9 ms·

Can confirm. They paint people who google symptoms as kooks or as annoying, but you have to if you ever want to get an actual diagnosis and treatment, because d

Can confirm. They paint people who google symptoms as kooks or as annoying, but you have to if you ever want to get an actual diagnosis and treatment, because doctors and hospitals are, quite often, worse than Google at figuring out WTF is wrong. Do your best not to end up in a hospital without an advocate (friend, relative) watching out for you. They'll fail to treat you at best, then discharge you with a shrug and a huge bill; and they'll kill you with mistakes, at worst.

JKCalhoun 4y ago
I thought expert systems were supposed to replace diagnosis, like three decades ago.
- loup-vaillant 4y ago
  In an April's fool story where Eliezer Yudkowsky was pretending to come from a rationalist parallel world (or outer planet), he suggested a medical system with a different way to specialize people. Most notably, he suggested we separate diagnosticians and prognosticators from practicians. The former do their best to guess what you have, send you to the right kind of practician, and estimate your possible outcomes (with probability distribution and Bayesian goodness and all). Then whatever practician you chose do their best to treat you. Separating prognosis from practice allows us to have a system where prognosticators are rewarded for their accuracy and calibration, and practicians are rewarded for their outcomes relative to prognosis. Being good doesn't mean having better outcomes, being good means having better outcomes than predicted. I'm not sure how well this system would work in practice, and there may be a huge problem with eliminating the short feedback loops we can have between diagnosis and practice when they're the same person. What should be a nice separation of concern may turn into a communication nightmare. Nevertheless, it is possible that specialised diagnosticians may be better than any expert system.
  - cupofpython 4y ago
    I only support this if I dont get charged for 2 visits
  - sharno 4y ago
    This seems to make sense to me as a better medical system.
  - thaumasiotes 4y ago
    We have the same problem in education; we've stupidly combined certifications (diplomas) with instruction. This is a huge conflict of interest for the schools.
  - ClumsyPilot 4y ago
    This is a really neat Idea, i never heard of it before
mindslight 4y ago
Doctors love to mockingly call this "Doctor Google" and reject anything mildly technical that you read on your own, even if you're just trying to have an open discussion and not push a diagnosis. I think the underlying dynamic is that doctors had one of the early monopolies on "knowledge work" and have never adapted their ways [0]. And so they're not used to having to engage with other's ideas, in stark contrast to the open collaboration we're used to in the engineering/scientific world. [0] srsly if I'm understanding some recent hospital records correctly, they still mostly work by verbally dictating at subordinates who transcribe for them. And they spend most of that dictation simply reciting the patient's known condition. Compare with programming where the working set is openly displayed on the screen (modulo scrolling), and then our contribution is only that of making changes.
rhexs 4y ago
The interesting part about this is that you'll also likely see a NP or physician's assistant, who, at best, "google" (uptodate) your symptoms if the case isn't obvious. Sometimes doctors will do the intake appointment and fail to tell you that any follow-ups are done with their "trained" NP. And then be billed 400-800$. Such an incredible system! I also gave up going to physicians with a chronic illness. They're in and out in five minutes, and just ramble off the top two treatments from uptodate. If it's a surgeon, they'll try to sell you on surgery or a diagnostic procedure to "re-validate" the diagnosis (conveniently to generate a trivial 10K for the hospital in a few hours). If you want anything beyond that or to have a discussion, good luck.
- throwawayboise 4y ago
  Yep, same. I only go to doctors for injuries or other clear, specific problems.
FollowingTheDao 4y ago
I was misdiagnosed with Bipolar Disorder for 30 years. Turns out it was Neuropsychiatric Lupus. Despite all my pleading to them to look further they never did. I had to teach myself biology and genetics while I was on disability. They missed all the common signs of Lupus; my skin, bad kidneys, etc. I am afraid all this technology is taking away all of our wisdom. Too easy to know things, very hard to understand them.
- Auracle 4y ago
  My dad almost died in the 90s because they couldn't diagnose his lupus.
  - bryanlarsen 4y ago
    Lupus is really hard to diagnose. There's a reason that ends up being the diagnosis on pretty much every episode of House M.D. Doctors generally see 6 patients an hour, and have 5-7 minutes of paperwork per patient. The remaining 3 minutes gives enough time to diagnose the obvious, but not much else.
    - FollowingTheDao 4y ago
      It is not hard to diagnose once you eventually get to a person that can diagnose it. You said it yourself. It is not about difficultly, but time spent with the patient. But I literally showed my doctor the cutaneous lupus in my ear and she said "Oh, some people just get gunk in their ears" and would not send me to a rheumatologist. The slow diagnosis is because the specialists are so reluctant to see people. Right now I am on a six month wait to see a rheumatologist. Why? Capitalism. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255118/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255118/
      - GFischer 4y ago
        You're blaming Capitalism, it isn't great, but the problem is that in the United States healthcare system you have Capitalism without Free Market, you have "crony"/rent-seeking/regulatory-capture Capitalism. You can get a rheumatologist TODAY if you're willing to pay (quite a bit) more (at least here in Uruguay). THAT is free-market capitalism. If you don't have money, you'll have to wait 2-3 months (quite a lot less than what you're saying), and you'll have it for free (here). That's socialism. In crony capitalism, you have the worst of both worlds...
chasd00 4y ago
i never go under without someone there with me. My father was almost killed twice be incompetent nurses double dosing IVs and other things. My mother, an RN herself, watched him like a hawk every time he was in the hospital to keep the staff from killing him. Another anecdote, my sister worked at the front desk in some department ( she was an admin and not a nurse) and a patient coded but came back by themselves. Only afterwards did the nurses realize they were marked "do not resucicate" by mistake! i do not trust hospitals at all.
deleted 4y ago
[deleted]
dillondoyle 4y ago
Feel this. Spent $500 for a pointless MRI. I have some specific domain knowledge on my injury (very sport specific) but obviously have not spent 10+ years in school studying hand surgery. But I did read and send AND tell/ask in my appoint real specifically relevant med publications saying the only way to see what I wanted was an ultra sound under stress. My PT also said this. But not a 'real md.' So I had to pay and sit through an uncomfortable MRI for nothing. And never got the ultrasound. Should have just said no thanks.
asdff 4y ago
To be fair, the vast majority of patients they see who do bring in their own sources are probably the kooks. Just look at the state of national discourse on any topic related to science. The number of people within the intersect of the venn diagram of "able to interperate the relevant literature", "has time to interperate the relevant literature", and "doesnt trust the doctors ability to interpretate the relevant literature" has to be remarkably small.
majormajor 4y ago
A hospital isn't the place to be unless you have a specific, acute need to be there. They're looking to stabilize you and get you able to survive outside the hospital, not to solve a mystery. Great place to go if you need it, though. Got internal bleeding? Get that taken care of. The risk of a debilitating or fatal hospital error isn't that high, so absolutely go when the risk of not going is high. TV, though, has trained us to expect to get everything figured out and root causes solved too. Unfortunately, that's just not realistic even if many of the complaints in this thread were solved. There are a lot of nasty rare diseases and conditions, and strange manifestations of conditions, that will still be missed if they have 60 minutes with you instead of 8. You should also realize that doctor quality varies as much as any other skill. SHOP AROUND. I've had better luck with second, third opinions than I have trying to pester an original doctor into changing their mind. There are doctors out there who appreciate it if you bring up a written self-history of the condition, the strange aspects or other things that may or may not be related, what has or hasn't worked so far, etc.

JKCalhoun 4y ago

I thought expert systems were supposed to replace diagnosis, like three decades ago.

loup-vaillant 4y ago
In an April's fool story where Eliezer Yudkowsky was pretending to come from a rationalist parallel world (or outer planet), he suggested a medical system with a different way to specialize people. Most notably, he suggested we separate diagnosticians and prognosticators from practicians. The former do their best to guess what you have, send you to the right kind of practician, and estimate your possible outcomes (with probability distribution and Bayesian goodness and all). Then whatever practician you chose do their best to treat you. Separating prognosis from practice allows us to have a system where prognosticators are rewarded for their accuracy and calibration, and practicians are rewarded for their outcomes relative to prognosis. Being good doesn't mean having better outcomes, being good means having better outcomes than predicted. I'm not sure how well this system would work in practice, and there may be a huge problem with eliminating the short feedback loops we can have between diagnosis and practice when they're the same person. What should be a nice separation of concern may turn into a communication nightmare. Nevertheless, it is possible that specialised diagnosticians may be better than any expert system.
- cupofpython 4y ago
  I only support this if I dont get charged for 2 visits
- sharno 4y ago
  This seems to make sense to me as a better medical system.
- thaumasiotes 4y ago
  We have the same problem in education; we've stupidly combined certifications (diplomas) with instruction. This is a huge conflict of interest for the schools.
- ClumsyPilot 4y ago
  This is a really neat Idea, i never heard of it before

mindslight 4y ago

Doctors love to mockingly call this "Doctor Google" and reject anything mildly technical that you read on your own, even if you're just trying to have an open discussion and not push a diagnosis. I think the underlying dynamic is that doctors had one of the early monopolies on "knowledge work" and have never adapted their ways [0]. And so they're not used to having to engage with other's ideas, in stark contrast to the open collaboration we're used to in the engineering/scientific world. [0] srsly if I'm understanding some recent hospital records correctly, they still mostly work by verbally dictating at subordinates who transcribe for them. And they spend most of that dictation simply reciting the patient's known condition. Compare with programming where the working set is openly displayed on the screen (modulo scrolling), and then our contribution is only that of making changes.

rhexs 4y ago

The interesting part about this is that you'll also likely see a NP or physician's assistant, who, at best, "google" (uptodate) your symptoms if the case isn't obvious. Sometimes doctors will do the intake appointment and fail to tell you that any follow-ups are done with their "trained" NP. And then be billed 400-800$. Such an incredible system! I also gave up going to physicians with a chronic illness. They're in and out in five minutes, and just ramble off the top two treatments from uptodate. If it's a surgeon, they'll try to sell you on surgery or a diagnostic procedure to "re-validate" the diagnosis (conveniently to generate a trivial 10K for the hospital in a few hours). If you want anything beyond that or to have a discussion, good luck.

throwawayboise 4y ago
Yep, same. I only go to doctors for injuries or other clear, specific problems.

FollowingTheDao 4y ago

I was misdiagnosed with Bipolar Disorder for 30 years. Turns out it was Neuropsychiatric Lupus. Despite all my pleading to them to look further they never did. I had to teach myself biology and genetics while I was on disability. They missed all the common signs of Lupus; my skin, bad kidneys, etc. I am afraid all this technology is taking away all of our wisdom. Too easy to know things, very hard to understand them.

Auracle 4y ago
My dad almost died in the 90s because they couldn't diagnose his lupus.
- bryanlarsen 4y ago
  Lupus is really hard to diagnose. There's a reason that ends up being the diagnosis on pretty much every episode of House M.D. Doctors generally see 6 patients an hour, and have 5-7 minutes of paperwork per patient. The remaining 3 minutes gives enough time to diagnose the obvious, but not much else.
  - FollowingTheDao 4y ago
    It is not hard to diagnose once you eventually get to a person that can diagnose it. You said it yourself. It is not about difficultly, but time spent with the patient. But I literally showed my doctor the cutaneous lupus in my ear and she said "Oh, some people just get gunk in their ears" and would not send me to a rheumatologist. The slow diagnosis is because the specialists are so reluctant to see people. Right now I am on a six month wait to see a rheumatologist. Why? Capitalism. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255118/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255118/
    - GFischer 4y ago
      You're blaming Capitalism, it isn't great, but the problem is that in the United States healthcare system you have Capitalism without Free Market, you have "crony"/rent-seeking/regulatory-capture Capitalism. You can get a rheumatologist TODAY if you're willing to pay (quite a bit) more (at least here in Uruguay). THAT is free-market capitalism. If you don't have money, you'll have to wait 2-3 months (quite a lot less than what you're saying), and you'll have it for free (here). That's socialism. In crony capitalism, you have the worst of both worlds...

chasd00 4y ago

i never go under without someone there with me. My father was almost killed twice be incompetent nurses double dosing IVs and other things. My mother, an RN herself, watched him like a hawk every time he was in the hospital to keep the staff from killing him. Another anecdote, my sister worked at the front desk in some department ( she was an admin and not a nurse) and a patient coded but came back by themselves. Only afterwards did the nurses realize they were marked "do not resucicate" by mistake! i do not trust hospitals at all.

deleted 4y ago

[deleted]

dillondoyle 4y ago

Feel this. Spent $500 for a pointless MRI. I have some specific domain knowledge on my injury (very sport specific) but obviously have not spent 10+ years in school studying hand surgery. But I did read and send AND tell/ask in my appoint real specifically relevant med publications saying the only way to see what I wanted was an ultra sound under stress. My PT also said this. But not a 'real md.' So I had to pay and sit through an uncomfortable MRI for nothing. And never got the ultrasound. Should have just said no thanks.

asdff 4y ago

To be fair, the vast majority of patients they see who do bring in their own sources are probably the kooks. Just look at the state of national discourse on any topic related to science. The number of people within the intersect of the venn diagram of "able to interperate the relevant literature", "has time to interperate the relevant literature", and "doesnt trust the doctors ability to interpretate the relevant literature" has to be remarkably small.

majormajor 4y ago

A hospital isn't the place to be unless you have a specific, acute need to be there. They're looking to stabilize you and get you able to survive outside the hospital, not to solve a mystery. Great place to go if you need it, though. Got internal bleeding? Get that taken care of. The risk of a debilitating or fatal hospital error isn't that high, so absolutely go when the risk of not going is high. TV, though, has trained us to expect to get everything figured out and root causes solved too. Unfortunately, that's just not realistic even if many of the complaints in this thread were solved. There are a lot of nasty rare diseases and conditions, and strange manifestations of conditions, that will still be missed if they have 60 minutes with you instead of 8. You should also realize that doctor quality varies as much as any other skill. SHOP AROUND. I've had better luck with second, third opinions than I have trying to pester an original doctor into changing their mind. There are doctors out there who appreciate it if you bring up a written self-history of the condition, the strange aspects or other things that may or may not be related, what has or hasn't worked so far, etc.