The Futility of Doctors | Hacker News Reader

The Futility of Doctors

andrewruiz.substack.com

13 pointsDantesKite19 comments

This is poorly written in stream of consciousness. Insurance companies and CMS make the irrelevant questions necessary. They also dictate how long one actually has to spend with a patient without losing money.

When you arrive at a hospital with a fever, I sure hope you have a doctor to help you figure out whether it is a deadly bacterial infection, malignancy, autoimmune, or just a common virus.

There are many things that medical science doesn’t understand, but that doesn’t mean that doctors aren’t trying.

Do a little research before you write such a scathing piece?

Its way more valid then your opinion. You are talking about acute illness, while he is talking mostly about chronic. Modern medicine doesn't cure chronic disease - or it wouldn't be chronic by definition. I am grateful that we don't die from a bacterial infection any more but those are replaced by hosts of civilization diseases for which there are next to 0 remedies, effort and patience. And the system is made in such way to prevent anything like that, in many countries.

> Its [sic] way more valid than your opinion.

Can you elaborate on what you mean by valid? My only opinion was that the piece was poorly written.

There are several fact-based statements in my original comment. People do still die from bacterial illnesses. The original author basically said we should do away with doctors. That also means people who know when and which antibiotics to use. Also, I commented on acute conditions in only one paragraph. I specifically admitted that there are limitations to modern medicine. There are many chronic illnesses that we can’t diagnose or don’t understand. There are also illnesses that are chronic because we have ways to keep people alive, even if we can’t cure the disease (HIV, several cancers).

If we are going to discuss validity, let’s do it with facts.

Overall, just pointing out that not all physicians are arrogant jerks or uncaring idiots. Many really try to be helpful, but are overworked and constrained by administrators, insurance, etc.

I didn't get much farther than the author describing how doctors "prescribe Ibuprofen." Ibuprofen is an over the counter medication. No doctor actually writes a script for it; they just say "hey try this for your pain." They make no money off saying that, or recommending ibuprofen over tylenol or whatever, because these are not prescription medications and doctors aren't being courted by pharma companies to push OTC drugs everyone already likes and knows about.

They actually recommend this because Ibuprofen and Tylenol are widely available, cheap, and very safe. (Unless you take too much Tylenol, which, seriously don't.) Most people already have a bottle of one or the other or both.

There are actual drugs doctors sometimes get rewarded for prescribing, in various ways, but OTC pills are rarely it. See opioids, for example: https://www.healthline.com/health-news/is-your-doctor-gettin...

The article mentions selling ibuprofen, not prescribing it, so it's even worse.

My dad practiced dentistry for ages, and would write prescriptions for ibuprofen. It's about the dose, frequency, and duration. You can of course buy the pills without a prescription.

> No doctor actually writes a script for it; they just say "hey try this for your pain."

Author here.

I don't mind criticisms of my essay, but that is factually incorrect. Doctors do in fact write prescription for over the counter ibuprofen in the United States and often do so as a remedial solution to various ailments, which may or may not benefit from pain relief.

Do you have any evidence for this? As an American who's been to many doctors, this just seems wrong.

I'm not saying it doesn't happen but it's not standard practice to write a prescription for an OTC med unless there's a reason (you need a higher dose, you can get it cheaper via insurance if it's prescribed, etc.).

In fact, the practice is uncommon enough some physicians have found the "loophole" situations I mentioned above too burdensome: https://amednews.com/article/20120507/government/305079963/1...

You went from "no doctor" to "not common".

It is in the UK in many cases. The reason might be 1) need a higher dose than allowed to sell OTC, 2) get it without paying, especially for elderly, but this practice is frown upon, 3) simply to streamline pharmaceutical care and include all needed medicines on one prescription, again, this is more common for elderly on several medicines.

We are not talking about ibuprofen here because that's actually bad for stomach and heart. Most common in the UK would be paracetamol. But many other OTC medicines are being routinely prescribed (painkillers like codeine). I was prescribed ear drops that the pharmacist advised me to buy OTC because that would be cheaper than pay the prescription fee.

I guess that for many patients going to the doctor and getting a prescription for something is part of their expectations that they would not be happy to return without anything.

But of course, the practice among countries may be very different that we cannot talk about one single culture. I think of author's article more like an allegory.

Every time a doctor has "written me a prescription" for an OTC, it's always been just a note to me to actually get it. They never bother to send it to the pharmacist, and I end up being just another nameless person to the pharmacist buying another pack of Tylenol.

To be fair, the quoted piece doesn't say "write a prescription for ibuprofen". It says doctors "prescribe ibuprofen". The former implies an actual written prescription you might give to a pharmacist, the latter is more ambiguous and can mean that the doctor told you to take ibuprofen. As in: "For my cold, the doctor prescribed plenty of rest and fluids".

Prescriptions are occasionally written for OTC meds so that they can be covered by medicaid, FSAs, etc.

Also, NSAIDs are not just for pain control. They are also anti-inflammatory (e.g. used for pericarditis) and can be used in more obscure circumstances such as closing a PDA in an infant.

> Why do they recommend plant-based foods when study after study has consistently shown how bad the effects are? > Why do doctors still prescribe statins when their efficacy has already been proven to be less useful than a diet change?

Can OP elaborate?

For such a horribly critical piece, the author doesn't seem to understand the bare minimum about the medical profession.

> Doctors become unwilling to take any risk out of fear of losing their license.

Perhaps because mistakes are paid in human lives?

True, so they have to be very careful. But what he describes has been my experience. Every time I've seen a doctor for a physical my doctors(more than one) have spent the majority of time typing on a keyboard looking up information, going thru a list and filling out forms. Rarely has it been a situation of analyzing the situation and giving advice on their own. They are just going thru the motions, some of them robot like. Those visits could have easily been done by assistants (AI?). At some point a lot of it will be replaced by automation with a few superstar doctors that act as managers at scale rather than what we would hope doctors should be. The article is on point.

This is the model of a lot of work of the future in my opinion with automation.

One 'wizard behind the curtain' and a bunch of automation with lower tier support staff.

Think truck drivers driving huge trains of trailers with the aid of self driving technology keeping the train in line.

A single Lawyer stamping off on support teams with legal automation, able to handle most of the cases a team would have done previously.

A single medical doctor stamping off on support teams work and automation, handling entire clinics.

In other words automation will start from the bottom up.

Very true. If you take the current manufacturing process as an example, every product is broken down to the simplest process. At that point it's analyzed and automation is put in place where possible. With the automation possible now, even without general AI, the same process will see a huge impact on white-collar jobs. It's only a matter of time.

This seems very weird to me

The US medical system is trash

But damn if I'm not usually very impressed with doctor expertise

Just seems like a hot take without much or any evidence

Starts talking about 'the system'

I always read the Dr column in the NYT that has doctors and other medical experts diagnosing the craziest illnesses

Computers, by comparison, are kindergarten-level play blocks or something

And new medical breakthroughs on an almost daily basis

To each their own

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