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> the median doctor is pretty worthless This seems fairly disrespectful. I suppose you mean that the median doctor isn't perfect, but do you have any idea how

> the median doctor is pretty worthless This seems fairly disrespectful. I suppose you mean that the median doctor isn't perfect, but do you have any idea how many hours residents put in? You might think carefully before calling the median one worthless, and ask whether they're really, truly wasting their lives in the service of others. Less emotionally, I find it hard to believe that half of doctors proved essentially no benefit. > it's a side effect that's been widely known since the 1970's Guess how many side effects have been widely known since the 1970's? For clarity: I am 100% in favor of thinking critically about a doctor's advice, having received contradictory diagnoses before.

ncouture 10y ago
> Guess how many side effects have been widely known since the 1970's? Does this make it fine not to expect a doctor to inspect the list of known side effects for drugs his patients are taking? I've heard this very story a few times already, perhaps the sources of data widely accepted by doctors are not up to par with what non-doctors consider as accurate, in some cases anyway.
- kevinalexbrown 10y ago
  Without knowing this specific case, I can't say for sure. But my broader point is that the knowledge base required of doctors is so huge that even if it's not excusable, it is understandable. Like online community moderation, it's really easy to point to cases where doctors got it wrong and assume it's all for naught. Absolutely the accuracy of doctors should be improved, but the bar is not "are you as good as a UCSF resident?" (one of the best programs nationally) but "are you better than nothing?" It just seems crazy to me to suggest that the median doctor, i.e. at least half, is worthless.
  - saiya-jin 10y ago
    yeah, arrogant comment that was. I presume the guy always does his work at 100% or more, flawless, checking every detail and aspect, thinking 10 minutes before saying anything... We all have our tiny and bigger faults, yet somehow when it comes to health we expect impossible. I have similar crappy experiences like most people here, and tended to hate all medical personnel uniformly. Then I started dating a young doctor - still can't wrap my head around how overworked over-stressed and underpaid piece of shit work that is. Bear in mind that we're talking about biggest university hospital in Switzerland. Working ridiculous amount of hours (normal shift can be 10-13 hours, overtime unpaid), night shifts that will just mess you up mentally, crazy and dangerous patients, drug addicts, very real danger of contracting stuff like HIV or hepatititis C by single tiny mistake, or actually killing somebody by overlooking some tiny fact about N-th patient that night. You can end your career for life and end up in jail and/or with lifelong debt by one mistake. ONE. Even after directly saving life of 500 other people. Compared to my comfy corporate job, where I earn much more, did get mistake or two in production over last 5 years (nothing critical like making loss, but still), well... We should be thankful that anybody clever is actually still doing that job. Most of them could earn more and have actually a life someplace else. Blame how system is setup much more than individuals forced to exist in it.
ethbro 10y ago
Incidentally, the question of "Do younger or older physicians produce better outcomes?" recently came up on the Freakonomics podcast (they were doing a 3-episode focus on the medical system). [1; 12/14/16] Or, if you want to search the transcript for it, "So, given a choice between two doctors, let’s say — one fresh out of medical school and the other with fifteen years’ experience, which one do you go for?" It's a good listen or read. Tl;dl: Anupam Jena [2], "And we can basically see what happens if a patient happens to be treated by a doctor who is 20 years out of residency versus 5 years out of residency. And what we find is that if you happen to be treated by a doctor who is 10 years or 15 years out of residency, your mortality within thirty days of being hospitalized is higher." [Note: surgeons were one of the specializations that did not follow this correlation] Side note: the medical profession is really terrible at keeping statistics on outcomes, outside of actual trials. [1] http://freakonomics.com/podcast/bad-medicine-part-3-death-diagnosis/ http://freakonomics.com/podcast/bad-medicine-part-3-death-di... [2] https://www.ncbi.nlm.nih.gov/pubmed/?term=Jena+AB%5BAuthor%5D https://www.ncbi.nlm.nih.gov/pubmed/?term=Jena+AB%5BAuthor%5...
- fapjacks 10y ago
  Well, I don't think this is surprising, really. Those doctors are closer temporally to their training than the old docs. This is also why "Are you smarter than a fifth grader?" is actually harder than people think, because all those kids just learned last week what the capital of West Virginia is. Surgery seems to be a logical exception, since at the end of the day, I suppose it's more like being a car mechanic than a trivia competitor, and having a body of experience and "tricks of the trade" is more valuable than trying to compete with knowing more than WebMD and Wikipedia. I can't wait to pass the torch of diagnostics over to computers. People are generally lazy and they get comfortable too quickly for my taste, including doctors. I bet if you found some kind of situation in which doctors were kept on their toes, and constantly retraining their knowledge base, you'd find that the mortality rate doesn't go up.

ncouture 10y ago

> Guess how many side effects have been widely known since the 1970's? Does this make it fine not to expect a doctor to inspect the list of known side effects for drugs his patients are taking? I've heard this very story a few times already, perhaps the sources of data widely accepted by doctors are not up to par with what non-doctors consider as accurate, in some cases anyway.

kevinalexbrown 10y ago
Without knowing this specific case, I can't say for sure. But my broader point is that the knowledge base required of doctors is so huge that even if it's not excusable, it is understandable. Like online community moderation, it's really easy to point to cases where doctors got it wrong and assume it's all for naught. Absolutely the accuracy of doctors should be improved, but the bar is not "are you as good as a UCSF resident?" (one of the best programs nationally) but "are you better than nothing?" It just seems crazy to me to suggest that the median doctor, i.e. at least half, is worthless.
- saiya-jin 10y ago
  yeah, arrogant comment that was. I presume the guy always does his work at 100% or more, flawless, checking every detail and aspect, thinking 10 minutes before saying anything... We all have our tiny and bigger faults, yet somehow when it comes to health we expect impossible. I have similar crappy experiences like most people here, and tended to hate all medical personnel uniformly. Then I started dating a young doctor - still can't wrap my head around how overworked over-stressed and underpaid piece of shit work that is. Bear in mind that we're talking about biggest university hospital in Switzerland. Working ridiculous amount of hours (normal shift can be 10-13 hours, overtime unpaid), night shifts that will just mess you up mentally, crazy and dangerous patients, drug addicts, very real danger of contracting stuff like HIV or hepatititis C by single tiny mistake, or actually killing somebody by overlooking some tiny fact about N-th patient that night. You can end your career for life and end up in jail and/or with lifelong debt by one mistake. ONE. Even after directly saving life of 500 other people. Compared to my comfy corporate job, where I earn much more, did get mistake or two in production over last 5 years (nothing critical like making loss, but still), well... We should be thankful that anybody clever is actually still doing that job. Most of them could earn more and have actually a life someplace else. Blame how system is setup much more than individuals forced to exist in it.

ethbro 10y ago

Incidentally, the question of "Do younger or older physicians produce better outcomes?" recently came up on the Freakonomics podcast (they were doing a 3-episode focus on the medical system). [1; 12/14/16] Or, if you want to search the transcript for it, "So, given a choice between two doctors, let’s say — one fresh out of medical school and the other with fifteen years’ experience, which one do you go for?" It's a good listen or read. Tl;dl: Anupam Jena [2], "And we can basically see what happens if a patient happens to be treated by a doctor who is 20 years out of residency versus 5 years out of residency. And what we find is that if you happen to be treated by a doctor who is 10 years or 15 years out of residency, your mortality within thirty days of being hospitalized is higher." [Note: surgeons were one of the specializations that did not follow this correlation] Side note: the medical profession is really terrible at keeping statistics on outcomes, outside of actual trials. [1] http://freakonomics.com/podcast/bad-medicine-part-3-death-diagnosis/ http://freakonomics.com/podcast/bad-medicine-part-3-death-di... [2] https://www.ncbi.nlm.nih.gov/pubmed/?term=Jena+AB%5BAuthor%5D https://www.ncbi.nlm.nih.gov/pubmed/?term=Jena+AB%5BAuthor%5...

fapjacks 10y ago
Well, I don't think this is surprising, really. Those doctors are closer temporally to their training than the old docs. This is also why "Are you smarter than a fifth grader?" is actually harder than people think, because all those kids just learned last week what the capital of West Virginia is. Surgery seems to be a logical exception, since at the end of the day, I suppose it's more like being a car mechanic than a trivia competitor, and having a body of experience and "tricks of the trade" is more valuable than trying to compete with knowing more than WebMD and Wikipedia. I can't wait to pass the torch of diagnostics over to computers. People are generally lazy and they get comfortable too quickly for my taste, including doctors. I bet if you found some kind of situation in which doctors were kept on their toes, and constantly retraining their knowledge base, you'd find that the mortality rate doesn't go up.