3 ms·

I taught medical students in a top-5 medical school and know how the sausage got made. They're great at the things I listed: trauma care, treatment of acute co

I taught medical students in a top-5 medical school and know how the sausage got made. They're great at the things I listed: trauma care, treatment of acute conditions, the concept of vitamins and use of antibiotics. For stuff involving chronic conditions, or even nutrition advice, they appear to be worse than useless.

YeGoblynQueenne 7y ago
This is not my experience. My experience is that- it's a mixed bag. I ... don't like to discuss personal medical details online of course. But, I recently had a dry cough that didn't go away after many months and I was obviously shitting bricks (though I don't smoke) so I went to my GP. She prescribed ...antacids. I left frustrated, and incomprehending, but of course she knows I have an ulcer, and it seems that the acid coming up my esophagus is irritating my vocal cords. Note that she didn't sit down at her computer and google my symptoms or anything like that. Our meeting took all of 5 minutes (stupid NHS guidelines...) which is btw why she had no time to explain and I had to look up things myself. But she got it right. In 5 minutes time and under the pressure of a couple dozen other patients in the waiting room. It reminded me of stories about machine learning systems modelling some complex dataset and coming up with surprising results that initially leave researchers bewildered, until digging a bit reveals the accuracy of the model. Perhaps teaching medical students rather than practicing yourself is skewing your view a bit (you didn't say you are actually a doctor though)? I have respect for doctors' intuition, but maybe, on my part, I'm just impressed because of my own lack of knowledge. On the other hand, another doctor I see for a chronic condition I don't want to discuss online is completely useless and has all the intuition and skill of a boiled piece of cabbage. But that's not a tale for HN.
- scottlocklin 7y ago
  I'm not a doctor of medicine; my course (experimental physics methods; basically something where they learn something approximating general diagnosis skills) was a weeder for medical students. I am in abundant agreement with you that some doctors are amazing and some are cabbage brained imbeciles. The point I'm trying to make here is that for squishy complex chronic conditions like hyperlipidemia, I don't think even the very good ones are well equipped to know what they're talking about unless they spend a lot of time reviewing the literature (and even then, if they act on it, they may be voiding their malpractice insurance terms among other things). T-tests on the differences in outcomes are fairly difficult to interpret for researchers; it's impossible to eyeball and make sense of it with the samples a GP is exposed to. There's all kinds of confounding bias as well; they don't see people who don't go to the doctor, have the condition (such as it is) and do fine without any intervention. As such, they basically stick with the prevailing ideology. And they get this ideology wrong all the time. It's not their fault; it's just how the world works. For myself, I build in a discount term for doctor advice based on what the issue is. Basically if doctors are provably good at treating an illness; I will shut my cake hole and obey. If they're not, I'm at least going to dig into the literature. FWIIW an anecdote for you: Andy Sessler, the former director of LBNL developed a brain tumor while running the place. He had access to the very best treatment in the world, including the Bevatron proton bombardment technique, but he chose to adopt some kind of macrobiotic diet and take up running (founding the LBNL runaround in the process). I think the tumors eventually killed him; 35 years after he was diagnosed. I didn't know him beyond seeing him around at seminars and runarounds and such, but I assume his gamble was based on a deep understanding of how the stats on the disease treatments played out.
  - YeGoblynQueenne 7y ago
    Thanks for a good conversation :)

YeGoblynQueenne 7y ago

This is not my experience. My experience is that- it's a mixed bag. I ... don't like to discuss personal medical details online of course. But, I recently had a dry cough that didn't go away after many months and I was obviously shitting bricks (though I don't smoke) so I went to my GP. She prescribed ...antacids. I left frustrated, and incomprehending, but of course she knows I have an ulcer, and it seems that the acid coming up my esophagus is irritating my vocal cords. Note that she didn't sit down at her computer and google my symptoms or anything like that. Our meeting took all of 5 minutes (stupid NHS guidelines...) which is btw why she had no time to explain and I had to look up things myself. But she got it right. In 5 minutes time and under the pressure of a couple dozen other patients in the waiting room. It reminded me of stories about machine learning systems modelling some complex dataset and coming up with surprising results that initially leave researchers bewildered, until digging a bit reveals the accuracy of the model. Perhaps teaching medical students rather than practicing yourself is skewing your view a bit (you didn't say you are actually a doctor though)? I have respect for doctors' intuition, but maybe, on my part, I'm just impressed because of my own lack of knowledge. On the other hand, another doctor I see for a chronic condition I don't want to discuss online is completely useless and has all the intuition and skill of a boiled piece of cabbage. But that's not a tale for HN.

scottlocklin 7y ago
I'm not a doctor of medicine; my course (experimental physics methods; basically something where they learn something approximating general diagnosis skills) was a weeder for medical students. I am in abundant agreement with you that some doctors are amazing and some are cabbage brained imbeciles. The point I'm trying to make here is that for squishy complex chronic conditions like hyperlipidemia, I don't think even the very good ones are well equipped to know what they're talking about unless they spend a lot of time reviewing the literature (and even then, if they act on it, they may be voiding their malpractice insurance terms among other things). T-tests on the differences in outcomes are fairly difficult to interpret for researchers; it's impossible to eyeball and make sense of it with the samples a GP is exposed to. There's all kinds of confounding bias as well; they don't see people who don't go to the doctor, have the condition (such as it is) and do fine without any intervention. As such, they basically stick with the prevailing ideology. And they get this ideology wrong all the time. It's not their fault; it's just how the world works. For myself, I build in a discount term for doctor advice based on what the issue is. Basically if doctors are provably good at treating an illness; I will shut my cake hole and obey. If they're not, I'm at least going to dig into the literature. FWIIW an anecdote for you: Andy Sessler, the former director of LBNL developed a brain tumor while running the place. He had access to the very best treatment in the world, including the Bevatron proton bombardment technique, but he chose to adopt some kind of macrobiotic diet and take up running (founding the LBNL runaround in the process). I think the tumors eventually killed him; 35 years after he was diagnosed. I didn't know him beyond seeing him around at seminars and runarounds and such, but I assume his gamble was based on a deep understanding of how the stats on the disease treatments played out.
- YeGoblynQueenne 7y ago
  Thanks for a good conversation :)