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In defense of doctors, they are ideally supposed to practice based on evidence. That is the whole point of Western medicine in good and bad. As a physician you

In defense of doctors, they are ideally supposed to practice based on evidence. That is the whole point of Western medicine in good and bad. As a physician you might see people in your work that report these dreams and take it as a data point if it is very common. But what about people who see such dreams that don’t report them, or who aren’t even sick and it was just a dream, and most of all, who are sick and see such a dream but don’t die? What is the real statistical correlation between those dreams and death? Any good doctor needs to be very skeptical about everything until there is properly gathered and assessed statistical evidence. It’s the opposite of being arrogant to require extraordinary evidence for extraordinary claims. This is not a statement to dismiss end of life dreams. I think it sounds like this is a real phenomenon.

clnq 3y ago
I disagree that a good doctor needs to be skeptical of everything until they properly gathered evidence. That is more a description of what a rigorous scientist should do. There is a school of thought in medicine among some doctors (at least in Central and Northern Europe) that many patients know what’s wrong with them and one can go a long way toward a diagnosis by listening to and trusting a patient. Tests are used to confirm the diagnosis if possible, but they are well-known to be less reliable than the patients’ own experience (pains and other symptoms, for example). As an ex-medic myself, I strongly believe this is a more correct way to practice medicine, at least until significant advances are made in testing. That is not to say that we don’t have highly accurate tests that will clearly indicate conditions (blood tests for IgGs, IgMs, BG, CRP, organ function, BP, ECGs, etc). But many conditions won’t show up reliably in common examinations and tests. One of my old and wise doctor colleagues from a long time ago used to say that we live in the Stone Age of medicine — most of our tests and exams have very low specificity and we must treat a lot of people by what they tell us and our own subjective experience. He used to say that future doctors will see us as benevolent cave men who were constantly failed by our tools, unable to effectively remove illness and suffering, only really able to effectively listen and try to help, sometimes by just trying therapies until something hopefully sticks. I agree with them. There is nothing worse than a distrusting doctor who dismisses the patients symptoms to instead blindly and arrogantly applies a schematic based on assumptions that our testing and examinations have very good specificity. That is just not the case for most diseases and violates the benevolence principle considered intrinsic in medicine by many. In my opinion, this is only acceptable for new doctors (like those still in training and under supervision). Otherwise, this behaviour is just malicious. The science of medicine is very different from practicing medicine. The consequences of malpractice are deadly, and the time to treat a patient correctly is often limited. Scientists work in a much less constrained environment. Applying rigorous scientific method has relatively few negative externalities.
- andrepd 3y ago
  > There is a school of thought in medicine among some doctors (at least in Central and Northern Europe) that many patients know what’s wrong with them and one can go a long way toward a diagnosis by listening to and trusting a patient. Tests are used to confirm the diagnosis if possible, but they are well-known to be less reliable than the patients’ own experience (pains and other symptoms, for example). As an ex-medic myself, I strongly believe this is a more correct way to practice medicine What evidence do you have to "strongly believe" this? It's quite something, to state that the patient does a better job diagnosing himself than the doctor does. In that case, there should be some evidence to that effect, to show that this is indeed the case? Otherwise, saying "I strongly believe" or "school of thought" is just a way of saying "I have a hunch". > There is nothing worse than a distrusting doctor who dismisses the patients symptoms to instead blindly and arrogantly applies a schematic based on assumptions that our testing and examinations have very good specificity What on earth are you talking about? Medical diagnoses are made using a variety of sources of information, including of course symptoms! What do you mean exactly "dismisses symptoms to arrogantly apply a testing scheme"? Maybe I'm misunderstanding.
  - clnq 3y ago
    Yes, possibly misunderstanding or perhaps I did not communicate clearly enough. My position is not extreme and speaks of the relative minority of medics who suffer from medical arrogance. > to state that the patient does a better job diagnosing himself than the doctor does This is not what I stated. I stated that listening to and trusting the patient helps arrive at a diagnosis more reliably than only doing tests. Sometimes it can even help arrive at a diagnosis more reliably than doing tests (for example, fungal infections can be seen or felt by patients more reliably than their cultures grow in the lab, and most doctors diagnose without a culture test). > Medical diagnoses are made using a variety of sources of information, including of course symptoms! Yes, but too often the diagnoses are made following algorithms or guidelines that don't suit many patients. A doctor is often required to follow the algorithms (and perhaps for a good reason), but should also know when they are not applicable to an individual patient. My position is not extreme, although it's not mainstream either. There is a large body of research talking about medical arrogance specifically manifesting as doctors ignoring the patients. Likewise, many people in the field (at least in some regions like the UK) have experience dealing with colleagues who swear by algorithms (or worse — their own ideas) and are skeptical of patients who don't fit within them. This seems to be much less common in other regions. My family works in the medical field in Central Europe where, in my opinion, very few medics have issues with medical arrogance. I cannot comment on the US where I assume a good number of readers of this text are from, although academic literature indicates it's a global problem.

clnq 3y ago

I disagree that a good doctor needs to be skeptical of everything until they properly gathered evidence. That is more a description of what a rigorous scientist should do. There is a school of thought in medicine among some doctors (at least in Central and Northern Europe) that many patients know what’s wrong with them and one can go a long way toward a diagnosis by listening to and trusting a patient. Tests are used to confirm the diagnosis if possible, but they are well-known to be less reliable than the patients’ own experience (pains and other symptoms, for example). As an ex-medic myself, I strongly believe this is a more correct way to practice medicine, at least until significant advances are made in testing. That is not to say that we don’t have highly accurate tests that will clearly indicate conditions (blood tests for IgGs, IgMs, BG, CRP, organ function, BP, ECGs, etc). But many conditions won’t show up reliably in common examinations and tests. One of my old and wise doctor colleagues from a long time ago used to say that we live in the Stone Age of medicine — most of our tests and exams have very low specificity and we must treat a lot of people by what they tell us and our own subjective experience. He used to say that future doctors will see us as benevolent cave men who were constantly failed by our tools, unable to effectively remove illness and suffering, only really able to effectively listen and try to help, sometimes by just trying therapies until something hopefully sticks. I agree with them. There is nothing worse than a distrusting doctor who dismisses the patients symptoms to instead blindly and arrogantly applies a schematic based on assumptions that our testing and examinations have very good specificity. That is just not the case for most diseases and violates the benevolence principle considered intrinsic in medicine by many. In my opinion, this is only acceptable for new doctors (like those still in training and under supervision). Otherwise, this behaviour is just malicious. The science of medicine is very different from practicing medicine. The consequences of malpractice are deadly, and the time to treat a patient correctly is often limited. Scientists work in a much less constrained environment. Applying rigorous scientific method has relatively few negative externalities.

andrepd 3y ago
> There is a school of thought in medicine among some doctors (at least in Central and Northern Europe) that many patients know what’s wrong with them and one can go a long way toward a diagnosis by listening to and trusting a patient. Tests are used to confirm the diagnosis if possible, but they are well-known to be less reliable than the patients’ own experience (pains and other symptoms, for example). As an ex-medic myself, I strongly believe this is a more correct way to practice medicine What evidence do you have to "strongly believe" this? It's quite something, to state that the patient does a better job diagnosing himself than the doctor does. In that case, there should be some evidence to that effect, to show that this is indeed the case? Otherwise, saying "I strongly believe" or "school of thought" is just a way of saying "I have a hunch". > There is nothing worse than a distrusting doctor who dismisses the patients symptoms to instead blindly and arrogantly applies a schematic based on assumptions that our testing and examinations have very good specificity What on earth are you talking about? Medical diagnoses are made using a variety of sources of information, including of course symptoms! What do you mean exactly "dismisses symptoms to arrogantly apply a testing scheme"? Maybe I'm misunderstanding.
- clnq 3y ago
  Yes, possibly misunderstanding or perhaps I did not communicate clearly enough. My position is not extreme and speaks of the relative minority of medics who suffer from medical arrogance. > to state that the patient does a better job diagnosing himself than the doctor does This is not what I stated. I stated that listening to and trusting the patient helps arrive at a diagnosis more reliably than only doing tests. Sometimes it can even help arrive at a diagnosis more reliably than doing tests (for example, fungal infections can be seen or felt by patients more reliably than their cultures grow in the lab, and most doctors diagnose without a culture test). > Medical diagnoses are made using a variety of sources of information, including of course symptoms! Yes, but too often the diagnoses are made following algorithms or guidelines that don't suit many patients. A doctor is often required to follow the algorithms (and perhaps for a good reason), but should also know when they are not applicable to an individual patient. My position is not extreme, although it's not mainstream either. There is a large body of research talking about medical arrogance specifically manifesting as doctors ignoring the patients. Likewise, many people in the field (at least in some regions like the UK) have experience dealing with colleagues who swear by algorithms (or worse — their own ideas) and are skeptical of patients who don't fit within them. This seems to be much less common in other regions. My family works in the medical field in Central Europe where, in my opinion, very few medics have issues with medical arrogance. I cannot comment on the US where I assume a good number of readers of this text are from, although academic literature indicates it's a global problem.