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Apologies, but it is hard for everyone to Unlean Things. It is just human nature/the way we are wired. It take discipline and great effort. What would doctors w

Apologies, but it is hard for everyone to Unlean Things. It is just human nature/the way we are wired. It take discipline and great effort. What would doctors want to be different? We all got a comfort zone :)

olooney 8y ago
Doctors are credentialed professionals. As professionals, they get a legal barrier to entry protecting them from competition in exchange for maintaining professional standards, which include ethical standards and continuing education. This in turn enables them to charge huge fees. A lawyer is not allowed to stop learning about new laws; he would eventually be disbarred. An architect is not allowed to construct buildings that would only have been up to code at the time she finished her degree. And doctors should likewise not ignore the state of the art in their field.
- kiriakasis 8y ago
  Totally true, but it misses the point. Doctors invest huge effort in keeping up with the state of the art in their field, the problem is that to be a competent doctor you also need considerable amount of intuition and heuristic. New advances sometimes requires that you unlearn things and this i a completely different process; when you simply keep up with the state of the art you have a set of known facts and techniques and slowly you discover more and more of them. Unlearning things requires you to review entire branches of your knowledge tree to eradicate every trace of the now wrong fact
  - WalterSear 8y ago
    >Doctors invest huge effort in keeping up with the state of the art in their field I'm afraid this hasn't been my usual experience.
  - pimmen 8y ago
    > Unlearning things requires you to review entire branches of your knowledge tree to eradicate every trace of the now wrong fact You cannot be serious. So if someone tells you that you’ve got a fact wrong, you have to review entire branches of your knowledge tree to eradicate every trace of the now wrong fact? So if you get the directions to a party wrong it’s a project to get rid of them and learn the correct one?
    - olooney 8y ago
      In a deductive context, yes, that's exactly what you have to do. This is a consequence of the principle of explosion: https://en.wikipedia.org/wiki/Principle_of_explosion https://en.wikipedia.org/wiki/Principle_of_explosion Let's say your "knowledge" is a set of propositions which you believe to be true. This set is continually expanding for two different reasons: 1. You're acquiring new facts about the world through direct observation (emperical knowledge) 2. You are thinking: making valid arguments which start from your current knowledge and lead to new propositions (analytic knowledge) At some point, a false fact creeps in. Your system is now "exploded" - the whole system is inconsistent and with a few lines of perfectly valid argument, you can now arrive at any conclusion. You now believe both "A" and "not A" for all values of A in the set of all well-formed formulas. Obviously this is not ideal. So we need to remove the false fact. But in the mean time, your mind has been at work, adding new propositions to your knowledge set. It is necessary to remove not only the offending bad fact that crept in, but any new proposition resulting from a valid argument which used that bad fact as a premise. Computationally, the easiest way to do this is to maintain a graph where the nodes are propositions and edges connect to their premises. For example, we would record in this graph structure that we now believe X because we deduced it from A, B, and C. If this structure, which the parent comment called "knowledge tree," exists, we can quickly remove all invalid propositions from our knowledge set and return to an consistent system. In practice its a very good idea to also store the arguments themselves. The metamath project does this, and can verify the entirety of its knowledge (which includes set theory, some calculus, complex numbers, trignometry, etc.) all the way back to axiomatic first principles in just a few minutes. http://us.metamath.org/ http://us.metamath.org/ Humans, of course, do not do this in their ordinary lives. They often believe propositions without being able to recall or reproduce the arguments, or cite the facts, which first led them to believe that proposition. This leads to a great deal of intellectual inertia. In mathematics and the sciences the situation is a little better: researchers certainly strive for this as an ideal, and largely succeed - a good research scientist has a deep understanding of the crucial experiments, theorems, and approximations that underpin their own work, and a rigorous practice of citing sources helps keep track of these dependencies. Therefore, if one paper is found fraudulent, other papers which cite it can be reviewed. But it is a difficult, even overwhelming project and no one can do it outside their own narrow area of expertise.
  - SilasX 8y ago
    It's fine for doctors to intuit that "the cost and side effects of HipNewDrug outweight the benefits". It's not fine for a doctor to be unaware that HeretoforeUncurableCondition now has HipNewDrug as a possible treatment -- i.e. to not have unlearned that HUC is a death sentence.
    - emodendroket 8y ago
      That's not really what the article is about. It's actually about someone finding HipNewDrug is actually not effective at curing Frobulitis and in fact has adverse side effects, and yet doctors continuing to prescribe it for that condition.
      - SilasX 8y ago
        It's the same failure mode though.
        emodendroket 8y ago
        It's not the same. It's a bigger problem than the one you're talking about, according to the article. It's easier to get doctors to adapt some procedure than to get them to give one up.
        SilasX 8y ago
        Both are the same failure mode: "You used to always do X. You shouldn't do that anymore." In my example, X was "tell patient they have a death sentence". The fact that yours is closer to a specific situation in the article does not make it "a different failure mode" with different dynamics and causes.
        emodendroket 8y ago
        I don't know what to tell you. You are saying the opposite of what the article says and not offering me any reason to take your word over the article.
- sigstoat 8y ago
  > A lawyer is not allowed to stop learning about new laws; he would eventually be disbarred. haaah. the things people believe about lawyers. merely being bad at your job isn't nearly enough to actually be disbarred.
  - LitFan 8y ago
    If a lawyer were to consistently lose cases as a result of not maintaining their knowledge of the law, they would not be disbarred (they would just lose clients). If a lawyer were to consistently act illegally as a result of not keeping up with their knowledge of the law, they definitely would eventually be disbarred.
agumonkey 8y ago
Doctors have too much emotional power of patients. That's when it become very dangerous to get stuck into your own paradigm.
dredmorbius 8y ago
My thought in submitting this was that behaviour (or skills) change is hard. For everyone. The case of doctors is interesting as they are a well defined, skilled, educated, and reasonably well-measured population engaged in activities for which outcomes can be quantitatively assessed; outcomes, health & wellness measures, or that ultimate outcome metric: deaths. Which means that in studying doctors there are valuable lessons which might be transferred to other fields. Such as software developers, venture finance, executive management, and end-user practices. Or in addressing social ills, economic inequality, education, opportunity, respecting others, expanding worldviews. The habit of looking past the immediate to see potential analogues and metaphors is a powerful one, though many seem resistant to acquiring it.
emodendroket 8y ago
Well it's right there below the headline. > Procedures live on even after they’ve been proved ineffective. It can lead to harms and wasted resources.

olooney 8y ago

Doctors are credentialed professionals. As professionals, they get a legal barrier to entry protecting them from competition in exchange for maintaining professional standards, which include ethical standards and continuing education. This in turn enables them to charge huge fees. A lawyer is not allowed to stop learning about new laws; he would eventually be disbarred. An architect is not allowed to construct buildings that would only have been up to code at the time she finished her degree. And doctors should likewise not ignore the state of the art in their field.

kiriakasis 8y ago
Totally true, but it misses the point. Doctors invest huge effort in keeping up with the state of the art in their field, the problem is that to be a competent doctor you also need considerable amount of intuition and heuristic. New advances sometimes requires that you unlearn things and this i a completely different process; when you simply keep up with the state of the art you have a set of known facts and techniques and slowly you discover more and more of them. Unlearning things requires you to review entire branches of your knowledge tree to eradicate every trace of the now wrong fact
- WalterSear 8y ago
  >Doctors invest huge effort in keeping up with the state of the art in their field I'm afraid this hasn't been my usual experience.
- pimmen 8y ago
  > Unlearning things requires you to review entire branches of your knowledge tree to eradicate every trace of the now wrong fact You cannot be serious. So if someone tells you that you’ve got a fact wrong, you have to review entire branches of your knowledge tree to eradicate every trace of the now wrong fact? So if you get the directions to a party wrong it’s a project to get rid of them and learn the correct one?
  - olooney 8y ago
    In a deductive context, yes, that's exactly what you have to do. This is a consequence of the principle of explosion: https://en.wikipedia.org/wiki/Principle_of_explosion https://en.wikipedia.org/wiki/Principle_of_explosion Let's say your "knowledge" is a set of propositions which you believe to be true. This set is continually expanding for two different reasons: 1. You're acquiring new facts about the world through direct observation (emperical knowledge) 2. You are thinking: making valid arguments which start from your current knowledge and lead to new propositions (analytic knowledge) At some point, a false fact creeps in. Your system is now "exploded" - the whole system is inconsistent and with a few lines of perfectly valid argument, you can now arrive at any conclusion. You now believe both "A" and "not A" for all values of A in the set of all well-formed formulas. Obviously this is not ideal. So we need to remove the false fact. But in the mean time, your mind has been at work, adding new propositions to your knowledge set. It is necessary to remove not only the offending bad fact that crept in, but any new proposition resulting from a valid argument which used that bad fact as a premise. Computationally, the easiest way to do this is to maintain a graph where the nodes are propositions and edges connect to their premises. For example, we would record in this graph structure that we now believe X because we deduced it from A, B, and C. If this structure, which the parent comment called "knowledge tree," exists, we can quickly remove all invalid propositions from our knowledge set and return to an consistent system. In practice its a very good idea to also store the arguments themselves. The metamath project does this, and can verify the entirety of its knowledge (which includes set theory, some calculus, complex numbers, trignometry, etc.) all the way back to axiomatic first principles in just a few minutes. http://us.metamath.org/ http://us.metamath.org/ Humans, of course, do not do this in their ordinary lives. They often believe propositions without being able to recall or reproduce the arguments, or cite the facts, which first led them to believe that proposition. This leads to a great deal of intellectual inertia. In mathematics and the sciences the situation is a little better: researchers certainly strive for this as an ideal, and largely succeed - a good research scientist has a deep understanding of the crucial experiments, theorems, and approximations that underpin their own work, and a rigorous practice of citing sources helps keep track of these dependencies. Therefore, if one paper is found fraudulent, other papers which cite it can be reviewed. But it is a difficult, even overwhelming project and no one can do it outside their own narrow area of expertise.
- SilasX 8y ago
  It's fine for doctors to intuit that "the cost and side effects of HipNewDrug outweight the benefits". It's not fine for a doctor to be unaware that HeretoforeUncurableCondition now has HipNewDrug as a possible treatment -- i.e. to not have unlearned that HUC is a death sentence.
  - emodendroket 8y ago
    That's not really what the article is about. It's actually about someone finding HipNewDrug is actually not effective at curing Frobulitis and in fact has adverse side effects, and yet doctors continuing to prescribe it for that condition.
    - SilasX 8y ago
      It's the same failure mode though.
      - emodendroket 8y ago
        It's not the same. It's a bigger problem than the one you're talking about, according to the article. It's easier to get doctors to adapt some procedure than to get them to give one up.
        SilasX 8y ago
        Both are the same failure mode: "You used to always do X. You shouldn't do that anymore." In my example, X was "tell patient they have a death sentence". The fact that yours is closer to a specific situation in the article does not make it "a different failure mode" with different dynamics and causes.
        emodendroket 8y ago
        I don't know what to tell you. You are saying the opposite of what the article says and not offering me any reason to take your word over the article.
sigstoat 8y ago
> A lawyer is not allowed to stop learning about new laws; he would eventually be disbarred. haaah. the things people believe about lawyers. merely being bad at your job isn't nearly enough to actually be disbarred.
- LitFan 8y ago
  If a lawyer were to consistently lose cases as a result of not maintaining their knowledge of the law, they would not be disbarred (they would just lose clients). If a lawyer were to consistently act illegally as a result of not keeping up with their knowledge of the law, they definitely would eventually be disbarred.

agumonkey 8y ago

Doctors have too much emotional power of patients. That's when it become very dangerous to get stuck into your own paradigm.

dredmorbius 8y ago

My thought in submitting this was that behaviour (or skills) change is hard. For everyone. The case of doctors is interesting as they are a well defined, skilled, educated, and reasonably well-measured population engaged in activities for which outcomes can be quantitatively assessed; outcomes, health & wellness measures, or that ultimate outcome metric: deaths. Which means that in studying doctors there are valuable lessons which might be transferred to other fields. Such as software developers, venture finance, executive management, and end-user practices. Or in addressing social ills, economic inequality, education, opportunity, respecting others, expanding worldviews. The habit of looking past the immediate to see potential analogues and metaphors is a powerful one, though many seem resistant to acquiring it.

emodendroket 8y ago

Well it's right there below the headline. > Procedures live on even after they’ve been proved ineffective. It can lead to harms and wasted resources.