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Comment by jl6 | Hacker News Reader

> You’d think that this would have meant a revolution in how doctors understand and treat concussions. It hasn’t.

The article takes a surprised tone that doctors haven’t updated their practices in line with the latest studies, but that’s not usually how doctors work. Doctors aren’t intrinsically academics, and aren’t necessarily hooked into the scientific literature. Doctors don’t get their orders direct from science, they follow the practices of their peers and network. New knowledge percolates slowly and conservatively through that network.

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It typically takes at least 30 years from a finding to becoming medicine. First it needs to reach sufficient consensus that it starts getting taught in medical school once that happens it then takes 10 years to become common place for it to be taught and then 10-20 for those students to become consultants and be in the position to dictate how a treatment is applied. Sometimes some findings can take a long time to get into textbooks or the textbooks on a topic to get updated and the initial stages take longer. But 30 years is about the best medicine can currently achieve in any volume.

I don't necessarily know if such consensus has been reached for return to normal with concussions, psychology and exercise researchers are trying to make Cognitive behavioural therapy and exercise and a general appeal to nature as the solution to everything in medicine at the moment and there is a lot of bad studies with low or very low quality results on that basis. I haven't followed concussion research so I don't know if that is what is happening here but I suspect its likely. I would just be aware that a lot of the replication crisis with medical research is due to this effect so you have to look at the studies and be aware of the alternatives.

> The article takes a surprised tone that doctors haven’t updated their practices in line with the latest studies

This isn't "new research" or the "latest study", this is now established scientific consensus.

> Doctors don’t get their orders direct from science, they follow the practices of their peers and network. New knowledge percolates slowly and conservatively through that network.

This is indeed part of the problem.

Doctors should get knowledge of new practices from medical school or CME, not haphazardly through gossip. As noted in the article, medical scools don't teach very much about concussions and clearly our new understanding of concussion treatments are not being dispersed with sufficient speed by CME.

We need to hold our medical system to higher standards, not give them a pass because the broken parts have been broken for a while.

Wait, is Continuing Professional Development not mandatory for medics in your country? That's crazy. Like, that's so obviously necessary there was a Scrubs episode about it.

You definitely shouldn't have medics who are relying on long obsolete practices and just incrementally learning via the grapevine, get some regulations. It's bad enough that so many countries don't require CPD for software engineering. I don't care that you've been copying the source code into a dated folder every day since 1987, it's 2024 and you need an actual Revision Control System.

The doctors I know go to conferences all the time, so I'm not sure this is 100% accurate. Many also read medical publication journals.

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