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>> I’m not a conspiracy nut. I believe in listening to experts (but ultimately making an informed decision). I believe in modern medicine. But that experience shook me and forever changed my trust in the dental industry.

Ask anybody who’s experienced a “chronic” illness about the “experts” and they’ll tell you a tale or two. The experts are great until they have a case that is unusual. The don’t have the time or knowledge to treat you properly. You get passed from “expert” to “expert” each time having your hopes dashed. You start feeling like a conspiracy nut chatting with other patients online sharing what’s anecdotally helped. After running into this issue more than once I’ve lost all blind trust in medical experts. I’ll verify what they tell me as best I can and get second opinions if necessary. In one case I was passed up the chain of experts until I finally found the right one myself after a year, and it still blows my mind that this wasn’t the first referral. The system is at the same time incredible and awful.

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This is very true. I had a SO with severe chronic gastric pain and they got passed around by doctors for years. One jerk wrote "drug seeking behavior" into her file and that made things even worse. Finally someone took her seriously, got imagery done, and discovered surgery was necessary.

In US healthcare you have to be your own advocate and be willing to push. The system breaks down if you don't have a routine and obvious illness.

Now imagine doing this on Canadian healthcare, having to wait months or years for each appointment, and nowadays they try to talk you into MAID to save resources…

Yeah that's a hyperbolic exaggeration.

I know HN is a privileged place but people should recognize that the “worst case” of Canadian/European healthcare wait times is already the reality for many if not most Americans.. You shouldn’t base your understanding of American health care on personal experience if you work for a big company that provides a nice health insurance plan.

I have jank government insurance and this is not true. When I got out of prison and had no insurance I went to the city's clinics. Wait times have never been an issue (at most was two weeks for specialist). The doctors in the clinic were also friggin amazing doctors/people. I had a ton of shame around getting out of prison, some much shame about needing to get tests ran for HIV/Hep from being in prison but they were so good about it all (all came out negative so woohoo).

Now dentists...when we had money we went to a family friend. He still totally f'd us and did unnecessary work. It's only now that I have a cash only country dentist that I trust my dentist again. Crazy part is the cash only dentist ends up being cheaper than my previous copay/premiums insurance dentists.

I'm always surprised when people leave comments like these, based on nothing but N=1 anecdata. You don't have any authority to say something like "this is not true" with regards to the whole of the American healthcare experience. Compared to my own personal experience, yours was uncommonly-good. Wait times for specialists for my SO's heart condition are routinely several months out.

What this demonstrates is that wait times are widely variable by specialty and region. Arguments like "for most Americans" are wrong on their face, because most Americans don't live in the same area or have the same issues.

My wife and I have both had to see various specialists. Some had very long wait times, many didn't, and of those that did, we were (fortunately) able to call around to different clinics to find one that wasn't too bad.

"Most" comes from the actual data

The exceptions are part of that data set

Really...

To be fair, their statement of n=1 is more evidence than the other person posted (comment without any evidence). Although both are weak.

I mean, n=1 of a guy that had a good experience -- n=roughly 28,000,000 with no health insurance at all. These don't seem like two sides of the same coin in my view.

I'd the original comment actually mentioned that and laid out a theory behind it, that would be different (is that health insurance or dental insurance?). Even your comment about uninsured people doesn't fully connect the dots or explain what their experiences are, as some people in these comments are stating that cash dentists are cheaper/easier to deal with than with insurance. I have had experiences that also back this up.

Absolutely true, and that is if you even have a family doctor to refer you to a specialist. For those who had the luck to lose their family doctor (mine through retirement), it is impossible to find one that takes new patients. Many retired during covid, many more only work part time. The Canadian health care is a disaster at this point, and those who have a family doctor have no clue how awful this is.

In the US it's not easy to find a primary care provider also. When we moved couple of years ago and called a local medical center to establish a primary care provider, we were given answers like "we have the nearest appointments in 6-8 months". If you have something urgent, there's telemedicine line where you can talk to advice nurse or if there's something really urgent, get an appointment with an urgent care doctor. But all primary care providers seem to be booked solid for months. And given how many patients they'd have and how often they see each one, establishing any kind of personal care relationship is out of the question. How personal can it be if you can see you doctor twice a year for 20 minutes? I think the only solution is go get rich enough so you can afford personal concierge doctors or however it is called (no idea since I'm not rich enough).

rich enough so you can afford personal concierge

A few minutes research suggests it's not that expensive. (As little as ~2000/year).

For most people, that's expensive.

No, it isn't. Most people pay about that much for their cable. For the bottom 20 percent, yes, it is a budget-buster.

However, that is beside the point. Believe me, I hate explaining simple, simple things--but the person I was responding to is probably comfortably middle or upper-middle class and could afford a miserable 2000/year on a doctor. He doesn't have to become "rich enough", and almost 100 percent of the people in this thread don't have to either.

Average canadian income is 60k

2 k is a lot for even those at the 50th percentile and extremely significant for those below it.

Min wage earners make about 30k, so that 2k is 6.6% of thier income....

What I can find around me with a quick look sounds like about ~$400/m, or $4800/yr - which I could handle if I had to, but it would sting (especially as I still would have to pay my regular health insurance, of course). And there doesn't seem to be all that much choice - at least in places where I know to look.

This is not true.

I mean, the wait times sometimes are, but they vary by province. More conservative provinces have worse wait times. That is not surprising given that the provincial conservative government are all actively attempting to sabotage public healthcare so we can move to an American style system. A system where we will all pay more, and still see similar wait times anyway.

MAID is not actively proposed as a way to save resources.

> More conservative provinces have worse wait times.

This feels like a pretty glaring generalization. If we look at the actual data, the story becomes a little more nuanced [1]. "Conservative" provinces have wait times that are a couple of days to a couple of weeks higher than national average (assuming we call BC, AB, SK and MB "conservative" [2]), but then again almost all of the maritimes provinces (which are considered strongly liberal-leaning) have abysmally bad wait times relative to the average (10-20 weeks worse).

Overall, the average is ~half a year anyways, which is pretty rough regardless.

[1] - https://www.fraserinstitute.org/file/waiting-your-turn-2021-... [2] - https://en.wikipedia.org/wiki/2021_Canadian_federal_election, "Results by province and territory

AB, SK and MB are conservative with high rates of Trump flags.

And nice lies dude. They all have over double the national average!

Don’t use Fraser institute for sources. They are a far right “think” tank. If they posted it, it’s a lie or misrepresentation.

Favorably comparing the US health system to the Canadian one is an interesting take indeed…

I know people in Canada who come to the US for healthcare (better care for specialties, shorter wait times).

I'm not aware of the reverse (admittedly, that would require more than just $$).

And Americans go to Mexico for healthcare, I'm not aware of the reverse, I guess that means Mexico has the best healthcare in the world.

I actually drove someone across the border from Mexico to the U.S. for healthcare (voluntourism injury).

The reason to go to Mexico is price. The reason to go to the U.S. is quality.

How about for Canada vs the U.S.?

If you're a Canadian citizen, Canadian healthcare is cheaper, but generally has much longer wait times.

U.S. healthcare is much more expensive, but much more quickly available, and specialty care (e.g., rare disease treatment) is much better.

Then there's this - When a woman went to the hospital for help with suicidal ideation, a clinician told her the waits to see a psychiatrist are long, "the system is broken", and "have you considered [assisted suicide?]...MAID would be a more “comfortable” process during which she would be given sedating benzodiazepines among other drugs."

She will be able to see a psychiatrist "when one is available in the fall."

https://web.archive.org/web/20230809170345/https://www.thegl...

I live in the US. I am a software engineer making more than a half a million annually. I have access to tremendous resources and can advocate for myself and my family. I live in a college town because of my wife's career. It is not a big city, but is also not rural middle of nowhere.

Getting a routine gynecological appointment for my wife any time in the next six months is impossible. I gave up on trying to get an appointment with an allergist for myself, even after getting a referral. What you describe is common in the US too, even for those with means. I cannot imagine what it is like for somebody who doesn't have money and insurance.

Preach.

I wanted to get a sleep study done to get to the bottom of my occasional insomnia. My PCP at the time put in the pulmonologist referral (because this hospital network required a referral to get a sleep study done, which is insane in its own right, but that's neither here nor there).

This was in January. His next available appointment? March! For a friggin sleep study! And I have a HDHP + HSA and was going to pay full boat!

(He also prescribed me with an antipsychotic that can double as a sleep aid at low dosages, which I didn't take because five minutes of research into it made it obvious that taking that for extended periods of time is bad news bears. I stopped seeing him after that.)

(For those looking for answers like I was, I eventually stumbled upon Cognitive Behavioral Therapy for Insomnia, or CBT-I. It's essentially a rigid sliding window-style sleep schedule plus challenge therapy to make you rethink how you approach sleep. I've been doing this for six months now and it has been transformational. Best part? No meds!)

FYI: I'm not a doctor and this isn't medical advice, but you can buy an APAP machine over the counter with money in your HSA, then hack around in it to figure out if you have sleep apnea and how bad it is if so

My wife got a sleep study done within 2 weeks of booking one, after she asked to be put on a cancellation list. Her actual appointment time was for end of October, scheduled about a month ago. You may need to be proactive and ask to be put on one, for some reason no one mentioned to her that there is one.

Well, no need to imagine any longer my friend. I have neither money nor insurance. My experience is identical to yours...other than that whole allergist thing. That's not something I would seek out answers on, as it is simple to figure out at home, and when you do get to an allergist, you will likely hear something very useless like "yeah you're allergic to at least some degree to these 17-25 different things; please try to limit exposure". :-D

If you think waiting for months is a Canada-only problem, you clearly haven't tried to get a specialist appointment[1] in much of the US. And that's with good insurance.

[1] Or shit, even a PCP that accepts new patients.

No one is talking anyone into going the MAID route, that's just some far right conservative party bs.

Really, you just engaged in deception and promulgation of propaganda intended to push people toward neofascist ideology.

Shame on you.

MAID == Medical assistance in dying (assisted suicide)

Went from nothing/reluctance to popular for some segments of the population

> In US healthcare you have to be your own advocate and be willing to push. The system breaks down if you don't have a routine and obvious illness.

100% the same thing on this side of the pond, US healthcare isn’t special here.

How is this problem specific to the US? I live in Germany and hear exactly the same problem of needing to be your own advocate in northern Europe.

Also in Europe and most doctors just want to get you out of the office. I've met only a few doctors who actually care and will work with you to figure out the issue. The equivalent in software engineering would be waiting for my client to tell me what line to change in what file.

To be fair, doctors are usually overworked and on a human level I understand that the system is a bit broken, but it's still infuriating when it's your health that is suffering.

The internal term is "Treat and street". Get them out on the street as quick as possible .

You got the street - the treat is some yummy meds.

I had this when I got shingles on my neck. I hadn’t even got through the door when the doctor had made the diagnosis based on eyeballing my obvious visual symptoms. She was right as it happened but it was my fastest ever doctors visit

It's not specific to the US. It's the problem of doctors seeing every particular patient for literally minutes and having zero incentive to dig deeper. 90% of the problems are of the nature that is either covered by standard remedies or will pass by itself with time. If you have one of the 10%, you need to have good luck to encounter an extra-ordinary doctor that would take personal interest in your problem, usually while all incentives point to "give the standard answer and move on" behavior.

I once had extended work done at a dentist. It took a few hours, some of which involved sitting around and waiting for things to happen.

It gave me a new perspective on that kind of work. From my/our point of view, I was the most important person in the room and my problems really really matter.

From the doctor or dentists POV, I'm one a long long list of people they're seeing that day. It's a health care production line, and even if they have the inclination to be equally caring about everyone - which is a rare quality, because a good medical professionals are only in it for the money - they just don't have the time.

This is not an excuse unprofessional behaviour. But it made me realise that self-advocacy works because you're asking - maybe demanding - more than the production line gives you by default.

Also, medicine is incredibly complicated. And the research is often very low quality.

And that's not taking into account Big Pharma trying to tout its products, whether or not they're suitable or effective.

The most depressing thing recently has been the professional response to Covid. In the UK countless doctors have aggressively given up masking, even in settings with immunocompromised patients.

It's really made it obvious that some doctors are just in it for the money, a good few are phoning it in, surprisingly many have quite irrational beliefs, and the caring expert professionals are much rarer than they should be.

>extra-ordinary

It’s just “extraordinary”.

While there's some truth here, medical diagnosis and treatment can be really hard.

People have weird habits, weird diets, are exposed to weird chemicals in small amounts over extended periods of time, etc. There are all kinds of genetic factors where something can be really minor for most people and debilitating for others. There are all kinds or problems or diseases that people can have, and there can be weird combinations that interact or provide an overall confusing array of symptoms. And it's all mixed up with the patient's brain, which may be exacerbating or compensating in all kinds of ways (psychologically or through behaviors that the patient develops).

That sounds very much like someone I know. She had pain in her stomach that doctors in the US just refused to examine in depth. One prescribed her pain-killers and another steroid. She asked more tests but they declined. Her father is a doctor in India and when she finally told him (after a few months of suffering) about her ordeal, he asked her to come immediately to India. After some reluctance, she flew down, and the first thing they did after reviewing her reports was a simple ultrasound. They discovered a tumour in her stomach. Operated and removed it and luckily it was not cancerous. The irony is that when her father asked her to come down to India, she refused initially arguing that the US was at the forefront of medical science in the world. She now understands that doctors matter too. (And unfortunately doctor behaviour in the US is very much influenced by insurance provider policies).

100%. I’m in India now after years in the US. Indian doctors I’ve interacted with (for my kid) are just better at empathy and analysis.

It may be because they see a wider range of illnesses and this empathy/awareness might not work well with the patients are of varying ethnicity and race but they’re pretty good if you look past the exterior - shabby offices, gruff manner.

That's pretty funny because every time I've interacted with a stomach doctor, it pretty much went from introducing themselves to the patient (one time myself) to "let's get you scheduled for an EGD and/or a colonoscopy!"

That's with 3 different people and a handful of different doctors. They are actually pretty eager to look inside your stomach out here heheh. I'm really sorry to hear that happened to your friend though! I hope they're doing better now!

I moved from the U.K. to the US and the situation is even worse in the UK. Unless you’re bleeding or have cancer it’s basically “please go away”.

So much he said she said is the UK better than us with healthcare or not?!

It's better in that it's free, but it's been defunded so much that it's beginning to fall apart.

Private healthcare is basically broken out the gate, public healthcare can be much better but it still does need to be funded.

I would say it’s been defunded relative to the expected pensioner to worker ratio.

Much of Europe went wild assuming that we would always have 5 to 7 workers per person retired to care for, and I won’t be surprised if we get down to 1 to 2 in the next 50 years.

That’s a type of system collapse people aren’t prepared for.

If it were possible to answer that with a simple yes or a no, it wouldn’t be such a perennial debate.

Clearly both systems have benefits and drawbacks.

It's a perrenial debate due to ideology, not actual stats. The UK, despite the struggles the NIH has with.... everything, still has better outcomes than the US. This is JUST "outcomes" btw, as the UK also rates significantly higher than the US in "access to care". The US also has nearly twice as many "deaths that could be prevented by timely access to healthcare".

The main complaint about the UK system that people quote is "it takes a while to see a doctor" but that's true about most people here in the US as well. If you have not top-line insurance or live in a slightly rural area or a million other things.

As of recently, doctors refuse to see you in person even when you tell them you're chronically having abdominal pains. They're doing this telephone medicine now. They kept prescribing PPIs and insisting its indigestion (it wasn't).

Not sure if this practice is just shit or if all of them are. They then have the audacity to strike too. I've had absolutely zero sympathy for them since the months long ordeal of being in pain and taking pills that made me feel worse rather than better. Fucking disgraceful is what it has become.

I had a sudden onset of extreme pain 2 years and 3 months ago. I've seen 13 doctors in this time, had 2 major surgeries and lots of different therapies, and this one of my main takeaways. In our system, you are forced to become a "general contractor" of your health. I understand the nature of my problem, and I've had a lot of improvement, but I'm still nailing down the particular patholog(ies). The doctors that stand out are the ones who take the time to review your records, and come to the appointment prepared. I've had two. I blame the insurance companies for extracting more and more profit from the system, causing doctors to spend just as little time as possible on, you know, something as silly as patients.

One thing that I think people need to understand is the distinction between science and the practice of medicine.

The practice of medicine is not science. The practice of medicine can be informed by science - to a degree that is almost entirely up to the practitioner. ; but it remains more art than science. The distinction is similar to that between an aviation maintenance and aerospace engineering.

Sometimes doctors are just out of their depth.

Do doctors know this? We need to tell them they need to practice at the art, to get better at it.

They are bound by regulations and liability, your typical GPs and even the specialists can't greenlight experiments outside of big research hospitals. Medicine and clinical diagnosis are heavily regulated. That's also why you rarely see single author papers in practical clinical medicine. Doctors are busy people, with horrendous work life balance. Most software engineers have it way easier, you get to choose your tools and you get to choose where you want to work. In the business of software engineering, a sufficiently senior engineer can get away with a lot of nonsense without risk of lawsuits.

HIPPA doesn’t allow it (yet?), you have to do it yourself.

> aviation maintenance and aerospace engineering

Which is which though? As I understand it, aviation maintenance is quite rigorous, systematic, and informed by and taking into account every mistake made in the past.

Absolutely right! Maybe the most regulated industry in the US, but not positive.

Doctors are technicians. Technicians with a large toolkit, but technicians nonetheless.

When you compare their behaviors to IT it all starts making sense.

Add to that the fact that experience matters a lot too. The more variety of cases a doctor sees, the more the chances are that their diagnosis is going to be useful.

Yes and no, the more a doctor sees a particular diagnosis the less likely they are to consider anything else.

Honestly of all the professions that could be enhanced by AI, medicine has the most to gain. An AI can remember a much larger data set than any human and look for correlations among many more dimensions.

Yes that's what I think as well. And it's sad that medical data being weaponized against you is the thing that takes more sound bytes than how medical data collection can improve diagnosis and healthcare. But with the way medical industry, insurance industry etc are we cant blame people for worrying about data collection specially in a country like the US where you can become destitute without medical insurance

The great thing is even LLMs who only take text input still can yield better results than doctors. Think about a healthcare system which utilizes transformers working on images etc.

Being a doctor is like debugging a unique humongous software application with thousands of years of organic patchwork added by a godlike AI which just generates random code and watches the failed experiments die, no source code to any of it just the final binary, no debugger that lets you kill the process and dump its memory or trace its execution, just a bunch of test cases that cost lots of money to run and may yield false positives and false negatives making every bug some sort of heisenbug which may or may not show up when you try to reproduce it and reduces you to guessing with some percentage of certainty fuzzy logic, and even if you do manage to figure anything out in your desperate attempt to fix it you're reduced to essentially inserting event objects into the software's internal event system and hoping it produces the desired effects as it circulates throughout the entire system while hoping it won't adversely affect anything else and it's not even guaranteed to make anything better, or alternatively you pry the program open very carefully while it's running and cut code sections which grew tumorous or stitch together other sections which are leaking precious data or remodel the pipes so the data flows more efficiently, all to hopefully fix the problem while praying to god your attempt to fix it didn't actually make it worse because some malware randomly made it into the program while you worked on it.

Not only that but you need to provide expertise more on the timelines of a customer support agent rather than a software developer or researcher.

Yeah. It's like a never ending stream of bug reports coming in constantly and you have like ten minutes to make sense of each and every one amidst that chaos and do something about all of it because if you don't there isn't gonna be enough time to see them all and the godlike AI's operating system is gonna start killing the buggiest of the processes assigned to you before you've even figured out what's wrong and when that happens the report is closed forever and there's nothing you can do anymore. The same bugs show up in the programs over and over again every single day and there's no permanent solution, no permanent fix at the source code level that would end the suffering of all of those programs. Just constant swimming against the current. You don't even fully understand the system you're trying to fix, it's like ancient technology left to you by a long gone alien civilization and the best you can do is reverse engineer bits and pieces of it from the outside in and top down so you can do some very educated guesswork based on research that's way too expensive to be reproduced or replicated in any way, research that doesn't produce exact predictions like physics but rather purely statistical statements like "in case of A associated with conditions B if you do C you'll fix D% of the programs". Everything is framed like this, everything, you're never fully certain, everything has risk, there's even a chance the research you're basing all of this on is just completely made up or tainted by conflicts of interest or something equally stupid.

And if you make a mistake that other people feel you really shouldn't have and it damages the thing, you get sued into oblivion.

And much like software development, it will all soon be done by ChatGPT.

Local models integrated into EMR systems could be a great tool for doctors but not ChatGPT. I really don't recommend feeding confidential medical information into a corporation's computer. At least doctors are ethically obligated to maintain confidentiality.

To be clear, I'm just using ChatGPT as a (slightly tongue in cheek) shorthand for LLMs in general, but I do think there is a large potential for them within medicine.

They are so unreasonably effective for being, fundamentally, word predictors.

> I do think there is a large potential for them within medicine

As do I.

ChatGPT correctly identified my wife's condition in a couple seconds when a dozen doctors failed to for over a decade. Less than half a percent of people suffer from this condition, but enough do that doctors should have thought about it. All I did was write down the symptoms and poof. It was actually really frustrating that doctors were mystified but this tech gave us a new (and ultimately correct) path of inquiry. I felt robbed of all that time. My trust in doctors is at an all-time low, but her medication is effective, so something in the system works.

Thanks, gonna keep this in mind!

It took four years after graduation for me to obtain enough knowledge and training to help my own mother with her chronic pain. I literally did not know what to do until relatively recently. Other doctors didn't either and they tried everything.

I also nearly died myself about 2 years ago. Appendicitis of all things. Unusual presentation. I didn't see it. Surgeons didn't see it. Gastroenterologists didn't see it. Ultrasounds were inconclusive. I couldn't believe it when I saw the CT scan. I underwent surgery. Twice. The infection would not go away despite 5 intravenous antibiotics 24/7. They wanted to operate a third time and I became convinced I would die if I went under the knife again. Then they somehow managed to fly in an interventional radiologist who found and drained a few abscesses. 40 days I was at the hospital.

I feel so grateful to be alive.

thats why i majored in biomed engineering but stopped short of going into medical school

a lot of the 'magic' around being human evaporates when you have to quantify the 'worth' of any particular organ

untangling this closed-source blob always reveals secrets: 2023 just had an update to anatomy! https://www.urmc.rochester.edu/news/story/newly-discovered-a...

“Have you tried turning it off and on again?” Doesn’t have quite the same applicability. I imagine quite a lot of medical issues could be solved if reboots were simpler.

For sure. A friend of mine went to med school and chose the general practitioner path. One time I was hanging out at their place, so I leafed through some of the GP journals on the coffee table. It seemed much more akin to car repair than to science.

yeah, I was just thinking about this today. Doctors seem less like engineers and more like QA testers or PMs trying to fix bugs since there's nobody better suited to the job available.

Hopefully medical science will keep advancing rapidly here..

I doubt doctors will get better at this in our lifetimes. As we discover ever more about the human body, how are doctors expected to keep up with the research on top of everything else?

I’m hoping AI systems can help. A good medical AI should be able to stay abreast of all the research, know your personal medical history and suggest and evaluate any and all medical tests that are needed. Doctors will hate it, but I expect AIs will give much more accurate diagnoses than humans before long.

Just some statistics can help. My family doctor has some kind of awful green screen practice software but amazingly it has prognosis statistics for certain lab diagnostic results. Makes for better discussion about treatment plans.

I agree. Doctors' performance will remain the same as it has for thousands of years: overall, not so good. But, they've been using AI systems for well near a decade, especially in triage and real-time transcriptions. I haven't met many that don't love AI already in their day to day work.

"The experts are great until they have a case that is unusual. "

I was so pissed by this I created a way to find experts. People that actually studied the issue, have actual publish papers on the topic. What I found was no one cared. No one wanted "experts" - they want a specialist that is in their network and close.

Example of searching for mohs surgury. https://www.opendoctor.io/research/?research_papers=mohs&zip...

Interesting service, thanks for sharing. I think most people are looking for their GP to be able to refer them to the correct specialist which seems fair. It shouldn’t be on the patient to try to find them. But good website nonetheless! (FYI it doesn’t display great on mobile Safari - content too wide so there is horizontal scrolling).

If this is in the US it would make sense that people are really bound by their insurance provider as to who they are allowed to see cheaply.

Wow this is awesome. You should post this as it’s own show HN thingy.

This is great, thank you.

I've often been struck dumb by the passive nature of so many people when facing health problems. My dad had multiple myeloma and was satisfied with local hosp. Nope. Made him go to Yale and the Dana Farber. He got the best care possible.

I struggled with back pain and told to go to a neurologist and informed my GP where I would and wouldn't go. The doc I was referred to was a no-go since I know him personally and he's a lying piece of shit in his personal life, I'm not trusting him with my back! Docs could NOT understand. "But he's so nice." Screw that.

Time and again, family and friends settle. I understand the insurance component, but even then, can you not find better?

And thank you for your work. It's very cool.

awesome stuff, how hard would it be to expand to other countries? I'm from Australia :)

Very cool resource, bookmarked. I hope I don't need it anytime soon, and I hope it's still there when I do.

Same experience here. My analysis is it's a money milking scheme between groups of doctors. Pass you around so everyone gets a cut and they cross refer people to scratch each other's backs. Surgeon refers you to pain management and pain management refers you to surgeon. Add in a physical therapist, testing facility, and chiropractor and you got a pretty lucrative meshnet of referrals going.

Tbf in my case this was NHS so no money to be made by referrals afaik. It mostly seems to be a lack of up-to date knowledge paired with a reluctance to take the initiative and research the latest information for a specific case. As a substitute they refer you up the chain where the same problem also exists.

> NHS so no money to be made by referrals afaik

I wouldn't assume that - just because the money isn't coming from your pocket directly, it's inevitable there are doctors that milk the system. But you'd think bureaucrats whose job it is to assess the legitimacy of requests to the NHS (or equivalent institution in your own country) for payment might be harder to swindle than your typical patient.

Hanlons razor

While this might happen, it's certainly a tiny minority of cases. In most cases it's just too big of an ego to admit that they really don't know, and not willing (private practice) or unable to (employed by a big hospital) spend the large amount of time needed to raise the chance of finding the cause from 0% to maybe 2%.

Truth is that modern medicine still knows much less than is often assumed, let alone individual doctors. There's an absurd amount of potential for LLMs here.

I was with you until the last sentence:

> There's an absurd amount of potential for LLMs here.

The problem is not that doctors are stupid, the problem is that a lot of ailments are just not easily diagnosed. Even if the doctor has one (or more) suspicions what the red rash on your skin is, there just aren't any tests for many conditions. Many diseases are only diagnosed by symptoms and the underlying cause is unknown.

And even if you get a diagnosis, there is often nothing you can do.

LLMs are not going to magically come up with cures.

Is LLM the new web3, where people just keep throwing it as a solution for every problem they encounter? Seems like it... Maybe soon they will throw LK-99 at every problem?

LK-99 is already on the blockchain

https://coinbrain.com/coins/bnb-0xb131f5e8ec273af4652eecdd87...

This will change everything

People always default to whatever the new thing is being somewhat magical. Radiation as a medical cure all didn’t age particularly well, but it’s not like the same people are falling into the trap. It’s been common across many generations and cultures, I doubt it’s going to change any time soon.

> Even if the doctor has one (or more) suspicions what the red rash on your skin is, there just aren't any tests for many conditions.

There aren't any tests that the doctor has on hand, because the doctor is a unit in the medical system designed to provision affordable care instead of a scientist attempting to cure you. It would be too expensive to test you, especially for something that will probably go away on its own.

If various scans were more readily available, quick and cheap, I wonder how far these guesswork scenarios would be improved? Rather than having to get a referral and separate appointment and waiting period for bloodwork or colonoscopy or whatever else.

Read HIPAA when you get the chance; Specifically how to calculate cost.

Everyone who talks to the patient, who touches them, and who is consulted by the doctor, gets to charge. Yup, that means if another doctor happens to walk by, and confirms what he just told me, he gets to charge me again (double).

Feels like theatre every time I go to the doctor, so I just tell the secretary "I'm talking to you and Doc, no one else", and just quietly stare at anyone else who pops in.

Usually insurance covers this stuff, but I was uninsured when I discovered it .

> My analysis is it's a money milking scheme between groups of doctors. Pass you around so everyone gets a cut and they cross refer people to scratch each other's backs.

This is accurate. Years ago I had a kidney stone and the GP asked for an IVU (Intravenous urography) image to make sure about the size. The report prepared by the radiologist had the statement "operation is required".

When I got back to my GP just laughed sarcastically and told me that it was nothing to be worried of. He also said "the radiologist just wanted to return the favor, in case the GP wanted to operate". He was sick of this scheme too, but there was nothing he could do.

Most of the complaints I read in this conversation have been about people NOT getting referred for scans when they've reported discomfort!

House, MD was a fictional show on how the medical system is supposed to work, with abundant detective work and testing of hypotheses and pursuing a solution until one is found.

On the other hand, from the administrator's perspective:

"Your team of four people treat about one patient a week, why am I paying your salaries again?"

In our universe, I probably won't receive that much medical care in my lifetime.

If you ever get cancer... Maybe it's just that I lucked into getting the most aggressive oncologists, but on more than one occasion I was sent to get an MRI or CT on the spur of the moment. There were times when it was scheduled out as well - but along the lines of "come back in six months; we'll schedule the CT for the week before".

(But I know I was lucky - my oncologist could order a river to reverse itself and it probably would.)

Your profile and your user name seem to imply you’ve changed the direction of your career? Glad you’re alive, by the way.

Yeah. There's a finite amount of resources and a literally never ending avalanche of patients. At some point they're going to have to make a cold calculation.

I don't really know how it works in the US but here in Brazil it's actually pretty easy to order laboratory tests and imaging studies. There's taxpayer funded public health care but it can't handle the demands of the entire population so people would rather pay for the ultrasound or CT scan than wait two years for the government to provide it. An ultrasound costs about $30, an MRI costs about $150 and the price of a CT scan is somewhere between those two.

This whole fear of being labeled a "conspiracy nut" for exploring less trodden paths needs to end. Calling people conspiracy nuts for looking behind curtains they shouldn't was a good tactic by various entities to cover up secrets and misdeeds, but it has spilled over into the non political arena and poisoned everything.

Humans don't have a full understanding of everything, and in fact it's quite the opposite, in that we don't understand almost everything. Almost all paths are untrodden. It's fine to look where others haven't and come up with your own theories and ideas, as long as you retain a healthy skepticism and back things up with data as much as you can.

Science and exploration should not use fear of social reprisal as a guide.

I’m torn about this now. I used to cautiously support the practice of double checking your doc, but not wholeheartedly because of all the various quacks: essential oil moms, natural/spiritual healers, psychics, supplement sellers, crystal therapists, “old school” (pre-COVID) antivaxers and so on, muddying the water.

Until COVID came around and unearthed the absolute hoards of dO yOuR oWn ReSeArCh imbeciles. Now the sensible practice of getting a second opinion and exploring other options/doctors has been mixed up with the kooks: extreme politics and actual conspiracy theories, to the point where it’s hard to take any of it seriously.

When someone now says they don’t trust doctors, you have to dig deeper to understand if it’s someone genuinely seeking out other options, or if it’s one of Those People who’ve gone off the deep end.

The pandemic revealed the degree to which any respectable field can harbour extremely dangerous kookery without realising it.

For example, Western health authorities used to be absolutely certain that viruses could not be airborne (outside of very specific medical procedures), even though they did not have any good reason or evidence to back that up: it was just an old idea that happened to fit in with their priors, so generations of experts kept parroting it until horror unfolded.

Completely agree: couldn't believe the amount of conspiracy theorist doctors that pushed untested "vaccines" to a whole cohort of people which were at 0% effective risk from COVID.

The earth is not 6000 years old

God didn’t do it

Gravity is the curvature of spacetime

Things are not attracted to the planet through static electricity

Covid is real

Vaccines work

Rich mother fuckers do NOT have our best interests at heart

Intelligent aliens have not visited earth

People are called conspiracy nuts for being conspiracy nuts. Not for “taking less trodden paths”. Getting real tired of the HNs new “wahh wahh, we’re such major victims for believing stupid shit and being called out on it!” And just trying to paint it as “less trodden paths”.

You are arguing with a straw man. Nothing in my post suggested support for any of those things. That's why I included the terms skepticism and data.

Add to that list, some version of the lab leak theory is plausible, but there was an attempt to make it sound like a conspiracy theory.

I don’t think it is possible to end the derogatory use of the term conspiracy theorist universally, but I do have some hope that we can put a stop to it’s use as an ad hominem here on Hacker News.

It is never used in the spirit of promoting insightful discussion.

Instead it is used to shut down a line of inquiry in its tracks. It’s like calling someone an anti-semite.

It is used as a soft form of censorship, to disqualify the mere idea of engaging in the specifics of an argument.

If someone dismisses a comment by implying it is a conspiracy instead of offering a substantive rebuttal of why the comment is mistaken, it reduces the quality of the entire community.

I think we can do better, but more people need to call out this bad behavior.

What you're suggesting leads to an offense/defense asymmetry. Spouting a conspiracy theory usually takes very little effort from the poster, they're either intimately familiar with it already or they just copy-paste the talking points from somewhere else (or both). Expecting others to write a deep rebuttal every time takes a lot of time, it basically amounts to a DDOS attack.

I reserve the right to dismiss low-quality posts with a low-quality answer. And yes, that's a judgement call. There is no way around that.

Pretty sad that you have to state the obvious ey? Amazed daily by the closed-mindedness on HN.

This whole fear of being labeled a "conspiracy nut" for exploring less trodden paths needs to end

People get called conspiracy nuts when they make big claims with no real evidence. That is the opposite of 'science and exploration'. The difference is always evidence. Go on a conspiracy site and ask for hard evidence of anything and they will get very upset.

Modern healthcare is very bad at treating chronic illnesses. Symtomatic treatment is not a cure. I believe if people would live by these simple rules chronic diseases would be actually prevented and cured (in order of importance and effectiveness):

1. Don't mouthbreathe and don't overbreathe. See "Breath - The New Science of A Lost Art" by James Nestor for why and how.

2. Don't eat sugar, it's a chronic poison. See https://www.youtube.com/watch?v=dBnniua6-oM

3. Min. 1 hr of physical activity per day. Your body is not meant to sit all the time.

4. Avoid noise of the city life as much as you can. It leads to chronic stress and thus chronic diseases. Noise-cancelling earphones may help.

"The experts are great until they have a case that is unusual."

Also the very standard cases, they can mess up very badly.

"The system is at the same time incredible and awful."

The science behind the medicine is awesome, but the standard implementation is horrible and not up to at all, where we could be.

This is the place where I'm really hopeful that AI can help people sooner rather than later. A lot of these diagnoses just involve large-scale, complex pattern matching - the problem is that docs don't know what pattern to look for because the diagnoses are rare, and they're often not asking the right questions for the same reason. I knew someone who had an extremely rare genetic disorder (her family represents about half the people diagnosed) and just by sheer, dumb luck, her doctor happened to know the single doctor at NIH who specialized in it.

It's a really ideal use case for AI - not only figuring these things out but also doing things like clinical trial and research matching.

1000% they have optimized for the things that they see often and most of the times they don't even consider what else could be going on (even if they maybe know about it). Ultimately it's on you to understand what they are saying and to decide if what they're saying makes sense. When in doubt you should never ever be afraid to ask for a 2nd, 3rd, 4th and so on opinion.

Don't even get me started on diseases where we have medication that sort of works with tons of side effect where no significant progress has been made for decades. If you're alergic to the said medication or your side effects make it a no go, tough luck!

This. But the deep trouble kicks in when you're prescribed some treatment (a wrong one), your situation gets worst, and then the next "expert" has to deal with the original condition plus the new symptoms.

Sometimes (when possible) you just reset yourself: stop all medications for some days, so that the collateral effects are gone and you're left with the original condition (aggravated, of course, because you left the one medication that was working with the 3 others that were just giving you wrong symptoms), and then another "expert" begins from the "start".

I had a neurologist tell me that the scans he'd performed proved that there was nothing wrong with my wife, and he didn't know why she was choosing to act as though she had a neurological issue.

In neurology at least, I think a lot of the problem is that everyone is hyper-specialized. Luckily for us, my wife's insurance company convinced a generalist neurologist to come out of retirement and examine her, which put us on the path to effective treatment. But yes, that whole experience completely soured me on blind trust in the medical profession

It's particularly bad when it comes to treating women.

Doctors tend to believe that female patients exaggerate pain in comparison to male patients, in accordance with stereotypes that portray men as "stoic" and women as "emotional". The bias is systemic, with female doctors often assuming the stereotype too[1].

You can trace this bias back through medical literature which (often subconsciously) reiterates these stereotypes[2]. It shows up in many statistics, such as the difference in wait times for analgesics: women reporting pain had to wait an average of 30% longer than men.[3]

But a key cause of the problem is worse than just assumption of stereotypes: it's that modern medicine still knows far more about men than it does women. For centuries, the primary medical research and literature was done by men, about men, for the treatment of men. Most of the clinical trials performed in the 20th century enrolled far fewer women than men, and often _none at all_.[4]

Of course, gender is not the only bias that shows up in medicine. Age, race, (dis)ability, body shape, and economic/social status are all useful factors to keep in mind when considering why certain people, even entire sectors of society, aren't getting the treatment they should.

- [1] https://www.dovepress.com/the-roles-of-gender-and-profession... - [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845507/ - [3] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1553-2712... - [4] https://www.theguardian.com/lifeandstyle/2019/nov/13/the-fem...

> The experts are great until they have a case that is unusual.

But this is true for every thing in the planet. Data modelling, computer programming, building, everything. Name something that the unusual is not more complicated and difficult to do.

Why would anyone think that it would not be true for the health field??

I think the problem is people think health is magical and everything is known. Because they choose not to educate themselves.

> I think the problem is people think health is magical and everything is known.

The problem is most doctors have absolutely no humility and will never admit to not knowing something. I don't see that behavior among engineers.

"The problem is most doctors have absolutely no humility and will never admit to not knowing something. I don't see that behavior among engineers."

That is incredibly surprising.

Really? Because I see it a lot in "engineers" in tech. They're right, you're wrong and that's how it plays out.

I mean that behavior is literally HN incarnate, so you might be exhibiting exactly that in this comment.

Yes, wanted to write the same. I met many of those experts, and some of them try even blame the patient as some kind of "psycho" when the symptoms dont match any text book definitions.

But to be honest: There are also some motivated and honest doctors. If you find one of these, stick to them.

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