4 ms·

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,

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.
  - tdrp 6y ago
    Thank for this discussion, it is really interesting to me! The surgeon proposed what was probably the algorithmic way to fix the problem. Given that the OP was having issues because of their heels, odds are that the surgery wouldn't have entirely fixed it and now the ligaments would have been unnecessarily tampered with by a surgeon whose thought was "we should totally reroute those ligaments that'll do it". OP mentioned she was a marathon runner, athletic and in her early thirties - what? did her ligaments suddenly get into a state where they needed rerouting? OK sure but why, why now, etc. I feel like even a non-medical professional could have gotten closer after talking to her for twenty minutes. I am not a doctor obviously, but I have been to some good doctors and the "imperfect information" can significantly be improved if they actually make a more clever, targeted effort to inquire, rather than just casually prescribing surgery or heavy medication. Good doctors will talk to you, actually tell you what the "algorithm" prescribes and often tell you why they think it is not the case here. The best way I can describe the difference is like talking to a customer support bot vs talking to a customer support person. I realize this is probably extinct now here in the US because of litigation and insurance requirements but it's still that way in many countries. I am certain that good, fluid doctors there beat the algorithmic approach hands down, whereas good doctors here may be capped and severely restrained by it.
    - medntech 6y ago

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.
- tdrp 6y ago
  Thank for this discussion, it is really interesting to me! The surgeon proposed what was probably the algorithmic way to fix the problem. Given that the OP was having issues because of their heels, odds are that the surgery wouldn't have entirely fixed it and now the ligaments would have been unnecessarily tampered with by a surgeon whose thought was "we should totally reroute those ligaments that'll do it". OP mentioned she was a marathon runner, athletic and in her early thirties - what? did her ligaments suddenly get into a state where they needed rerouting? OK sure but why, why now, etc. I feel like even a non-medical professional could have gotten closer after talking to her for twenty minutes. I am not a doctor obviously, but I have been to some good doctors and the "imperfect information" can significantly be improved if they actually make a more clever, targeted effort to inquire, rather than just casually prescribing surgery or heavy medication. Good doctors will talk to you, actually tell you what the "algorithm" prescribes and often tell you why they think it is not the case here. The best way I can describe the difference is like talking to a customer support bot vs talking to a customer support person. I realize this is probably extinct now here in the US because of litigation and insurance requirements but it's still that way in many countries. I am certain that good, fluid doctors there beat the algorithmic approach hands down, whereas good doctors here may be capped and severely restrained by it.
  - medntech 6y ago