3 ms·

They're not becoming stupider, the culture of following protocols rather than understanding is a pre-scientific one. It certainly has benefits- predictable cons

by _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
  I just wish I could find a doctor that was open minded, and would discuss things. I have a PhD and do research in a medically related field, and will deeply read all of the scientific literature about any conditions I have, yet I still get the "just shut up and do what I say- your google search is not equivalent to my medical degree" treatment. I would like to be engaged by the doctor as a sort of collaborator on my medical issues, rather than be treated like an infant. My feeling is they are hiding behind the "I'm the expert here" thing because they are actually self conscious about how little they know, and are worried it will show if they engage in a discussion.
  - 2devnull 4y ago
    This is my great frustration. They are trained to detect “narcissistic” patients, and having seen some of those training videos, I now understand that their treatment of patients who try and reference the literature is guided by that training. I have to pretend to be stupid and find weird “people hacks” because I can’t just come out and say, “here is a recent meta analysis in nejm that says x. Could you read that sometime in the next few weeks and see if it applies?” Often it’s not even recent research but common knowledge you can find in bio 101 textbooks or Wikipedia. But asking questions the wrong way, you can come across as “thinking you know more than the clinician” (you do!) so you have engage in bizarre kabuki theater and feign ignorance hoping they feel the urge to revisit their textbooks, or google it.

by _yb2s 4y ago

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
I just wish I could find a doctor that was open minded, and would discuss things. I have a PhD and do research in a medically related field, and will deeply read all of the scientific literature about any conditions I have, yet I still get the "just shut up and do what I say- your google search is not equivalent to my medical degree" treatment. I would like to be engaged by the doctor as a sort of collaborator on my medical issues, rather than be treated like an infant. My feeling is they are hiding behind the "I'm the expert here" thing because they are actually self conscious about how little they know, and are worried it will show if they engage in a discussion.
- 2devnull 4y ago
  This is my great frustration. They are trained to detect “narcissistic” patients, and having seen some of those training videos, I now understand that their treatment of patients who try and reference the literature is guided by that training. I have to pretend to be stupid and find weird “people hacks” because I can’t just come out and say, “here is a recent meta analysis in nejm that says x. Could you read that sometime in the next few weeks and see if it applies?” Often it’s not even recent research but common knowledge you can find in bio 101 textbooks or Wikipedia. But asking questions the wrong way, you can come across as “thinking you know more than the clinician” (you do!) so you have engage in bizarre kabuki theater and feign ignorance hoping they feel the urge to revisit their textbooks, or google it.