I wish / hope the medical community will address stories like this before people lose trust in them entirely. How frequent are mis-diagnosis like this? How often is "user research" helping or hurting the process of getting good health outcomes? Are there medical boards that are sending PSAs to help doctors improve common mis-diagnosis? Whats the role of LLMs in all of this?
So what? Am I supposed to clutch pearls and turn off my brain at the stopword now?
A doctor can also have an in-the-moment negatively impactful context: depression, exhaustion, or any number of life events going on, all of which can drastically impact their performance. Doctors get depressed like everybody else. They can care less due to something affecting them. These are not problems a good LLM has.
Also the anti vax movement isn’t completely wrong. It’s now confirmed (officially) that the covid-19 vaccine isn’t completely safe and there are risks taking it that don’t exist in say something like the flu shot. The risk is small but very real and quite deadly. Source: https://med.stanford.edu/news/all-news/2025/12/myocarditis-v... This was something many many doctors originally claimed was completely safe.
The role of LLMs is they take the human bias out of the picture. They are trained on formal medical literature and actual online anecdotal accounts of patients who will take a shit on doctors if need be (the type of criticism a doctor rarely gets in person). The generalization that comes from these two disparate sets of data is actually often superior to a doctor.
Key word is “often”. Less often (but still often in general) the generalization can be an hallucination.
Your post irked me because I almost got the sense that there’s a sort of prestige, admiration and respect given to doctors that in my opinion is unearned. Doctors in my opinion are like car mechanics and that’s the level of treatment they deserve. They aren’t universally good, a lot of them are shitty, a lot are manipulative and there’s a lot of great car mechanics I respect as well. That’s a fair outlook they deserve… but instead I see them get these levels of respect that matches mother Theresa as if they devoted their careers to saving lives and not money.
No one and I mean no one should trust the medical establishment or any doctor by default. They are like car mechanics and should be judged on a case by case basis.
You know for the parent post, how much money do you think those fucking doctors got to make a wrong diagnosis of dementia? Well over 700 for less than an hour of there time. And they don’t even have the kindness to offer the patient a refund for incompetence on their part.
How much did ChatGPT charge?
I never heard any doctors claim any of the covid vaccines were completely safe. Do you mind if I ask which doctors, exactly? Not institutions, not vibes, not headlines. Individual doctors. Medicine is not a hive mind, and collapsing disagreement, uncertainty, and bad messaging into “many doctors” is doing rhetorical work that the evidence has to earn.
> The role of LLMs is they take the human bias out of the picture.
That is simply false. LLMs are trained on human writing, human incentives, and human errors. They can weaken certain authority and social pressures, which is valuable, but they do not escape bias. They average it. Sometimes that helps. Sometimes it produces very confident nonsense.
> Your post irked me because I almost got the sense that there’s a sort of prestige, admiration and respect given to doctors that in my opinion is unearned. Doctors in my opinion are like car mechanics and that’s the level of treatment they deserve.
> No one and I mean no one should trust the medical establishment or any doctor by default. They are like car mechanics and should be judged on a case by case basis.
You are entitled to that opinion, but I wanted to kiss the surgeon who removed my daughter’s gangrenous appendix. That reaction was not to their supposed prestige, it was recognition that someone applied years of hard won skill correctly at a moment where failure had permanent consequences.
Doctors make mistakes. Some are incompetent. Some are cynical. None of that justifies treating the entire profession as functionally equivalent to a trade whose failures usually cost money rather than lives.
And if doctors are car mechanics, then patients are machines. That framing strips the humanity from all of us. That is nihilism.
No one should trust doctors by default. Agreed. But no one should distrust them by default either. Judgment works when it is applied case by case, not when it is replaced with blanket contempt.
There’s no data here. Many aspects of life are not covered by science because trials are expensive and we have to go with vibes.
And even on just vibes we often can get accurate judgements. Do you need clinical trials to confirm there’s a ground when you leap off your bed? No. Only vibes unfortunately.
If you ask people (who are not doctors) to remember this time they will likely tell you this is what they remember. I also do have tons of anecdotal accounts of doctors saying the Covid 19 vaccine is safe and you can find many yourself by searching. Here’s one: https://fb.watch/Evzwfkc6Mp/?mibextid=wwXIfr
The pediatrician failed to communicate the risks of the vaccine above and made the claim it was safe.
At the time to my knowledge the actual risks of the vaccine were not fully known and the safety was not fully validated. The overarching intuition was that the risk of detrimental of effects from the vaccine was less than the risk+consequence of dying from Covid. That is still the underlying logic (and best official practice) today even with the knowledge about the heart risk covid vaccines pose.
This doctor above did not communicate this risk at all. And this was just from a random google search. Anecdotal but the fact that I found one just from a casual search is telling. These people are not miracle workers.
> That is simply false. LLMs are trained on human writing, human incentives, and human errors. They can weaken certain authority and social pressures, which is valuable, but they do not escape bias. They average it. Sometimes that helps. Sometimes it produces very confident nonsense.
No it’s not false. Most of the writing on human medical stuff is scientific in nature. Formalized with experimental trials which is the strongest form of truth humanity has both practically and theoretically. This “medical science” is even more accurate than other black box sciences like psychology as clinical trials have ultra high thresholds and even test for causality (in contrast to much of science only covers correlation and assumes causality through probabilistic reasoning)
This combined with anecdotal evidence that the LLM digests in aggregate is a formidable force. We as humans cannot quantify all anecdotal evidence. For example, I heard anecdotal evidence of heart issues with rna vaccines BEFORE the science confirmed it and LLMs were able to aggregate this sentiment through sheer volumetric training on all complaints of the vaccine online and confirm the same thing BEFORE that Stanford confirmation was available.
> You are entitled to that opinion, but I wanted to kiss the surgeon who removed my daughter’s gangrenous appendix. That reaction was not to their supposed prestige, it was recognition that someone applied years of hard won skill correctly at a moment where failure had permanent consequences.
Sure I applaud that. True hero work for that surgeon. I’m talking about the profession in aggregate. In aggregate in the US 800000k patients die or get permanently injured from a misdiagnosis every year. Physicians fuck up and it’s not occasionally. It’s often and all the fucking time. You were safer getting on the 737 max the year before they diagnosed the mcas errors then you are NOT getting a misdiagnosis and dying from a doctor. Those engineers despite widespread criticism did more for your life and safety than doctors in general. That is not only a miracle of engineering but it also speaks volumes of the medical profession itself which DOES not get equivalent criticism for mistakes. That 800000k statistic is swept under the rug like car accidents.
I am entitled to my own opinion just as you are to yours but I’m making a bigger claim here. My opinion is not just an opinion. It’s a ground truth general fact backed up by numbers.
> And if doctors are car mechanics, then patients are machines. That framing strips the humanity from all of us. That is nihilism.
There is nothing wrong with car mechanics. It’s an occupation and it’s needed. And those cars if they fail they can cause accidents that involve our very lives.
But car mechanics are fallible and that fallibility is encoded into the respect they get. Of course there are individual mechanics who are great and on a case by case basis we pay those mechanics more respect.
Doctors need to be treated the same way. It’s not nilhism. It’s a quantitative analysis grounded in reality. The only piece of evidence you provided me in your counter is your daughter’s life being saved. That evidence warrants respect for the single doctor who saved your daughter’s life and not for the profession in general. The numbers agree with me.
And treatment for say the corporation responsible for the mcas failures and the profession responsible for medical misdiagnosis that killed people is disproportionate. Your own sentiment and respect for doctors in general is one piece of evidence for this.
> No it’s not false. Most of the writing on human medical stuff is scientific in nature. Formalized with experimental trials which is the strongest form of truth humanity has both practically and theoretically. This “medical science” is even more accurate than other black box sciences like psychology as clinical trials have ultra high thresholds and even test for causality (in contrast to much of science only covers correlation and assumes causality through probabilistic reasoning)
Sorry, but these kinds of remarks wreck your credibility and make it impossible for me to take you seriously.
Saying something like my "credibility is wrecked" and impossible to take me "seriously" crosses a line into deliberate attack and insult. It's like calling me an idiot but staying technically within the HN rules. You didn't need to go there and breaking those rules in spirit is just as bad imo.
Yeah I agree I think the conversation is over. I suggest we don't talk to each other again as I don't really appreciate how you shut down the conversation with deliberate and targeted attacks.
The anecdote in question is not about mis-diagnosis, it's about a delayed diagnosis. And yeah, the inquiry sent a doctor down three paths, one of which led to a diagnosis, so let's be clear: no, the doctor didn't get it completely on their own, and: ChatGPT was, at best, 33% correct.
The biggest problem in medicine right now (that's creating a lot of the issues people have with it I'd claim) is twofold:
- Engaging with it is expensive, which raises the expectations of quality of service substantially on the part of the patients and their families
- Virtually every doctor I've ever talked to complains about the same things: insufficient time to give proper care and attention to patients, and the overbearingness of insurance companies. And these two lead into each other: so much of your doc's time is spent documenting your case. Basically every hour of patient work on their part requires a second hour of charting to document it. Imagine having to write documentation for an hour for every hour of coding you did, I bet you'd be behind a lot too. Add to it how overworked and stretched every medical profession is from nursing to doctors themselves, and you have a recipe for a really shitty experience on the part of the patients, a lot of whom, like doctors, spend an inordinate amount of time fighting with insurance companies.
> How often is "user research" helping or hurting the process of getting good health outcomes?
Depends on the quality of the research. In the case of this anecdote, I would say middling. I would also say though if the anecdotes of numerous medical professionals I've heard speak on the topic are to be believed, this is an outlier in regard to it actually being good. The majority of "patient research" that shows up is new parents upset about a vaccine schedule they don't understand, and half-baked conspiracy theories from Facebook. Often both at once.
That said, any professional, doctors included, can benefit from more information from whomever they're serving. I have a great relationship with my mechanic because by the time I take my car to him, I've already ruled out a bunch of obvious stuff, and I arrive with detailed notes on what I've done, what I've tried, what I've replaced, and most importantly: I'm honest about it. I point exactly where my knowledge on the vehicle ends, and hope he can fill in the blanks, or at least he'll know where to start poking. The problem there is the vast majority of the time, people don't approach doctors as "professionals who know more than me who can help me solve a problem," they approach them as ideological enemies and/or gatekeepers of whatever they think they need, which isn't helpful and creates conflict.
> Are there medical boards that are sending PSAs to help doctors improve common mis-diagnosis?
Doctors have shitloads of journals and reading materials that are good for them to go through, which also factors into their overworked-ness but nevertheless; yes.
> Whats the role of LLMs in all of this?
Honestly I see a lot of applications of them in the insurance side of things, unless we wanted to do something cool and like, get a decent healthcare system going.
The distinction between "can't do" and "can't get paid for" seems to get lost a lot with medical providers. I'm not saying this is necessarily what's happening with your wife, but I've had it happen to me where someone says, "I can't do this test. Your insurance won't pay for it," and then I ask what it costs and it's a few hundred or a couple thousand dollars and I say, "That's OK. I'll just pay for the test myself," and something short-circuits and they still can't understand that they can do it.
The most egregious example was a prescription I needed that my insurance wouldn't approve. It was $49 without insurance. But the pharmacy wouldn't sell it to me even though my doctor had prescribed it because they couldn't figure out how to take my money directly when I did have insurance.
I get that when insurance doesn't cover something, most patients won't opt to pay for it anyway, but it feels like we need more reminders on both the patient and the provider side that this doesn't mean it can't be done.
Tell me you've never lived in poverty without telling me.
An unexpected expense of several hundred to a couple thousand dollars, for most of my lived life both as a child and a young adult, would've ruined me. If it was crucial, it would've been done, and I would've been hounded by medical billing and/or gone a few weeks without something else I need.
This is inhumanity, plain as.
This is ignorance, plain as.
The statistics you see about bankruptcy due to medical debt are highly misleading. While it is a problem, very few consumers are directly forced into bankruptcy by medical expenses. What tends to happen is that serious medical problems leave them unable to work and then with no income and then with no income all of their debts pile up. What we really need there is a better disability welfare system to keep consumers afloat.
I am absolutely not. I am reacting to what's been replied to what I've said. In common vernacular, this is called a "conversation."
To recap: the person who replied to me left a long comment about the various strugglings and limitations of healthcare when subjected to the whims of insurance companies. You then replied:
> I generally agree (and sympathize with your wife), but let's not present an overly rosy view of government run healthcare or single-payer systems. In many countries with such systems, extensive therapy simply isn't available at all because the government refuses to pay for it. Every healthcare system has limited resources and care is always going to be rationed, the only question is how we do the rationing.
Which, at least how I read it, attempts to lay the blame for the lack of availability of extensive therapies at the feet of a government's unwillingness to pay, citing that every system has limited resources and care is always being rationed.
I countered, implying that while that may or may not be true, that lack of availability is effectively status quo for the majority of Americans under our much more expensive, and highly exploitative insurance-and-pay-based healthcare system, and that, even if those issues around lack of availability persisted through a transition to a single-payer healthcare system, it would at least alleviate us from the uniquely American scourge of people being sent to the poorhouse, sometimes poor-lack-of-house, for suffering illnesses or injuries they are in no way responsible for which in my mind is still a huge improvement.
> The statistics you see about bankruptcy due to medical debt are highly misleading. While it is a problem, very few consumers are directly forced into bankruptcy by medical expenses. What tends to happen is that serious medical problems leave them unable to work and then with no income and then with no income all of their debts pile up.
I mean we can expand this if you like into a larger conversation about how insurance itself being tied to employment and everyone being kept broke on purpose to incentivize them to take on debt to survive, placing them on a debt treadmill their entire lives which has been demonstrably shown to reduce quality and length of life, as well as introducing the notion that missing any amount of work for no matter how valid a reason has the potential to ruin your life, is probably a highly un-optimal and inhumane way to structure a society.
> What we really need there is a better disability welfare system to keep consumers afloat.
On that at least, we can agree.
I don't know any country that has banned paid healthcare just because they have government run one.
If you can pay out of your pocket for it in USA system when denied by insurance company then you would be able to afford it when denied by goverment. Since the criteria of whats necessary wouldn't shift (hospitals might even more money per patient)
https://bmjopen.bmj.com/content/bmjopen/5/7/e008155.full.pdf
Fair question but one has to keep in mind about ALL the other situations we do NOT hear about, namely all the failed attempts that did take time from professionals. It doesn't the successful attempts are not justified, solely that a LOT of positive anecdotes might give the wrong impressions that they are not radically most negative ones that are simply not shared. It's hard to draw conclusions either way without both.
Classic HN. /s
There's a reason why flour has iron and salt has iodine, right? Individual responsibility simply does not scale.
Applies doubly now that many health care interactions are transactional and you won't even see the same doctor again.
On a systemic level, the likely outcome is just that people who manage their health better will survive, while people who don't will die. Evolution in action. Managing your health means paying attention when something is wrong and seeking out the right specialist to fix it, while also discarding specialists who won't help you fix it.
This is just factually not true. Healthy people subsidize the unhealthy (even those made unhealthy by their own idiocy) to a truly absurd degree.
This includes researching their own condition, looking into alternate diagnoses/treatments, discussing them with a physician, and potentially getting a second opinion.
Especially the second opinion. There are good and bad physicians everywhere.
But advocating also does not mean ignoring a physician's response. If they say it's unlikely to be X because of Y, consider what they're saying!
Physicians are working from a deep well of experience in treating the most frequent problems, and some will be more or less curious about alternate hypotheses.
When it comes down to it, House-style medical mysteries are mysteries because they're uncommon. For every "doc missed Lyme disease" story there are many more "it's just flu."
I believe you do not fully appreciate how long and exhausting this is especially when sick...
They do this not because it isn't their job to protect fighters from illegal blows, but because the consequences of illegal blows are sometimes unfixable.
An encouragement for patients to co-own their own care isn't a removal of a physician's responsibility.
It's an acknowledgement that (1) physicians are human, fallible, and not omniscient, (2) most health systems have imperfect information sync'ing across multiple parties, and (3) no one is going to care more about you than you (although others might be much more informed and capable).
Self-advocacy isn't a requirement for good care -- it's due diligence and personal responsibility for a plan with serious consequences.
If a doc misses a diagnosis and a patient didn't spend any effort themselves, is that solely the doctor's fault?
PS to parent's insinuation: 20 years in the industry and 15 years of managed cancer in immediate family, but what do I know?
My question is, since you understand this very well, how successful are patients (that manage the effort) at both acquiring scientifically accurate knowledge and improving their health meaningfully?
And maybe share some tips like good knowledge databases?
1. Take ownership of their own medical records, learn them, and bring them to appointments. The most common failure in the current US medical system is incomplete/missing record transfer because of disconnected systems. Physicians will almost always attempt to confirm critical details, but that doesn't help if the patient says "I don't know."
2. Learn basic medical system-level knowledge relevant to a case. E.g. college 1xx freshman-level. No need to become an expert, but if a patient is dealing with kidney issues... it's pretty important to learn the basics about what kidneys are and do.
3. Ask about alternatives. "If we didn't go with that plan, what would be your next two recommended plans, and why aren't they first?" Having that alternative context is especially helpful when visiting specialists / other parties, as the patient can more fully describe the thinking behind their treatment plan. Also when researching online, the context helps avoid obvious pitfalls. (And yes, sometimes the reason will be "Because your insurance wouldn't cover X", which is also useful to know)
4. Use second options to measure uncertainty about the primary plan (e.g. everyone agrees vs it's debatable), but don't treatment-shop. The useful piece of information is opening a discussion about specific alternatives, while also listening to reasons against them.
Peer reviewed studies are surprisingly accessible (e.g. PubMed et al.), but they're also functionally useless without basic medical knowledge and details about a specific case.
Finally, for potentially lethal and/or lengthy conditions, I'm a firm believer that any empowerment improves outcomes simply by making the patient feel more involved and in control of their care.
Almost every "that could have been avoided" case I know was a willfully-ignorant and/or disinterested patient.
We trade away our knowledge and skills for convenience. We throw money at doctors so they'll solve the issue. We throw money at plumbers to turn a valve. We throw money at farmers to grow our veggies.
Then we wonder why we need help to do basic things.
Anyway, what are you paid for? Guessing a programmer, you just sit in a chair all day and press buttons on a magical box. As your customer, why am I having to explain what product I want and what my requirements are? Why don't you have all my answers immediately? How dare you suggest a different specialism? You made a mistake?!?
This is disorganized thinking. Anecdotes about what? Does my uncle having an argument with his doctor over needing more painkillers, combine with an anecdote about my sister disagreeing with a midwife over how big her baby would be, combined with my friend outliving their stage 4 cancer prognosis all add up to "therefore I'm going to disregard nutrition recommendations"? Even if they were all right and the doctors were all wrong, they still wouldn't aggregate in a particular direction the way that a study on processed foods does.
And frankly it overlooks psychological and sociological dynamics that drive this kind of anecdotal reporting, which I think are more about tribal group emotional support in response to information complexity.
In fact, reasoning from separate instances that are importantly factually different is a signature line of reasoning used by alien abduction conspiracy theorists. They treat the cultural phenomenon of "millions" of people reporting UFOs or abduction experiences over decades as "proof" of aliens writ large, when the truth is they are helplessly incompetent interpreters of social data.
It's when "being your own health advocate" turns into "being your own doctor" that the system starts to break down.
Not sure about your sister and uncle, but from my observations the anecdotes combine into “doctor does not have time and/or doesn’t care”. People rightfully give exactly zero fucks about Bayes theorem, national health policy, insurance companies, social dynamics or whatever when the doctor prescribes Alvedon after 5 minutes of listening to indistinct story of a patient with a complicated condition which would likely be solved with additional tests and dedicated time. ChatGPT is at least not in a hurry.
I think similar to tech, Doctors are attracted to the money, not the work. The AMA(I think, possibly another org) artificially restricts the number of slots for new doctors restricting doctor supply while private equity squeezes hospitals and buys up private practices. The failure doctors sit on the side of insurance trying to prevent care from being performed and it's up to the doctor who has the time/energy to fight insurance and the hospital to figure out what's wrong.
I think there's a difference between questioning your doctor, and questioning advice given by almost every doctor. There are plenty of bad doctors out there, or maybe just doctors who are bad fits for their patients. They don't always listen or pay close attention to your history. And in spite of their education they don't always choose the correct diagnosis.
I also think there's an ever-increasing difference between AI health research and old-school WebMD research.
Anti-vax otoh is driven by ignorance and failure to trust science in the form of neither doctors, nor new types of science. Plus, anti-vax works like flat earth; a signaling mechanism of poor epostemic judgment."
Too late for me. I have a similar story. ChatGPT helped me diagnose an issue which I had been suffering with my whole life. I'm a new person now. GPs don't have the time to spend hours investigating symptoms for patients. ChatGPT can provide accurate diagnoses in seconds. These tools should be in wide use today by GPs. Since they refuse, patients will take matters into their own hands.
FYI, there are now studies showing ChatGPT outperforms doctors in diagnosis. (https://www.uvahealth.com/news/does-ai-improve-doctors-diagn...) I can believe it.
My own story is one of bias. I spent much of the last 3 years with sinus infections (the part I wasn't on antibiotics). I went to a couple ENTs and one observed allergic reaction in my sinuses, did a small allergy panel, but that came back negative. He ultimately wanted to put me on a CPAP and nebulizer treatments. I fed all the data I got into ChatGPT deep research and it came back with an NIH study that said 25% of people in a study had localized allergic reactions that would show up one place, but not show up elsewhere on the body in an allergy test. I asked my ENT about it and he said "That's not how allergies work."
I decided to just try second generation allergy tablets to see if they helped, since that was an easy experiment. It's been over 6 months since I've had a sinus infection, where before this I couldn't go 6 weeks after antibiotics without a reoccurrence.
Now, obviously none of this math would actually hold up to any scrutiny, and there's a bevy of reasons that the quality of those interactions would not be random. But just as a sense of scale, and bearing in mind that a lot of people will easily remember a single egregious interaction for the rest of their life, and (very reasonably!) be eager to share their experience with others, it would require a frankly statistically impossibly low error rate to not be able to fill threads like these with anecdotes of the most heinous, unpleasant, ignorant, and incompetent anecdotes anyone could ever imagine.
And this is just looking at the sheer scale of medical care, completely ignoring the long hours and stressful situations many doctors work in, patients' imperfect memories and one-sided recollections (that doctors can never correct), and the fundamental truth that medicine is always, always a mixture of probabilistic and intuitive judgement calls that can easily, routinely be wrong, because it's almost never possible to know for sure what's happening in s given body, let alone what will happen.
That E.N.T. wasn't up to date on the latest research on allergies. They also weren't an allergy specialist. They also were the one with the knowledge, skills, and insight to consider and test for allergies in the first place.
Imagine if we held literally any other field to the standard we hold doctors. It's, on the one hand, fair, because they do something so important and dangerous and get compensated comparitively well. But on the other hand, they're humans with incomplete, flawed information, channeling an absurdly broad and deep well of still insufficient education that they're responsible for keeping up-to-date while looking at a unique system in unique circumstances and trying to figure out what, if anything, is going wrong. It's frankly impressive that they do as well as they do.
Nothing. You just... feel more sympathetic to doctors and less confident that your own experience meant anything.
Notice what's absent: any engagement with whether the AI-assisted approach actually worked, whether there's a systemic issue with ENTs not being current on allergy research, whether patients should try OTC interventions as cheap experiments, whether the 25% localized-reaction finding is real and undertaught.
The actual medical question and its resolution get zero attention.
Also though...
You are sort of just telling people "sometimes stuff is going to not work out, oh also there's this thing that can help, and you probably shouldn't use it?"
What is the action you would like people to take after reading your comment? Not use ChatGPT to attempt to solve things they have had issues solving with their human doctors?
This is not ChatGPT outperforming doctors. It is doctors using ChatGPT.
Overtime, as a human, the doctors just turn into ABC -> 123 machines.
Why wouldn't they? This would seem to be engagement bait for a certain type of Anti-AI person? Why would you expect this to be the case? "My dad died because he used that dumb machine" -- surely these will be everywhere right?
Let's make our beliefs pay rent in anticipated experiences!
Where's the failure?
I hear you but there are two fundamentally different things:
1. Distrust of / disbelief in science 2. Doctors not incentivized to spend more than a few minutes on any given patients
There are many many anecdotes related to the second, many here in this thread. I have my own as well.
I can talk to ChatGPT/whatever at any time, for any amount of time, and present in *EXHAUSTIVE* detail every single datapoint I have about my illness/problem/whatever.
If I was a billionaire I assume I could pay a super-smart, highly-experienced human doctor to accommodate the same.
But short of that, we have GPs who have no incentive to spend any time on you. That doesn't mean they're bad people. I'm sure the vast majority have absolutely the best of intentions. But it's simply infeasible, economically or otherwise, for them to give you the time necessary to actually solve your problem.
I don't know what the solution to this is. I don't know nearly enough about the insurance and health industries to imagine what kind of structure could address this. But I am guessing that this might be what is meant by "outcome-based medicine," i.e., your job isn't done until the patient actually gets the desired outcome.
Right now my GP has every incentive to say "meh" and send me home after a 3-minute visit. As a result I more or less stopped bothering making doctor appointments for certain things.
Even good doctors have a real hard time convincing the bad doctors to do their job right. Never mind some random patient with a slightly less obvious diagnosis.
This is nothing like anti vax, because it is not implying a failing of medical science. It just states that enough doctors are bad enough at their job that user research is useful. To realize you need to go to a better doctor
Quite a mouthful for the layman and the symptoms you are describing would fit. NPH has one of my favorite mnemonic in medicine for students learning about the condition, describing the hallmark symptoms as: "Wet, Wobbly and Wacky."
Wet referring to urinary incontinence, Wobbly referring to ataxia/balance issues and Wacky referring to encephalopathy (which could mimic dementia symptoms).
But it seems "is it possible" also leads it into answering "no, it can't" probably modelling a bunch of naysayers.
Sometimes, if you coax it a little bit, it will tell you how to do a thing which is quite esoteric.
I wouldn't be surprised if AI was better than going to GP or many other specialists in majority of cases.
And the issue is not with the doctors themselves, but the complexity of human body.
Like many digestive issues can cause migraines or a ton of other problems. I am yet to see when someone is referred to gut health professional because of the migraine.
And a lot of similar cases when absolutely random system causes issues in seemingly unrelated system.
A lot of these problems are not life threatening thus just get ignored as they would take too much effort and cost to pinpoint.
AI on the other hand should be pretty good at figuring out those vague issues that you would never figured out otherwise.
Not least because it almost certainly has orders of magnitude more data to work with than your average GP (who definitely doesn't have the time to keep up with reading all the papers and case studies you'd need to even approach a "full view".)
They aren’t that much smarter. The selection criteria is more about the ability to handle pressure than it is about raw intelligence.
Tons of bottom feeders go to medical schools in say Kansas, so there’s a lot of leeway here in terms of intelligence.
There’s a school in Kansas that sits right on top of Caribbean schools in terms of reputation. I know several people who had to go there.
I never said the state is correlated with the quality of the doctor, or even if the quality of the school is associated with the quality of the doctor. You made that up. Which makes you the liar.
You're fucking right. I should've named the specific school. (And I didn't make a comment about the state I made a comment about school(s) in the state which is not about all schools in the state.)
That's would I should do. What you should do is: Don't accuse me of lying and then lie yourself. Read the comment more carefully. Don't assume shit.
No point in continue this. We both get it and this thread is going nowhere.
My previous one was, too.
The one I had as kid, well. He was old, stuck in old ways, but I still think he was decent at it.
But seeing the doctor is a bit more difficult these days, since the assistants are backstopping. They do some heavy lifting / screening.
I think an LLM could help with symptoms and then looking at the most probable cause, but either way I wouldn't take it too serious. And that is the general issue with ML: people take the output too serious, at face value. What matters is: what are the cited sources?
In the rest of the world doctors are basically like white-collar car mechanics, and often earn less money and respect.
"According to the Government of Canada Job Bank, the median annual salary for a General Practitioner (GP) in Canada is $233,726 (CAD) as of January 23, 2024."
That's roughly $170,000 in the US. If you adjust for anything reasonable, such as GDP per capita or median income between the US & Canada, that $170k figure matches up very well with the median US general practitioner figure of around $180k-$250k (sources differ, all tend to fall within that range). The GPs in Canada may in fact be slightly better paid than in the US.
https://www.pnc.com/insights/personal-finance/borrow/physici...
In reality you'll find the vast majority of GPs are highly intelligent and quite good at problem solving.
In fact, I'd go so far as to say their training is so intensive and expansive that laypeople who make such comments are profoundly lacking in awareness on the topic.
Physicians are still human, so like anything there's of course bad ones, specialists included. There's also healthcare systems with various degrees of dysfunction and incentives that don't necessarily align with the patient.
None of that means GPs are somehow less competent at solving problems; not only is it an insult but it's ridiculous on the face of it.
In one case, a specialist made arguments that were trivially logically fallacious and went directly against the evidence from treatment outcomes.
In other cases, sheer stupidity of pattern matching with rational thinking seemingly totally turned off. E.g. hearing I'd had a sinus infection for a long time, and insisting that this meant it was chronic and chronic meant the solution was steroids rather than antibiotic, despite a previous course having done nothing, and despite the fact that an antibiotic course had removed most of the symptoms both indicating the opposite - in the end, after bypassing my GP at the time and explaining and begging an advance nurse practitioner, I got two more courses of antibiotic and the infection finally fully went.
I'm sure all of them could have done better, and that a lot of it is down to dysfunction, such as too little time allotted to actually look at things properly, but some of the interactions (the logical fallacy in particular) have also clearly been down to sheer ignorance.
I also expect they'd eventually get there, but doing your own reading and guiding things in the right direction can often short-circuit a lot of bullshit that might even deliver good outcomes in a cost effective way on a population level (e.g. I'm sure the guidance on chronic sinus issues is right the vast majority of time - most bacterial sinus infections either clear by themselves or are stopped early enough not to "pattern match" as chronic), but might cause you lots of misery in the meantime...
However your anecdotal experience is not only inline with my own experience. It is actually inline with the facts as well.
When the person your responding to said that what you wasn’t backed up by facts I’m going to tell you straight up that, that statement was utter bullshit. Everything you’re saying here is true and generally true and something many many patients experience.
The person you just replied to here isn't the same person I replied to.
Is this statement supported by facts? If anything this statement is just your internal sentiment. If you claim it’s not supported by facts the proper thing you should do is offer facts to counter his statement. Don’t claim his statement isn’t supported by facts than make a counter claim without facts yourself.
https://www.statnews.com/2023/07/21/misdiagnoses-cost-the-u-...
Read that fact. 800,000 deaths from misdiagnosis a year is pretty pathetic. And this is just deaths. I can guarantee you the amount of mistakes unreported that don’t result in deaths dwarfs that number.
Boeing the air plane manufacurwe who was responsible for the crashing Boeing 737 mcas units have BETTER outcomes than this. In the year that those planes crashed you have a 135x better survival rate of getting on a 737 max then you are getting an important diagnosis from a doctor and not dying from a misdiagnosis. Yet doctors are universally respected and Boeing as a corporation was universally reviled that year.
I will say this GPs are in general not very competent. They are about as competent and trust worthy as a car mechanic. There are good ones, bad ones, and also ones that bullshit and lie. Don’t expect anything more than that, and this is supported by facts.
Yeah, the main fact here is called medical school.[0]
>Read that fact. 800,000 deaths from misdiagnosis a year is pretty pathetic. And this is just deaths.
Okay, and if that somehow flows from GPs (but not specialists!) being uniquely poor at problem solving relative to all other types of physicians—irrespective of wider issues inherent in the U.S. healthcare system—then I stand corrected.
>135x better survival rate of getting on a 737 max
The human body isn't a 737.
>I will say this GPs are in general not very competent. They are about as competent and trust worthy as a car mechanic.
Ignorant.
[0] https://medstudenthandbook.hms.harvard.edu/md-program-object...
Instead you say “medical school” and cite the Harvard handbook as if everyone went to Harvard and that the medical book was a quantitative metric on problem solving success or failure. Come on man. Numbers. Not manuals.
> The human body isn't a 737
Are you joking? You know a 737 is responsible for ensuring the survival of human bodies hurdling through the air at hundreds of miles per hour at altitudes higher than Mount Everest? The fact that your risk of dying is lower going through that then getting a correct diagnosis from a doctor is quite pathetic.
This statement you made here is manipulative. You know what I mean by that comparison. Don’t try to spin it like I'm not talking about human lives.
> Ignorant.
Being a car mechanic is a respectable profession. They get the typical respect of any other occupation and nothing beyond that. I’m saying doctors deserve EXACTLY the same thing. The problem is doctors sometimes get more than that and that is not deserved at all. Respect is earned and the profession itself doesn’t earn enough of that respect.
Are you yourself a doctor? If so your response speaks volumes about the treatment your patients will get.
No. The human body actually isn't a 737.
>This statement you made here is manipulative. You know what I mean by that comparison. Don’t try to spin it like I'm not talking about human lives.
Let me spell it out then: The mechanisms by which a human body and a 737 work are so vastly different that one may as well be alien to the other. It's quite an apples and oranges comparison.
Yeah, you can draw parallels in some areas but I'd say on the whole the analogy isn't exactly apt. That said, I'll indulge:
Imagine if every 737 was a few orders of magnitude more complex, and also so different to the point that no plane even looked or functioned the same. Then, imagine we didn't fully understand how they worked.
Point being: Medicine is fuzzy because the human body is fuzzy and imprecise. Everybody's a little different. Contrast to aviation, which is very much an exact science and engineering discipline at this point.
Medicine isn't engineering. Treating patients isn't the same as the design and manufacture of aircraft.
That of course doesn't excuse shitty healthcare systems that can clearly do better when stats indicate there's preventable adverse outcomes happening. I just don't think laying the blame at the feet of doctors somehow being too stupid to problem solve is helpful when there's a larger system that's preventing them from doing their best work for their patients. If anything that narrative is counterproductive.
>Are you yourself a doctor?
Nope, just a layperson who knows they're a layperson.
No shit sherlock.
>Let me spell it out then: The mechanisms by which a human body and a 737 work are so vastly different that one may as well be alien to the other. It's quite an apples and oranges comparison.
Should've done this in the first place because no one understands what you're saying otherwise.
The problem internals are different but we are comparing the outcome and that is: human lives. You seem to think this is an invalid comparison. It's not.
>Medicine isn't engineering. Treating patients isn't the same as the design and manufacture of aircraft.
I never said that. The whole point was you made the claim doctors are good problem solvers because they went to medical school.
I said that claim is utter bullshit. They aren't that good and they misdiagnose shit all the time. The point still stands and you delivered evidence to validate that. You said Medicine is fuzzy and engineering exact. You said the problem was vastly more complex as well.
All of this proves the point. The problem is harder, the science is fuzzy. Doctors armed with medical science, which is definitively worse, operating on a problem that is definitively harder will be generally WORSE problem solvers then people in other occupations IF we hold everything else the same. So doctors as a group ARE not good problem solvers. That WAS the point. We are referring to doctors as a group and thus the ONLY point of comparison for problem solvers ARE other occupations.
That's just a given and it follows from your OWN logic.
>That of course doesn't excuse shitty healthcare systems that can clearly do better when stats indicate there's preventable adverse outcomes happening. I just don't think laying the blame at the feet of doctors somehow being too stupid to problem solve is helpful when there's a larger system that's preventing them from doing their best work for their patients. If anything that narrative is counterproductive.
Did I lay the blame on doctors? No. I just said they aren't good problem solvers. That's a fact. That's not blame.
But let's be clear, I agree it's counter productive to lay blame OR call doctors stupid and such a thing WAS not done by me. I was simply making the claim that THEY are NOT good problem solvers. You inserted extra negative sentiment into the "narrative" as an hallucination by your own imagination.
Look, point is you're wrong on every count. Doctors are not good at problem solving period. They're pretty bad at it. The comparison with aviation engineers is apt because those guys are GOOD problem solvers.
And again, it's not the doctors fault that they are incompetent. It's the hardness of the problem and the limitations of the science that make them like this.
I don't know how you expect people to take you seriously, but good luck.
I imagine the issue with problem solving more lays in the system doctors are stuck in and the complete lack of time they have to spend on patients.
As opposed to what, proving that GPs are highly trained, not inherently inferior to other types of physicians, and regularly conduct complex problem solving?
Heck, while I'm at it I may as well attempt to prove the sky is blue.
>I imagine the issue with problem solving more lays in the system doctors are stuck in and the complete lack of time they have to spend on patients.
Bingo.
Pay for concierge medicine and a private physician and you get great health care. That's not what ordinary health insurance pays for.
After undergoing stomach surgery 8 years ago I started experiencing completely debilitating stomach aches. I had many appointments with my GP and a specialist leading to endoscopies, colonoscopies, CAT scans, and MRI scans all to no avail and they just kept prescribing more and more anti-acids and stronger painkillers.
It was after seven years of this that I paid for a private food allergy test to find that I am allergic to Soya protein. Once I stopped eating anything with Soya in it the symptoms almost completely vanished.
At my next GP appointment I asked why no-one had suggested it could be an allergic reaction only to be told that it is not one of the things they check for or even suggest. My faith in the medical community took a bit of a knock that day.
On a related note, I never knew just how many foods contain Soya flour that you wouldn't expect until I started checking.
On second thought — the opposite. A bulge/blockage of CSF?
It's pretty wild that a doctor wouldn't have that as a hypothesis.
So many doctors never bothered to conduct any tests. Many said it's in my head. Some told me to just exercise. I tried general doctors, specialists. At some point, I was so desperate that I went to homeopathy route.
15 years wasted. Why did it take 15 years for the current system?
I'd bet that if I had ChatGPT earlier, it could have helped me in figuring out the issue much faster. When you're sick, you don't give a damn who might have your health data. You just want to get better.
Anyways, that's why I'm so bullish on LLMs for healthcare.
I have some statistically very common conditions and a family medical history with explicit confirmation of inheritable genetic conditions. Yet, if I explain my problems A to Z I’m a Zebra whose female hysteria has overwhelmed his basic reasoning and relationship to reality. Explained Z to A, well I can’t get past Z because, holy crap is this an obvious Horse and there’s really only one cause of Horse-itis and if your mom was a Horse then you’re Horse enough for Chronic Horse-itis.
They don’t have time to listen, their ears aren’t all that great, and the mind behind them isn’t necessarily used to complex diagnostics with misleading superficial characteristics. Fire that through a 20 min appointment, 10 of which is typing, maybe in a second language or while in pain, 6 plus month referral cycles and… presto: “it took a decade to identify the cause of the hoof prints” is how you spent your 30s and early 40s.
Drawing medical conditions from an urn occasionally yields a true diagnostic, even more so if conditions are weighed in the urn according to their prevalence in society. But disease lottery is no medical practice.
Two essential errors exist in medicine:
1. Delivering a wrong intervention.
2. Failing to deliver an intervention at the right time due to misdiagnosis.
These are the sins of harm and distraction. The metric for judging a system is not whether it gets things right on one occasion, but whether it makes those mistakes on the others.
Doctors err because people and institutions are imperfect, biology is messy, and human variability is immense. But the former can be attenuated by a plurality of opinions and greater resources (including time), while statistical systems are inherently vulnerable to the latter two.
Language models hallucinate and deliver both essential errors - all while speaking in a very confident and convincing manner. What OpenAI is advertising is a system that nudges vulnerable people to abandon, distrust, ignore, or simply avoid seeking true medical practitioners to rely on a statistical system out of an unjustified, naive trust in the machine.
As a reminder to those concerned with healthcare accessibility, picking the wrong solution to a problem for lack of a right one does not solve the problem. That reasoning was the basis of practices such as bloodletting and lobotomy. Time after time again, medical science teaches us the limits of this kind of thinking.