6 ms·

Similar story: I went to the doctor with sharp hip pain a few years back, aged 32, relatively fit (running 5 miles every workday and swimming 1+ mile most days)

by Fezzik 6y ago

Similar story: I went to the doctor with sharp hip pain a few years back, aged 32, relatively fit (running 5 miles every workday and swimming 1+ mile most days), but the hip pain was getting worse by the day. I was referred to a surgeon who wanted to re-route tendons or ligaments in my hips. It made no sense to me. I realized, with a little reflection, that I had been wearing heeled dress shoes far more than I normally did. I started wearing zero-drop shoes and the pain went away in a few days. Neither the GP nor the surgeon did any digging about possible causes.

tdrp 6y ago
Dealing with some specialists feels like dealing with automated bots. They almost sound like they follow a script down to the letter. If A then prescribe B, then C. And almost never look at the big picture. And every symptom that happens they tend to shoehorn into their own specialization, and not realize that it might be an indication that the problem lies elsewhere.
- lhuser123 6y ago
  And after a few minutes they start signaling that the conversation is about to end.
- phobosanomaly 6y ago
  In medicine there is a lot of emphasis placed behind evidence-based approaches. The alternative is an experience-based approach (the more fluid approach you're describing). The problem with experience-based approaches are that they're hard to evaluate since it's impossible to standardize, and they may open the provider up to risk of litigation. As a result, an evidence-based mindset may result in the algorithmic behavior you describe. We don't have a good codified way to standardize the practitioner's balance between evidence-based and experience-based, so it's a bit up in the air right now. Medicine is really, really hard to do well. Love to hear from anyone with a different take.
  - alexvoda 6y ago
    This is going to sound harsh but I feel it is true and inevitable. If you are not using an experience-based approach you are not doing your job. People seek doctors precisely because they are supposed to have experience. Medical school is many years long precisely so you can build that experience. If you just execute algorithms based on evidence you are a prime target for automation. Those in my profession (software) will automate your role away and do it better and faster and more available and more reliable. Because you make it easy for us. We may be cursed to solve only 80% of any problem but if you solve even less, we still end up ahead. My point, all of the interest and investment in AI diagnosis (IBM Watson comes to mind, but the field is decades old) is caused precisely by the poor practices in the medical field. It is of course naive to think we will solve medicine with software. But we only need to be better than average just like self driving cars are not aming to be perfect, just better than average. Be a HUMAN doctor and we will need AGI to replace you. Be a robot and you will be replaced by an actual robot. (note: I do not believe technology is the solution here. I am just a bit pissed after a doctor prescribed stuff without even touching or looking at an acquaintance.)
    - phobosanomaly 6y ago
      Not saying I disagree with your sentiment, but the idea behind evidence-based medicine is that it's effectiveness can be demonstrated through a randomized control trial. Experience-based medicine cannot. So, it's tricky because we want to identify those treatments that actually work based on objective clinical data, as well as those that clinicians have anecdotally found effective based on experience. And do we want treatments that have been demonstrated to work, or treatments that are based on a provider's best judgement? That's not an easy question to answer. The benefits of demonstrated effect are balanced with those you describe of the experience-based approach. It's a gray area. You just can't AI-away an ER doc (at least not with current tech). Something's got to interview, intubate, suture, palpate, and prescribe all those bleeding, festering, diabetic masses flowing into the ER like the tide of the Thames. Note the downside, an ER doc is a very exhausted, burned-out human, prone to error. I'm sorry about your acquaintance, I'd be pissed too. You definitely have a right to be!
phobosanomaly 6y ago
That's one of the reasons why medicine is tricky. Sit down and come up with every single possible cause of that pain, from something random and physiological, to something psychological, to something you may be doing, but may be embarrassed to talk about, to shoes, to pants, to your belt, to your cell phone holster, to the wallet you sit on, to the chair you use at work, to referred pain, to a myopathy, to a pulled muscle, to a whatever. What if during those morning runs one side of the street where your left foot falls is a slightly different height than the other side where your right foot falls and that was causing the pain? What if you keep smacking your hip on the edge of the pool? What if you tread water weird? That's what you're asking a general practitioner to do perfectly in 20 minutes, who then would also have to know every single weird possible cause of every other possible thing a human being could wander into the office complaining of, a nonzero percentage of which is totally imaginary. You are far, far better at knowing every strange element of your daily routine that may be causing you bodily discomfort. No doctor can reasonably sort all of that out for every patient, let alone a GP who is supposed to know everything about everything. It's like the office HR person doing WFH asking the tech guys to diagnose their computer that is bugging out because the HR person's cat unknowingly puked on the case and it leaked onto the motherboard the night before. All in 20 minutes. Then the HR person gets mad because the tech guys didn't specifically ask "is there any possibility that an animal may have vomited on the motherboard?" I don't mean to belittle your experience in any way, I'm just trying to make my comment entertaining so you might chuckle at it, but does my point make sense?
- tdrp 6y ago
  Yes, except OP being offered surgery for "ligament and tendon rerouting" as the solution to a problem the doctors spent just a few minutes understanding is the equivalent of your IT guy above suggesting the HR person open up their computer and reroute a bunch of wires, and take out a bunch of capacitors, to "see if it helps".
  - phobosanomaly 6y ago
    I will push back a little bit, because I'm curious to see if anyone has a good argument for why I'm wrong on this. I would say that it's the equivalent of having the HR person mail their computer in, swapping out the motherboard, and mailing it back. This is, from my experience, what most IT departments actually do in this sort of situation. Maybe I'm wrong. I'm not an IT guy. The surgeons proposed to directly fix the problem. I don't see a good alternative proposal for their team to make, given imperfect information about every patient. What is a plausible mechanism for a real-world physician to intricately investigate every moment of every patient's personal life to get to the elemental root cause of every single illness? Someone would have to follow them around 24/7 with a video camera.

by Fezzik 6y ago

tdrp 6y ago

Dealing with some specialists feels like dealing with automated bots. They almost sound like they follow a script down to the letter. If A then prescribe B, then C. And almost never look at the big picture. And every symptom that happens they tend to shoehorn into their own specialization, and not realize that it might be an indication that the problem lies elsewhere.

lhuser123 6y ago
And after a few minutes they start signaling that the conversation is about to end.
phobosanomaly 6y ago
In medicine there is a lot of emphasis placed behind evidence-based approaches. The alternative is an experience-based approach (the more fluid approach you're describing). The problem with experience-based approaches are that they're hard to evaluate since it's impossible to standardize, and they may open the provider up to risk of litigation. As a result, an evidence-based mindset may result in the algorithmic behavior you describe. We don't have a good codified way to standardize the practitioner's balance between evidence-based and experience-based, so it's a bit up in the air right now. Medicine is really, really hard to do well. Love to hear from anyone with a different take.
- alexvoda 6y ago
  This is going to sound harsh but I feel it is true and inevitable. If you are not using an experience-based approach you are not doing your job. People seek doctors precisely because they are supposed to have experience. Medical school is many years long precisely so you can build that experience. If you just execute algorithms based on evidence you are a prime target for automation. Those in my profession (software) will automate your role away and do it better and faster and more available and more reliable. Because you make it easy for us. We may be cursed to solve only 80% of any problem but if you solve even less, we still end up ahead. My point, all of the interest and investment in AI diagnosis (IBM Watson comes to mind, but the field is decades old) is caused precisely by the poor practices in the medical field. It is of course naive to think we will solve medicine with software. But we only need to be better than average just like self driving cars are not aming to be perfect, just better than average. Be a HUMAN doctor and we will need AGI to replace you. Be a robot and you will be replaced by an actual robot. (note: I do not believe technology is the solution here. I am just a bit pissed after a doctor prescribed stuff without even touching or looking at an acquaintance.)
  - phobosanomaly 6y ago
    Not saying I disagree with your sentiment, but the idea behind evidence-based medicine is that it's effectiveness can be demonstrated through a randomized control trial. Experience-based medicine cannot. So, it's tricky because we want to identify those treatments that actually work based on objective clinical data, as well as those that clinicians have anecdotally found effective based on experience. And do we want treatments that have been demonstrated to work, or treatments that are based on a provider's best judgement? That's not an easy question to answer. The benefits of demonstrated effect are balanced with those you describe of the experience-based approach. It's a gray area. You just can't AI-away an ER doc (at least not with current tech). Something's got to interview, intubate, suture, palpate, and prescribe all those bleeding, festering, diabetic masses flowing into the ER like the tide of the Thames. Note the downside, an ER doc is a very exhausted, burned-out human, prone to error. I'm sorry about your acquaintance, I'd be pissed too. You definitely have a right to be!

phobosanomaly 6y ago

That's one of the reasons why medicine is tricky. Sit down and come up with every single possible cause of that pain, from something random and physiological, to something psychological, to something you may be doing, but may be embarrassed to talk about, to shoes, to pants, to your belt, to your cell phone holster, to the wallet you sit on, to the chair you use at work, to referred pain, to a myopathy, to a pulled muscle, to a whatever. What if during those morning runs one side of the street where your left foot falls is a slightly different height than the other side where your right foot falls and that was causing the pain? What if you keep smacking your hip on the edge of the pool? What if you tread water weird? That's what you're asking a general practitioner to do perfectly in 20 minutes, who then would also have to know every single weird possible cause of every other possible thing a human being could wander into the office complaining of, a nonzero percentage of which is totally imaginary. You are far, far better at knowing every strange element of your daily routine that may be causing you bodily discomfort. No doctor can reasonably sort all of that out for every patient, let alone a GP who is supposed to know everything about everything. It's like the office HR person doing WFH asking the tech guys to diagnose their computer that is bugging out because the HR person's cat unknowingly puked on the case and it leaked onto the motherboard the night before. All in 20 minutes. Then the HR person gets mad because the tech guys didn't specifically ask "is there any possibility that an animal may have vomited on the motherboard?" I don't mean to belittle your experience in any way, I'm just trying to make my comment entertaining so you might chuckle at it, but does my point make sense?

tdrp 6y ago
Yes, except OP being offered surgery for "ligament and tendon rerouting" as the solution to a problem the doctors spent just a few minutes understanding is the equivalent of your IT guy above suggesting the HR person open up their computer and reroute a bunch of wires, and take out a bunch of capacitors, to "see if it helps".
- phobosanomaly 6y ago
  I will push back a little bit, because I'm curious to see if anyone has a good argument for why I'm wrong on this. I would say that it's the equivalent of having the HR person mail their computer in, swapping out the motherboard, and mailing it back. This is, from my experience, what most IT departments actually do in this sort of situation. Maybe I'm wrong. I'm not an IT guy. The surgeons proposed to directly fix the problem. I don't see a good alternative proposal for their team to make, given imperfect information about every patient. What is a plausible mechanism for a real-world physician to intricately investigate every moment of every patient's personal life to get to the elemental root cause of every single illness? Someone would have to follow them around 24/7 with a video camera.