4 ms·

What is frustrating is cases where doctors insist they are right, and how dare you the patient question their expertise based on your internet research. I mean

What is frustrating is cases where doctors insist they are right, and how dare you the patient question their expertise based on your internet research. I mean, look, I totally get their side--you are paying them for their knowledge which they accumulated from years of practicing and years of specialized training. You SHOULD largely trust them. But doctors are also often overworked, and may not always specialize in your particular area. You also obviously have a much more vested interest in the outcome as a patient, so there's a decent chance you'll spend much more time researching it than your doctor. All of this to ask..."how can we strike a balance?" If one has doubts about what their doctor is telling them, they can always get another opinion. I just wish there was a better way to vet any research one might do on their own without the doctor getting upset that you continued to look into the matter instead of just taking their word on it when things don't improve. Personally, I have an awesome doctor, but when I have these concerns I preface them by saying "I recognize this is internet research, and I trust your opinions on these things, but I had X, Y and Z questions." They have always been perfectly happy to answer my questions and address my concerns (as I would hope given what they bill my insurance for a 15 minute visit...)

aantix 11y ago
Why worry about offending them when it's your life on the line? You're paying them.
- mfoy_ 11y ago
  Well, not in Canada. So instead of paying through the nose for a second opinion you have the guilt of possibly squandering taxpayer money by having more doctors spend more time on you.
  - gohrt 11y ago
    Getting it right is cheaper than getting it wrong.
    - nmcfarl 11y ago
      Getting it done right with a bunch of tests to rule out 1 in a million chances is a lot more expensive than getting it right without tests (and wrong 1 in a million times.)
ubernostrum 11y ago
I feel it's the other way around. I am a sample size of one; the doctor's experience, and the experience of the people who trained that doctor, is a far larger and more reliable sample, and so the doctor's diagnosis is more likely to be correct (absent any other information) than mine. My go-to example here is a few years ago I had unbelievable abdominal pain for a day or two and saw a doctor about it. And the first thing the doctor thought it was -- gallstones, which I ended up having a mildly-complicated and expensive test for -- turned out to be completely wrong. But I don't fault the doctor for that: it was, given what I was experiencing and my family's medical history (multiple people who had to have their gallbladders out due to gallstones), the most likely cause, to such an extent that focusing on anything else until it had been ruled out would have been a bad idea. (it turned out to be inflamed cartilage in my ribs, which was the second thing investigated, once the abdominal ultrasound ruled out gallstones)
- shostack 11y ago
  Except medical knowledge is not like pushing up a code commit. A new break through comes out, but it takes time for it to filter its way through the medical community, get doctors educated, convince them to change their ways, etc. Doctors are often required to get a certain number of CME credits every year, but there's no guarantee they'll be 100% current on the cutting edge of your issue. So if a doctor can lag behind from an education standpoint, is that an opportunity for a patient to help fill in gaps if they are willing to invest time? Please make no mistake, I largely agree that doctors are much better at considering the options and diagnosing accordingly. My point is that they are not omniscient, and new developments in medicine happen all the time. While a specialist might be expected to be more current in their specialty, a general practitioner might not be.
- MichaelGG 11y ago
  We should be free to push a doctor on things and have them answer as to why we're wrong. I can only imagine that must be very annoying to doctors. After working even with technical clients that manage to misunderstand and come up with all sorts of troublesome reports of non-issues, it's easy to get complacent. While it's not a good use of resources to run all sorts of tests for everyone, the tradeoff changes for you individually. Sorta like how the fox is only running for its lunch while the rabbit is running for its life. The limiting factor is probably the reliability of tests: get enough done and you'll find _something_ that looks wrong but isn't. Wikipedia lists hospital error as the leading preventable cause of death[1]. The source used notes "Serious harm seems to be 10- to 20-fold more common than lethal harm.". I'm a bit biased due to repeated experience. I lost one child due to being overly deferential to doctors instead of pushing a harder (trivially preventable issue). I saved another after flat-out rejecting the analysis of a nurse that appeared to be having trouble with simple math (after insisting on being re-evaluated, the child was rushed to emergency care; issue avoided - even got an apology). It reminds me of patio11's advice on salary negotiation. A bit of discomfort while discussing the subject vs a large payoff. I'd prefer to feel a little uncomfortable and annoy a doctor with a few additional questions, piss of a nurse for double-checking their work, given the stakes. https://en.wikipedia.org/wiki/Preventable_causes_of_death https://en.wikipedia.org/wiki/Preventable_causes_of_death
mahyarm 11y ago
You should not feel guilty getting second or third opinions for any serious diagnosis. It also discourages the moral hazard of diagnosing what is not there for personal profit. The pain and cost of treating a disease that is not there costs society a lot more than doing a cheap verification.
JesperRavn 11y ago
The flipside of that is that patients might bias doctor's decision away from what was a good decision in the first place. I've had many American doctors be somewhat apologetic when they recommended no treatment, or a less invasive treatment. My response was that if they didn't recommend a treatment then I didn't want it either. There are real risks from any treatment. The only time I ignored advice was when I went to a doctor for a cough, and because I mentioned chest pain (from coughing), they decided to get an EKG, which showed some abnormality. Apparently this abnormality is not uncommon in healthy people. They recommended more tests with a specialist, but I figured that a not uncommon result on a test, when doing that test wasn't justified by my original symptoms, didn't amount to enough evidence to go any further.

aantix 11y ago

Why worry about offending them when it's your life on the line? You're paying them.

mfoy_ 11y ago
Well, not in Canada. So instead of paying through the nose for a second opinion you have the guilt of possibly squandering taxpayer money by having more doctors spend more time on you.
- gohrt 11y ago
  Getting it right is cheaper than getting it wrong.
  - nmcfarl 11y ago
    Getting it done right with a bunch of tests to rule out 1 in a million chances is a lot more expensive than getting it right without tests (and wrong 1 in a million times.)

ubernostrum 11y ago

I feel it's the other way around. I am a sample size of one; the doctor's experience, and the experience of the people who trained that doctor, is a far larger and more reliable sample, and so the doctor's diagnosis is more likely to be correct (absent any other information) than mine. My go-to example here is a few years ago I had unbelievable abdominal pain for a day or two and saw a doctor about it. And the first thing the doctor thought it was -- gallstones, which I ended up having a mildly-complicated and expensive test for -- turned out to be completely wrong. But I don't fault the doctor for that: it was, given what I was experiencing and my family's medical history (multiple people who had to have their gallbladders out due to gallstones), the most likely cause, to such an extent that focusing on anything else until it had been ruled out would have been a bad idea. (it turned out to be inflamed cartilage in my ribs, which was the second thing investigated, once the abdominal ultrasound ruled out gallstones)

shostack 11y ago
Except medical knowledge is not like pushing up a code commit. A new break through comes out, but it takes time for it to filter its way through the medical community, get doctors educated, convince them to change their ways, etc. Doctors are often required to get a certain number of CME credits every year, but there's no guarantee they'll be 100% current on the cutting edge of your issue. So if a doctor can lag behind from an education standpoint, is that an opportunity for a patient to help fill in gaps if they are willing to invest time? Please make no mistake, I largely agree that doctors are much better at considering the options and diagnosing accordingly. My point is that they are not omniscient, and new developments in medicine happen all the time. While a specialist might be expected to be more current in their specialty, a general practitioner might not be.
MichaelGG 11y ago
We should be free to push a doctor on things and have them answer as to why we're wrong. I can only imagine that must be very annoying to doctors. After working even with technical clients that manage to misunderstand and come up with all sorts of troublesome reports of non-issues, it's easy to get complacent. While it's not a good use of resources to run all sorts of tests for everyone, the tradeoff changes for you individually. Sorta like how the fox is only running for its lunch while the rabbit is running for its life. The limiting factor is probably the reliability of tests: get enough done and you'll find _something_ that looks wrong but isn't. Wikipedia lists hospital error as the leading preventable cause of death[1]. The source used notes "Serious harm seems to be 10- to 20-fold more common than lethal harm.". I'm a bit biased due to repeated experience. I lost one child due to being overly deferential to doctors instead of pushing a harder (trivially preventable issue). I saved another after flat-out rejecting the analysis of a nurse that appeared to be having trouble with simple math (after insisting on being re-evaluated, the child was rushed to emergency care; issue avoided - even got an apology). It reminds me of patio11's advice on salary negotiation. A bit of discomfort while discussing the subject vs a large payoff. I'd prefer to feel a little uncomfortable and annoy a doctor with a few additional questions, piss of a nurse for double-checking their work, given the stakes. https://en.wikipedia.org/wiki/Preventable_causes_of_death https://en.wikipedia.org/wiki/Preventable_causes_of_death

mahyarm 11y ago

You should not feel guilty getting second or third opinions for any serious diagnosis. It also discourages the moral hazard of diagnosing what is not there for personal profit. The pain and cost of treating a disease that is not there costs society a lot more than doing a cheap verification.

JesperRavn 11y ago

The flipside of that is that patients might bias doctor's decision away from what was a good decision in the first place. I've had many American doctors be somewhat apologetic when they recommended no treatment, or a less invasive treatment. My response was that if they didn't recommend a treatment then I didn't want it either. There are real risks from any treatment. The only time I ignored advice was when I went to a doctor for a cough, and because I mentioned chest pain (from coughing), they decided to get an EKG, which showed some abnormality. Apparently this abnormality is not uncommon in healthy people. They recommended more tests with a specialist, but I figured that a not uncommon result on a test, when doing that test wasn't justified by my original symptoms, didn't amount to enough evidence to go any further.