4 ms·

Come on now, there is a good amount of scientific evidence, doctors do know some things ... it's just that, if you're not a decent doctor, you can't tell the bu

by ploxiln 10y ago

Come on now, there is a good amount of scientific evidence, doctors do know some things ... it's just that, if you're not a decent doctor, you can't tell the bullshit from the useful information. My mother is a GP, but I'm a software engineer, so I'd like to make a software metaphor. The experts have come up with best practices and agile methodologies. If you follow the Agile processes rigorously and use industry-standard tools ... often the results are total crap, like the Military or the State of Virginia spending 300M on an accounting software project over 5 years and then just throw it away. I guess we don't know anything about software, do we? Well, some of us do. Some of us are reasonable about how much various techniques help, what the trade-offs are, the inherent uncertainties. Some get good results fairly consistently. And it isn't by rigorously following Agile Methodologies, it's more than that, you have to be thoughtful about the code itself. And, medicine is often like debugging a large complicated messy system. It takes time, and many practitioners are a bit lazy. They have a lot on their plate, the don't have the time to really dig in and figure out each case. They guess, patch in a work-around, and move on. But, frankly, western medicine has been massively useful, and I think we all know that. EDIT: and of course there's the hype cycle: everyone, especially those who are managers or customers rather than practitioners, are looking for the secret, the trick to getting good results. Before agile, it was object-oriented, etc...

newman314 10y ago
Problem is that if she screws up, someone might die. I would be terrified if someone approached the medical profession the way people do software development.
- ploxiln 10y ago
  You're right, there are differences - medicine is more rigorous (in a sense), processes are more regulated, there's more "standard procedure" which is more specifically taught and widely followed. But doctors screw up all the time. Sometimes it's dumb mistakes like instruments left in the body after surgery, or the wrong limb operated on. (Like failing to check length when copying a buffer perhaps? Sometimes it's just a bit embarrasing, sometimes catastrophic.) More often, it's just not finding the real cause of the "bug", applying a "fix" or "cleanup" that doesn't fix it.
  - newman314 10y ago
    But applying the same logic to other professions does not work in my opinion. For example, if a pilot screws up, people die, lots of people die. Unfortunately, there are a whole bunch of professions where it's not really ok to be "Oops, my bad". And those are the professions that I would say need the most rigor (yet with enough flexibility to catch unknown corner cases) in general. So it's not really debug but more likely post-mortem. =(
- matheusmoreira 10y ago
  Doctors are human too. Medical error is pretty common. It's not just doctors, either; every healthcare professional is affected. Recognizing this fact led to studies in patient safety. https://www.ncbi.nlm.nih.gov/books/NBK2673/ https://www.ncbi.nlm.nih.gov/books/NBK2673/ It's a really interesting read, especially the chapter "Basic Concepts in Patient Safety". I find it notable that greater safety is achieved by avoiding reliance on memory. The amount of memorization in medicine is astounding. When I tell my friends there's no shame in looking something up, they look at me like I'm some kind of madman. "What will the patient think? If you can just look something up, why have doctors at all?" Yet this article clearly advocates the use of checklists to make sure nothing is forgotten.
babyrainbow 10y ago
>medicine is often like debugging a large complicated messy system... A system, that you didn't write and don't have access to the source, Now, try fixing a large and complex software system only by observing inputs and outputs only. This is not even going into the fact that how every one will be running a slight different version, which might also be influenced by a million factors such as environment, food habits and past and current medications.... It is virtually impossible, even for moderately large software, even without considering the latter..
rscho 10y ago
M.Ds know things, that's the point! Have we been trained for scientific thinking? Absolutely, totally not. Test your mother on basic statistics and scientific reasoning, and you will quickly see the limits. This has absolutely nothing to do with being a decent doctor or not. Now, you are going to tell me she can read the scientific literature and make sense of it? Medicine is caring for patients, meaning applying knowledge. Knowledge applied in the clinics is mostly passed through practical training from generation to generation. Arguably, the decisive factor of change in medicine has up to now always been technology: a stent in an artery, ether anesthesia, organ transplant, etc. A certain base of irrefutable knowledge is present, of course, but it is proportionally small compared to the amount of downright false information we get from clinical trials. We could debate for hours on that subject, but I dare say that someone who believes that most M.Ds can do real science is very wrong. Statistics done by M.Ds is akin to a junkie cooking meth. He knows how to make it, but has no idea why sometimes it goes wrong. Moreover, you drastically underestimate the dishonesty of the "experts" you are citing.
- Fomite 10y ago
  MDs are not the only ones doing medical research.
  - rscho 10y ago
    That is indeed a valid point. Unfortunately, most of biology can also be qualified of "soft science". I however expect that a new age is coming for medicine: the age of science (the real one, this time). We are already seeing the birth of sizable databases exploited by professional scientists, but this is still a very minor part of the research output, and the signal-to-noise ratio is currently dismal. Additionally, the progress of medicine is somewhat parallel to the progress of hard science. What is lacking the most, is solid data and the methods to collect them.
    - Fomite 10y ago
      Ironically enough though, "hard scientists" wandering into biology and medicine and going "Right, time to show you lot how real science is done..." are notorious for producing really awful research.

by ploxiln 10y ago

newman314 10y ago

Problem is that if she screws up, someone might die. I would be terrified if someone approached the medical profession the way people do software development.

ploxiln 10y ago
You're right, there are differences - medicine is more rigorous (in a sense), processes are more regulated, there's more "standard procedure" which is more specifically taught and widely followed. But doctors screw up all the time. Sometimes it's dumb mistakes like instruments left in the body after surgery, or the wrong limb operated on. (Like failing to check length when copying a buffer perhaps? Sometimes it's just a bit embarrasing, sometimes catastrophic.) More often, it's just not finding the real cause of the "bug", applying a "fix" or "cleanup" that doesn't fix it.
- newman314 10y ago
  But applying the same logic to other professions does not work in my opinion. For example, if a pilot screws up, people die, lots of people die. Unfortunately, there are a whole bunch of professions where it's not really ok to be "Oops, my bad". And those are the professions that I would say need the most rigor (yet with enough flexibility to catch unknown corner cases) in general. So it's not really debug but more likely post-mortem. =(
matheusmoreira 10y ago
Doctors are human too. Medical error is pretty common. It's not just doctors, either; every healthcare professional is affected. Recognizing this fact led to studies in patient safety. https://www.ncbi.nlm.nih.gov/books/NBK2673/ https://www.ncbi.nlm.nih.gov/books/NBK2673/ It's a really interesting read, especially the chapter "Basic Concepts in Patient Safety". I find it notable that greater safety is achieved by avoiding reliance on memory. The amount of memorization in medicine is astounding. When I tell my friends there's no shame in looking something up, they look at me like I'm some kind of madman. "What will the patient think? If you can just look something up, why have doctors at all?" Yet this article clearly advocates the use of checklists to make sure nothing is forgotten.

babyrainbow 10y ago

>medicine is often like debugging a large complicated messy system... A system, that you didn't write and don't have access to the source, Now, try fixing a large and complex software system only by observing inputs and outputs only. This is not even going into the fact that how every one will be running a slight different version, which might also be influenced by a million factors such as environment, food habits and past and current medications.... It is virtually impossible, even for moderately large software, even without considering the latter..

rscho 10y ago

M.Ds know things, that's the point! Have we been trained for scientific thinking? Absolutely, totally not. Test your mother on basic statistics and scientific reasoning, and you will quickly see the limits. This has absolutely nothing to do with being a decent doctor or not. Now, you are going to tell me she can read the scientific literature and make sense of it? Medicine is caring for patients, meaning applying knowledge. Knowledge applied in the clinics is mostly passed through practical training from generation to generation. Arguably, the decisive factor of change in medicine has up to now always been technology: a stent in an artery, ether anesthesia, organ transplant, etc. A certain base of irrefutable knowledge is present, of course, but it is proportionally small compared to the amount of downright false information we get from clinical trials. We could debate for hours on that subject, but I dare say that someone who believes that most M.Ds can do real science is very wrong. Statistics done by M.Ds is akin to a junkie cooking meth. He knows how to make it, but has no idea why sometimes it goes wrong. Moreover, you drastically underestimate the dishonesty of the "experts" you are citing.

Fomite 10y ago
MDs are not the only ones doing medical research.
- rscho 10y ago
  That is indeed a valid point. Unfortunately, most of biology can also be qualified of "soft science". I however expect that a new age is coming for medicine: the age of science (the real one, this time). We are already seeing the birth of sizable databases exploited by professional scientists, but this is still a very minor part of the research output, and the signal-to-noise ratio is currently dismal. Additionally, the progress of medicine is somewhat parallel to the progress of hard science. What is lacking the most, is solid data and the methods to collect them.
  - Fomite 10y ago
    Ironically enough though, "hard scientists" wandering into biology and medicine and going "Right, time to show you lot how real science is done..." are notorious for producing really awful research.