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I have a lot of doctors in my family, and while it's not surprising that they've fully swallowed the bizarre fetishization of doctors we have in this country[0]

I have a lot of doctors in my family, and while it's not surprising that they've fully swallowed the bizarre fetishization of doctors we have in this country[0], it's really shocking to me the degree to which almost _everyone_ I know has, including those with no ties to the medical field whatsoever. To be extremely clear, I don't think there's anything wrong with appreciating doctors for the hard work they do, nor the special feelings that people have historically always had towards healers[1]. If someone said they respected a person more for choosing medicine as a career, I can't say I'd disagree. But for some reason, most people seem to model doctors as incorruptible angels, incapable of making decisions that are suboptimal for others or for society. This makes it uniquely difficult to have a conversation about the problems of the devilishly complex healthcare system, since it's impossible to talk about one of the most important groups of stakeholders and their role in healthcare economics. I remember talking to my sister shortly after her med school graduation about a topic that involved influences , and she said with a straight face "doctors don't do things that aren't in the patient's best interest". My (Ivy-League educated, MD-holding) sister isn't the sharpest tool in the shed, but even for her, the idea that an entire industry full of people are immune to incentives is an especially pants-on-head stupid model of the world. She's since unlearned much of the creepy indoctrination that med school drilled into her (and that her much-smarter doctor husband was never fully taken by), but the same messages have trickled down to many of the friends and family I have that are unconnected with the medical field, without any of the ego-protective incentives that my doctor acquaintances have. [0] And most countries; if anything, it's way worse in the other countries I'm familiar with, as the US tends to be (on average) more dynamic and less worshiping of formal credentials than the average country [1] Though I do think it's irrational; I distinctly remember my mom trying to communicate this feeling to me when trying to get me to be a doctor, and my high-decoupling teenage self telling her that she should also be appreciating the engineers whose work powers the hospital and the economists whose work was critical to building the hospital and paying doctor's salaries.

bsanr2 6y ago
Ask marginalized people - generally a subset of, but not limited to, people subject to generational poverty, people with prominent genetic ancestry in the Global South, LGBT/queer folk (especially the T), and those with visible, chronic physical (weight, height, mobility, etc.) or mental (developmental disorders, mental illness, etc.) "deviances" - and you'll learn just how effective and esteemed doctors really are. (Of course, people generally don't ask us, so...) While I imagine that some people have already had a certain particular rage switch thrown in their brain wrt the preceding list, stay with me here. We're not just talking about intersectional pile-ups; go ask your fat friend about his last check-up.
- throwaway201103 6y ago
  > go ask your fat friend about his last check-up The doctor probably told him to lose weight. And?
  - wutbrodo 6y ago
    The complaint is usually that doctors are overly reductive towards overweight people, treating their weight as a hard-blocker to listening to any other problems that can potentially be treated (or palliated) in parallel. I can't speak to its veracity, as I'm not privy to the medical history of anyone I know who's overweight.
    - pc86 6y ago
      Overweight people have more medical problems, and the more overweight you are, the more problems you will have and the more severe they will be (in aggregate, we can find exceptions to every rule). I've heard this complaint as well but it's usually from people not doing much to lose the weight in the first place. If you've gone from 400 lbs to 300 lbs in 6 months and suddenly you have knee pain you never had before, I think most GPs would take an acute interest in that and not just chalk it up to being 300 lbs. But if you've gone from 250 lbs to 300 lbs and suddenly develop knee pain, you're going to have a hard time convincing anyone that it's not the obvious problem.
      - wutbrodo 6y ago
        Sure, the fact that there's a plausible motivation on the doctor's side is the reason I don't have much of an opinion on the veracity of the claim. That doesn't preclude the possibility a trend exists within the medical system of worse care for the overweight due to treating weight as a hard blocker. I chose my framing of the claim I've heard pretty carefully, and what you're saying only supports it: as being overweight is upstream of so many health problems, it seems entirely plausible that doctors (given that they're human beings) would be prone to falling in the trap of not wanting to think about anything that can be done while the weight problem is still being worked on (or not). Again, this doesn't require assuming that doctors are horrible people; this kind of reductiveness is the way most people respond to everything. > it's usually from people not doing much to lose the weight in the first place This is far too arrogant an assumption for a doctor to be making about a patient. I don't know any overweight people, but I do know people who have had (theoretically solvable) drug problems and other bad health habits, and the blockers to fixing them are not always "just believe in yourself and have some willpower", especially when (even sub-clinical) mental health issues are involved. Hell, I used to smoke way too much weed and not eat particularly well (though never badly enough to get overweight) and it turns out I had an undiagnosed sleep disorder. If smoking weed happened to be associated with a bunch of health problems and I had a doctor who was narrowly focused on it and refused to help me with other incidental issues before I solved it, I'd be pretty upset too.
nostrademons 6y ago
> the idea that an entire industry full of people are immune to incentives is an especially pants-on-head stupid model of the world This is true of nearly every industry, though. Our real estate agent (who was otherwise pretty good) insisted that he was a fiduciary to us and would seek the best financial deal for us, but his advice on our bid was "I don't think that'll be enough to get the job done", and then we were the high bid. I'm a Google engineer, and from my perception, my job is to give people free services that they want, despite HN's perception of my employer. Investors will say that they "get paid for allocating capital and making the economy more efficient", lawyers are here to "help people enforce the rights granted to them by law", salesmen "make people aware of products that they really want to buy anyway", etc. Of possible interest: https://slatestarcodex.com/2017/10/02/different-worlds/ https://slatestarcodex.com/2017/10/02/different-worlds/ People's perceptions really do differ, and people see through their values and emotions. When people hold a self-perception of what they do that is wildly at odds with what you think they do, it's often because folks who actively believe they are doing bad for the world are often so bitter that nobody wants to be around them.
- wutbrodo 6y ago
  > This is true of nearly every industry, though. Yes, I think this is implied by the portion of my comment that you quoted. The claim that _any_ industry is immune to incentives is what I describe as "pants-on-head stupid". I've also read every Scott post shortly after its posting for probably the past 8 years, but I appreciate the share!
- wutbrodo 6y ago
  Sorry for the double-reply, but I realize I didn't address the meat of your comment. > When people hold a self-perception of what they do that is wildly at odds with what you think they do, it's often because folks who actively believe they are doing bad for the world are often so bitter that nobody wants to be around them. I don't agree with this, at least as applied to my comment. There's a wide, wide gulf of reasonableness between "what I do is unhelpfuly and unworthy" and "everyone in my industry is an omnibenevolent, maximally-selfless angel". I'm quite proud of the work I do without thinking this, and as I mentioned in my previous comment, if my sister had a possibly-irrational but not totally-unreasonable greater pride in her work, I wouldn't blame her at all. But doctors who consider themselves a separate moral species from human beings aren't just egomaniacs, they're _dangerous_ (as I said, my sister luckily grew out of this a little bit).
programmertote 6y ago
Thanks for sharing this! I went to med school for two years in my home country, married to a doctor who is in her residency training in the US and couldn't agree more. If you look at my HN comment history, you'll see that I've tried to mention that part of the problem of exorbitant healthcare expenses in the US is the artificial scarcity of doctors. It starts with this inflated/unnecessary requirement to have a bachelor's degree before going to med school. Other nations in the world (e.g., India) do fine with training their doctors for five years (even that, I think is too much; the first year of med school training in my country is pretty much an extended high school curriculum not essential to medicine). An internal medicine (generalist) doctor in the US can earn $250K right after finishing the residency. Elsewhere in the world (e.g., in the UK), the doctors earn about $90-150K. I also have to agree with you that contrary to the popular belief in the US, doctors can be fairly un-intellectual. The main requirement to do well in their career is to rely on rote memorization (go check out on YouTube how Anki is so important/popular among med school people).
- wutbrodo 6y ago
  > contrary to the popular belief in the US, doctors can be fairly un-intellectual. The main requirement to do well in their career is to rely on rote memorization (go check out on YouTube how Anki is so important/popular among med school people). I agree with everything in your comment, but this is one of the most important ones. This is actually the basis upon which my cocky little 17-year-old self decided he wanted to study math instead of medicine, contrary to the pressure my family was exerting: the idea of turning my brain into a file drawer was somewhere between horrifying and nauseating. I point-blank asked my brother-in-law at one point (he was around ~30 at the time) how someone as intelligent as him was satisfied with going into a field as unchallenging as medicine, and he was on exactly the same page as me: over the course of his medical education (started the same year as my sister), he also got an MBA and has started on a PhD, because being a GP would be immensely dissatisfying to his intellect. If you have a sense of yourself as fairly intelligent, it is _absolutely crucial_ for your health as a patient interacting with the healthcare world that you internalize that doctors aren't necessarily that smart (though of course, some are!). This isn't an insult! Most professions are filled with people that aren't that smart. But putting yourself blindly in the hands of an imagined omniscient without being an informed and opinionated advocate for yourself as a patient is foolhardy and dangerous, and you'll quickly discover the costs, if you're self-aware enough. If you have a doctor who buys into the God Complex and scoffs at the notion of a patient having an opinion, then you're double-fucked, and should definitely get a new doctor. This can be a delicate balance, and the doctors I know are quite fairly annoyed at the patient who does his own research (often poorly) and argues with them on the basics. "Knowing what you don't know" is an important part of being informed. Just 1) find a doctor who understands his limits and 2) approach the conversation as a meeting of mutually-interested peers logically discussing a problem (your health): one who has substantial headstart on the intimate, sometimes-inarticulable details of the problem, and one who has a substantial headstart on general research that's relevant to the problem.
anonymouse008 6y ago
"Physicians are just human mechanics" - a disgruntled PhD
- Fezzik 6y ago
  Or, as the late-great Christopher Hitchens said - “Picture all experts as if they were mammals.”

bsanr2 6y ago

Ask marginalized people - generally a subset of, but not limited to, people subject to generational poverty, people with prominent genetic ancestry in the Global South, LGBT/queer folk (especially the T), and those with visible, chronic physical (weight, height, mobility, etc.) or mental (developmental disorders, mental illness, etc.) "deviances" - and you'll learn just how effective and esteemed doctors really are. (Of course, people generally don't ask us, so...) While I imagine that some people have already had a certain particular rage switch thrown in their brain wrt the preceding list, stay with me here. We're not just talking about intersectional pile-ups; go ask your fat friend about his last check-up.

throwaway201103 6y ago
> go ask your fat friend about his last check-up The doctor probably told him to lose weight. And?
- wutbrodo 6y ago
  The complaint is usually that doctors are overly reductive towards overweight people, treating their weight as a hard-blocker to listening to any other problems that can potentially be treated (or palliated) in parallel. I can't speak to its veracity, as I'm not privy to the medical history of anyone I know who's overweight.
  - pc86 6y ago
    Overweight people have more medical problems, and the more overweight you are, the more problems you will have and the more severe they will be (in aggregate, we can find exceptions to every rule). I've heard this complaint as well but it's usually from people not doing much to lose the weight in the first place. If you've gone from 400 lbs to 300 lbs in 6 months and suddenly you have knee pain you never had before, I think most GPs would take an acute interest in that and not just chalk it up to being 300 lbs. But if you've gone from 250 lbs to 300 lbs and suddenly develop knee pain, you're going to have a hard time convincing anyone that it's not the obvious problem.
    - wutbrodo 6y ago
      Sure, the fact that there's a plausible motivation on the doctor's side is the reason I don't have much of an opinion on the veracity of the claim. That doesn't preclude the possibility a trend exists within the medical system of worse care for the overweight due to treating weight as a hard blocker. I chose my framing of the claim I've heard pretty carefully, and what you're saying only supports it: as being overweight is upstream of so many health problems, it seems entirely plausible that doctors (given that they're human beings) would be prone to falling in the trap of not wanting to think about anything that can be done while the weight problem is still being worked on (or not). Again, this doesn't require assuming that doctors are horrible people; this kind of reductiveness is the way most people respond to everything. > it's usually from people not doing much to lose the weight in the first place This is far too arrogant an assumption for a doctor to be making about a patient. I don't know any overweight people, but I do know people who have had (theoretically solvable) drug problems and other bad health habits, and the blockers to fixing them are not always "just believe in yourself and have some willpower", especially when (even sub-clinical) mental health issues are involved. Hell, I used to smoke way too much weed and not eat particularly well (though never badly enough to get overweight) and it turns out I had an undiagnosed sleep disorder. If smoking weed happened to be associated with a bunch of health problems and I had a doctor who was narrowly focused on it and refused to help me with other incidental issues before I solved it, I'd be pretty upset too.

nostrademons 6y ago

> the idea that an entire industry full of people are immune to incentives is an especially pants-on-head stupid model of the world This is true of nearly every industry, though. Our real estate agent (who was otherwise pretty good) insisted that he was a fiduciary to us and would seek the best financial deal for us, but his advice on our bid was "I don't think that'll be enough to get the job done", and then we were the high bid. I'm a Google engineer, and from my perception, my job is to give people free services that they want, despite HN's perception of my employer. Investors will say that they "get paid for allocating capital and making the economy more efficient", lawyers are here to "help people enforce the rights granted to them by law", salesmen "make people aware of products that they really want to buy anyway", etc. Of possible interest: https://slatestarcodex.com/2017/10/02/different-worlds/ https://slatestarcodex.com/2017/10/02/different-worlds/ People's perceptions really do differ, and people see through their values and emotions. When people hold a self-perception of what they do that is wildly at odds with what you think they do, it's often because folks who actively believe they are doing bad for the world are often so bitter that nobody wants to be around them.

wutbrodo 6y ago
> This is true of nearly every industry, though. Yes, I think this is implied by the portion of my comment that you quoted. The claim that _any_ industry is immune to incentives is what I describe as "pants-on-head stupid". I've also read every Scott post shortly after its posting for probably the past 8 years, but I appreciate the share!
wutbrodo 6y ago
Sorry for the double-reply, but I realize I didn't address the meat of your comment. > When people hold a self-perception of what they do that is wildly at odds with what you think they do, it's often because folks who actively believe they are doing bad for the world are often so bitter that nobody wants to be around them. I don't agree with this, at least as applied to my comment. There's a wide, wide gulf of reasonableness between "what I do is unhelpfuly and unworthy" and "everyone in my industry is an omnibenevolent, maximally-selfless angel". I'm quite proud of the work I do without thinking this, and as I mentioned in my previous comment, if my sister had a possibly-irrational but not totally-unreasonable greater pride in her work, I wouldn't blame her at all. But doctors who consider themselves a separate moral species from human beings aren't just egomaniacs, they're _dangerous_ (as I said, my sister luckily grew out of this a little bit).

programmertote 6y ago

Thanks for sharing this! I went to med school for two years in my home country, married to a doctor who is in her residency training in the US and couldn't agree more. If you look at my HN comment history, you'll see that I've tried to mention that part of the problem of exorbitant healthcare expenses in the US is the artificial scarcity of doctors. It starts with this inflated/unnecessary requirement to have a bachelor's degree before going to med school. Other nations in the world (e.g., India) do fine with training their doctors for five years (even that, I think is too much; the first year of med school training in my country is pretty much an extended high school curriculum not essential to medicine). An internal medicine (generalist) doctor in the US can earn $250K right after finishing the residency. Elsewhere in the world (e.g., in the UK), the doctors earn about $90-150K. I also have to agree with you that contrary to the popular belief in the US, doctors can be fairly un-intellectual. The main requirement to do well in their career is to rely on rote memorization (go check out on YouTube how Anki is so important/popular among med school people).

wutbrodo 6y ago
> contrary to the popular belief in the US, doctors can be fairly un-intellectual. The main requirement to do well in their career is to rely on rote memorization (go check out on YouTube how Anki is so important/popular among med school people). I agree with everything in your comment, but this is one of the most important ones. This is actually the basis upon which my cocky little 17-year-old self decided he wanted to study math instead of medicine, contrary to the pressure my family was exerting: the idea of turning my brain into a file drawer was somewhere between horrifying and nauseating. I point-blank asked my brother-in-law at one point (he was around ~30 at the time) how someone as intelligent as him was satisfied with going into a field as unchallenging as medicine, and he was on exactly the same page as me: over the course of his medical education (started the same year as my sister), he also got an MBA and has started on a PhD, because being a GP would be immensely dissatisfying to his intellect. If you have a sense of yourself as fairly intelligent, it is _absolutely crucial_ for your health as a patient interacting with the healthcare world that you internalize that doctors aren't necessarily that smart (though of course, some are!). This isn't an insult! Most professions are filled with people that aren't that smart. But putting yourself blindly in the hands of an imagined omniscient without being an informed and opinionated advocate for yourself as a patient is foolhardy and dangerous, and you'll quickly discover the costs, if you're self-aware enough. If you have a doctor who buys into the God Complex and scoffs at the notion of a patient having an opinion, then you're double-fucked, and should definitely get a new doctor. This can be a delicate balance, and the doctors I know are quite fairly annoyed at the patient who does his own research (often poorly) and argues with them on the basics. "Knowing what you don't know" is an important part of being informed. Just 1) find a doctor who understands his limits and 2) approach the conversation as a meeting of mutually-interested peers logically discussing a problem (your health): one who has substantial headstart on the intimate, sometimes-inarticulable details of the problem, and one who has a substantial headstart on general research that's relevant to the problem.

anonymouse008 6y ago

"Physicians are just human mechanics" - a disgruntled PhD

Fezzik 6y ago
Or, as the late-great Christopher Hitchens said - “Picture all experts as if they were mammals.”