6 ms·

There's a catastrophic "the map is the territory" mentality in the medical world that leads to that kind of attitude. Many (most?) doctors work as if their kno

by pygy_ 8y ago

There's a catastrophic "the map is the territory" mentality in the medical world that leads to that kind of attitude. Many (most?) doctors work as if their knowledge was exact and exhaustive, and every symptom that's not in the book is binned as psychosomatic or psychiatric, and basically blamed on the patient. Paired with the fact that many doctors don't understand that credibly behaving as if the patient's well-being is important for the therapeutic relationship (the social part of the placebo effect, health being a mean, not an end), and you understand why BS alternative medicines are so popular.

theprotocol 8y ago
I agree. I think it's OK to be flawed, and it's even OK not to know your limitations. But what's not acceptable is the attitude. Many of the doctors I've seen act like "pshhh, get a load of this rube!" whenever I open my mouth. They mutter something about patients not being supposed to read things on the Internet (I read because I'm desperate and nobody has managed to help me, perhaps?). Many act like "oh, you read medical articles? Great you can help yourself then, I'm out." although they won't say that outright, but essentially they stop trying the second they find out.
- pygy_ 8y ago
  Yes, ignoring if not mocking real patient expertise is yet another issue that's pretty prevalent. Patient knowledge may be accepted for diseases that are rare but well know, but for stuff in foreign territory you'll find that kind of attitude.
- threeseed 8y ago
  1. You pay to see a doctor. You weren't forced to. You chose to. 2. You tell them you read about your condition on the internet. Even though the majority of the health information on the internet is utter garbage. 3. You then get offended when they tell you to not trust what is on the internet. Although again they are 100% spot on here. 4. You are confused why they are dismissive of you. When you chose to see them, paid money for their expert advice and then wanted to dismiss it in favour of your expert advice. Except that your expert advice = 5 mins of Google and theirs = 20 years of schooling. I really do feel really sorry for GPs to have to go through this 100x a day.
  - wavegeek 8y ago
    > You weren't forced to. Actually you are. Doctors have a carefully protected monopoly on ordering diagnostic tests and on prescribing treatments. At least where I live, if you want diagnostic tests or drug treatments you need a prescription from a member of the cartel.
    - amelius 8y ago
      Yes, and the crazy thing is you can get cosmetic surgery on every corner of every street, no questions asked.
  - theprotocol 8y ago
    >1. You pay to see a doctor. You weren't forced to. You chose to. Yes, that they couldn't help me is not the problem. The problem is that they behaved unprofessionally and mocked me. >2. You tell them you read about your condition on the internet. Even though the majority of the health information on the internet is utter garbage. >3. You then get offended when they tell you to not trust what is on the internet. Although again they are 100% spot on here. - I am 100% OK with a doctor disagreeing with me. A few of the doctors I've met I respect immensely - even though I disagree with them - simply because they were respectful in their disagreement of what I had to say and had an adult answer for me that didn't involve mockery. - They did not tell me not to trust what is on the Internet. They mocked me and gave up trying to treat me. They became aggressive. And they still wanted to get paid even after deciding I wasn't worthy enough for them to try! I am an expert in my field, yet I don't dare imagine what would happen if I mocked a client who asked a "stupid" question! And even if there were no consequence, I'd never do it. Why is this somehow OK in medicine? >4. You are confused why they are dismissive of you. When you chose to see them, paid money for their expert advice and then wanted to dismiss it in favour of your expert advice. Except that your expert advice = 5 mins of Google and theirs = 20 years of schooling. I did not dismiss their advice. I took it, for decades. You underestimate the hubris of some of these people - they mocked me even if I took their advice, simply for reporting what happened to me. >I really do feel really sorry for GPs to have to go through this 100x a day. Oh those poor snowflakes, having to speak to non-expert clients without mocking them! There exists no other industry where the expert can be so ineffective, yet at the same time aggressively mock the client outright, even deciding not to do the work because the client is not to his/her liking, while still getting paid.
PhantomGremlin 8y ago
Many (most?) doctors work as if their knowledge was exact and exhaustive, and every symptom that's not in the book is binned as psychosomatic or psychiatric, and basically blamed on the patient. You know this since you have a medical degree, but to inform general readers, here's what takes to become a doctor in the USA[1]: K-12 4 years college, perhaps pre-med emphasis 4 years medical school 3 to 7 years residency 1 to 4 years fellowship (for specialization) After all that, they probably do think they know it all. But in reality their knowledge has only scratched the surface. Perhaps the right answer is even more specialization? Maybe that's where places like the Mayo Clinic come in? Maybe an organization like that is big enough that they can have specialists who can recognize and treat all the rare conditions that are "not in the book"? [1] https://en.wikipedia.org/wiki/Medical_school#United_States https://en.wikipedia.org/wiki/Medical_school#United_States
- j7ake 8y ago
  I think the right answer is that doctors should also be required to produce an original piece of research. This will immediately make it clear how limited book knowledge is and how vast the unexplored territory is. Ask many genuine scientists who have been doing research in a field for 30+ years and they can tell you how small the book knowledge is compared to the unexplored territory.
  - medntech 8y ago
    Med student here. The majority of us do research starting from day one of undergrad. It's not uncommon to graduate med school with 5+ publications. It is effective at showing how little we know, but so are the lectures we have everyday that have unknowns in them. We're also taught by "genuine" scientist, people with PhDs, PhD/MD, and MDs on a daily basis about what we don't know.
    - theprotocol 8y ago
      > It is effective at showing how little we know, but so are the lectures we have everyday that have unknowns in them. I really appreciate this being taught, and from what little you wrote, I appreciate the humility shown. Please don't ever become a "big shot" that's too good to talk openly to people who are afraid about their health.
threeseed 8y ago
> Many (most?) doctors work as if their knowledge was exact and exhaustive No they don't. They try to give you the best advice that they can at that point in time. But I've never met a medical professional who thought they knew everything and anything. What are you saying is really quite rude and dismissive.
- wavegeek 8y ago
  OK here is an example from me. I have hypercortisolemia since 25 years at least. I have been to various endocrinologists to investigate this. It has caused numerous serious problems including blinding me in my left eye (from a cortisol related condition), osteoporosis, weakened immune system and other problems. Every time they test me for a tumour, find no tumour and in every case I was told, "there is no problem". Even though the high cortisol is screwing up my health. They do not know the cause so there is no problem. Once the recipe book is exhausted they are just totally lost. My brother had a problem that was eventually found to be due to salycilate intolerance. But in the meantime, until this was found, he was told he was neurotic, imagining it etc etc. My mother was prescribed anti-anxiety medications when she actually had hypothyroidism due to a tumour, with classic symptoms. Just about everyone you speak to has a story of delayed or misdiagnosis, problems being dismissed or denied because they didn't fit someone's cookbook. The sooner we have AIs doing diagnosis the better as far as I am concerned.
  - majewsky 8y ago
    What would AIs change about this? They need to be trained with existing diagnoses, so my expectation is that they will describe common cold medicine 50% more efficiently.
    - hfdgiutdryg 8y ago
      I've read that way back in the 80s, Expert Systems were shown to diagnose more accurately than doctors.
    - scotty79 8y ago
      I think AI will win with bedside manner even if everything else is equal. Overworked humans suck at being humane.

by pygy_ 8y ago

theprotocol 8y ago

I agree. I think it's OK to be flawed, and it's even OK not to know your limitations. But what's not acceptable is the attitude. Many of the doctors I've seen act like "pshhh, get a load of this rube!" whenever I open my mouth. They mutter something about patients not being supposed to read things on the Internet (I read because I'm desperate and nobody has managed to help me, perhaps?). Many act like "oh, you read medical articles? Great you can help yourself then, I'm out." although they won't say that outright, but essentially they stop trying the second they find out.

pygy_ 8y ago
Yes, ignoring if not mocking real patient expertise is yet another issue that's pretty prevalent. Patient knowledge may be accepted for diseases that are rare but well know, but for stuff in foreign territory you'll find that kind of attitude.
threeseed 8y ago
1. You pay to see a doctor. You weren't forced to. You chose to. 2. You tell them you read about your condition on the internet. Even though the majority of the health information on the internet is utter garbage. 3. You then get offended when they tell you to not trust what is on the internet. Although again they are 100% spot on here. 4. You are confused why they are dismissive of you. When you chose to see them, paid money for their expert advice and then wanted to dismiss it in favour of your expert advice. Except that your expert advice = 5 mins of Google and theirs = 20 years of schooling. I really do feel really sorry for GPs to have to go through this 100x a day.
- wavegeek 8y ago
  > You weren't forced to. Actually you are. Doctors have a carefully protected monopoly on ordering diagnostic tests and on prescribing treatments. At least where I live, if you want diagnostic tests or drug treatments you need a prescription from a member of the cartel.
  - amelius 8y ago
    Yes, and the crazy thing is you can get cosmetic surgery on every corner of every street, no questions asked.
- theprotocol 8y ago
  >1. You pay to see a doctor. You weren't forced to. You chose to. Yes, that they couldn't help me is not the problem. The problem is that they behaved unprofessionally and mocked me. >2. You tell them you read about your condition on the internet. Even though the majority of the health information on the internet is utter garbage. >3. You then get offended when they tell you to not trust what is on the internet. Although again they are 100% spot on here. - I am 100% OK with a doctor disagreeing with me. A few of the doctors I've met I respect immensely - even though I disagree with them - simply because they were respectful in their disagreement of what I had to say and had an adult answer for me that didn't involve mockery. - They did not tell me not to trust what is on the Internet. They mocked me and gave up trying to treat me. They became aggressive. And they still wanted to get paid even after deciding I wasn't worthy enough for them to try! I am an expert in my field, yet I don't dare imagine what would happen if I mocked a client who asked a "stupid" question! And even if there were no consequence, I'd never do it. Why is this somehow OK in medicine? >4. You are confused why they are dismissive of you. When you chose to see them, paid money for their expert advice and then wanted to dismiss it in favour of your expert advice. Except that your expert advice = 5 mins of Google and theirs = 20 years of schooling. I did not dismiss their advice. I took it, for decades. You underestimate the hubris of some of these people - they mocked me even if I took their advice, simply for reporting what happened to me. >I really do feel really sorry for GPs to have to go through this 100x a day. Oh those poor snowflakes, having to speak to non-expert clients without mocking them! There exists no other industry where the expert can be so ineffective, yet at the same time aggressively mock the client outright, even deciding not to do the work because the client is not to his/her liking, while still getting paid.

PhantomGremlin 8y ago

Many (most?) doctors work as if their knowledge was exact and exhaustive, and every symptom that's not in the book is binned as psychosomatic or psychiatric, and basically blamed on the patient. You know this since you have a medical degree, but to inform general readers, here's what takes to become a doctor in the USA[1]: K-12 4 years college, perhaps pre-med emphasis 4 years medical school 3 to 7 years residency 1 to 4 years fellowship (for specialization) After all that, they probably do think they know it all. But in reality their knowledge has only scratched the surface. Perhaps the right answer is even more specialization? Maybe that's where places like the Mayo Clinic come in? Maybe an organization like that is big enough that they can have specialists who can recognize and treat all the rare conditions that are "not in the book"? [1] https://en.wikipedia.org/wiki/Medical_school#United_States https://en.wikipedia.org/wiki/Medical_school#United_States

j7ake 8y ago
I think the right answer is that doctors should also be required to produce an original piece of research. This will immediately make it clear how limited book knowledge is and how vast the unexplored territory is. Ask many genuine scientists who have been doing research in a field for 30+ years and they can tell you how small the book knowledge is compared to the unexplored territory.
- medntech 8y ago
  Med student here. The majority of us do research starting from day one of undergrad. It's not uncommon to graduate med school with 5+ publications. It is effective at showing how little we know, but so are the lectures we have everyday that have unknowns in them. We're also taught by "genuine" scientist, people with PhDs, PhD/MD, and MDs on a daily basis about what we don't know.
  - theprotocol 8y ago
    > It is effective at showing how little we know, but so are the lectures we have everyday that have unknowns in them. I really appreciate this being taught, and from what little you wrote, I appreciate the humility shown. Please don't ever become a "big shot" that's too good to talk openly to people who are afraid about their health.

threeseed 8y ago

> Many (most?) doctors work as if their knowledge was exact and exhaustive No they don't. They try to give you the best advice that they can at that point in time. But I've never met a medical professional who thought they knew everything and anything. What are you saying is really quite rude and dismissive.

wavegeek 8y ago
OK here is an example from me. I have hypercortisolemia since 25 years at least. I have been to various endocrinologists to investigate this. It has caused numerous serious problems including blinding me in my left eye (from a cortisol related condition), osteoporosis, weakened immune system and other problems. Every time they test me for a tumour, find no tumour and in every case I was told, "there is no problem". Even though the high cortisol is screwing up my health. They do not know the cause so there is no problem. Once the recipe book is exhausted they are just totally lost. My brother had a problem that was eventually found to be due to salycilate intolerance. But in the meantime, until this was found, he was told he was neurotic, imagining it etc etc. My mother was prescribed anti-anxiety medications when she actually had hypothyroidism due to a tumour, with classic symptoms. Just about everyone you speak to has a story of delayed or misdiagnosis, problems being dismissed or denied because they didn't fit someone's cookbook. The sooner we have AIs doing diagnosis the better as far as I am concerned.
- majewsky 8y ago
  What would AIs change about this? They need to be trained with existing diagnoses, so my expectation is that they will describe common cold medicine 50% more efficiently.
  - hfdgiutdryg 8y ago
    I've read that way back in the 80s, Expert Systems were shown to diagnose more accurately than doctors.
  - scotty79 8y ago
    I think AI will win with bedside manner even if everything else is equal. Overworked humans suck at being humane.