5 ms·

American doctors are trained to dogmatically accept medical treatments uncritically. The dogma is called the "standard of care" and the entire medical, billing,

American doctors are trained to dogmatically accept medical treatments uncritically. The dogma is called the "standard of care" and the entire medical, billing, and legal system will work against you if you deviate from it. They will only change their ways when they are told to do so from higher up.

pixl97 3y ago
"Airplane mechanic decides service manual incorrect, custom fix leads to 200 dead" And yes, what you state is exactly what the doctor should do. Otherwise you're taking all the testing and experience of all the other doctors that have already worked on this issue and tossed it out the window. When an individual patient shows anonymous behavior your document everything you can for future investigation. You don't get to play research laboratory on your patients.
- orangepurple 3y ago
  Doctors aren't mechanics. They are the engineers. Nurses are the mechanics.
  - pixl97 3y ago
    Engineers run it by QA before pushing it to prod.
    - salawat 3y ago
      Oh, you wish. You frigging wish. That lasts until someone who is the CTO's buddy gets a hair and decides to get exec override, then pushes to prod, deleting the company financials. And the medical equivalent of QA is generally a very awe inspiring strain of nurse.
- user_7832 3y ago
  > "Airplane mechanic decides service manual incorrect, custom fix leads to 200 dead" All airplanes of the identical model have an identical manual. No two humans respond the same to complex (or often, even simple) health conditions/situations. Just because we don't have enough docs doesn't mean custom solutions are the enemy.
  - pixl97 3y ago
    Now, if we had an unlimited number of doctors this wouldn't be near the problem (why we have a limited number of doctors is a different question). If a huge portion of the US population wasn't old relative to the part of the population that is young, this wouldn't be near the problem. If a massive portion of the US population wasn't... um... massive, well then this wouldn't as much of a problem. But the country we are left with has too few doctors, too many old people, and too many unhealthy people. We can argue until we're blue on why that is the case, but that does nothing to change that your doctor has about 5 minutes with you and an entire waiting room full of patients today, tomorrow, and the everyday after that to the point they are turning patients away in most places.
  - nradov 3y ago
    Custom solutions aren't the enemy, but in situations where an applicable evidence-based medicine protocol exists it would be malpractice to deviate from that without a damn good reason. Those treatment protocols produce good results for average patients (i.e. most of us).
nradov 3y ago
Nonsense. That is not how American doctors are trained. Have your ever actually talked to a medical school professor, or an attending physician in a teaching hospital? In recent years the medical profession has been shifting from being mostly an art to mostly a science. Clinicians are supposed to follow evidence-based medicine protocols rather than making things up as they go along because those produce better outcomes on average. They should only deviate from those protocols if the patient has some sort of contraindication, experiences serious side effects, or fails to respond. Unfortunately we still lack clear protocols for many conditions including post-viral syndrome. http://dx.doi.org/10.1136/bmjebm-2023-112311 http://dx.doi.org/10.1136/bmjebm-2023-112311
- orangepurple 3y ago
  Yes, there are several doctors in my family. They are great at treating acute problems and absolutely clueless about managing chronic health conditions unless there is a drug for it.
  - nradov 3y ago
    The majority of chronic health conditions are the result of lifestyle choices. Those are largely outside the scope of medicine, and it is unreasonable to expect solutions from doctors. They have some drugs that can ameliorate symptoms in severe cases but those mostly don't address root causes. Patients might get better results from a personal trainer, dietician, therapist, or social worker.

pixl97 3y ago

"Airplane mechanic decides service manual incorrect, custom fix leads to 200 dead" And yes, what you state is exactly what the doctor should do. Otherwise you're taking all the testing and experience of all the other doctors that have already worked on this issue and tossed it out the window. When an individual patient shows anonymous behavior your document everything you can for future investigation. You don't get to play research laboratory on your patients.

orangepurple 3y ago
Doctors aren't mechanics. They are the engineers. Nurses are the mechanics.
- pixl97 3y ago
  Engineers run it by QA before pushing it to prod.
  - salawat 3y ago
    Oh, you wish. You frigging wish. That lasts until someone who is the CTO's buddy gets a hair and decides to get exec override, then pushes to prod, deleting the company financials. And the medical equivalent of QA is generally a very awe inspiring strain of nurse.
user_7832 3y ago
> "Airplane mechanic decides service manual incorrect, custom fix leads to 200 dead" All airplanes of the identical model have an identical manual. No two humans respond the same to complex (or often, even simple) health conditions/situations. Just because we don't have enough docs doesn't mean custom solutions are the enemy.
- pixl97 3y ago
  Now, if we had an unlimited number of doctors this wouldn't be near the problem (why we have a limited number of doctors is a different question). If a huge portion of the US population wasn't old relative to the part of the population that is young, this wouldn't be near the problem. If a massive portion of the US population wasn't... um... massive, well then this wouldn't as much of a problem. But the country we are left with has too few doctors, too many old people, and too many unhealthy people. We can argue until we're blue on why that is the case, but that does nothing to change that your doctor has about 5 minutes with you and an entire waiting room full of patients today, tomorrow, and the everyday after that to the point they are turning patients away in most places.
- nradov 3y ago
  Custom solutions aren't the enemy, but in situations where an applicable evidence-based medicine protocol exists it would be malpractice to deviate from that without a damn good reason. Those treatment protocols produce good results for average patients (i.e. most of us).

nradov 3y ago

Nonsense. That is not how American doctors are trained. Have your ever actually talked to a medical school professor, or an attending physician in a teaching hospital? In recent years the medical profession has been shifting from being mostly an art to mostly a science. Clinicians are supposed to follow evidence-based medicine protocols rather than making things up as they go along because those produce better outcomes on average. They should only deviate from those protocols if the patient has some sort of contraindication, experiences serious side effects, or fails to respond. Unfortunately we still lack clear protocols for many conditions including post-viral syndrome. http://dx.doi.org/10.1136/bmjebm-2023-112311 http://dx.doi.org/10.1136/bmjebm-2023-112311

orangepurple 3y ago
Yes, there are several doctors in my family. They are great at treating acute problems and absolutely clueless about managing chronic health conditions unless there is a drug for it.
- nradov 3y ago
  The majority of chronic health conditions are the result of lifestyle choices. Those are largely outside the scope of medicine, and it is unreasonable to expect solutions from doctors. They have some drugs that can ameliorate symptoms in severe cases but those mostly don't address root causes. Patients might get better results from a personal trainer, dietician, therapist, or social worker.