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“the vast majority of doctors would have any knowledge on today, most would consider it ridiculous despite thousands of papers on this topic with growing eviden

“the vast majority of doctors would have any knowledge on today, most would consider it ridiculous despite thousands of papers on this topic with growing evidence” Are doctors, as a group, becoming stupider? I’m not trying to troll by asking that question. I legitimately feel, as a patient of a large HMO, that the doctors I interact with aren’t very bright, making frequent mistakes about stuff they could google as quickly as they give out wrong information, but instead confidently insist upon something they’re misremembering or have never learned correctly in the first place. It feels like the profession has been optimizing for the wrong things: quick recall of a breadth of information rather than a scientific orientation towards the work. Perhaps I’m just seeing downstream effects of the reform of health economics in the last decade. Perhaps it’s elite overproduction. In any case reading the featured article, I’m just not at all optimistic about current medical practices experiencing any sort of kuhnian paradigm shift. They can’t even get the basics right, and seem prone to extreme group think bordering on religiosity.

speakfreely 4y ago
> Are doctors, as a group, becoming stupider? I don't think they're becoming stupider, but I think the information age is making their errors more accessible and obvious to the general public.
connicpu 4y ago
I think as the pool of knowledge balloons exponentially in size it becomes nearly impossible for a doctor to be familiar with all of it, so their only choice is to deeply specialize in one field and limit the breadth of patients they can treat (also becoming less knowledgeable about anything unrelated to their field), or they must be incredibly general and have only surface level knowledge of everything. 100 years ago a few years of study could teach you nearly everything there was to know in the medical field at the time. The expanding pool of knowledge also makes it harder to determine which knowledge is actually helpful to take in. I think this is an area where technology can help. The best primary care providers I've had have been the ones who aren't afraid to look things up as we're talking about them. I think better tools to aggregate the cutting edge of medical knowledge would help greatly.
- 2devnull 4y ago
  Very much agree. I hope language models make a big dent in the problem. Many other places tech can move the needle as well, like imaging and diagnostics.
HEmanZ 4y ago
These threads always have lots of people jumping on doctors and their decisions/callousness/lack-of-reason/missing up-to-date-into/etc.etc.etc. My wife is a physician (OBGYN) at a major city hospital that primarily serves a very poor population. I'd like to share her schedule, and see if you think what kind of care you could perform under these circumstances, or how up-to-date you could stay in field: Monday - Friday - Wake up at 4:30 AM - Get to hospital by 5AM to start rounding on patients - Sometimes work inpatient all day sometimes clinic thrown in, but usually not done working until 7 PM, without even a 15 min break or a chance to eat a meal (15 hour day) - Come home and do about an hour of notes, 16 hour work day - At least once per week, wake up in the middle of the night to deliver a patient who asked for that kind of continuity of care. 24 hour work day Saturday: - Wake up around 5am to be in by 6am to start the day - Work inpatient, usually without time for a 15min break for food, until 10AM SUNDAY (28-30 hours shift) Repeat 49 weeks/year (days of 24/hr shift can vary and she usually gets one weekend off/month). Her average time at the hospital last year was 96 hours/week. She is not a resident. How much confidence do you have that you'd be able to stay up-to-date in your field, or make recommendations that aren't ultra-standard, with this kind of schedule?
- TheBlight 4y ago
  Is it possible intelligent people are aware of these conditions and it may be causing them to choose a different path instead of practicing medicine?
  - myself248 4y ago
    Ditto with teaching, anecdotally. Worse yet, experienced people in these professions tend to defend the insane schedules, which I take for some sort of hazing ritual / Stockholm syndrome.
- AngriestLettuce 4y ago
  I don't see how your wife's unreasonable work schedule is supposed to make me feel better about the poor quality of health care I receive. If anything, it makes me question her judgement more, that's just not healthy. How are unhealthy people supposed to educate people on health?
heavyset_go 4y ago
Hospitals and some practices run their medical professionals on long shifts, often back to back, and on skeleton crews. They're profiting at the expense of the quality of care they're providing by spreading doctors, nurses, etc as thin as they possible can.
_yb2s 4y ago
They're not becoming stupider, the culture of following protocols rather than understanding is a pre-scientific one. It certainly has benefits- predictable consistency, limited liability for doctors. Unfortunately, Dr. House style deep thinking in widely available medicine is legally impossible, and only a tiny percentage of the population is able to think that way. I think this quote really sums up this issue, and it's history: Knowledge isn’t a commodity, especially not a fungible commodity, as the medical business sees it. Consciousness and culture are part of the life process. It is exactly the commoditization of medical knowledge that makes it dangerous, and generally stupid. Doctors buy their knowledge, and then resell it over and over; it’s valuable as a commodity, so its value has to be protected by the equivalent of a copyright, the system of laws establishing the profession. Without its special status, its worthlessness would be quickly demonstrated. When A.C. Guyton wrote his textbook of medical physiology (the most widely used text in the world) in the 1950s, it was trash; as it was studied and applied by generations of physicians, it was still trash. The most compliant patients who bought their treatment from the most authoritative, Guytonesque, doctors were buying their own disability and death. Each time you learn something, your consciousness becomes something different, and the questions you ask will be different; you don’t know what the next appropriate question will be when you haven’t assimilated the earlier answers. Until you see something as the answer to an urgent question, you can’t see that it has any value. The unexpected can’t be a commodity. When people buy professional knowledge they get what they pay for, a commodity in a system that sustains ignorance. -Ray Peat [1] [1] https://raypeatinsight.wordpress.com/2013/06/06/raypeat-interviews-revisited/ https://raypeatinsight.wordpress.com/2013/06/06/raypeat-inte...
- gymbeaux 4y ago
  All told I had a pretty fun time trying to self-diagnose myself, and I did a better job diagnosing myself than the docs I saw. I firmly believe that the only reason I’m not on disability and unemployed is because I took my diagnosis and treatment into my own hands. That said, if I had to do that 20x per day with only 20 minutes allotted per patient, I can’t imagine I’d be very good at diagnosis either.
  - _yb2s 4y ago
curun1r 4y ago
I don’t think they’re getting stupider. They’re what they’ve always been…a source of conventional wisdom. When conventional wisdom said bloodletting was good for health, they bled their patients. When mercury was considered a medicine, they administered it. When hacking off limbs was considered the best way to fight infections, their toolkit included bone saws. When electroshock therapy was considered a treatment for mental illness, they shocked the hell out of their patients. I’m sure that one day we’ll look at chemotherapy and radiation as barbaric practices representative of our ignorance of how easy it is to deal with cancer. Scientists/researchers advance the state of our medical knowledge and doctors, over subsequent generations, absorb what they find and practices slowly change. But there’s always a lag. What we need to get past is the notion that doctors are some font of truth when it comes to medical information. They are, largely, a snapshot of what was conventionally believed at the time they graduated med school. We don’t have a system that effectively updates their knowledge or keeps them in the loop for cutting-edge research. They do learn a set of first principles that can help them reason about novel situations better than a lay person, but only if the right answer is one that follows from those principles as opposed to being counterintuitive. It’s the nature of being a practitioner rather than a researcher.
- maweaver 4y ago
  > We don’t have a system that effectively updates their knowledge or keeps them in the loop for cutting-edge research That's not true... generally, in order to practice doctors must be licensed, and in order to keep their license they must have annual continuing education. Generally accomplished by attending conferences where the latest research results are presented. The details vary but the system does exist.
  - darrin 4y ago
    The required continuing education is pretty limited. It may cover new treatment strategies, drugs, etc. but not cutting-edge research unless the physician seeks that out. In emergency medicine (where I have some friends), continuing education doesn't include new procedures. Some of my friends have had much more senior docs ask to be taught a new procedure or technique that didn't exist when they were in residency. Many older docs don't seek out new knowledge (no one is forcing them to), and end up just doing what they've always done. The continuing education system does exist, but it's far from perfect.
dec0dedab0de 4y ago
Are doctors, as a group, becoming stupider? I think patients are getting smarter, and conditions for doctors are worse causing some intelligent people to choose different fields. That said, I recently went through a major illness and interacted with many medical professionals. My first hand experience/anecdata is that doctors are just like every other professional. Some are good, some are mediocre. Some are so consumed by hubris they believe the public is always wrong, and Some are willing to talk things through and keep an open mind about everything, even if it is ridiculous. The best thing we could do for healthcare is to remove the idea that "doctor knows best." While it is important for doctors to feel confident, and to teach the public to avoid snakeoil, it just places unreal expectations on these people. If patients took more accountability for their own health, then we could loosen some of the malpractice laws, and doctors insurance premiums would go down, and that would in turn cause rates to go down. But that was a bit of a tangent from my point that doctors are just people, maybe with an average intelligence that is slightly above the population at large, but still just people.
- ROTMetro 4y ago
  To make life and death decisions for people requires you have hubris and faith in yourself. I can't imagine what would happen to my hypercritical/overthinking self if I was a doctor making life and death choices, some resulting in death, for people for 10 years. I had a hard enough time when I did medical software, working 80 hour weeks to get a new release out the door because it was going to positively impact people's lives and a delay meant X people's lives wouldn't be improved, and I took that on as me failing those people who I didn't help every day the release didn't go out.
  - dec0dedab0de 4y ago
    To make life and death decisions for people requires you have hubris and faith in yourself. Sure, but outside of surgeons and the ER, most doctors are not making life or death decisions all too often. Your average family medicine doctor should always be presenting multiple options for care, and be honest with the patient and themselves that they may be wrong about the diagnosis. I know some people dislike so-called weasel words, but doctors should be using them regularly.
gymbeaux 4y ago
I had my first real foray into the US healthcare system in 2022. I went to three orthopedic surgeons and a neurologist, and none of them diagnosed me correctly. I was having nerve pain in my hands, and they all jumped on “carpal tunnel syndrome”, however none mentioned or even tested me for Thoracic Outlet Syndrome, which is what I actually have. Three doctors. One of them, who was the shoulder specialist ironically (he should have nailed the diagnosis as TOS), looked at my hand X-Rays, said there is no arthritis, then did a test on me to that I said hurt, and then diagnosed me with arthritis. I’m 27. It borders on malpractice and at the very least should be considered gross negligence. And they were all in a big hurry. I had to stop all of them on their way out of the examination room to ask my questions!
- jnovek 4y ago
  I’ve been a patient dealing with a chronic condition for about four years now. IMO you had a pretty good experience relative to the norm. It’s not uncommon for it to take years to get a proper diagnosis for chronic conditions.
  - gymbeaux 4y ago
    It’s because I spent a tens of hours doing research. I’m sure it would take me a lot longer if I had to specialist-hop until I found someone familiar with TOS
- cfu28 4y ago
  That's weird, TOS is something taught to first year med students. It isn't that esoteric of a diagnosis.
  - gymbeaux 4y ago
    I’ve done a lot of research on TOS and my findings are that TOS is A) very difficult to diagnose even with diagnostic imaging and B) considered much less-common than Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, and Tendonitis. I’ll add that all three ortho docs did those “provocative tests” for CTS, like bending my wrists, and NONE made my symptoms worse. This alone should have been an indicator that the nerve impingement was happening closer to the spine. Meanwhile, the provocative tests for TOS almost immediately and drastically worsened my symptoms.
jsonne 4y ago
I don't think so, I think there's a combination of things that are happening that makes their jobs more difficult and a lot of macro changes happening in the world as well as just bad expectations that we have as patients. I am not in the medical field, this is simply my layman's interpretation of what is going on. 1. Doctors are not the same are researchers in many or most cases. They are more akin to technicians than scientists. In the same way I wouldn't expect my electrician to meaningfully innovate the way that he hooks up my house to the power grid or I wouldn't expect my plumber to fundamentally shift my city's sewer system to better serve my individual house that simply isn't their job as front line folks administering care. 2. I think we are massively overlooking simply the breadth and depth of the changes in the world and how that affects their profession. We are exposed to a staggering and exponentially increasing amount of chemicals, environmental toxins, pollutants, foods, and their patients come from a variety of different ethnic backgrounds and live in wildly different environments with wildly different lifestyles. I have to imagine 100 years ago if you were a doctor in say Ireland, you mostly knew what your patients did for work, what they ate, they all lived in roughly the same area, etc. The variables of health were simply much less. 3. The same time the amount of diseases / disorders / etc. that we've identified has grown exponentially. When the field of things that it could be even if that was an incomplete list (obviously) it was much easier to give a broad diagnosis than a specific one. This has improved treatment to be sure but also demanded specialization so any one doctor having all the answers gets less likely over time. 4. Lastly it's just financial pressures. Markets and especially insurance is part of this but I think in general as globalization has continued to accelerate and resources are being distributed more and more in some sense (and concentrated in other senses) you have to take a holistic view. You say doctors used to be "better" but better where? If all the doctors are in a handful of countries with most of the resources that sub group of people will yes get better care but what about everyone else?

speakfreely 4y ago

> Are doctors, as a group, becoming stupider? I don't think they're becoming stupider, but I think the information age is making their errors more accessible and obvious to the general public.

connicpu 4y ago

I think as the pool of knowledge balloons exponentially in size it becomes nearly impossible for a doctor to be familiar with all of it, so their only choice is to deeply specialize in one field and limit the breadth of patients they can treat (also becoming less knowledgeable about anything unrelated to their field), or they must be incredibly general and have only surface level knowledge of everything. 100 years ago a few years of study could teach you nearly everything there was to know in the medical field at the time. The expanding pool of knowledge also makes it harder to determine which knowledge is actually helpful to take in. I think this is an area where technology can help. The best primary care providers I've had have been the ones who aren't afraid to look things up as we're talking about them. I think better tools to aggregate the cutting edge of medical knowledge would help greatly.

2devnull 4y ago
Very much agree. I hope language models make a big dent in the problem. Many other places tech can move the needle as well, like imaging and diagnostics.

HEmanZ 4y ago

These threads always have lots of people jumping on doctors and their decisions/callousness/lack-of-reason/missing up-to-date-into/etc.etc.etc. My wife is a physician (OBGYN) at a major city hospital that primarily serves a very poor population. I'd like to share her schedule, and see if you think what kind of care you could perform under these circumstances, or how up-to-date you could stay in field: Monday - Friday - Wake up at 4:30 AM - Get to hospital by 5AM to start rounding on patients - Sometimes work inpatient all day sometimes clinic thrown in, but usually not done working until 7 PM, without even a 15 min break or a chance to eat a meal (15 hour day) - Come home and do about an hour of notes, 16 hour work day - At least once per week, wake up in the middle of the night to deliver a patient who asked for that kind of continuity of care. 24 hour work day Saturday: - Wake up around 5am to be in by 6am to start the day - Work inpatient, usually without time for a 15min break for food, until 10AM SUNDAY (28-30 hours shift) Repeat 49 weeks/year (days of 24/hr shift can vary and she usually gets one weekend off/month). Her average time at the hospital last year was 96 hours/week. She is not a resident. How much confidence do you have that you'd be able to stay up-to-date in your field, or make recommendations that aren't ultra-standard, with this kind of schedule?

TheBlight 4y ago
Is it possible intelligent people are aware of these conditions and it may be causing them to choose a different path instead of practicing medicine?
- myself248 4y ago
  Ditto with teaching, anecdotally. Worse yet, experienced people in these professions tend to defend the insane schedules, which I take for some sort of hazing ritual / Stockholm syndrome.
AngriestLettuce 4y ago
I don't see how your wife's unreasonable work schedule is supposed to make me feel better about the poor quality of health care I receive. If anything, it makes me question her judgement more, that's just not healthy. How are unhealthy people supposed to educate people on health?

heavyset_go 4y ago

Hospitals and some practices run their medical professionals on long shifts, often back to back, and on skeleton crews. They're profiting at the expense of the quality of care they're providing by spreading doctors, nurses, etc as thin as they possible can.

_yb2s 4y ago

They're not becoming stupider, the culture of following protocols rather than understanding is a pre-scientific one. It certainly has benefits- predictable consistency, limited liability for doctors. Unfortunately, Dr. House style deep thinking in widely available medicine is legally impossible, and only a tiny percentage of the population is able to think that way. I think this quote really sums up this issue, and it's history: Knowledge isn’t a commodity, especially not a fungible commodity, as the medical business sees it. Consciousness and culture are part of the life process. It is exactly the commoditization of medical knowledge that makes it dangerous, and generally stupid. Doctors buy their knowledge, and then resell it over and over; it’s valuable as a commodity, so its value has to be protected by the equivalent of a copyright, the system of laws establishing the profession. Without its special status, its worthlessness would be quickly demonstrated. When A.C. Guyton wrote his textbook of medical physiology (the most widely used text in the world) in the 1950s, it was trash; as it was studied and applied by generations of physicians, it was still trash. The most compliant patients who bought their treatment from the most authoritative, Guytonesque, doctors were buying their own disability and death. Each time you learn something, your consciousness becomes something different, and the questions you ask will be different; you don’t know what the next appropriate question will be when you haven’t assimilated the earlier answers. Until you see something as the answer to an urgent question, you can’t see that it has any value. The unexpected can’t be a commodity. When people buy professional knowledge they get what they pay for, a commodity in a system that sustains ignorance. -Ray Peat [1] [1] https://raypeatinsight.wordpress.com/2013/06/06/raypeat-interviews-revisited/ https://raypeatinsight.wordpress.com/2013/06/06/raypeat-inte...

gymbeaux 4y ago
All told I had a pretty fun time trying to self-diagnose myself, and I did a better job diagnosing myself than the docs I saw. I firmly believe that the only reason I’m not on disability and unemployed is because I took my diagnosis and treatment into my own hands. That said, if I had to do that 20x per day with only 20 minutes allotted per patient, I can’t imagine I’d be very good at diagnosis either.
- _yb2s 4y ago

curun1r 4y ago

I don’t think they’re getting stupider. They’re what they’ve always been…a source of conventional wisdom. When conventional wisdom said bloodletting was good for health, they bled their patients. When mercury was considered a medicine, they administered it. When hacking off limbs was considered the best way to fight infections, their toolkit included bone saws. When electroshock therapy was considered a treatment for mental illness, they shocked the hell out of their patients. I’m sure that one day we’ll look at chemotherapy and radiation as barbaric practices representative of our ignorance of how easy it is to deal with cancer. Scientists/researchers advance the state of our medical knowledge and doctors, over subsequent generations, absorb what they find and practices slowly change. But there’s always a lag. What we need to get past is the notion that doctors are some font of truth when it comes to medical information. They are, largely, a snapshot of what was conventionally believed at the time they graduated med school. We don’t have a system that effectively updates their knowledge or keeps them in the loop for cutting-edge research. They do learn a set of first principles that can help them reason about novel situations better than a lay person, but only if the right answer is one that follows from those principles as opposed to being counterintuitive. It’s the nature of being a practitioner rather than a researcher.

maweaver 4y ago
> We don’t have a system that effectively updates their knowledge or keeps them in the loop for cutting-edge research That's not true... generally, in order to practice doctors must be licensed, and in order to keep their license they must have annual continuing education. Generally accomplished by attending conferences where the latest research results are presented. The details vary but the system does exist.
- darrin 4y ago
  The required continuing education is pretty limited. It may cover new treatment strategies, drugs, etc. but not cutting-edge research unless the physician seeks that out. In emergency medicine (where I have some friends), continuing education doesn't include new procedures. Some of my friends have had much more senior docs ask to be taught a new procedure or technique that didn't exist when they were in residency. Many older docs don't seek out new knowledge (no one is forcing them to), and end up just doing what they've always done. The continuing education system does exist, but it's far from perfect.

dec0dedab0de 4y ago

Are doctors, as a group, becoming stupider? I think patients are getting smarter, and conditions for doctors are worse causing some intelligent people to choose different fields. That said, I recently went through a major illness and interacted with many medical professionals. My first hand experience/anecdata is that doctors are just like every other professional. Some are good, some are mediocre. Some are so consumed by hubris they believe the public is always wrong, and Some are willing to talk things through and keep an open mind about everything, even if it is ridiculous. The best thing we could do for healthcare is to remove the idea that "doctor knows best." While it is important for doctors to feel confident, and to teach the public to avoid snakeoil, it just places unreal expectations on these people. If patients took more accountability for their own health, then we could loosen some of the malpractice laws, and doctors insurance premiums would go down, and that would in turn cause rates to go down. But that was a bit of a tangent from my point that doctors are just people, maybe with an average intelligence that is slightly above the population at large, but still just people.

ROTMetro 4y ago
To make life and death decisions for people requires you have hubris and faith in yourself. I can't imagine what would happen to my hypercritical/overthinking self if I was a doctor making life and death choices, some resulting in death, for people for 10 years. I had a hard enough time when I did medical software, working 80 hour weeks to get a new release out the door because it was going to positively impact people's lives and a delay meant X people's lives wouldn't be improved, and I took that on as me failing those people who I didn't help every day the release didn't go out.
- dec0dedab0de 4y ago
  To make life and death decisions for people requires you have hubris and faith in yourself. Sure, but outside of surgeons and the ER, most doctors are not making life or death decisions all too often. Your average family medicine doctor should always be presenting multiple options for care, and be honest with the patient and themselves that they may be wrong about the diagnosis. I know some people dislike so-called weasel words, but doctors should be using them regularly.

gymbeaux 4y ago

I had my first real foray into the US healthcare system in 2022. I went to three orthopedic surgeons and a neurologist, and none of them diagnosed me correctly. I was having nerve pain in my hands, and they all jumped on “carpal tunnel syndrome”, however none mentioned or even tested me for Thoracic Outlet Syndrome, which is what I actually have. Three doctors. One of them, who was the shoulder specialist ironically (he should have nailed the diagnosis as TOS), looked at my hand X-Rays, said there is no arthritis, then did a test on me to that I said hurt, and then diagnosed me with arthritis. I’m 27. It borders on malpractice and at the very least should be considered gross negligence. And they were all in a big hurry. I had to stop all of them on their way out of the examination room to ask my questions!

jnovek 4y ago
I’ve been a patient dealing with a chronic condition for about four years now. IMO you had a pretty good experience relative to the norm. It’s not uncommon for it to take years to get a proper diagnosis for chronic conditions.
- gymbeaux 4y ago
  It’s because I spent a tens of hours doing research. I’m sure it would take me a lot longer if I had to specialist-hop until I found someone familiar with TOS
cfu28 4y ago
That's weird, TOS is something taught to first year med students. It isn't that esoteric of a diagnosis.
- gymbeaux 4y ago
  I’ve done a lot of research on TOS and my findings are that TOS is A) very difficult to diagnose even with diagnostic imaging and B) considered much less-common than Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, and Tendonitis. I’ll add that all three ortho docs did those “provocative tests” for CTS, like bending my wrists, and NONE made my symptoms worse. This alone should have been an indicator that the nerve impingement was happening closer to the spine. Meanwhile, the provocative tests for TOS almost immediately and drastically worsened my symptoms.

jsonne 4y ago

I don't think so, I think there's a combination of things that are happening that makes their jobs more difficult and a lot of macro changes happening in the world as well as just bad expectations that we have as patients. I am not in the medical field, this is simply my layman's interpretation of what is going on. 1. Doctors are not the same are researchers in many or most cases. They are more akin to technicians than scientists. In the same way I wouldn't expect my electrician to meaningfully innovate the way that he hooks up my house to the power grid or I wouldn't expect my plumber to fundamentally shift my city's sewer system to better serve my individual house that simply isn't their job as front line folks administering care. 2. I think we are massively overlooking simply the breadth and depth of the changes in the world and how that affects their profession. We are exposed to a staggering and exponentially increasing amount of chemicals, environmental toxins, pollutants, foods, and their patients come from a variety of different ethnic backgrounds and live in wildly different environments with wildly different lifestyles. I have to imagine 100 years ago if you were a doctor in say Ireland, you mostly knew what your patients did for work, what they ate, they all lived in roughly the same area, etc. The variables of health were simply much less. 3. The same time the amount of diseases / disorders / etc. that we've identified has grown exponentially. When the field of things that it could be even if that was an incomplete list (obviously) it was much easier to give a broad diagnosis than a specific one. This has improved treatment to be sure but also demanded specialization so any one doctor having all the answers gets less likely over time. 4. Lastly it's just financial pressures. Markets and especially insurance is part of this but I think in general as globalization has continued to accelerate and resources are being distributed more and more in some sense (and concentrated in other senses) you have to take a holistic view. You say doctors used to be "better" but better where? If all the doctors are in a handful of countries with most of the resources that sub group of people will yes get better care but what about everyone else?