can agree with.

Most hospitals provide UpToDate for all providers with privileges at the hospital.

To add to this, which at least in the systems I'm aware of, being a GP is a specialisation. General doesn't mean non specialist. It means being a specialist at general medicine.

This is country-dependent. In practice though, it's absolutely true that GP is specialist work.

potato potato, the meaning is obvious. GP differs from a medical specialist in that they focus on diagnostics and broad knowledge as opposed to deep narrow focus. Whether you call focusing on that a specialization is irrelevant.

Calling focusing on that a specialization means a 6y education difference in some countries.

As a programmer one of the skills I value the most is being able to find and use information from external sources. These days that primarily means the internet.

I'm not very good with recalling specifics, but I'm very good at recalling how or where to find the specifics.

As with your father, expertise is necessary to interpret and determine which information is relevant, and to notice discrepancies between the found information and the concrete issue at hand.

That shows that there's a need for a specialized database of cases where physicians can search for symptoms and add new information. If it was only used by medical personnel it would filter out various blogs and forum posts that probably are getting worse and worse and more time consuming to sift through.

> with personalisation of search results

There is not much personalization on Google except on your location, which is not going to help you have more relevant results as a doctor

It also might prefer to tell you the patient has scurvy instead of cancer if you’ve been searching for and buying pirate toys for your niece recently.

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