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Comment by julianeon | Hacker News Reader

I think sometimes these articles don't pose the question all that well. The way I would ask it is:

Imagine a pain scale of 1-10; pretend 10 is so high that you die from the pain.

Is it worth living at a 7-8 at every moment continuously, to extend your life for 2 months? How about living at a 9 for just 2 more weeks?

If you say "no" that just means you're not hooked up to a machine where that's your living experience (not like someone is actively killing you).

I think, when you put it that way, it becomes easier to set some rules around it. Btw I'm pretty close to someone who would always choose to live longer, but even I would say no to, for example, living at a 10 of pain for just 1 more week of life.

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Doctor here.

This is overly simplistic. There is little to debate about your example of living at a 7/8 for 2 months. What is more realistic is some hypothetical situation where the average patient has an expected survival of 6 to 18 months, with the hope that the 7/8 pain can be reduced to a 4/5, and with acknowledgement that some days may be a score of 5, some days may be a score of 9. Then what?

As a provider on the other side of it you witness two similar patients take two different paths. Perhaps the first patient lives 36 months with pain score averaging a 3. The family will often appreciate the intervention and effort. The other patient experiences a string of complications and dies after 2 weeks, living at a pain score of 10. Their family paints you as an evil torturer who should have never been listened to.

In fact you can see both types of opinions in this very thread.

Thank you for taking the time to explain this, a really valuable contribution to this thread. When I consider this going forward, I'll think of it this way.

I'm glad I could help. Thank you for your kindness.

While I agree he's being too simplistic I think you're not getting it, either. You're making the standard error of the medical world of focusing too much on stuffing pigeons into pigeonholes because once you have found the supposedly correct (look at the patients who go to doctor after doctor after doctor until someone finally finds the rare issue that's the correct diagnosis--and realize that there are those who never get answers) pigeonhole you see the pigeonhole rather than the patient.

You're looking into that pigeonhole and observing the result is anywhere from two weeks of horror to three years of not too bad. Just because you can't predict how any given case will turn out doesn't mean you can't look at the patients and see how things are turning out. And recognize that things are not static--your first patient doesn't exist. Things don't just sit there at three for three years and then kill you.

> You're making the standard error of the medical world of focusing too much on stuffing pigeons into pigeonholes because once you have found the supposedly correct (look at the patients who go to doctor after doctor after doctor until someone finally finds the rare issue that's the correct diagnosis--and realize that there are those who never get answers) pigeonhole you see the pigeonhole rather than the patien

This is another common misunderstanding of why people so commonly struggle to get a convincing diagnosis. The problem isn't a clueless doctor robotically listening for keywords. It's that the doctor has 10 minutes to dedicate to you and if it's not in the 80% of straightforward cases for them, the patient gets the bare minimum and then becomes someone else's problem. To solve that you need to fix provider shortages and (in the US) remove the corporate overlords constantly applying pressure on the little worker bees beneath them.

> out doesn't mean you can't look at the patients and see how things are turning out. And recognize that things are not static--your first patient doesn't exist. Things don't just sit there at three for three years and then kill you.

It's becoming clear to me you have a really odd sense of what doctors generally know and don't know. I don't really have an interest in exploring the left side of the Dunning kruger curve with respect to how medicine works.

You're explaining why it happens--and I agree, it's forces outside your control. But that doesn't make it not happen.

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