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Comment by bambax | Hacker News Reader

Excellent blog post, excellent advice. This part in particular:

> When working with paid professionals, I think people tend to put them into one of two categories: doctors or general contractors.

> With doctors, if your oncologist says you have a lump that needs to come out, you pretty much do whatever they say. You’re the patient; they’re the expert leading the charge.

> With general contractors doing home renovations, most people intuitively know that’s not the right approach. You stay on top of them, give clear instructions, try to understand the issues yourself, and assume you need to provide lots of direction and monitoring to get what you want done.

> Most people—entrepreneurs included, certainly myself—put lawyers in the doctor category when they should really treat them more like general contractors.

Except... I think if one has enough time, it's better to treat everyone like general contractors. Doctors make mistakes, often. You can and should challenge them.

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> Doctors make mistakes, often. You can and should challenge them.

The problem with challenging doctors is that the body is incredibly complex, and is not really under any obligation to "make common sense" / be bro-science-y.

The vast majority of the time you're going to be wrong and annoying, even if you're consulting LLMs first.

If a doctor is making a mistake, and you're a lay-person, you're not likely to spot it. But you are likely to challenge a bunch of things that the doctor is right and just be an annoying back-seat driver.

You're better off trying to get a doctor you can trust than treating your doctor like someone who isn't good at their job.

There are bad and shady doctors to be sure, but they are extreme outliers.

Doctors, unlike lawyers, typically care about your care - whereas lawyers are mostly interested in extracting as much of your money into their pocket as possible.

Unless you're going to some elective surgeon, most doctors are so busy, they don't need to make up pretend bs to have you come back and get work.

Lawyers on the other hand...

Two separate doctors have almost killed my wife with incorrect diagnoses over the span of 15 years.

She had cancer when she was 18 and the doctor insisted that women just don’t get cancer at that age, and insisted the lump was benign without testing it. We got another doctor to remove it, and it turns out it was stage 1 cancer.

A decade ago she was in crippling pain right in the gall bladder area. The doctor insisted it was indigestion. We found another doctor (thank goodness for PPOs letting us go directly to specialists without a referral) who did an ultrasound and said my wife probably had less than a week before she would suffer a rupture, and she had to have emergency surgery.

I’m glad you haven’t had that experience, but it’s a very real problem.

The inverse of this is people blowing off doctors then dying from very preventable illnesses, which I wager is orders of magnitude more common.

That's not to say that you should just believe doctors. If someone is telling you something isn't a big deal but you think it is, then get a second opinion.

It's especially common for women, particularly young women, to not be taken seriously. The implication is that young people are healthy, and women are over dramatic. Well... they're not always. I, for one, got cancer in my 20s.

The reason, I think, doctors are like this is because they want to err on the side of caution. They don't want to put people on medication unless they're 100% sure. They don't want to put people through anxiety-inducing tests for kicks. They don't want to cut people open unless it's the absolute last resort. And I can understand that mentality to a degree.

Not true in my experience. Just because a doctor has gone to medical school doesn't mean they are good at debugging/troubleshooting. I've had many doctors try to diagnose my chronic issues with guesswork and hunches instead of methodically eliminating possibilities with tests. I had to switch doctors many times to find one good enough to diagnose my condition (LADA aka type 1.5 diabetes). I actually asked the first doctor if it could be LADA and he said "nah, I don't think so", so then I asked if we could test for it to rule it out and again he declined and confidently encouraged me to exercise more and eat fewer carbs.

It's surprising how bad most people are at debugging. They make hypotheses but don't test them in isolation, so they can't reach conclusions. I see this everywhere, from IT issues to trying to fix a broken vacuum cleaner.

There should be a specific course on boolean logic in high school, distinct from math. Doesn't need to last a year; but needs to be graded separately from everything else.

The irony is how transferable these actual skills are, and often how intangible they are (difficult to measure, in a sense).

A few really good programmers/IT types I've worked with over the years were also very handy at auto repair, home repairs, and the like.

I guess, for a vague description, "root cause analysis", "isolation of the issue", and "reproducibility" are vitally important skills across domains.

My only "skills" in these domains are software stuff and some auto repair/troubleshooting and the process is nearly identical.

So you found a doctor to agree with your preconceived diagnosis and he's the one who is right, while the others were wrong?

You're intentionally ignoring the part about tests and methodical reasoning vs guesswork so you can be snarky about someone's take.

No but one of the things doctors learn is that when you hear hoofbeats, think horses not zebras.

It's not practical to test for everything right away, and if an adult is overweight and presenting with diabetes you initally treat for type 2, and advise losing weight and changing diet.

Every medical school class has people who graduate near the bottom. The critera for entry, and the filters that you have to pass before you can practice as a physician means that even those people are generally decent doctors.

I'm not saying doctors are never wrong but you're not likely outguess even an average doctor by googling your symptoms. It's very easy to convince yourself you have some rare condition because your symptoms match, but you ignore "rare." The fact that someone has an anecdote to the contrary doesn't change this.

In my case I am very skinny (150 lbs, 6'0") which is the main reason that I thought I might have LADA and not T2 - my own research suggested that T2 was rare in skinny patients and that LADA might explain my elevated blood sugars (and also that up to 12% of T2 might actually be misdiagnosed LADA). So IMO the horse should have been LADA. However, LADA doesn't seem super well known or understood among doctors that haven't worked with a lot of pre-diabetic patients. This particular doctor claimed that my A1C would have been much higher than it was if I had LADA/T1 and that I was exhibiting symptoms of insulin resistance. I tried to argue that maybe we were catching it early and that insulin resistance and insulin deficiency present with the same symptoms (high blood sugar), but the doctor suspected I was non-compliant with the requested low-carb/exercise regiment and told me to try harder instead of ordering the tests and that I would see results if I did that.

I went to a second random doctor I found on ZocDoc who also thought I was T2, but then LADA was eventually confirmed by a third doctor who I chose specifically because he's worked with a lot of diabetic and pre-diabetic patients. He took one look at me and said "You look too skinny for a typical T2, let's run a GAD-65 autoantibody test", which came back 10x higher than the normal rate.

So yes, if you are a doctor and you hear hoofs I do think it's a good idea to think horses not zebras, but also if you've never actually worked with zebras, maybe have the humility to defer to a different doctor or listen to the patient who clearly has done more research than you about the condition they've struggled with for years instead of confidently pushing your wrong theory.

P.S. Early on in the process I also tried to see an endocrinologist (who probably also would have recognized LADA). However, they are a gated resource. I was unable to set an appointment with an endocrinologist without a recommendation from my PCP, and my PCP wouldn't give one. Just frustrating all around.

This is a much better comment with some thought behind it and a point at the end and without the snark. Thanks for adding it.

Any good doctor will tell you that you should be an advocate for your own care. That includes asking questions when something does seem right or doesn't make sense. You don't have to be a doctor to tell them they marked the wrong limb to be removed in surgery or ask why they recommend one treatment over another.

You sound like someone who was lucky enough to only meet good doctors.

Bad doctors, that really don’t give a shit, exist and are doing well, at least where I live, because there simply isn’t enough doctors.

The ratio good to bad doctors is the same as good to bad contractors in my experience.

I fully understand how annoying it is to be challenged by a patient as a doctor but why would the doctor do that with his contractor and not accept that from the patient? Because he’s more of an expert? I’d argue he’s less of an expert actually, because medicine is so insanely complex and we know so incredibly little of it.

> Doctors, unlike lawyers, typically care about your care

Yes but doctors, like laywers, often err on the side of caution. I don't want to be cut open unless absolutely necessary.

Maybe the approach is simply to ask for a second, expert opinion rather than trying to make your own. But asking pointy questions can't hurt (within reason, of course; you don't want to be the guy "doing their own research" (even if you are)).

This approach seems more like an overreaction to bro-science/anti-vaccine crowd. Like you arrived here by deciding to trust doctors more, since others don't trust doctors enough.

Often, you get out of something what you put into it. People who don't try to understand their own health/relationships/finances often end up where they didn't want to be.

If you won't advocate for yourself, why should you expect a 3rd party do it?

Topical: "How I Built an Open Source AI Tool to Find My Autoimmune Disease (After $100k and 30+ Hospital Visits) - Now Available for Anyone to Use" --> https://www.reddit.com/r/OpenAI/comments/1ij6619/how_i_built...

I'm in the UK. As well as doctors making mistakes, they can be under direction diagnosing critera. The UK has had a multi-year struggle for people with ME/CFS, (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome). It falls under neurology in the UK, and a sub-chapter neuro-psychiatry has the ear of the national health service's supremos, and has historically entertained an "all in the mind" approach. I digress. Back to AI and medicine again: https://x.com/vipintukur/status/1931049593535627417 - insights can come from that quarter, and medicine is going to have to play catch up at times.

> Doctors make mistakes, often. You can and should challenge them.

It is worse. Many doctors will administer against your interest if it boost their bottom line. There is, also, very little legal recourse against doctors.

This. Doctors have to work in a system. The hospitals are institutions that have quarterly quotas to hit, and they want doctors to maximize profit. How much the doctor will oblige depends on the individual doctors but the pressure is always there.

I read the same and came to the opposite conclusion. I said: "Yikes. The balls on this guy.":

> Some lawyers bristle at clients setting strategic direction. They believe there’s a “correct way” to do things, they know it, and they’ll fight you if you disagree. In that case, get different lawyers.

The thing is -- there are correct ways to do things in the legal sphere. Litigation is highly professional and highly formal, and has only become more so. While sub rosa it's fine to ask an AI for advice, and to engage it in draft brief writing, summarization to bullets, etc., it's wild not to realize how much of litigation and the law is wrapped up in people and experience and intricate formal processes. Such as this court has local rules, and this judge likes his briefs this length and the arguments just so, this needs to be filed here, stamped by the clerk, and filed again over there.

AIs may be exceptionally clever, but they may misunderstand the theatre of a trial. They may overweight the importance of the law and then underweight human factors, like the importance of assigning blame, or the lack of credibility of certain witnesses, or the bad faith of certain actors. AIs may fail to give credence to the ordinary meaning of terms, or fail to emphasize that these are two sophisticated businesses which understand the technical terms. AIs are still very poor at actual "reasoning", that is, a deep consideration of the multitude of ways of looking at any one set of facts and/or words on the page.

One area in which this article is entirely right is -- one must manage attorneys, and you must make certain that legal costs don't become leverage against you. But there are points at which you say: Can this guy keep it all straight? Does he know how to be useful to his own defense and then does he know how to get out of his own way?

Lawyers shouldn’t set the direction because they tend to try to minimize liability at the expense of everything else.

CPAs shouldn’t set the direction because they tend to want to structure your business in ways that save taxes, at the expense of everything else.

If you’re the CEO/President of your company, you should set the direction, using lawyers to know what the liabilities of the different options are and using accountants to know what the different tax implications are. Lawyers and accountants help you make informed decisions, but they should not be deciding the strategy.

> The thing is -- there are correct ways to do things in the legal sphere. The legal sphere is highly professional and highly formal, and has only become more so.

In some ways. OTOH, my wife works in the legal sphere, and after spending most of her career at a small boutique firm before being subsumed by a larger one, she was kinda dismayed to discover that there’s no singular “right way” to do things, and that different lawyers kind all do their own thing in a multitude of different ways.

> different lawyers kind all do their own thing in a multitude of different ways.

Agreed. There is no formal processes to the inner workings of firms (but perhaps there should be).

What I think the author is saying is: There is no single way to conduct the lawyer-client relationship. Agreed, as well. But what I am saying is: There are certain areas in which the client can be a detriment to himself by ignoring the ways legal processes function.

Like -- "I am certain if the judge only hears what I have to say re: X, she will immediately dismiss this frivolous suit. You must tell her about this now. You must file something now." Okay, lawsuits are governed by highly formal processes, and there may be a time and a place for such merits arguments, at certain points in the suit, but this may not be that time. This is the time we talk about process, like jurisdiction, etc.

The correct procedures are why you (and the OP) need a lawyer in the mix.

Strategic direction, though, isn't something that has a correct mechanism. That strategic direction can include things like how hard you want to fight on each motion and if/when you want to try and settle and for how much.

Said another way, if you approach a plumber with "I need more hot water" they'll probably try and sell you an industrial tankless water heater with a nice markup. However, if you tell them "I want you to install this water heater that I purchased" then they'll do the work to get it fit in and setup. 1 option will cost you $1000s of dollars more. There is still a correct way to install water heaters, but the stuff related to whether or not you need a new water heater and what kind shouldn't be left up to the plumber.

The law is the same way. If you just tell a lawyer "I'm being sued, help me" they can justify putting any amount of time researching case law for your case. Taking a more active role, though, and saying "this is how I want you to respond to that motion" will shortcut a lot of that research time. They'll still have to do some work to validate you aren't giving them garbage to file. And of course they are still expected to follow all the local rules. But the actual billable hours will be massively reduced because they aren't doing nearly as much research.

> Taking a more active role, though, and saying "this is how I want you to respond to that motion" will shortcut a lot of that research time.

Taken literally however "this is how I want you to respond to that motion" could be wildly reckless. I think your discussion above amounts to equivocation on the word "strategy". It's fine to set business "strategy". Telling an attorney what should literally be in his response to a motion, ignores all his/her knowledge about motion practice, the law, and evidence which will be relevant to the question. Like -- this is a 12(b)(6) motion, not a motion for summary judgment. We are questioning the sufficiency of the claim on the page, not whether there are genuine issues of material fact.

Business strategy is "don't spend gobs of money on this motion" not "file what I tell you."

> could be wildly reckless

Could be, which is why you have a lawyer to put guiderails on and give a "are you sure you want to go down this path?".

> Telling an attorney what should literally be in his response to a motion, ignores all his/her knowledge about motion practice, the law, and evidence which will be relevant to the question.

No, because before a lawyer files the response they have to (well, they should) both read, understand, and verify that it is in fact a valid response to file. Not doing so can get them sanctioned.

It's also their job to bring up to the client "Look, I know you want to file this but in my experience you'd really be better served if you did this instead".

> Could be, which is why you have a lawyer to put guiderails on and give a "are you sure you want to go down this path?".

Guardrails are the wrong way to think about the relationship. The attorney is not your mother and you are not a toddler. The attorney is not there to figure out the 1000s of different ways for you not to get hurt, when you present them with a bogus response. Why? Because verifying the 1000s of ways for you not to get hurt is often a waste of time which will cost you time and money itself.

A better way to think of the relationship is a partnership. A: I feel business needs to do X. B: I think X with a few addendums stands a better chance of success, but will cost a few dozen deep research hours, which likely can't be handled by AI. A: Can you cap my cost at $Z? B: Done.

> No, because before a lawyer files the response they have to (well, they should) both read, understand, and verify that it is in fact a valid response to file. Not doing so can get them sanctioned.

Simply being formally valid is not enough. Most clients want to have a reasonable chance of success?

Moreover, attorneys like doctors, shouldn't simply be considered instruments of your desires. Especially in litigation contexts where they have other independent duties to fulfill. Attorneys, for instance, are not allowed to simply ignore adverse precedent.

A: The AI said X and Y and Z. B: That's fine, but we need to be sure we have addressed the relevant case law in this jurisdiction. A: The AI was last updated a week ago. B: Afraid we have to a deeper search than Claude.

> The attorney is not there to figure out the 1000s of different ways for you not to get hurt, when you present them with a bogus response.

They are, because they are a partner with you in law. Part of their job is working with you and looking out for your best interests.

> Because verifying the 1000s of ways for you not to get hurt is often a waste of time which will cost you time and money itself.

That verification is what you are shortcutting but also not what you are after. You want their experience to be able to say whether or not a path is good. The fact is, there's no 1 right way to do things and what you really want is "is this reasonable".

> Most clients want to have a reasonable chance of success?

Most clients want to pay the least amount of money possible, including legal fees (In civil cases). "Success" isn't really measurable beyond "will this bankrupt me".

There's also not a lot of guarantees that this motion or that motion will ultimately drive down the cost of the case. There are literally thousands of motions that get field especially when talking about corporate lawsuits.

> However, if you tell them "I want you to install this water heater that I purchased" then they'll do the work to get it fit in and setup.

Yea, but plumbers tend to hate this. Electricians and HVAC pros also don't like it when you sit in the driver's seat. Car mechanics, too. When you've already done the diagnosis, and you just want them to install this OEM fuel pump which you've already purchased. Some mechanics will even refuse the job. They want to pump their bills with hours of diagnosis and their parts markup.

Tradesmen have a process they want you to go through that maximizes their revenue.

I disagree with your sweeping statements. Tradies fear crappy clients, but if you're pleasant to work with and you pay them fairly and you don't shit on them then you can find good tradies that will work closely with you.

Pick your tradie, to suit your requirements, and be a great PM and pay for quality work. I've been the Purchaser, Project Manager and often the apprentice/gofer too (saving myself many many billable hours of cost on each job).

The last three multi-thousand tradie jobs (builder, plumber, electrician) I've had deep interaction with the tradie and I am a repeated client with significant different jobs with each.

Properly respect the person, be ultra-polite if you want to question how anything is done. Never micro-manage or be an overdemanding perfectionist and accept normal mistakes. They are the experts but they sometimes get things wrong.

You are an apprentice trying to learn, but you can be firm with requirements and watch for gross mistakes.

I often get involved with other tradies or professionals too (recently car electrical, car mechanical, medical specialists, fencer). Sometimes to save money, sometimes to get job done better.

If you want to be OCD about a job, then pick an OCD tradie and be prepared to pay for your perfectionism. I'm usually more cowboy. One friend is a tiler, and he likes delivering amazing jobs (but he costs somewhat more per hour than average).

> and you just want them to install this OEM fuel pump which you've already purchased

Recently just done similar with my mechanic (supplied wheel studs and they've told me where to get replacement handbrake cable which they'll fit), and I did this with my electrician (used my own reels of cable) and I wish I did this with my plumber (because I would have made a better choice of fitting than they did). For cheaper jobs perhaps pay them for the lost income (trade discount or trade markups are usually known, or you can just ask). Actually did this with a fuel pump with the second hand car dealer when they had to fix under warrantee (helped simplify things to get their mechanic to fix car while I waited).

Context: I'm in New Zealand and I'm in my 50s.

On-topic: when you're a founder you need to hone the skill of working with professionals (e.g. lawyers) and getting them to do work right. My take on being a founder is that you are ignorant about everything but you have to get it done anyway: you often have to become your own expert and just do it (your meta-skills are most relevant). Advisors/mentors often lack context or have their own agendas, so you just gotta get ahead regardless of your ignorance. Learning how to listen to advice, pick the value out, and throw away the dross is just hard. Being submissive or falling for status plays is ruinous.

Not disagreeing about the risks of AI here. But the thing is, there are correct ways to do things in court. But this guy's strategy was to improve his negotiating position, pre-court. That sounds like it's a lot more to do with assessment of risk, assessment of your adversaries strategy, and business position. Which are all matters that totally aren't solely the province of lawyers. In effect, that means that the lawyers should have been doing what he got the AI to do.

> in court. But this guy's strategy was to improve his negotiating position, pre-court.

"The court" generally just means stuff that involves a judge. Not the actual trial. There is no "pre-court" really.

Whenever you and the opposing side have a disagreement, a judge will be involved to determine who should do what. That's what filing motions are all about.

For example, in a deposition, your lawyer is going to ask the opposing side 1 million questions. While asking those questions their council will pretty frequently say "objection". Each time they do that, they can go back to the judge (court) and fight over whether or not that line of questioning will be admissible into evidence in the trial.

The guys strategy is around the motions and briefs filed. It's not infrequent that a judge will ask each side for a brief about the current legal state and why their motion should be granted. That's where mountains of lawyer money can be spent. Every hour they spend researching the caselaw around a motion they get to bill you.

But further, strategy involves how often you fight the other side. There is an endless amount of stuff lawyers can argue over which ultimately does not (or barely does) affect the final outcomes. Being able to tell your lawyer "No, don't fight this motion it won't really matter" is where money can be saved.

Every expert will tend to miss the forest from the trees because it's their job, and mission, and billing criteria, to find every possible tree and categorize it. But you and I don't care about the trees, we only care about the forest.

There's this comedian who tells the story of his grandmother aged 97 who was diagnosed with cancer, and they offered her chemotherapy. She said: what's the point? Are you going to prolong my life for an hour? That makes people laugh, but it's the truth, and it's also, I think, the point of the post.

The point of defending a lawsuit is not to be right, and die. It's to survive it.

It worked for Steve Jobs!

Jobs didn’t do this part correctly:

“try to understand the issues yourself”

Your contractor is a skilled professional, not a drone. You need to exercise good judgment if you’re going to make decisions.

That's my point: are you sure you understand the issue better than your doctor, who has over a decade of training? In most cases, it's easier to find a good doctor than to learn enough to outguess your bad one. Devote your efforts to learning to select the doctor.

You need to be informed to know which doctor is better. I generally try to follow the advice of my family doctor, but that’s because I’ve made an informed decision on past experiences where I double checked him.

But that’s easy with a doctor you have a long term relationship with. I imagine it’s different eg. if you get cancer it’s probably going to just be a part time job to keep informed on all the doctor’s recommendations, and getting second opinions sounds like it would be time prohibitive. I don’t know of an easy way around this though.

You don't need to be informed because the beauty of second opinions is that you have a statistical advantage. Meaning, if one dude is telling you something, he could be wrong. If two are... well you might want to listen. 3? 4? What are the odds they're all idiots?

Yep, i'm pretty sure every kind of patient, from a cancer patient to someone with an ingrown toenail has googled their condition, looked for alternatives (especially if the proposed treatment was subjectively bad for the patient, even if it was objectively good).

People tend to skip the googling and verification process only if the problem is something simple or if the treatment is simple... eg. broken outlet, for legal reasons can't replace yoursefl, call contractor, outlet replaced... or in case of doctors, fever, infection, blood test, it's bacterial, antibiotics, two pills per day for 10 days, done.

There is actually a significant portion of the population that wants nothing to do with it and wont even google their cancer diagnosis and leave it up to the experts.

You should in that case at least get a second opinion.

Also, just an FYI for anyone in here, there are people that call themselves doctors who will diagnose and cure cancer using magic. Any "clinic" that staffs a number of naturopathic doctors (NDs) and suggests that you can treat cancer with dietary changes is a grift that should be illegal.

I'm dealing with cancer in my family and one such clinic was the first suggestion by family members. This isn't the place, but it what to watch out for [1]. Always be leery when you see clinics downplaying traditional medicine. Notice on their staffing page that they have exactly 1 doctor on staff (not even a nurse practitioner) and that this doctor doesn't have any credentials in oncology. And if you check out the billing section, notice that they instruct you on how to commit insurance fraud. There's a reason they don't take medicare/medicaid and it's because committing fraud there is a jail sentence for them and you. For a large insurance company, it's a lawsuit to you.

Edit: Ah, found the actual place suggested to us [2]. You can see a lot of the same hallmarks on it vs the first link.

[1] https://brio-medical.com/

[2] https://www.envita.com

completely agree. there are doctors who were bottom of the class or who are not updated with the latest research.

My wife went through this.

We had a doctor that had prescribed us a dangerous amount of medicine (we didn't know) without running any tests. The doctor was also doing procedures he didn't need to do and ultimately recommended a surgery that has been stopped since the 90s.

We caught him because of the surgery. We sought a second opinion about it because the google was telling me "This surgery is no longer performed because it has serious negative consequences, and it rarely treats the symptom it's done for". I even double checked with the quack that it's the surgery he wanted to do because I was a bit flabbergasted he was suggested it (he was, of course, annoyed that I looked it up).

We sought a second opinion and I've never seen a doctor angrier. First, he was livid that the doc had us on such a mega dose of the drug and wasn't doing bloodwork to confirm we even needed it. But also, he was furious the doctor wanted to do the surgery. I'm 90% sure he got the docs' license pulled because the quack sent out a sad "Sorry to inform everyone but we'll be closing up shop".

Needless to say, always always look up the procedures and medications doctors want. Second opinions are also a good thing and good doctors will respond with "The more the merrier". And don't be like us, you should be thinking at all times "what test did the doctor do to determine we should be doing X". If a doctor is freeballing shit, you should be leery. Except maybe if they are throwing Tylenol at you for pain. [1]

[1] https://www.youtube.com/watch?v=gD6olRJ8S3I

I agree with you. I think it comes down to the fact that you have to “live in the house.” Whether it’s a doctor (where the house is your body) or a general contractor (where the house is a house), at the end of the day, nobody cares about the house more than you do.

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