6 ms·

>If you don't have a knowledge base, you simply can not practice medicine because you don't understand how things actually work... Nonsense. Why does a heart

by treis 8y ago

>If you don't have a knowledge base, you simply can not practice medicine because you don't understand how things actually work... Nonsense. Why does a heart surgeon need to know anything about psychiatry? What does a radiologist need to know about cellular biology? The equivalent for programming would be forcing someone to understand how transistors work at the atomic level, CPU architecture, and OS structure before letting them write a webapp. It's definitely one of the problems in medicine. There's way too much useless knowledge required leading to a limited supply of people being able and willing to master it. Plus, it makes it much more expensive and time consuming to train all of those people.

riahi 8y ago
As a radiologist, I have to know a lot about cellular biology to understand and predict the imaging manifestations of cellular disease. You can’t just delete the baseline foundational knowledge.
- treis 8y ago
  >As a radiologist, I have to know a lot about cellular biology to understand and predict the imaging manifestations of cellular disease. A given radiologist shouldn't be predicting the imaging manifestation of cellular disease. They should be using their knowledge of how known diseases or conditions appear on scans to diagnose the issue. The people that need to understand things on a deeper level are the ones trying to devise new tests or scans to expand front line radiologists diagnostic abilities.
  - natalyarostova 8y ago
    It's pretty wild you're telling a practicing radiologist how they should be doing their job.
    - treis 8y ago
      One of the problems with letting people in a profession set the requirements for that profession is that they exaggerate them to limit competition and increase their earnings. You end up with things like radiologists saying they need to know cellular biology. It's simply ludicrous on its face. Radiology is a particularly egregious case. If it weren't for legal protection the profession would be dramatically different. It's obviously stupid to spend a bunch of time training them to interpret and diagnosis a bunch of different scans. Basic efficiency would be to train Person A to interpret chest X-Rays, person B to do CT scans, Person C for leg X-rays and have them spend all day doing that one thing. Instead, radiologists spend a decade learning how to interpret a hundred different things and spend 1/100 of their time on each of them.
      - assblaster 8y ago
        How do you interpret an image if you don't have an understanding of what is in it? In other words, let's say that a patient has a fever. Chest X-ray was done. High-school educated "radiologist" sees the image. Does he understand the anatomy? The variations of anatomy? Pathological manifestations of potential causes of fever? How to exclude image artifact versus include potential sign of pathology? What about findings that are not related to fever but need to be identified, further characterised and further imaging required for follow-up? What about signs of infectious fluid versus non-infectious fluid like blood or extravasated fluid? What about when the ordering physician wants to discuss the findings with the "radiologist"? Will that "radiologist" actually understand anything that the physician is talking about? There is a role for AI assisting in rapid analysis of radiological studies, however radiologists can never be replaced because AI will never perform to the level of or have the same functions as a physician radiologist.
        treis 8y ago
        >How do you interpret an image if you don't have an understanding of what is in it? Because you're looking to identify patterns and match them to known ones. To use an analogy, I can teach you to identify statues of Hindu Gods without teaching you anything about Hinduism. For example, to identify Ganesh you need to know that he has an elephant head. Knowing that he has an elephant head because Shiva cut his human head off doesn't really help you. >In other words, let's say that a patient has a fever. Chest X-ray was done. >High-school educated "radiologist" sees the image. Does he understand the anatomy? The variations of anatomy? Pathological manifestations of potential causes of fever? How to exclude image artifact versus include potential sign of pathology? What about findings that are not related to fever but need to be identified, further characterised and further imaging required for follow-up? What about signs of infectious fluid versus non-infectious fluid like blood or extravasated fluid? All of the things you mentioned are things that a radiologist interpreting a chest X-ray needs to know. What you need to explain is why someone interpreting a chest X-ray needs to understand Organic Chemistry. And the vein structure of the leg. And the typical development pattern of a child. And the various mental illnesses a person might have. And interpret a knee MRI. >There is a role for AI assisting in rapid analysis of radiological studies, however radiologists can never be replaced because AI will never perform to the level of or have the same functions as a physician radiologist. No, but I could easily take 10 people, train them each 1/10th of what a radiologist studies, and have them perform just as well as 10 radiologists by routing the right stuff to the right person.
  - nradov 8y ago
    The level of aggressive ignorance displayed in comments like this is quite shocking. I'm puzzled as to why engineers and developers think they're qualified to give advice to other professionals in fields where they have no education or experience. What causes that type of hubris?
ams6110 8y ago
Knowing about CPU architecture and OS structure helps me to reason about the application code I write. Do I understand those things as much as someone who specializes in them? No of course not. But a certain level of baseline knowledge does have its benefits.
- treis 8y ago
  Baseline? Sure. But that's not what med school is. It's the equivalent of a masters level course on a dozen different topics.
  - ams6110 8y ago
    Medicine is more complicated than computing.
    - deleted 8y ago
      [deleted]
    - treis 8y ago
      Is it? They seem to follow a pretty similar career arc. If you take a typical CS grad they're going to go through a couple years as a junior dev, couple more as a more senior one, and then five years or more in they are ready to be in charge of their own project. That's pretty similar to the intern -> resident -> attending pattern that doctors follow. Honestly, the biggest difference between having a career in programming and being a doctor is the gate keeping. In programming, you can drop out of high school and 20 years later be an expert in the field. There's a path for talented people to go from junior -> dev -> senior -> lead -> principle -> whatever. There's no path like that in medicine. Sure, as a nurse you can go from LPN -> RN -> NP but that's where it ends. Your only option at that point is to spend 4 years and hundreds of thousands of dollars. And there's really no reason for that.
    - gbear605 8y ago
      They’re not directly comparable topics like that. A doctor definitely needs to know more than a computer scientist. But all of medicine compared to all of computer science is not an easy comparison to accurately make, since they’re both such broad topics - in medicine, everything from psychology to pharmocology to genetic engineering - in computer science, everything from transistors to complex mathematics to artificial intelligence safety. They’re both topics that are impossible for one human to understand in entirety, but society requires doctors to know a lot more of medicine.
assblaster 8y ago
>Why does a heart surgeon need to know anything about psychiatry? Heart surgeons have patients with psychiatric problems. And patients are typically on psychiatric medications, which have cardiac side effects. More broadly, heart surgeons are also general surgeons, and some psychiatry base knowledge is necessary to understand their patients. Heart surgeons don't have to be psychiatrists, but they need some knowledge in it, which is why it's a 4 week rotation in medical school.
- treis 8y ago
  >Heart surgeons have patients with psychiatric problems. Which they don't treat. That's why we have psychiatrists. >And patients are typically on psychiatric medications, which have cardiac side effects. Which is something a cardiologist should know. Knowing which mental illness they treat and how it does that isn't relevant.
  - DanBC 8y ago
    > >Heart surgeons have patients with psychiatric problems. > Which they don't treat. That's why we have psychiatrists. People with mental illness also have heart problems that need heart surgery. It'd be nice if heart surgeons had a bit of understanding of psychiatry so they can avoid diagnostic overshadowing. This is a significant problem that contributes to the shorted lifespan of people with severe mental illness. https://meta4rn.com/2018/12/15/shadow/ https://meta4rn.com/2018/12/15/shadow/
    - treis 8y ago
      How to treat heart problems in the mentally ill would be useful training for a cardiologist. How to treat mental illness isn't.
  - markroseman 8y ago
    Compliance with medication regimes and followup care can affect outcomes in cardiology, as in other areas. Understanding a patient's psychiatric illness, psychosocial functioning, and other factors can help predict treatment compliance. That in turn may influence the treatment regime the cardiologist recommends. Medications that are prone to abuse, ones that may be more complex to take, ones that can be dangerous if someone takes too many... all are things the cardiologist should be aware of which takes some basic psychiatric knowledge. There are few in cardiology, but many physical health meds can definitely create psychiatric side effects. How do you differentiate those from an existing psychiatric illness? There's a large body of literature that recognizes the links between cardiac care and mental health, resulting in poorer outcomes, increased system utilization and costs, etc. Saying "this is my area, that's yours" exacerbates this problem.
jacques_chester 8y ago
> Nonsense. Why does a heart surgeon need to know anything about psychiatry? What does a radiologist need to know about cellular biology? Medicine doesn't resemble neatly modulular systems with crisp APIs. A nodding familiarity with distant specialities is required because very frequently a patient cannot be well-treated by a single specialist. I have a psychiatrist, an endocrinologist and an orthopaedic surgeon. They all take an intense interest in what the others have investigated, diagnosed or treated. More to the point, they have enough overlapping knowledge to profit from their interest. > The equivalent for programming would be forcing someone to understand how transistors work at the atomic level, CPU architecture, and OS structure before letting them write a webapp. Webapps don't often come down to distinguishing between conditions which are benign through uncomfortable, disruptive, disabling up to fatal, and besides, our hardware cousins have striven mightily to hide the messiness of reality from us. Medicine doesn't have improvable subject matter to protect it in the same way.

by treis 8y ago

riahi 8y ago

As a radiologist, I have to know a lot about cellular biology to understand and predict the imaging manifestations of cellular disease. You can’t just delete the baseline foundational knowledge.

treis 8y ago
>As a radiologist, I have to know a lot about cellular biology to understand and predict the imaging manifestations of cellular disease. A given radiologist shouldn't be predicting the imaging manifestation of cellular disease. They should be using their knowledge of how known diseases or conditions appear on scans to diagnose the issue. The people that need to understand things on a deeper level are the ones trying to devise new tests or scans to expand front line radiologists diagnostic abilities.
- natalyarostova 8y ago
  It's pretty wild you're telling a practicing radiologist how they should be doing their job.
  - treis 8y ago
    One of the problems with letting people in a profession set the requirements for that profession is that they exaggerate them to limit competition and increase their earnings. You end up with things like radiologists saying they need to know cellular biology. It's simply ludicrous on its face. Radiology is a particularly egregious case. If it weren't for legal protection the profession would be dramatically different. It's obviously stupid to spend a bunch of time training them to interpret and diagnosis a bunch of different scans. Basic efficiency would be to train Person A to interpret chest X-Rays, person B to do CT scans, Person C for leg X-rays and have them spend all day doing that one thing. Instead, radiologists spend a decade learning how to interpret a hundred different things and spend 1/100 of their time on each of them.
    - assblaster 8y ago
      How do you interpret an image if you don't have an understanding of what is in it? In other words, let's say that a patient has a fever. Chest X-ray was done. High-school educated "radiologist" sees the image. Does he understand the anatomy? The variations of anatomy? Pathological manifestations of potential causes of fever? How to exclude image artifact versus include potential sign of pathology? What about findings that are not related to fever but need to be identified, further characterised and further imaging required for follow-up? What about signs of infectious fluid versus non-infectious fluid like blood or extravasated fluid? What about when the ordering physician wants to discuss the findings with the "radiologist"? Will that "radiologist" actually understand anything that the physician is talking about? There is a role for AI assisting in rapid analysis of radiological studies, however radiologists can never be replaced because AI will never perform to the level of or have the same functions as a physician radiologist.
      - treis 8y ago
        >How do you interpret an image if you don't have an understanding of what is in it? Because you're looking to identify patterns and match them to known ones. To use an analogy, I can teach you to identify statues of Hindu Gods without teaching you anything about Hinduism. For example, to identify Ganesh you need to know that he has an elephant head. Knowing that he has an elephant head because Shiva cut his human head off doesn't really help you. >In other words, let's say that a patient has a fever. Chest X-ray was done. >High-school educated "radiologist" sees the image. Does he understand the anatomy? The variations of anatomy? Pathological manifestations of potential causes of fever? How to exclude image artifact versus include potential sign of pathology? What about findings that are not related to fever but need to be identified, further characterised and further imaging required for follow-up? What about signs of infectious fluid versus non-infectious fluid like blood or extravasated fluid? All of the things you mentioned are things that a radiologist interpreting a chest X-ray needs to know. What you need to explain is why someone interpreting a chest X-ray needs to understand Organic Chemistry. And the vein structure of the leg. And the typical development pattern of a child. And the various mental illnesses a person might have. And interpret a knee MRI. >There is a role for AI assisting in rapid analysis of radiological studies, however radiologists can never be replaced because AI will never perform to the level of or have the same functions as a physician radiologist. No, but I could easily take 10 people, train them each 1/10th of what a radiologist studies, and have them perform just as well as 10 radiologists by routing the right stuff to the right person.
- nradov 8y ago
  The level of aggressive ignorance displayed in comments like this is quite shocking. I'm puzzled as to why engineers and developers think they're qualified to give advice to other professionals in fields where they have no education or experience. What causes that type of hubris?

ams6110 8y ago

Knowing about CPU architecture and OS structure helps me to reason about the application code I write. Do I understand those things as much as someone who specializes in them? No of course not. But a certain level of baseline knowledge does have its benefits.

treis 8y ago
Baseline? Sure. But that's not what med school is. It's the equivalent of a masters level course on a dozen different topics.
- ams6110 8y ago
  Medicine is more complicated than computing.
  - deleted 8y ago
    [deleted]
  - treis 8y ago
    Is it? They seem to follow a pretty similar career arc. If you take a typical CS grad they're going to go through a couple years as a junior dev, couple more as a more senior one, and then five years or more in they are ready to be in charge of their own project. That's pretty similar to the intern -> resident -> attending pattern that doctors follow. Honestly, the biggest difference between having a career in programming and being a doctor is the gate keeping. In programming, you can drop out of high school and 20 years later be an expert in the field. There's a path for talented people to go from junior -> dev -> senior -> lead -> principle -> whatever. There's no path like that in medicine. Sure, as a nurse you can go from LPN -> RN -> NP but that's where it ends. Your only option at that point is to spend 4 years and hundreds of thousands of dollars. And there's really no reason for that.
  - gbear605 8y ago
    They’re not directly comparable topics like that. A doctor definitely needs to know more than a computer scientist. But all of medicine compared to all of computer science is not an easy comparison to accurately make, since they’re both such broad topics - in medicine, everything from psychology to pharmocology to genetic engineering - in computer science, everything from transistors to complex mathematics to artificial intelligence safety. They’re both topics that are impossible for one human to understand in entirety, but society requires doctors to know a lot more of medicine.

assblaster 8y ago

>Why does a heart surgeon need to know anything about psychiatry? Heart surgeons have patients with psychiatric problems. And patients are typically on psychiatric medications, which have cardiac side effects. More broadly, heart surgeons are also general surgeons, and some psychiatry base knowledge is necessary to understand their patients. Heart surgeons don't have to be psychiatrists, but they need some knowledge in it, which is why it's a 4 week rotation in medical school.

treis 8y ago
>Heart surgeons have patients with psychiatric problems. Which they don't treat. That's why we have psychiatrists. >And patients are typically on psychiatric medications, which have cardiac side effects. Which is something a cardiologist should know. Knowing which mental illness they treat and how it does that isn't relevant.
- DanBC 8y ago
  > >Heart surgeons have patients with psychiatric problems. > Which they don't treat. That's why we have psychiatrists. People with mental illness also have heart problems that need heart surgery. It'd be nice if heart surgeons had a bit of understanding of psychiatry so they can avoid diagnostic overshadowing. This is a significant problem that contributes to the shorted lifespan of people with severe mental illness. https://meta4rn.com/2018/12/15/shadow/ https://meta4rn.com/2018/12/15/shadow/
  - treis 8y ago
    How to treat heart problems in the mentally ill would be useful training for a cardiologist. How to treat mental illness isn't.
- markroseman 8y ago
  Compliance with medication regimes and followup care can affect outcomes in cardiology, as in other areas. Understanding a patient's psychiatric illness, psychosocial functioning, and other factors can help predict treatment compliance. That in turn may influence the treatment regime the cardiologist recommends. Medications that are prone to abuse, ones that may be more complex to take, ones that can be dangerous if someone takes too many... all are things the cardiologist should be aware of which takes some basic psychiatric knowledge. There are few in cardiology, but many physical health meds can definitely create psychiatric side effects. How do you differentiate those from an existing psychiatric illness? There's a large body of literature that recognizes the links between cardiac care and mental health, resulting in poorer outcomes, increased system utilization and costs, etc. Saying "this is my area, that's yours" exacerbates this problem.

jacques_chester 8y ago

> Nonsense. Why does a heart surgeon need to know anything about psychiatry? What does a radiologist need to know about cellular biology? Medicine doesn't resemble neatly modulular systems with crisp APIs. A nodding familiarity with distant specialities is required because very frequently a patient cannot be well-treated by a single specialist. I have a psychiatrist, an endocrinologist and an orthopaedic surgeon. They all take an intense interest in what the others have investigated, diagnosed or treated. More to the point, they have enough overlapping knowledge to profit from their interest. > The equivalent for programming would be forcing someone to understand how transistors work at the atomic level, CPU architecture, and OS structure before letting them write a webapp. Webapps don't often come down to distinguishing between conditions which are benign through uncomfortable, disruptive, disabling up to fatal, and besides, our hardware cousins have striven mightily to hide the messiness of reality from us. Medicine doesn't have improvable subject matter to protect it in the same way.