5 ms·

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

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.

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.