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Comment by perlgeek | Hacker News Reader

> Do other careers have such a vast gap between the platonic ideal and the actual lived experience?

In the past few years I've got the impression that when I go to a doctor with a slightly unusual symptom, they are very much lost. It seems the average GP learned a whole lot at University, and 20 years later treats the same 50 common things (colds, cuts, high blood pressure, you name it) and doesn't really remember all the quirky and exciting stuff from uni.

I'd guess that the more academic the education is, the more likely you fall into that pattern.

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I've interfaced with a fair few MDs in the US behind the scenes, so to speak.

The site nearly every MD in the US uses is called UpToDate:

https://www.uptodate.com/login

It's not really for laypeople, so you can't poke around in there (check your alumni benefits though, many associations have subscriptions). But, to give you an idea, the site is pretty much a diagnostician. You can just plug in symptoms, patient history and demographics, and it'll give you nearly everything that you need to know. Lots of best practices, research papers, summary papers, testimonials, etc. It's effectively an AI for MDs, and it's good.

What I'm trying to say is that your first instinct is correct: The MDs that you're going to really are in fact idiots that can't even be arsed to use a web form.

Not sure why people are downvoting this - my partner is an MD and uses uptodate literally every few hours, when she's at home - I'm sure it's higher at the hospital/clinic.

Some Doctors are checked out/lazy/make assumptions, just like everyone else.

Definitely. Resources like UpToDate are invaluable. Patient safety research proves it. Just double checking something to make sure reduces errors.

Better not to do it in front of patients though. Many will assume you're incompetent if they see you doing it. Few will understand that you are a fallible human being who's using every possible resource to make up for it.

unfortunately, many (most?) doctors have simply become prescription writing machines - "got a problem? there is a pill for that", and if that pill doesn't work, we will try something else.

Good luck finding a MD that actually wants you to be healthy and drug free - the system is setup to give you a prescription and hope that it works; doctors around me won't even broach the subject of suggesting you lose some weight or get more exercise or even just eat more healthy food - they just write a prescription to deal with the adverse affects of your poor lifestyle.

In my experience, it's the opposite. Day in day out I tell patients to exercise and eat better. Some people manage to change their lifestyle, get better and even get off medications such as statins. Many don't and medication ends up being the only thing keeping things under control.

Then there are the patients who will destroy you on social media when you tell them to take some responsibility because that's "intolerance" of their morbid obesity. Plenty of people out there looking for easy pill solutions to everything.

Yep - I have several family members that work in primary care - many patients have filed formal complaints with the practice if the provider calls attention to the fact that someone is obese or is making unhealthy lifestyle choices and should make changes if they want to be healthier - one even threatening to sue if the office didn't take references to her chart that said she was clinically obese - so more and more providers are simply not broaching the subject and instead writing the prescription for whatever the pill-de-jour is.

I can't remember how long ago, but I read or heard about a few studies that show you're better off going to a freshly minted doctor, at least in the US. They'll not have had the time to build a cynicism around "what they learned is all they need to know".

I know Dr's learn a lot throughout their career, but after they get into a practice they just don't have the time they did in medical school (or won't spend the time), and the trajectory flattens.

Or go to a doctor that is part of a top university system that does real research, such as Northwestern or Rush in Chicago.

A research oriented doctor is going to have very little interest in anything but their research. So if you know you have a rare disease, sure. But most people do not.

Go to a doctor from a hospital with acclaimed primary care, like University of Washington Medicine. Ranked #1: https://www.usnews.com/best-graduate-schools/top-medical-sch...

I used Northwestern for years and my internal medicine doctor always seemed more up to date. The specialists he referred me to were often involved with the university in some capacity and seemed to be aware of very up to date info in their fields.

Awesome! Good medical care is what everyone deserves

It's the same in software and likely every industry. Yeah, you still have plenty of very senior folks who have adopted the cloud and are building things in modern ways and on the bleeding edge of things. Then you've got the crusty HN types who think a Hetzner VM and Postgres is the best way to solve all the problems in the world and javascript is the bane of all existence. I've met the 50 year old developer who has written nothing but Java enterprise apps for the last 20 years who are all but useless outside of their niche, and a 60 year old developer who is still as giddy as a child while he's playing with code generation models. If technology is your passion, it's far easier to stay up to date and stay relevant. If technology is just your chosen career, you've got to intentionally put in the effort to stay up to date or risk becoming out of touch with the industry. There are passionate doctors and career doctors. Passionate home builders and career home builders. Etc. Etc.

General practice and primary care are all about what's common. It's designed to soak up all the easy stuff that makes up 80% of the cases so that the specialists can deal with the hard complicated 20% stuff. If a doctor can't help you, they should still know who to refer you to.

Can you give an example of a slightly unusual symptom that stumps doctors?

>'d guess that the more academic the education is, the more likely you fall into that pattern.

of treating the most comments stuff and being lost? Would have thought the opposite, no, or am I misunderstanding

Yes- I've had the same experience... the same "Huh, that's weird" kind of unknowing response that I give my parents when their printer isn't working again

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