Comment by doix | Hacker News Reader

Comment by doix | Hacker News Reader

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This doesn't really surprise me given my experience with doctors. If it's a common problem then doctors do fine. As soon as you're not the common case or have something somewhat rare, it becomes a bit of a crap shoot, at least in the UK when you deal primarily with your GP (general practitioner).

I have a friend with Crohn's who was feeling low energy. I was a gym bro at the time and convinced him to take a testosterone test (because all problems re caused by low T when you're a gym bro).

His doctor wouldn't even entertain the idea, saying he's a young man and it's very unlikely that he'd have low T. He did the test privately and his T is significantly below normal. If you Google, there are actually many papers showing correlation between Crohn's and low T. I bet an AI would find it.

Similarly, doctors missed my mum's recent cancer diagnosis. She also had factors that would make her more susceptible to breast cancer, googling finds many papers that show causation.

The problem is that those things aren't extremely common and haven't made their way to NICE guidelines or whatever GPs use.

Not that I'm blaming doctors, they have 10 minute appointments and don't have time to do anything. I'm sure AI would recommend significantly more lab tests which would put even more pressure on the NHS.

Part of this is by design - from medical school, doctors are quite literally taught "when you hear hoof beats think horses, not zebras." The progression and flow the decision trees in diagnosis are built to find the most common ailments in the most efficient way. It sucks for people whose conditions are further down the tree, but generally it does what it was designed to do.

Hopefully technology like this can help us rethink those decision trees, or else crunch more patient-specific information to adjust the diagnosis process on an individual level more efficiently.

I dropped out of medical school fifteen years ago — entered another [non-tech] profession entirely - and there's one thing I always tell either of the following groups:

Said to physicians: "I dropped out and I TELL EVERYBODY I KNOW you cannot pay a doctor enough for all the unnecessary sacrifices they had to make, just to prescribe you an antibiotic."

...to Non-physicians: "While I believe that you cannot pay physicians enough for their sacrifices, you should definitely investigate your own ailments, and seek multiple opinions whenever your `gut feeling` indicates `abnormal`. Physicians simply DO NOT HAVE TIME to give a fuck about your specifics.

More recently, I have included (to all) "it is probably ALREADY UNETHICAL TO NOT BE CONSULTING WITH LLMs during differential diagnoses."

Just my ¢¢

Not yet. Your faith in people not being led astray by the LLM is too high right now IMO.

I've seen way too many people who I consider generally intelligent, completely falling for the convincing bullshit. Mostly in my online communities, but also a few times in person.

I have hypertension, as well as diabetes. I wanted my cardiologist to test me for hyperaldosteronism, because I had read it was not uncommon and could be a factor in hypertension that continues to get worse and worse, without an obvious explanation. He refused, saying that it was the job of my endocrinologist to do that test.

So, I talked to my endocrinologist and he said it wasn't a normal test they do, but he was happy to do it if I wanted it. Well, the test came back positive. So they sent me in for a CAT scan of my adrenal glands to see if anything was obviously abnormal there. Which came back negative. So, now they want me to do a salt test to see how bad my hyperaldosteronism is, so that they can give me the right amount of the drug for that condition.

But the key thing that set me off was that original article that said this was now recommended by cardiologists as a standard screening test. Maybe only 10% of patients have this problem, but it's common enough that it's still worthwhile screening for.

So, why didn't my cardiologist screen me for it in the first place? Why didn't my endocrinologist screen me for it without me having to explicitly request it?

I'm pissed.

I don't want to sue anyone for malpractice, or even mention that word to any of my doctors. But I do want to convince them that they really do need to screen for this condition.

Meanwhile, I'm going to continue to follow this diagnosis to see where it goes, and if they can help me get my blood pressure under better control.

You don't know how these doctors view you. They view you as a "non-expert" as one commenter put it. Basically you're stupid to them and your thoughts are pointless.

The only way to convince them is to sue. But there's nothing worth suing here for, you got the test. You can only sue if damage was done, then the doctor would be responsible for blocking the test when you explicitly requested it.

I need to find a doctor who can be a more active partner in helping me diagnose and address my problems.

If you have any suggestions in the Austin area, please let me know.

Best bet would be make a lot of money and get a concierge doctor haha. Otherwise you're what, probably a 10 minute a month appointment to them and whatever happens to you, they can add it to their statistics.

It seems they usually test for hyperaldosteronism if they see the obvious signs like low potassium levels. Maybe they did not observe this at the beginning?

My endocrinologist did mention that my potassium levels had tested out as normal. That is certainly true.

As almost every comment of this kind on this site, you are missing the wider socioprofessional context. Yeah sure, you may find papers about plenty of things that may affect you without your doc's knowledge, perhaps even guidelines that are to be followed.

The problem is that respecting every detail of every guideline all the time is pretty much impossible, and even a debatable stance. There are many committees producing guidelines left and right. Because those people's jobs are to produce guidelines, not care for people. The exact same goes for research papers, and validity for patients in practice is a difficult issue.

So, docs all practice mostly from habit and experience. It's a craft supported by science, but clinical medicine itself is science as much as bricklaying is a science. But that doesn't make AI the use-all-do-all, because if everybody starts to test for every little thing, diagnostic probabilities will decrease massively and guidelines would have to adjusted in conséquence. It's a feedback loop. And also, you'd pay 5x the price for healthcare, so not realistic.

> But that doesn't make AI the use-all-do-all, because if everybody starts to test for every little thing, diagnostic probabilities will decrease massively and guidelines would have to adjusted in conséquence. It's a feedback loop. And also, you'd pay 5x the price for healthcare, so not realistic.

It's hard for me to write out all my thoughts on the subject, but I completely agree with this. The paper cherry-picked difficult cases and compared how AI deals with them vs regular clinicians. I think that is something AI will excel at because there is no cost to being "wrong", as long as something it spews out is correct.

In difficult to diagnose cases, that kind of makes sense. Find the answer at "any cost". But you cannot apply that to every case. If you let the AI loose on fairly simple cases, I bet it would over complicate many simple things, because it couldn't handle the nuance of people coming in and just whining about a regular cold. "Patient comes in with a headache, might be brain cancer but might be a cold" ~ type DDx.

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