8 ms·

Unfortunately medical doctors are not scientists. They do not collect new evidence, they just try to fit their observations (the symptoms) in the straight-jacke

Unfortunately medical doctors are not scientists. They do not collect new evidence, they just try to fit their observations (the symptoms) in the straight-jacket of the catalog of drugs or surgery they are aware of (the cure). Sometimes they choose to ignore symptoms you report, and sometimes they recommend a cure that can have terrible secondary effects without saying one word about those. If you make the mistake of believing that they are scientists, and present your own observations of possible cause and effect, they will either ignore you or mock you. I have so many examples of my own and close relatives, from the glaringly perceptual to the more subtle and personal, and have very little respect left for their profession and insane costs.

pygy_ 8y ago
I have a medical degree (but I do not practice medicine), and this is spot on. I wouldn't generalize it to the entire profession, but many doctors behave as you describe. Generalists tend to be more humble w.r.t. not knowing everything, but specialists are often bad offenders.
Razengan 8y ago
Doctors in that sense, and similarly lawyers, seem like the best candidates to be replaced by ML/AI. Why aren't we on this yet? (or are we?) That would be one of the best applications of AI, with wide benefits for civilians the world over but also causing social upheaval and thus facing resistance from the humans it attempts to supplant.
- Jgoure 8y ago
  Facebook announced that they are using ML to fix compilation errors just yesterday. They said they were contracting out companies to build ASICS for the AI. We are a long way from AI making good medical decisions.
- threeseed 8y ago
  1. Because the health industry is about as regulated as it gets so even if ML/AI is possible there is zero chance of it being allowed to replace the advice of a doctor. 2. Because most people like seeing their doctor and talking to someone about their issues. There isn't exactly an appetite for disruption here.
  - renjimen 8y ago
    To add to your second point: some conditions, such as mental health illnesses, require personal contact. Also, many people need to feel reassured when they're sick. An algorithm is not going to provide that, no matter how you dress it up.
  - peteretep 8y ago
    I make reasonable use of: https://en.wikipedia.org/wiki/Dr_Fox_Pharmacy https://en.wikipedia.org/wiki/Dr_Fox_Pharmacy When I want a medicine that requires a Dr's prescription, I can go and fill out a survey on their site. A real Dr (presumably) makes the actual prescription and my drugs show up. I am much happier for not seeing a doctor or talking to someone about my issues. The survey I take isn't traditional ML/AI, but it's definitely AI, as it boots me out of the process if I answer some of the questions incorrectly. Anyway, my point is: there's already disruption here, and it's awesome.
    - Timmah 8y ago
      That's not awesome that you hacked the system to prescribe yourself anything you want. At best you're going to get the least efficient path to treatment. At worst you could miss a serious condition and kill yourself.
      - peteretep 8y ago
        I am using the system directly as it is intended to be used, exactly as the UK government is intending it is to be used. I'm not sure what you think the hack is here. How the process works is detailed here: https://www.doctorfox.co.uk/how-it-works.html https://www.doctorfox.co.uk/how-it-works.html And you can see how they're regulated in the UK here: https://www.doctorfox.co.uk/regulation.html https://www.doctorfox.co.uk/regulation.html
  - pessimizer 8y ago
    > 1. Because the health industry is about as regulated as it gets so even if ML/AI is possible there is zero chance of it being allowed to replace the advice of a doctor. i.e. the necessity of an identifiable scapegoat if things turn out badly > 2. Because most people like seeing their doctor and talking to someone about their issues. There isn't exactly an appetite for disruption here. Maybe a certain type of person who craves an authority figure of some sort to soothe their fears, but I'd have to see evidence of this. Most people I know hate going to the doctor, and dislike and distrust the doctor they end up seeing as often as not. Having a friendly doctor that you've been seeing most of your life, that other members of your family see, and that you get Christmas cards from is a class thing (at least in the US) that maybe 10-15% of people get.
- mrob 8y ago
  In my experience, we don't need ML/AI to replace doctors. A good flowchart would do it. When your condition is on their standard list of diseases, the medical system (at least here in the UK) is a marvel of bureaucracy. Everybody works together with perfect coordination, to deliver the standard treatment at the lowest cost possible. Patient time or comfort isn't a priority, but it gets results. But as soon as you stray from their flowchart, the system is completely useless. Nobody is allowed to think for themselves, because any deviation from procedure would make the bureaucracy machine break down. As far as I can tell, the main purpose of the extensive doctor training is to raise barriers to entry and keep doctor wages up.
- carapace 8y ago
  > The first expert systems were created in the 1970s and then proliferated in the 1980s. Expert systems were among the first truly successful forms of artificial intelligence (AI) software. ~https://en.wikipedia.org/wiki/Expert_system https://en.wikipedia.org/wiki/Expert_system Applications include diagnosis and some systems are listed: CADUCEUS, MYCIN, PUFF, Mistral, Eydenet, Kaleidos.
threeseed 8y ago
GPs do not exist in a vacuum. They follow the advice dictated by the authorities. And the whole point of that advice is to be conservative. They aren't there to prescribe you the latest drugs or try some new cutting edge technique. They are there to present the best practice at that particular point in time. You know that whole saving lives part. And so in your case. You are coming to see your GP and are presenting some analysis that you read off the internet and are now upset that they didn't jump up and down in amazement. Well sure. They probably get that 100x a day and 99.99% of the information is probably wrong.
- username3 8y ago
  GPs are tier 1 support.
- theprotocol 8y ago
  > upset that they didn't jump up and down in amazement There's that aggression again. No, I'm upset about paying someone who mocked me and decided not to do any work because I was too pathetic for someone of his/her status. I am an expert in my field. Many people I work with suggest things that I know to be wrong. I have NEVER mocked or acted vengeful. If they choose to continue with their ideas that I disagree with, that's their right. Is it really that hard to be respectful? In every event that I've related in my posts, it was the doctor who was unwilling to give the most basic level of respect.
  - toxik 8y ago
    I see your point, but also you do not give health advice to other people as a profession. It's more akin to the mechanic dealing with people coming in with cars that almost all have the same issues, but then every now and then somebody reads something online about some extravagant maybe-it's-lupus kind of diagnosis, and they just roll their eyes.
    - theprotocol 8y ago
      That assumes the expert has actually given an answer to my questions, in which case, you'd be 100% right. Even a "we don't know why this happens yet, here's what we know about it: ..." would be more than satisfactory. Just give me something! But when the expert has nothing to say, yet mocks my questions and even just my reporting of what is happening to me, as he very eagerly waits for me to leave so he can get paid... Then there's not much more I can do than read on the Internet. Some throw in a veiled insult by suggesting I should be sent to a psych ward for my "panic attacks." You might say it's not an insult, but I accepted the psychiatric evaluation once - and then a whole team of psychiatrists determined after 2 weeks that I was genuinely sick with stomach issues, and called that doctor up and asked him what the hell he was doing sending me to them when I had real physiological issues. The truth is, most patients will accept the doctor's advice if the doctor can give an answer, any answer that's genuine. "We checked out the inflammation and we don't know why it's there, we'll keep working on it." <--- GREAT. Even the most "annoying" and inquisitive patients will accept this answer. The problem occurs when the doctor thinks him/herself too good to work with the patients by giving answers like this.
renjimen 8y ago
Good doctors are aware of their ignorance. At least in the UK continued training of GPs with the latest medical practice is normal. How quickly these findings find their way in to the latest medical practice is another question.
- GordonS 8y ago
  > At least in the UK continued training of GPs with the latest medical practice is normal At least within the NHS, my (unfortunately vast and varied) experience has been very different - GPs' knowledge varies dramatically, and many have no idea how the medications they prescribe actually work. In general, I'd say they conservative are very outdated; although to be fair, a lot of NICE guidance fits that description, and that's what they have to follow. As well as GPs, I've found consultants across multiple disciplines to have similarly outdated ways, and occasionally a shocking lack of knowledge - even about diagnoses they make. Maybe your experience is more on the private side? My own experience there is much smaller, but I have found private GPs and consultants to be much more up-to-date and knowledgeable.
  - renjimen 8y ago
    That's sad to hear. Thankfully I haven't had too much personal experience with doctors in the UK for anything serious. I have several friends and family members who are doctors, so my experience comes from talking with them. They're probably not representative, judging from your comment.
kensai 8y ago
Medical doctors ARE scientists. They are just forced from the system (insurance companies, health ministries, etc) to classify symptoms/diseases and act appropriately. It is a very regulated work and if you act out of the prescribed guidelines you risk your license. Sorry, no physician I know who studies for 10+ years will ever risk that to please a patient. Unfortunately or not, I leave it to others.
- deleted 8y ago
  [deleted]
chiefalchemist 8y ago
Oh. But they are scientists, or should be, in the sense that the scientific method is their #1 tool. - have a theory, that is a preliminary diagnosis. - look for and listen for evidence. Speak with the patient. Run some tests. - do the symptoms support the diagnosis? -- yes? Ok. Prescribe. -- no? Repeat step 2. Keep looking. Keep listening. The doctors you describe don't fail because they are (per you) not scientists. They fail because they presume that they know all; that there is nothing beyond the reach of tbeir expertise. With that mind set they ignore facts in order to avoid saying, "I don't know" or "I'm not sure." Put another way, think of how many doctors are slapping open palm to forehead and thinking "I saw that 1,000 and I ignored it." I'm not sure intentional ignorance falls under "do no harm."
singularity2001 8y ago
> Unfortunately medical doctors are not scientists. at least average/bad doctors aren't
growlist 8y ago
This matches my experience exactly, even with some of the best doctors in the country: very good at passing exams, not so good at lateral thinking.
1_over_n 8y ago
I do agreee and have actually asked many people before if they believe doctors are scientists. The sad answer is many people assume that they are (or should be). There are also researcher-clinicians who practice medicine with patients and are actively involved in research. They are much more likely to be in touch with the latest findings in that field (rather than a standard GP /doctor). I think if you had something that the medical community cant deal with the best thing to do is to do a lit review and take a stack of papers to them although i understand it's not easy for members of the public (especially with a medical ailment) to critically review scientific research. Hopefully, the latest move by the EU to remove paywalls from academic journals means more people from the general public start reading them.
matheusmoreira 8y ago
A doctor stands before a judge due to a malpractice lawsuit. Do you think they will be interested in whatever novel research he used to justify his decisions? They're going to ask what the established best practice is and why he thought the patient was special enough to deviate from it. I seriously doubt that research will better than the articles references by the numerous guidelines. Any non-standard decision is risky.
- theprotocol 8y ago
  >Any non-standard decision is risky. I disagree, there are many potential non-bog-standard decisions that are not risky and certainly better than mocking you and doing literally nothing (while still getting paid). Also: "we don't know why this happens" and a bit of two-sided discussion is satisfactory for most people.

pygy_ 8y ago

I have a medical degree (but I do not practice medicine), and this is spot on. I wouldn't generalize it to the entire profession, but many doctors behave as you describe. Generalists tend to be more humble w.r.t. not knowing everything, but specialists are often bad offenders.

Razengan 8y ago

Doctors in that sense, and similarly lawyers, seem like the best candidates to be replaced by ML/AI. Why aren't we on this yet? (or are we?) That would be one of the best applications of AI, with wide benefits for civilians the world over but also causing social upheaval and thus facing resistance from the humans it attempts to supplant.

Jgoure 8y ago
Facebook announced that they are using ML to fix compilation errors just yesterday. They said they were contracting out companies to build ASICS for the AI. We are a long way from AI making good medical decisions.
threeseed 8y ago
1. Because the health industry is about as regulated as it gets so even if ML/AI is possible there is zero chance of it being allowed to replace the advice of a doctor. 2. Because most people like seeing their doctor and talking to someone about their issues. There isn't exactly an appetite for disruption here.
- renjimen 8y ago
  To add to your second point: some conditions, such as mental health illnesses, require personal contact. Also, many people need to feel reassured when they're sick. An algorithm is not going to provide that, no matter how you dress it up.
- peteretep 8y ago
  I make reasonable use of: https://en.wikipedia.org/wiki/Dr_Fox_Pharmacy https://en.wikipedia.org/wiki/Dr_Fox_Pharmacy When I want a medicine that requires a Dr's prescription, I can go and fill out a survey on their site. A real Dr (presumably) makes the actual prescription and my drugs show up. I am much happier for not seeing a doctor or talking to someone about my issues. The survey I take isn't traditional ML/AI, but it's definitely AI, as it boots me out of the process if I answer some of the questions incorrectly. Anyway, my point is: there's already disruption here, and it's awesome.
  - Timmah 8y ago
    That's not awesome that you hacked the system to prescribe yourself anything you want. At best you're going to get the least efficient path to treatment. At worst you could miss a serious condition and kill yourself.
    - peteretep 8y ago
      I am using the system directly as it is intended to be used, exactly as the UK government is intending it is to be used. I'm not sure what you think the hack is here. How the process works is detailed here: https://www.doctorfox.co.uk/how-it-works.html https://www.doctorfox.co.uk/how-it-works.html And you can see how they're regulated in the UK here: https://www.doctorfox.co.uk/regulation.html https://www.doctorfox.co.uk/regulation.html
- pessimizer 8y ago
  > 1. Because the health industry is about as regulated as it gets so even if ML/AI is possible there is zero chance of it being allowed to replace the advice of a doctor. i.e. the necessity of an identifiable scapegoat if things turn out badly > 2. Because most people like seeing their doctor and talking to someone about their issues. There isn't exactly an appetite for disruption here. Maybe a certain type of person who craves an authority figure of some sort to soothe their fears, but I'd have to see evidence of this. Most people I know hate going to the doctor, and dislike and distrust the doctor they end up seeing as often as not. Having a friendly doctor that you've been seeing most of your life, that other members of your family see, and that you get Christmas cards from is a class thing (at least in the US) that maybe 10-15% of people get.
mrob 8y ago
In my experience, we don't need ML/AI to replace doctors. A good flowchart would do it. When your condition is on their standard list of diseases, the medical system (at least here in the UK) is a marvel of bureaucracy. Everybody works together with perfect coordination, to deliver the standard treatment at the lowest cost possible. Patient time or comfort isn't a priority, but it gets results. But as soon as you stray from their flowchart, the system is completely useless. Nobody is allowed to think for themselves, because any deviation from procedure would make the bureaucracy machine break down. As far as I can tell, the main purpose of the extensive doctor training is to raise barriers to entry and keep doctor wages up.
carapace 8y ago
> The first expert systems were created in the 1970s and then proliferated in the 1980s. Expert systems were among the first truly successful forms of artificial intelligence (AI) software. ~https://en.wikipedia.org/wiki/Expert_system https://en.wikipedia.org/wiki/Expert_system Applications include diagnosis and some systems are listed: CADUCEUS, MYCIN, PUFF, Mistral, Eydenet, Kaleidos.

threeseed 8y ago

GPs do not exist in a vacuum. They follow the advice dictated by the authorities. And the whole point of that advice is to be conservative. They aren't there to prescribe you the latest drugs or try some new cutting edge technique. They are there to present the best practice at that particular point in time. You know that whole saving lives part. And so in your case. You are coming to see your GP and are presenting some analysis that you read off the internet and are now upset that they didn't jump up and down in amazement. Well sure. They probably get that 100x a day and 99.99% of the information is probably wrong.

username3 8y ago
GPs are tier 1 support.
theprotocol 8y ago
> upset that they didn't jump up and down in amazement There's that aggression again. No, I'm upset about paying someone who mocked me and decided not to do any work because I was too pathetic for someone of his/her status. I am an expert in my field. Many people I work with suggest things that I know to be wrong. I have NEVER mocked or acted vengeful. If they choose to continue with their ideas that I disagree with, that's their right. Is it really that hard to be respectful? In every event that I've related in my posts, it was the doctor who was unwilling to give the most basic level of respect.
- toxik 8y ago
  I see your point, but also you do not give health advice to other people as a profession. It's more akin to the mechanic dealing with people coming in with cars that almost all have the same issues, but then every now and then somebody reads something online about some extravagant maybe-it's-lupus kind of diagnosis, and they just roll their eyes.
  - theprotocol 8y ago
    That assumes the expert has actually given an answer to my questions, in which case, you'd be 100% right. Even a "we don't know why this happens yet, here's what we know about it: ..." would be more than satisfactory. Just give me something! But when the expert has nothing to say, yet mocks my questions and even just my reporting of what is happening to me, as he very eagerly waits for me to leave so he can get paid... Then there's not much more I can do than read on the Internet. Some throw in a veiled insult by suggesting I should be sent to a psych ward for my "panic attacks." You might say it's not an insult, but I accepted the psychiatric evaluation once - and then a whole team of psychiatrists determined after 2 weeks that I was genuinely sick with stomach issues, and called that doctor up and asked him what the hell he was doing sending me to them when I had real physiological issues. The truth is, most patients will accept the doctor's advice if the doctor can give an answer, any answer that's genuine. "We checked out the inflammation and we don't know why it's there, we'll keep working on it." <--- GREAT. Even the most "annoying" and inquisitive patients will accept this answer. The problem occurs when the doctor thinks him/herself too good to work with the patients by giving answers like this.

renjimen 8y ago

Good doctors are aware of their ignorance. At least in the UK continued training of GPs with the latest medical practice is normal. How quickly these findings find their way in to the latest medical practice is another question.

GordonS 8y ago
> At least in the UK continued training of GPs with the latest medical practice is normal At least within the NHS, my (unfortunately vast and varied) experience has been very different - GPs' knowledge varies dramatically, and many have no idea how the medications they prescribe actually work. In general, I'd say they conservative are very outdated; although to be fair, a lot of NICE guidance fits that description, and that's what they have to follow. As well as GPs, I've found consultants across multiple disciplines to have similarly outdated ways, and occasionally a shocking lack of knowledge - even about diagnoses they make. Maybe your experience is more on the private side? My own experience there is much smaller, but I have found private GPs and consultants to be much more up-to-date and knowledgeable.
- renjimen 8y ago
  That's sad to hear. Thankfully I haven't had too much personal experience with doctors in the UK for anything serious. I have several friends and family members who are doctors, so my experience comes from talking with them. They're probably not representative, judging from your comment.

kensai 8y ago

Medical doctors ARE scientists. They are just forced from the system (insurance companies, health ministries, etc) to classify symptoms/diseases and act appropriately. It is a very regulated work and if you act out of the prescribed guidelines you risk your license. Sorry, no physician I know who studies for 10+ years will ever risk that to please a patient. Unfortunately or not, I leave it to others.

deleted 8y ago
[deleted]

chiefalchemist 8y ago

Oh. But they are scientists, or should be, in the sense that the scientific method is their #1 tool. - have a theory, that is a preliminary diagnosis. - look for and listen for evidence. Speak with the patient. Run some tests. - do the symptoms support the diagnosis? -- yes? Ok. Prescribe. -- no? Repeat step 2. Keep looking. Keep listening. The doctors you describe don't fail because they are (per you) not scientists. They fail because they presume that they know all; that there is nothing beyond the reach of tbeir expertise. With that mind set they ignore facts in order to avoid saying, "I don't know" or "I'm not sure." Put another way, think of how many doctors are slapping open palm to forehead and thinking "I saw that 1,000 and I ignored it." I'm not sure intentional ignorance falls under "do no harm."

singularity2001 8y ago

> Unfortunately medical doctors are not scientists. at least average/bad doctors aren't

growlist 8y ago

This matches my experience exactly, even with some of the best doctors in the country: very good at passing exams, not so good at lateral thinking.

1_over_n 8y ago

I do agreee and have actually asked many people before if they believe doctors are scientists. The sad answer is many people assume that they are (or should be). There are also researcher-clinicians who practice medicine with patients and are actively involved in research. They are much more likely to be in touch with the latest findings in that field (rather than a standard GP /doctor). I think if you had something that the medical community cant deal with the best thing to do is to do a lit review and take a stack of papers to them although i understand it's not easy for members of the public (especially with a medical ailment) to critically review scientific research. Hopefully, the latest move by the EU to remove paywalls from academic journals means more people from the general public start reading them.

matheusmoreira 8y ago

A doctor stands before a judge due to a malpractice lawsuit. Do you think they will be interested in whatever novel research he used to justify his decisions? They're going to ask what the established best practice is and why he thought the patient was special enough to deviate from it. I seriously doubt that research will better than the articles references by the numerous guidelines. Any non-standard decision is risky.

theprotocol 8y ago
>Any non-standard decision is risky. I disagree, there are many potential non-bog-standard decisions that are not risky and certainly better than mocking you and doing literally nothing (while still getting paid). Also: "we don't know why this happens" and a bit of two-sided discussion is satisfactory for most people.