6 ms·

> Googling “RSI” is useless. A few times a month my wife has what she calls a "Google patient". Her canned response is: "Your google search isn't equivalent

> Googling “RSI” is useless. A few times a month my wife has what she calls a "Google patient". Her canned response is: "Your google search isn't equivalent to my medical degree." Some get it.

gymbeaux 4y ago
Yeah, but at the same time I saw 3 orthopedic surgeons and 1 neurologist and 2 of them said "carpal tunnel syndrome", one of them said "arthritis" (after saying my X-Rays didn't show any signs of arthritis), and none of them got the diagnosis right (thoracic outlet syndrome). The kicker is the one who settled on "arthritis" is a shoulder guy, the one you'd expect to at least test for TOS.
- robomartin 4y ago
  Just like there are bad engineers, the medical community has bad doctors. Perhaps "bad" is too strong a term. It might be more accurate to refer to them as "low information" or "not up to date" or "low skill" professionals. On the engineering front, it takes work to stay up to date on the latest technologies. I have been in the field for 40 years, I know lots of people with the same time in the domain who can barely deal with a modern computer, much less design with modern FPGA's, processors and write software in a range of modern languages. People do stagnate. That's just reality. The same is the case with doctors, or almost any profession. One plumber might be up to date with the latest advances and have great diagnostics skills while the other hits everything with a hammer. Which hints at the other reality. I have worked with dozens of young engineers just out of school. It is interesting to see just how wide a range of skills and capabilities you get. Those who went into engineering with passion stand out because they are engaged in the field and have a real tangible sense of how things work. For lack of a better term, they were getting their hands dirty before they started university, and it shows. Others came to my desk with such low skills it was hard to conceive how they might succeed. Doctors have to be in the same reality. We've all heard of doctors who misdiagnose people who, months or years later, through great personal effort, finally discover what was wrong and got it handled. What I have never seen is a root-cause analysis of this (well, there was a TV show years back that did some of this). That's what matters. Medicine (or engineering) will never improve if we don't have a mechanism through which we can go back and ensure some of these things happen with less frequency. This is where I believe AI-based diagnosis will eventually become a useful tool. Not to replace doctors, but rather to present them with a range of opinions to explore. As with anything in computing, these systems will require accurate data, both medical and from the patient. And that's how we come full circle to the problems in medicine, one of which is having to work with patients who are uninformed or ill-informed from whom it is difficult to obtain accurate data for diagnostics. Not an easy problem.
  - gymbeaux 4y ago
    While all the docs I saw were "friendly", they were all in a hurry, which is probably imposed by the hospital they work for (where applicable), but 2 of the orthopedic surgeons I saw were father and son, with their own practice. Nevertheless, each of them were incredibly late (over 30 min) seeing me. So I would suppose that greed is a component. The son literally came into the exam room with a laptop showing my X-Rays, said I don't have arthritis, went to leave, I had to stop him and kind of press him because he didn't diagnose me with anything, then he did some test where he pressed my thumbs into their joints and asked if that hurt. It did. Then he said that I have arthritis in my thumb joints. This is the kind of sloppiness I would expect from the juniorist of junior developers, not a medical doctor who spent over a decade in school and specializes in orthopedics. Needless to say, that same maneuver does not hurt my thumbs anymore, and I brought this up when I saw his dad a couple of weeks later. He said something to the effect of "well sometimes arthritis comes and goes" and then changed the subject. The sheer arrogance (I don't think it's incompetence) in that building was astounding. So I, a 27 year old with no signs of arthritis on X-Rays, have arthritis that "comes and goes", even though I continue to work a desk job for 8 hours a day. Makes sense. I saw a hand surgeon who said the arthritis diagnosis was wrong and couldn't explain why he made that diagnosis. When the nerve conduction study came back normal, it was subtly suggested that the pain might be psychosomatic since I mentioned the pain went down when I started taking an SSRI. So after being told by 3 docs it was carpal tunnel syndrome, and then the neurologist saying it wasn't, I went back to the Internet, and stumbled upon Thoracic Outlet Syndrome. It fit so perfectly, and the provocative tests for it immediately made my symptoms worse. At the follow-up with the hand surgeon, I brought this up after she said something to the effect of "well, it's not CTS so I can't help you, here's a prescription for physical therapy, good luck", she immediately said that "TOS is very rare, and it would have shown on the nerve conduction study". This is obviously false (even without the research papers I found) because performing stretches and exercises meant to treat TOS have been incredibly effective for me. Complete shitshow. And of course I had to pay ~$1000 for all that. It's funny how we can see doctors who are either wrong or unable to come to a diagnosis, and we have to pay them anyway, but if a plumber comes to my house, says I have a bad septic tank, then proceeds to replace my kitchen faucet, obviously I am not going to pay him. I think my issue was that I was not assertive ENOUGH with these docs, but of course I don't want to be "that guy". Kind of a lose-lose situation.
feanaro 4y ago
I dislike this quip. If you are so sure of your thinking, then surely you can argument it rationally and calmly rather than reaching for the quip. Sure, if I then insist and do not seem to respond to reason, then it may become appropriate.
- robomartin 4y ago
  The part that isn't visible by reading a simple one-line comment describing the interaction is the reality of dealing with patients in almost any kind of practice. I cannot properly convey the experience here. For one, I am just an observer. Here are a few points that seem to come up with some frequency during our "How was your day?" conversations: Patients, just like doctors and engineers, are in a range between good and horrible. Some work with the doctor, follow directions, take the medicine/treatment and make progress. Others are the opposite, they keep coming back with the same issues (and often more) and, when interrogated, doctors discover they completely ignored (or worse, modified) what they where told to do. This kind of thing is truly frustrating. To put it in CS terms, imagine telling a junior developer how to fix a problem that has been compromising a codebase, only to discover, a month later, that the developer ignored your advice and decide to change variable names instead, because an article on the web said short variable names are better. Bullshit example, yet not too far from medical reality sometimes. At the extreme are patients who are uninformed, rude, entitled and combative. It seems my wife comes home rattled once every couple of months after having to deal with a complete asshole who ruined her day. With regards to information, yes, of course, she absolutely prefers informed patients. Why? Because those often turn out to be the good patients she can really help. The "Your google search..." comment isn't a universal statement delivered to anyone who says "I read on the web...". No, that isn't the case at all. She tells me patients do come-in who have done their homework and contribute valuable information to the process. These patients are actively engaged in the process. There's a vast difference between being informed and engaged in what's going on and reading a few things in social media and actually thinking you know what you are talking about. People insisting on getting antibiotics for just-about everything is one example of this. Those who receive and deserve the put-down are zero-effort, zero-knowledge patients who, after having read something on the web --which is often irrelevant or way out there-- come to the doctor absolutely convinced that is THE way to handle whatever it is might ail them. These patients are often in the combative, arrogant, rude category. The often require what my wife calls "The New York attitude" treatment. In other words, you have to forcefully (not physically, of course) assert yourself or you can't help them. As an example, imagine someone coming in asking for a prescription to some ridiculous medicine to be protected from COVID and, at the same time, refuse to get vaccinated because they believe the government injects you with microscopic radio transmitters that track you. Yes, this is an extreme example, of course, however, it is hard for someone not dealing with dozens of patients a day to imagine the range of situations a doctor encounters on a daily basis.
balfirevic 4y ago
> Your google search isn't equivalent to my medical degree. True, occasionally it's better.
- thro1 4y ago
  Same. One doctor didn't understand the previuos one prescription - that it's a combo for self-amplifying symptoms and makes no sense incomplete - I'm lucky that the other worked there for a while. No doctor found out that as a vegetarian I may be missing an enzyme (bromelain, which dissolve mucus).
- robomartin 4y ago
  With a strong emphasis on "occasionally". The vast majority of doctors and hospitals (the overwhelming majority) are good and medicine is too complex for most people to understand. I see how hard my wife works to keep up with the latest medicines, research, treatments and developments in her field. It's on part with what any top-level hardware or software engineer has to do on a daily basis to be informed and remain relevant. The exception is: We don't generally kill people if we make a mistake. In other words, yes, being informed is good. Everyone should dig as deep as their education allows them to when it comes to their own medical needs. However, at the end of the day, it is impossible (and unwise) to pretend that this can substitute for a real doctor. We are talking about good doctors here, not the few at the bottom of the barrel who would have better-served society by choosing a different career.
  - maxbond 4y ago
    I don't think "good doctors" and "bad doctors" is really a good framing. I think the medical system sabotages the relationship between doctor and patient and creates incentives to spend the least amount of effort on any given patient. That isn't anyone's fault but if your diagnosis is off the beaten path, and especially if it looks like a common diagnosis but isn't that one, it can be incredibly difficult to get a doctor to take you seriously. I think people reacted strongly to your comment because they felt it was emblematic of a dismissive attitude they receive from doctors - regardless of how good a doctor may be. To help illustrate, here's a skit where a doctor satirizes this attitude: https://youtube.com/shorts/u_-a7pvFpsA https://youtube.com/shorts/u_-a7pvFpsA

> Googling “RSI” is useless. A few times a month my wife has what she calls a "Google patient". Her canned response is: "Your google search isn't equivalent to my medical degree." Some get it.

gymbeaux 4y ago

Yeah, but at the same time I saw 3 orthopedic surgeons and 1 neurologist and 2 of them said "carpal tunnel syndrome", one of them said "arthritis" (after saying my X-Rays didn't show any signs of arthritis), and none of them got the diagnosis right (thoracic outlet syndrome). The kicker is the one who settled on "arthritis" is a shoulder guy, the one you'd expect to at least test for TOS.

robomartin 4y ago
Just like there are bad engineers, the medical community has bad doctors. Perhaps "bad" is too strong a term. It might be more accurate to refer to them as "low information" or "not up to date" or "low skill" professionals. On the engineering front, it takes work to stay up to date on the latest technologies. I have been in the field for 40 years, I know lots of people with the same time in the domain who can barely deal with a modern computer, much less design with modern FPGA's, processors and write software in a range of modern languages. People do stagnate. That's just reality. The same is the case with doctors, or almost any profession. One plumber might be up to date with the latest advances and have great diagnostics skills while the other hits everything with a hammer. Which hints at the other reality. I have worked with dozens of young engineers just out of school. It is interesting to see just how wide a range of skills and capabilities you get. Those who went into engineering with passion stand out because they are engaged in the field and have a real tangible sense of how things work. For lack of a better term, they were getting their hands dirty before they started university, and it shows. Others came to my desk with such low skills it was hard to conceive how they might succeed. Doctors have to be in the same reality. We've all heard of doctors who misdiagnose people who, months or years later, through great personal effort, finally discover what was wrong and got it handled. What I have never seen is a root-cause analysis of this (well, there was a TV show years back that did some of this). That's what matters. Medicine (or engineering) will never improve if we don't have a mechanism through which we can go back and ensure some of these things happen with less frequency. This is where I believe AI-based diagnosis will eventually become a useful tool. Not to replace doctors, but rather to present them with a range of opinions to explore. As with anything in computing, these systems will require accurate data, both medical and from the patient. And that's how we come full circle to the problems in medicine, one of which is having to work with patients who are uninformed or ill-informed from whom it is difficult to obtain accurate data for diagnostics. Not an easy problem.
- gymbeaux 4y ago
  While all the docs I saw were "friendly", they were all in a hurry, which is probably imposed by the hospital they work for (where applicable), but 2 of the orthopedic surgeons I saw were father and son, with their own practice. Nevertheless, each of them were incredibly late (over 30 min) seeing me. So I would suppose that greed is a component. The son literally came into the exam room with a laptop showing my X-Rays, said I don't have arthritis, went to leave, I had to stop him and kind of press him because he didn't diagnose me with anything, then he did some test where he pressed my thumbs into their joints and asked if that hurt. It did. Then he said that I have arthritis in my thumb joints. This is the kind of sloppiness I would expect from the juniorist of junior developers, not a medical doctor who spent over a decade in school and specializes in orthopedics. Needless to say, that same maneuver does not hurt my thumbs anymore, and I brought this up when I saw his dad a couple of weeks later. He said something to the effect of "well sometimes arthritis comes and goes" and then changed the subject. The sheer arrogance (I don't think it's incompetence) in that building was astounding. So I, a 27 year old with no signs of arthritis on X-Rays, have arthritis that "comes and goes", even though I continue to work a desk job for 8 hours a day. Makes sense. I saw a hand surgeon who said the arthritis diagnosis was wrong and couldn't explain why he made that diagnosis. When the nerve conduction study came back normal, it was subtly suggested that the pain might be psychosomatic since I mentioned the pain went down when I started taking an SSRI. So after being told by 3 docs it was carpal tunnel syndrome, and then the neurologist saying it wasn't, I went back to the Internet, and stumbled upon Thoracic Outlet Syndrome. It fit so perfectly, and the provocative tests for it immediately made my symptoms worse. At the follow-up with the hand surgeon, I brought this up after she said something to the effect of "well, it's not CTS so I can't help you, here's a prescription for physical therapy, good luck", she immediately said that "TOS is very rare, and it would have shown on the nerve conduction study". This is obviously false (even without the research papers I found) because performing stretches and exercises meant to treat TOS have been incredibly effective for me. Complete shitshow. And of course I had to pay ~$1000 for all that. It's funny how we can see doctors who are either wrong or unable to come to a diagnosis, and we have to pay them anyway, but if a plumber comes to my house, says I have a bad septic tank, then proceeds to replace my kitchen faucet, obviously I am not going to pay him. I think my issue was that I was not assertive ENOUGH with these docs, but of course I don't want to be "that guy". Kind of a lose-lose situation.

feanaro 4y ago

I dislike this quip. If you are so sure of your thinking, then surely you can argument it rationally and calmly rather than reaching for the quip. Sure, if I then insist and do not seem to respond to reason, then it may become appropriate.

robomartin 4y ago
The part that isn't visible by reading a simple one-line comment describing the interaction is the reality of dealing with patients in almost any kind of practice. I cannot properly convey the experience here. For one, I am just an observer. Here are a few points that seem to come up with some frequency during our "How was your day?" conversations: Patients, just like doctors and engineers, are in a range between good and horrible. Some work with the doctor, follow directions, take the medicine/treatment and make progress. Others are the opposite, they keep coming back with the same issues (and often more) and, when interrogated, doctors discover they completely ignored (or worse, modified) what they where told to do. This kind of thing is truly frustrating. To put it in CS terms, imagine telling a junior developer how to fix a problem that has been compromising a codebase, only to discover, a month later, that the developer ignored your advice and decide to change variable names instead, because an article on the web said short variable names are better. Bullshit example, yet not too far from medical reality sometimes. At the extreme are patients who are uninformed, rude, entitled and combative. It seems my wife comes home rattled once every couple of months after having to deal with a complete asshole who ruined her day. With regards to information, yes, of course, she absolutely prefers informed patients. Why? Because those often turn out to be the good patients she can really help. The "Your google search..." comment isn't a universal statement delivered to anyone who says "I read on the web...". No, that isn't the case at all. She tells me patients do come-in who have done their homework and contribute valuable information to the process. These patients are actively engaged in the process. There's a vast difference between being informed and engaged in what's going on and reading a few things in social media and actually thinking you know what you are talking about. People insisting on getting antibiotics for just-about everything is one example of this. Those who receive and deserve the put-down are zero-effort, zero-knowledge patients who, after having read something on the web --which is often irrelevant or way out there-- come to the doctor absolutely convinced that is THE way to handle whatever it is might ail them. These patients are often in the combative, arrogant, rude category. The often require what my wife calls "The New York attitude" treatment. In other words, you have to forcefully (not physically, of course) assert yourself or you can't help them. As an example, imagine someone coming in asking for a prescription to some ridiculous medicine to be protected from COVID and, at the same time, refuse to get vaccinated because they believe the government injects you with microscopic radio transmitters that track you. Yes, this is an extreme example, of course, however, it is hard for someone not dealing with dozens of patients a day to imagine the range of situations a doctor encounters on a daily basis.

balfirevic 4y ago

> Your google search isn't equivalent to my medical degree. True, occasionally it's better.

thro1 4y ago
Same. One doctor didn't understand the previuos one prescription - that it's a combo for self-amplifying symptoms and makes no sense incomplete - I'm lucky that the other worked there for a while. No doctor found out that as a vegetarian I may be missing an enzyme (bromelain, which dissolve mucus).
robomartin 4y ago
With a strong emphasis on "occasionally". The vast majority of doctors and hospitals (the overwhelming majority) are good and medicine is too complex for most people to understand. I see how hard my wife works to keep up with the latest medicines, research, treatments and developments in her field. It's on part with what any top-level hardware or software engineer has to do on a daily basis to be informed and remain relevant. The exception is: We don't generally kill people if we make a mistake. In other words, yes, being informed is good. Everyone should dig as deep as their education allows them to when it comes to their own medical needs. However, at the end of the day, it is impossible (and unwise) to pretend that this can substitute for a real doctor. We are talking about good doctors here, not the few at the bottom of the barrel who would have better-served society by choosing a different career.
- maxbond 4y ago
  I don't think "good doctors" and "bad doctors" is really a good framing. I think the medical system sabotages the relationship between doctor and patient and creates incentives to spend the least amount of effort on any given patient. That isn't anyone's fault but if your diagnosis is off the beaten path, and especially if it looks like a common diagnosis but isn't that one, it can be incredibly difficult to get a doctor to take you seriously. I think people reacted strongly to your comment because they felt it was emblematic of a dismissive attitude they receive from doctors - regardless of how good a doctor may be. To help illustrate, here's a skit where a doctor satirizes this attitude: https://youtube.com/shorts/u_-a7pvFpsA https://youtube.com/shorts/u_-a7pvFpsA