8 ms·

This could be true for many professions. If I need some long-tail obscure help (suppose, for example, my car was acting up in a strange way the mechanic never h

This could be true for many professions. If I need some long-tail obscure help (suppose, for example, my car was acting up in a strange way the mechanic never had seen or heard of before) I'd expect roughly the same set of reactions. Most professionals are state machines that do X Y Z well. You throw A B C at them and few will introspect deeply into it.

s1artibartfast 4y ago
Exactly this. You have to run into an individual on the long tail of mechanics that is uniquely curious about finding the root cause, or throw enough money at them that they are incentivized to track down the problem. Doctors are no different than other humans. Your problem isn't necessarily their problem.
- mindslight 4y ago
  Sure, but coming at it from a programming/engineering background, that is a tough pill to swallow. If I'm going to a "professional" and paying them $1k/hour, why the fuck aren't they applying their full intellect to analyze my problem ? If we're supposed to expect front line doctors to be mere rule-applying automatons that just take a few pieces of input and produce outputs like "run common test X" and "apply common drug Y", that's technician-level work that should cost closer to mechanics' shop rates - where it can't just be entirely replaced by automation and self-service.
  - 88913527 4y ago
    Doctors cost so much because there are artificial caps on supply in the US. So much for the hippocratic oath of "do no harm". Fewer doctors decreases access to the medical system which undoubtedly causes harm.
    - nradov 4y ago
      The main cap on the supply of doctors is imposed by limited Medicare funding for residency programs. Members of Congress who control that funding aren't subject to the Hippocratic Oath. https://savegme.org/ https://savegme.org/
      - s1artibartfast 4y ago
        I never understood why residency programs need to be funded to begin with. I dont think this is how it works elsewhere and I struggle to believe that a hospital bill enough to cover employment and training of a resident.
        nradov 4y ago
        It's not clear whether graduate medical education programs operate at a profit or loss. The accounting is complex, and the results depend on how revenues and expenses are allocated internally. https://www.fiercehealthcare.com/finance/do-teaching-hospitals-profit-from-graduate-medical-education https://www.fiercehealthcare.com/finance/do-teaching-hospita...
        s1artibartfast 4y ago
        It's not clear because medical finance and insurance is so Twisted that even the hospitals operating them don't understand it. I still find a dubious that residents can't build enough hours at a high enough rate to cover their cost of employment.
        wl 4y ago
        Not all residency programs are funded by Medicare. And even among those that are funded by Medicare, many have additional slots that are unfunded but exist anyway because a resident provides cheap labor. If a physician decides to change specialties and do a second residency, these unfunded programs and slots are their only options because Medicare won't pay for second residencies.
  - s1artibartfast 4y ago
    I don't think that they aren't applying their brain. It simply can take a lot of time the work from possible cause A to Z. It doesn't matter how brilliant or applied they are. I agree with your second point. A lot of doctors time and expertise is squandered covering A and B which could probably be handled by a bot. I think there are a lot of regulatory and liability barriers to doing this.
    - mindslight 4y ago
      I do understand that even the most brilliantly engaged person isn't going to be able to do much first principles analysis in fifteen minutes, or even an hour. Rather my critique is based on the output most doctors produce, which seems quite one-way mechanical. Trying to have some mutual discussion or supplying your own input (whether from your own investigation or a different doctor) is often met with dialtone or even overt rejection.
      - zdragnar 4y ago
        In America at least, there's a bit of a trope among doctors who see patients self diagnosing wildly incorrectly after doing a quick scan of WebMD and various quackery websites. Then there's the old phrase "think horses, not zebras". Whether their funding is as a business or paid by universal care, all doctors answer to someone about how they charge for care. A doctor letting a patient dictate the course of assessment and determination of illness outside the "standards of care" is at best a potential waste of time and money, and at worst a malpractice claim waiting to happen ("you should have known I didn't know what I was talking about!") if it turns out there patient was wrong. Edit: FWIW I have a batch of undiagnosed symptoms. I was temporarily on a new medication that cost an obscene amount of money, but it helped... Until COVID showed up, and I stopped it because it could potentially weaken my immune system. Now, my symptoms haven't fully returned, and I can't get a prescription for it again because the symptoms cross specialist boundaries, and no one specialist says that my symptoms for the area they treat are bad enough yet. (Psoriasis, joints inflammation, connective tissue pain, nervous system excitement). Guess I'll have to wait and see if any one area gets bad enough to go to the right specialist.
  - Aeolun 4y ago
    I mean, people come to engineers to apply their full intellect too, but I’m certainly not capable of giving 100% every day.
  - ryandrake 4y ago
    When you are a naturally curious problem solver, it can be maddening working with service providers like doctors and mechanics and plumbers who just want to apply some known formula, spend the minimum amount of time, and cram more cu$tomer$ through the funnel. When your problem doesn’t fit into an easy, known pattern, it’s “whellp, you’re on your own. I can’t charge you enough to make this worth doing, and I’ve got 50 customers in line behind you with easy issues!”
- harimau777 4y ago
  I think that the difference is that doctors have much greater legal protection that keeps non-doctors from doing anything when they don't.
  - s1artibartfast 4y ago
    I would say it's basically two things: Legal ability to provide medical advice Legal ability to prescribe Without these two things there is very little to prevent someone from setting up a low cost Clinic out of their garage. Malpractice insurance is another Factor, but without the legal barriers I'm sure the the insurance Market would be willing to cover someone for extremely low risk basic care. You can get many medications over the counter from a pharmacist and other countries that require a licensed doctor with 10 years of training and the US. Meanwhile, hey Barbara can't even cut someone's hair without a year of training and expensive license to operate from the state.
dclowd9901 4y ago
I’m currently having a hard time packaging a react-native app as a cocoa pod because apparently basically no one else has ever thought to do it. It’s quite frustrating, though nothing on the level of the poor person who wrote this article.

s1artibartfast 4y ago

Exactly this. You have to run into an individual on the long tail of mechanics that is uniquely curious about finding the root cause, or throw enough money at them that they are incentivized to track down the problem. Doctors are no different than other humans. Your problem isn't necessarily their problem.

mindslight 4y ago
Sure, but coming at it from a programming/engineering background, that is a tough pill to swallow. If I'm going to a "professional" and paying them $1k/hour, why the fuck aren't they applying their full intellect to analyze my problem ? If we're supposed to expect front line doctors to be mere rule-applying automatons that just take a few pieces of input and produce outputs like "run common test X" and "apply common drug Y", that's technician-level work that should cost closer to mechanics' shop rates - where it can't just be entirely replaced by automation and self-service.
- 88913527 4y ago
  Doctors cost so much because there are artificial caps on supply in the US. So much for the hippocratic oath of "do no harm". Fewer doctors decreases access to the medical system which undoubtedly causes harm.
  - nradov 4y ago
    The main cap on the supply of doctors is imposed by limited Medicare funding for residency programs. Members of Congress who control that funding aren't subject to the Hippocratic Oath. https://savegme.org/ https://savegme.org/
    - s1artibartfast 4y ago
      I never understood why residency programs need to be funded to begin with. I dont think this is how it works elsewhere and I struggle to believe that a hospital bill enough to cover employment and training of a resident.
      - nradov 4y ago
        It's not clear whether graduate medical education programs operate at a profit or loss. The accounting is complex, and the results depend on how revenues and expenses are allocated internally. https://www.fiercehealthcare.com/finance/do-teaching-hospitals-profit-from-graduate-medical-education https://www.fiercehealthcare.com/finance/do-teaching-hospita...
        s1artibartfast 4y ago
        It's not clear because medical finance and insurance is so Twisted that even the hospitals operating them don't understand it. I still find a dubious that residents can't build enough hours at a high enough rate to cover their cost of employment.
      - wl 4y ago
        Not all residency programs are funded by Medicare. And even among those that are funded by Medicare, many have additional slots that are unfunded but exist anyway because a resident provides cheap labor. If a physician decides to change specialties and do a second residency, these unfunded programs and slots are their only options because Medicare won't pay for second residencies.
- s1artibartfast 4y ago
  I don't think that they aren't applying their brain. It simply can take a lot of time the work from possible cause A to Z. It doesn't matter how brilliant or applied they are. I agree with your second point. A lot of doctors time and expertise is squandered covering A and B which could probably be handled by a bot. I think there are a lot of regulatory and liability barriers to doing this.
  - mindslight 4y ago
    I do understand that even the most brilliantly engaged person isn't going to be able to do much first principles analysis in fifteen minutes, or even an hour. Rather my critique is based on the output most doctors produce, which seems quite one-way mechanical. Trying to have some mutual discussion or supplying your own input (whether from your own investigation or a different doctor) is often met with dialtone or even overt rejection.
    - zdragnar 4y ago
      In America at least, there's a bit of a trope among doctors who see patients self diagnosing wildly incorrectly after doing a quick scan of WebMD and various quackery websites. Then there's the old phrase "think horses, not zebras". Whether their funding is as a business or paid by universal care, all doctors answer to someone about how they charge for care. A doctor letting a patient dictate the course of assessment and determination of illness outside the "standards of care" is at best a potential waste of time and money, and at worst a malpractice claim waiting to happen ("you should have known I didn't know what I was talking about!") if it turns out there patient was wrong. Edit: FWIW I have a batch of undiagnosed symptoms. I was temporarily on a new medication that cost an obscene amount of money, but it helped... Until COVID showed up, and I stopped it because it could potentially weaken my immune system. Now, my symptoms haven't fully returned, and I can't get a prescription for it again because the symptoms cross specialist boundaries, and no one specialist says that my symptoms for the area they treat are bad enough yet. (Psoriasis, joints inflammation, connective tissue pain, nervous system excitement). Guess I'll have to wait and see if any one area gets bad enough to go to the right specialist.
- Aeolun 4y ago
  I mean, people come to engineers to apply their full intellect too, but I’m certainly not capable of giving 100% every day.
- ryandrake 4y ago
  When you are a naturally curious problem solver, it can be maddening working with service providers like doctors and mechanics and plumbers who just want to apply some known formula, spend the minimum amount of time, and cram more cu$tomer$ through the funnel. When your problem doesn’t fit into an easy, known pattern, it’s “whellp, you’re on your own. I can’t charge you enough to make this worth doing, and I’ve got 50 customers in line behind you with easy issues!”
harimau777 4y ago
I think that the difference is that doctors have much greater legal protection that keeps non-doctors from doing anything when they don't.
- s1artibartfast 4y ago
  I would say it's basically two things: Legal ability to provide medical advice Legal ability to prescribe Without these two things there is very little to prevent someone from setting up a low cost Clinic out of their garage. Malpractice insurance is another Factor, but without the legal barriers I'm sure the the insurance Market would be willing to cover someone for extremely low risk basic care. You can get many medications over the counter from a pharmacist and other countries that require a licensed doctor with 10 years of training and the US. Meanwhile, hey Barbara can't even cut someone's hair without a year of training and expensive license to operate from the state.

dclowd9901 4y ago

I’m currently having a hard time packaging a react-native app as a cocoa pod because apparently basically no one else has ever thought to do it. It’s quite frustrating, though nothing on the level of the poor person who wrote this article.