Hacker News Reader

Comment by prettyStandard | Hacker News Reader

About halfway through the article, I'm trying to understand how they measure energy usage.

When I herniated a disc, because my hamstring atrophied, because I got a knee scope, I could not find a single doctor or physical therapist to explain it and such straightforward words, I had to do months and years of research myself to figure out what was happening. I probably saw a good 8 to 10 different "professionals" on this.

This taught me to not trust doctors. They're probably slackers and they probably don't care.

View on HN

Much more likely, they know so much about this issue that they struggle with finding simple words. Similarly how I often overcomplicate answers to technical problems of my family.

What is more likely: that doctors are slackers that have no idea what they are doing, or that their education path prioritized doing things over explaining anatomy to laymen.

I think the main issue with doctors is they only give each patient a few minutes of their time. There's not much "deep work" in the medical field.

You really need to be your own advocate to get thorough treatment for anything non-routine from many primary care physicians.

That’s my theory. They are good at obvious things but if something is a little tricky nobody puts the time in to figure it out. And nobody talks to each other. I always read about “care teams” but I have never seen such a thing.

There are care teams at specialized and high cost situations, main examples being a major surgery to treat well understood condition. But for normal folks living with non life threatening conditions, this is almost impossible to find unless you're very rich.

It's interesting to characterize this as an issue. If 20% effort can solve 80% of the problems...

Then there are the 5% of problems that could be solved with 20% effort, but there is enough money in it to convince the patient to pay for more attention even if they don't need it.

Let's hope that 80% of doctors don't gravitate to the 1% of patients that can afford to pay for exclusivity.

People with enough money to see 10 different specialists in search of a satisfying answer are probably already moving outside of the treadmill medicine realm.

It’s not that they have no idea what what they’re doing, it’s that they typically are mapping patient problems to a set of scripts. I’m analogizing shell scripts, not using shorthand for prescriptions.

In nearly all cases this works out pretty well, most people will have some improvement when the right script is applied, and doctors are pretty good at mapping problems to scripts.

But for edge cases, that approach is not going to work. Human propensities to slack notwithstanding, the business model discourages doctors from spending all day debugging one patient that isn’t responsive to their scripts.

We do this in software, too. “Really rare race condition, one in a million chance, not going to rathole, deprioritized.”

They're just people working jobs and in what's become a pretty troubled industry.

For reasonably smart, reasonably disciplined people, going to med school and getting licensed is not some transformative experience that forces them all to become brilliant diagnosticians and healers. It's just a bit of a long grind to score what's hoped to be a well-paying and traditionally respected job.

And then once you finish that grind and have the job, you still need to balance it with a regular old life of resposinilities and crises and kids and vacations; and in fact, because of the grind many people necessarily shift their personal and mental focus towards those other things.

Meanwhile, the job sucks in a lot of ways and doesn't deliver on the childhood fantasies of what it must be like. Colleages and administrators make it miserable quite often, and patiets sure do too.

The upshot is that no: many doctors are not all that brilliant and attentive to start with, and many who may sometimes be so are slackers. Shortcuts win, knowledge outside routine/common stuff fades, etc

Just like all jobs.

It's great when you can find the diamond in the rough for your own care, but don't assume they're all diamonds just because they went to med school for a while.

The pisser is that doctors mostly continue to act authoritative rather than collaborative. Regardless of how much education one has received, someone that spends a total of 20 minutes thinking about something (starting from a context without specific details) really should not be sitting there asserting one prescriptive take-it-or-leave-it answer like they've got the whole situation all figured out. Rather they should be engaging with questions to explain their reasoning and inform you of the larger context, since your health decisions are ultimately your own responsibility to make, especially in this brave new world of the "nobody's fault" medical system.

A girl next to me on the plane was studying for med school interviews.

I tried to imagine what questions they might ask, I looked over and the first question on her sheet was “why do you want to be a doctor.

This is not an intellectual interview, it’s a class and commitment signaling exercise.

Not on topic, but related. I made a video explaining my side project - Buckaroo for my less technical friends and family. In 6 minutes I give a high level overview of why data scientists use NumPy and Pandas, how they use Jupyter Notebooks, and why Buckaroo makes their life better. I'm proud of it. https://www.youtube.com/watch?v=pfAkz6L5rMI

I think the issue mentioned by parent comment is that doctors don't care to investigate the causes of what they're treating. They're trained to isolate and fix the issue at hand, not to think through what is causing the whole cascade of events.

Humans crave certainty. Doctors, politicians, executives, salespeople, and so on are rewarded for conveying certainty even — especially — when reality is uncertain. It’s not that doctors don’t care to ferret out the truth, but that the market rewards them for claiming that they have the truth regardless of whether they actually have it in their grasp.

I have, in my adult life, had precisely one physician convincingly show that he cared about me. The overwhelming majority are obviously phoning it in, with varying levels if pleasantness.

I remember my mom asking this when she was learning to drive a stick-shift in her 60s - "If both the gears and the clutch help in changing the speed, what's the difference between them?"

I had a huge problem in explaining this in simple terms without having to go into the the huge amount of detail.

Maybe it's something like that?

In general relying on excessive detail or jargon is symptomatic of not really understanding something when required to explain things in simple terms. I believe Richard Feynman said as much.

The general idea is people hide behind that detail/jargon precisely because they don't REALLY understand it enough to explain in simple terms what it is. That doesn't mean everything IS simple of course.

I assume you know now but in simple terms: the clutch connects the engine to the gearbox (transmission), so how well the clutch is engaged (connected) helps control speed. Gears multiply (increase or decrease) power from the engine depending on the gear you've selected.

> Gears multiply (increase or decrease) power from the engine

Ah, so when you want a lot of power - such as to tow something heavy - you'd want a high gear for high power, right?

But fuel consumption will be highest in 6th gear, because more power means more power consumption - I'll save money by using a lower gear, yes?

Honestly I'm not sure how people who've never learned about gear ratios understand this stuff. Maybe a combination of "have you ever ridden a bike? It's like that" and "always pull away in first gear" and "when the engine makes a vreeeee sound change up, when it makes a wubwubwub sound change down."

See: https://news.ycombinator.com/item?id=41821494

If I understand things correctly then my intuition for the answer to their mom's question would be gears wear out much less quickly than a clutch would if it were engaged all the time. Can anyone who knows more chime in?

Edit: ah wait no it's two multipliers isn't it, you're reducing overall power output when engaging the clutch?

Gears are multipliers. A clutch is basically two spinning plates - one on the gearbox/transmission, one on the engine.

When you press the clutch pedal in, it moves the plates apart so they don't touch. When you let the pedal out, the plates move together, slip and rub for a bit, and then grab.

While they are all the way apart or all the way grabbed, they don't wear. While you are in between, they are rubbing and wearing, and trying to get the engine/transmission to spin the same speed.

Thank you!

> Gears multiply (increase or decrease) power from the engine depending on the gear you've selected.

Gears change how many times the wheels turn for every engine revolution.

Engine power is the product of angular velocity (rpm) and torque.

Gears are tangentially related to engine power output since they allow a user to select how fast the engine is spinning, but an engine outputs the same amount of power at a specific RPM regardless of what gear the transmission is in. 1800 RPM in 1st gear and 5th gear will generate the same amount of kW (or HP, if you prefer)

Understood, but in this (hypothetical) example his mother probably doesn't know exactly what angular velocity or torque are, so making things even simpler with a laymans "power" serves to get the point across.

One could include torque in the explanation to which the follow-up is probably "what's torque?".

The simpler one goes for that initial understanding, in most cases, the less technically correct one is; by design that helps the newbie learn and build up to a more technically correct understanding later on.

2 things. Doctors know a whole damn lot. Secondly, what doctors don’t know far outnumber what we do know. Lots of time, the best we have is hand wavy explanation that connects the biology we sort of know to the pathology the patient is coming up with

Reply on news.ycombinator.com