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Comment by jkokenge | Hacker News Reader

It seems that health care professionals don't have a nuanced problem solving attitude. They make a diagnosis, see how this diagnosis fits into a preconceived treatment bin, then just solve from that position without understanding what's different, what's unique to each case. And, in their defense, they probably just don't have the time for that extra work. That's where I see technology as most useful....how to automate and make more efficient the redundant parts so professionals can concentrate on the important, unique parts to each patient's diagnosis.

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I come from a long line of docs, though I'm a software dev. Let me tell you that the vast majority of patients can easily be sorted into these pre-formed category bins. Rare conditions are rare by definition. Most of medicine is dreary repetition.

This ought to be highlighted, before people start an echo chamber of "doctor's don't know what they're doing!" that ultimately undermines everyone (guess what argument the anti-vaxxers use).

A string of anecdotes of "I double-checked and it turned out the doctor was wrong" remains less than a trickle compared to the flood of patients doctors have to deal with, and a tiny fraction of the hypochondriacs they must deal with. Our medical system is broken enough without adding doubts on the competence of its medical professionals.

By all means, people should double-check what the doctors say, but realize the much worse consequences of sowing doubt.

There are some useful questions patients can ask.

"What happens if we do nothing? If we do watchful waiting?"

"What happens if I don't take these meds?"

"How likely is that bad event? Tell me in terms of numbers per 10,000 people rather than percentages".

Another useful one is to ask him to explain his reasoning.

If he can't justify his decisions, then he's probably using instinct which is unreliable in the case of rare diseases, or he doesn't know how to diagnose known diseases which means he's incompetent.

Some people are offended when you challenge them for reasons for their advice, but I think that's because they aren't confident in it themselves or feel superior. Doctors shouldn't be in either of those positions and should be willing to tell you how they came to their conclusions.

Whilst on the whole I agree with you, the amount of doctors I know that would react (quite strongly) negatively to that is quite high, so anyone who takes your advice should be prepared. The most common response I've seen to your question was the doctor reminding the patient "there is always something called a second opinion", a couple of times though I noticed them taking the time to explain it.

Why is "numbers per 10,000 people" meaningfully different than taking the percentage and multiplying it by 100?

Doctors and patients do not know what you mean when you say "your risk has gone up 50%". When you say "in a group of ten thousand people we would expect 4 to experience this thing. But in a group of 10,000 people who eat peas we expect about 6 people to experience this thing".

Gerd Gigerenzer has a book explainin it better than I do.

This highlights the importance of a second and third opinion as well.

As the joke goes, "what do you call the guy that graduated last in his class at medical school? Doctor."

Doctor's aren't machines, they're more like mechanics, they see a symptom, use their knowledge to make an educated guess essentially, and then work from there. If their knowledge is soft it's likely an incorrect diagnoses could just be exacerbated by incorrect treatment.

Get another opinion, and then another, the next problem is deciding on siding with consensus or outlier.

> Most of medicine is dreary repetition.

Hence why we can automate away most of the problems with it.

Yes, which is also why The Checklist Manifesto was so successful.

It's exactly this attitude that turns me off of a lot of doctors. It dehumanizes the experience of being a patient. First you are put in a bin, then the doctor basically runs you through a check list.

It's really unfortunate that nearly 100% of the bins are disease or a disorder. A typical interaction with a doctor involves finding out which disease bin you should be in, and then putting you in there. Once you're there, they're not concerned with making you healthier, or looking at the variety of options that could improve your life. They're just concerned with doing the standard operating procedure for dealing with the disease. Instead of being a person, the patient becomes a checklist.

Many doctors don't even see you. They see the bin you're in, and the many potential bins you could potentially be in.

What if half the bins were about great physical health? And what if the doctors worked just as hard to get you into one of those, as they do "treating" the diseases you might have?

Ugghhh. It makes me sad thinking about how far we are from that world.

I think it is not so much the doctor that is at fault, as the system of checks and measurements that make up modern health care. The boxes are there for the convenience of management, insurance, etc, as much as it is for the doctors.

Or rare variant of common issues. Got told a story by a relative in the health care profession about a patient that complained about pains. But their location etc didn't match anything fitting the the age etc. Eventually they discovered that it was a heart condition...

There's a similarity of sorts here to airline pilots. What separates the decent ones from the great ones is how they handle the rare cases. There's enough dreary repetition that it's easy to be unprepared when it counts the most.

I agree with you and also believe this extends to the majority of professions. Even within software development, there are a significant number of people that will only solve the immediate problem in front of them in a stepwise manner, rather than using lateral thinking to evaluate if the problem should be solved in the way that's most familiar to them, or to look at it from a different perspective and solve another problem entirely (e.g. the root cause).

To be fair, the majority of problems are probably addressable without thinking differently. So people get into habit/routine and that's their "job"; thinking otherwise is not a day-to-day operation. To your point, automating the redundant/repetitive problems should allow for creative problem solving where machines don't yet excel.

A lot of school administrators have PhDs, but get one to tell you how they learned about some really cool experimental results at some conference (probably publicized by someone trying to sell them something, incidentally, but that's another problem) and are trying to reproduce them at their school(s).

You'll be in for a treat.

A "treat".

Fun bonus anecdote:

One of my wife's principals was convinced the prayer jar she provided for the staff was effective because over half of the prayers the prior year had been answered. When she told me that story it damn near broke my brain.

>One of my wife's principals was convinced the prayer jar she provided for the staff was effective because over half of the prayers the prior year had been answered.

Depending on the prior probability of the prayers that were answered (and those that weren't), 51% could be plenty to support the efficacy of the prayer jar.

I know, the problem is that she was evidently entirely unaware that without knowing something about the probability of "answered prayers" absent the prayer jar, the simple "over half of all wishes came true" was entirely meaningless. Without more information any number could, potentially, support either conclusion (did/did-not work). This wasn't said in jest, either, if you're wondering (I did).

This depends also on the person having the organizational position and time to do said thinking.

Couldn't this be argued of people in all professions, including software engineering? There are some who just don't care; people who just follow the process and procedure and aren't interested in the bigger picture.

While I agree that technology and automation can help, in addition we should find ways to help professionals move beyond their routines.

but software engineers 'pretty much' make at most in the early 6 figures and doctors 'pretty much' start there. i'd love to give customers max 15 minutes to tell me how they want their website only to tell them this is what they are going to get because its the standard of care.

why should a doctor care? they get paid weather you live or die. what happens to you basically has no bearing on their career. a doctor i know worked on a guy who was having chest pains but was 'diagnosed' with COPD. he was to be sent home, but that doctor refused to because of patient history: all 5 of his brothers died of a heart attack before 60. what would have happened to anyone there had he been sent home? nothing, just another heart attack death.

at least they got things right on brother #6 though.

in short, doctors have little incentive to pick up their game. the supply of doctors is kept short purposefully to ensure they make money++. Only way out of this mess is technology when people can finally take their health back into their own hands.

They'll rue the day they purposefully restricted the available supply of skilled physicians through limitations on residency programs when those pesky technology engineers perfect the doc-in-a-box.

Even worse is when some of those guys open source it and give away the software and hardware schematics, just because they hate giving $30 co-pays and dealing with deductibles, just to get an antibiotic prescription for a viral infection.

Don't make professional problem solvers see you as a problem, or you might just get solved.

Your post is a gold mine of potential points to attack but I'll save it and just focus on this:

>the supply of doctors is kept short purposefully to ensure they make money++

No. It's costly to train them, and it's hard for an average person to afford.

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