4 ms·

This doesn't really surprise me given my experience with doctors. If it's a common problem then doctors do fine. As soon as you're not the common case or have s

by doix 3y ago

This doesn't really surprise me given my experience with doctors. If it's a common problem then doctors do fine. As soon as you're not the common case or have something somewhat rare, it becomes a bit of a crap shoot, at least in the UK when you deal primarily with your GP (general practitioner). I have a friend with Crohn's who was feeling low energy. I was a gym bro at the time and convinced him to take a testosterone test (because all problems re caused by low T when you're a gym bro). His doctor wouldn't even entertain the idea, saying he's a young man and it's very unlikely that he'd have low T. He did the test privately and his T is significantly below normal. If you Google, there are actually many papers showing correlation between Crohn's and low T. I bet an AI would find it. Similarly, doctors missed my mum's recent cancer diagnosis. She also had factors that would make her more susceptible to breast cancer, googling finds many papers that show causation. The problem is that those things aren't extremely common and haven't made their way to NICE guidelines or whatever GPs use. Not that I'm blaming doctors, they have 10 minute appointments and don't have time to do anything. I'm sure AI would recommend significantly more lab tests which would put even more pressure on the NHS.

corethree 3y ago
[flagged]
- acover 3y ago
  You can make the right call but still be wrong sometimes. There's a cost to tests of rare diseases.
  - corethree 3y ago
    Then let the person who is wrong foot the cost. The cost isn't just the cost of the test. It's the cost of what occurred because the doctor decided to block a test.
    - evgen 3y ago
      No one is preventing you from going to a private clinic and paying for the test yourself. The doctor is not 'blocking' the test or preventing you from getting it, they are just not authorising it. Sounds like you have a problem with either your insurance provider or your wallet.
      - amluto 3y ago
        Or the jurisdiction in which you live in which labs are not permitted to test without a doctor’s order? This is very common.
      - corethree 3y ago
        https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%20Library/AuthorizationOrderTests.pdf https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%... This is a cartel based law. Basically patients can't order tests or even look at results from tests by law. The "made up" reasoning for why this law exists is because the law makers acquiesced into agreeing with doctors that all patients are fucking idiots. That's the bullshit reason. But really it's business reasons. Same reason why the doctor supply is made artificially low, all these things are legislated by the AmA to lower the supply of doctors and give them more control. >Sounds like you have a problem with either your insurance provider or your wallet. If you're a doctor. My problem is you. How does a doctor even have the gall to say this? It's flat out wrong. So if you're a doctor there's only two logical possibilities for why you said what you said. 1. You're a liar and are therefore untrustworthy. 2. You don't know what you're talking about and are therefore incompetent. Which is it?
        rscho 3y ago
        I am a doctor, and I encourage you to learn about how diagnostic test performance is modelled, and the consequences linked to overtesting and testing without contextual knowledge. It may change your perspective and lead you towards less extreme opinions.
        3y ago
- staunton 3y ago
  > statements like this literally set me off. The patient being right and the doctor ignoring the patient and treating the patient like an idiot There's a huge number of people who vastly overestimate their medical knowledge, google some symptoms (I'm sure you know the pitfalls of that but many don't), do self-diagnosis as a hobby with friends over coffee, come to absurd conclusions and then bother their doctors about it. It's not ideal but somewhat understandable that under time pressure experts want to to know the object level (symptoms, history) and don't want to waste time listening to the speculation of non-experts, even if that speculation is sometimes right, and even if some (the doctor can't tell who) of those non-experts actually make good points.
  - corethree 3y ago
    Given the amount paid by the patient to the doctor, the doctor is honor bound to listen to the patient, to consider what he said. This is not a trivial amount of money that the patient is forking over to the doctor. It's understandable from the standpoint of irritation, if the doctor is presented with the same crack pot theories all the time then it's understandable how he would ignore such theories. It's not understandable from a moral standpoint. If the doctor isn't delivering to the patient what equates to the thousands of dollars the patient forked over to him, then the doctor needs to be paid the amount he deserves. When a drunk driver kills someone on accident he is honor bound by morality to be responsible for the death. Being drunk is not excuse. Same with a doctor. If he claims he's an expert and he's paid thousands of dollars for a check up he is responsible for being right and if being right means listening to every single theory from the patient because that's what he's morally obligated to do. Not wanting to "waste time" because of "pressure" is not an excuse. Ever. Lives are at stake.
    - intended 3y ago
      If the doctor was free, would any of these things change?
      - corethree 3y ago
        A patient isn't just damaged by bad treatment. He's damaged by medical costs. He's damaged by the very thing that makes doctors rich. And often given in return incompetency. Bled dry by "experts" holding their lives hostage. https://www.cnn.com/2023/01/31/health/us-health-care-spending-global-perspective/index.html https://www.cnn.com/2023/01/31/health/us-health-care-spendin... It's disgusting. Oh and check this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139931/#:~:text=It%20is%20estimated%20that%2050,deaths%20related%20to%20opioid%20overdose.&text=(See%20Figure%201.)&text=But%20statistics%20on%20death%20do%20not%20tell%20the%20whole%20story https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139931/#:~:tex.... It's not just incompetence. Trustworthiness is also an issue.
- chaxor 3y ago
  They suck the *insurers* dry? Insurance is one of the major problems in the US, and they're a parasite on all of the US society, so this line of thinking is completely backwards. However, the idea that physicians should make less is reasonable, in order to get people who are more interested in the real medicine, rather than money seeking people that is often found now. Getting rid of insurance and the structures that involve it essentially solves this issue. Unfortunately, it's unlikely to occur, so sidestepping everything using capitalism is the only way forward I can see. One good example is making diagnostic tools at the house more common place. It's pretty typical to be able to purchase an entire machine for the price you will be charged at a physician's office. For instance, a good 12 lead ECG may cost about $1300 to get for your house, but it will also cost that much to get one test done at the physicians office. So it's clear that buying one for the house is the way to go, as you can do it everyday for years for the price of one time through 'the system'. It could also be much cheaper if targeting every household through economies of scale. This is true for essentially all diagnostic tools. So it's about time people just expand their first aid kits to involve some of these simple diagnostic tools, like urinalysis kits, etc. The interpretation is of course valuable, as it takes a little while to understand the output of different tools, but much of this is very capable to be automated and sold with the tool or plugged into a foss solution. Perhaps it's not ideal to some, but it's the easiest to occur in capitalistic settings and where insurance keeps costs at institutions so high.
  - corethree 3y ago
    Insurance is parasitic but they are the symptom not the root of the problem. They suck insurance dry so insurance has to suck you dry. The root is low supply of doctors. Thus unhealthy competition and thus doctors and the whole industry can charge exorbitant prices. They rip off insurance so insurance in turn rips you off. Make no mistake insurance is ripping you off, but there's healthy competition in this area. One insurance company can undercut another if they could... But they can't. Because the root of the problem is the cost of care itself. Of course the reason why there's a low supply of doctors is a deliberate business maneuver made by the AmA to lower the amount of doctors by lowering the amount of medical schools. In short Doctors are the reason why there's a low supply of doctors. The problem isn't purely capitalistic. It's sort of a hybrid of capitalism and government thats what causes this problem. When doctors aka the AmA are able to influence law to give them an unfair advantage that's what is responsible for the current state of things. In fact hybrids are responsible for most of corruption. You have to keep a clear separation between business and government for a healthy free market economy as in business cannot influence government but government can influence business. The incentives are misaligned for both parties. One is profit the other is honor, thus they cannot mix.
bradknowles 3y ago
I have hypertension, as well as diabetes. I wanted my cardiologist to test me for hyperaldosteronism, because I had read it was not uncommon and could be a factor in hypertension that continues to get worse and worse, without an obvious explanation. He refused, saying that it was the job of my endocrinologist to do that test. So, I talked to my endocrinologist and he said it wasn't a normal test they do, but he was happy to do it if I wanted it. Well, the test came back positive. So they sent me in for a CAT scan of my adrenal glands to see if anything was obviously abnormal there. Which came back negative. So, now they want me to do a salt test to see how bad my hyperaldosteronism is, so that they can give me the right amount of the drug for that condition. But the key thing that set me off was that original article that said this was now recommended by cardiologists as a standard screening test. Maybe only 10% of patients have this problem, but it's common enough that it's still worthwhile screening for. So, why didn't my cardiologist screen me for it in the first place? Why didn't my endocrinologist screen me for it without me having to explicitly request it? I'm pissed. I don't want to sue anyone for malpractice, or even mention that word to any of my doctors. But I do want to convince them that they really do need to screen for this condition. Meanwhile, I'm going to continue to follow this diagnosis to see where it goes, and if they can help me get my blood pressure under better control.
- corethree 3y ago
  You don't know how these doctors view you. They view you as a "non-expert" as one commenter put it. Basically you're stupid to them and your thoughts are pointless. The only way to convince them is to sue. But there's nothing worth suing here for, you got the test. You can only sue if damage was done, then the doctor would be responsible for blocking the test when you explicitly requested it.
  - bradknowles 3y ago
    I need to find a doctor who can be a more active partner in helping me diagnose and address my problems. If you have any suggestions in the Austin area, please let me know.
    - 3y ago
gundmc 3y ago
Part of this is by design - from medical school, doctors are quite literally taught "when you hear hoof beats think horses, not zebras." The progression and flow the decision trees in diagnosis are built to find the most common ailments in the most efficient way. It sucks for people whose conditions are further down the tree, but generally it does what it was designed to do. Hopefully technology like this can help us rethink those decision trees, or else crunch more patient-specific information to adjust the diagnosis process on an individual level more efficiently.
- ProllyInfamous 3y ago
  I dropped out of medical school fifteen years ago — entered another [non-tech] profession entirely - and there's one thing I always tell either of the following groups: Said to physicians: "I dropped out and I TELL EVERYBODY I KNOW you cannot pay a doctor enough for all the unnecessary sacrifices they had to make, just to prescribe you an antibiotic." ...to Non-physicians: "While I believe that you cannot pay physicians enough for their sacrifices, you should definitely investigate your own ailments, and seek multiple opinions whenever your `gut feeling` indicates `abnormal`. Physicians simply DO NOT HAVE TIME to give a fuck about your specifics. More recently, I have included (to all) "it is probably ALREADY UNETHICAL TO NOT BE CONSULTING WITH LLMs during differential diagnoses." Just my ¢¢
  - Tostino 3y ago
    Not yet. Your faith in people not being led astray by the LLM is too high right now IMO. I've seen way too many people who I consider generally intelligent, completely falling for the convincing bullshit. Mostly in my online communities, but also a few times in person.
rscho 3y ago
As almost every comment of this kind on this site, you are missing the wider socioprofessional context. Yeah sure, you may find papers about plenty of things that may affect you without your doc's knowledge, perhaps even guidelines that are to be followed. The problem is that respecting every detail of every guideline all the time is pretty much impossible, and even a debatable stance. There are many committees producing guidelines left and right. Because those people's jobs are to produce guidelines, not care for people. The exact same goes for research papers, and validity for patients in practice is a difficult issue. So, docs all practice mostly from habit and experience. It's a craft supported by science, but clinical medicine itself is science as much as bricklaying is a science. But that doesn't make AI the use-all-do-all, because if everybody starts to test for every little thing, diagnostic probabilities will decrease massively and guidelines would have to adjusted in conséquence. It's a feedback loop. And also, you'd pay 5x the price for healthcare, so not realistic.
- doix 3y ago
  > But that doesn't make AI the use-all-do-all, because if everybody starts to test for every little thing, diagnostic probabilities will decrease massively and guidelines would have to adjusted in conséquence. It's a feedback loop. And also, you'd pay 5x the price for healthcare, so not realistic. It's hard for me to write out all my thoughts on the subject, but I completely agree with this. The paper cherry-picked difficult cases and compared how AI deals with them vs regular clinicians. I think that is something AI will excel at because there is no cost to being "wrong", as long as something it spews out is correct. In difficult to diagnose cases, that kind of makes sense. Find the answer at "any cost". But you cannot apply that to every case. If you let the AI loose on fairly simple cases, I bet it would over complicate many simple things, because it couldn't handle the nuance of people coming in and just whining about a regular cold. "Patient comes in with a headache, might be brain cancer but might be a cold" ~ type DDx.

by doix 3y ago

corethree 3y ago

[flagged]

acover 3y ago
You can make the right call but still be wrong sometimes. There's a cost to tests of rare diseases.
- corethree 3y ago
  Then let the person who is wrong foot the cost. The cost isn't just the cost of the test. It's the cost of what occurred because the doctor decided to block a test.
  - evgen 3y ago
    No one is preventing you from going to a private clinic and paying for the test yourself. The doctor is not 'blocking' the test or preventing you from getting it, they are just not authorising it. Sounds like you have a problem with either your insurance provider or your wallet.
    - amluto 3y ago
      Or the jurisdiction in which you live in which labs are not permitted to test without a doctor’s order? This is very common.
    - corethree 3y ago
      https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%20Library/AuthorizationOrderTests.pdf https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%... This is a cartel based law. Basically patients can't order tests or even look at results from tests by law. The "made up" reasoning for why this law exists is because the law makers acquiesced into agreeing with doctors that all patients are fucking idiots. That's the bullshit reason. But really it's business reasons. Same reason why the doctor supply is made artificially low, all these things are legislated by the AmA to lower the supply of doctors and give them more control. >Sounds like you have a problem with either your insurance provider or your wallet. If you're a doctor. My problem is you. How does a doctor even have the gall to say this? It's flat out wrong. So if you're a doctor there's only two logical possibilities for why you said what you said. 1. You're a liar and are therefore untrustworthy. 2. You don't know what you're talking about and are therefore incompetent. Which is it?
      - rscho 3y ago
        I am a doctor, and I encourage you to learn about how diagnostic test performance is modelled, and the consequences linked to overtesting and testing without contextual knowledge. It may change your perspective and lead you towards less extreme opinions.
        3y ago
staunton 3y ago
> statements like this literally set me off. The patient being right and the doctor ignoring the patient and treating the patient like an idiot There's a huge number of people who vastly overestimate their medical knowledge, google some symptoms (I'm sure you know the pitfalls of that but many don't), do self-diagnosis as a hobby with friends over coffee, come to absurd conclusions and then bother their doctors about it. It's not ideal but somewhat understandable that under time pressure experts want to to know the object level (symptoms, history) and don't want to waste time listening to the speculation of non-experts, even if that speculation is sometimes right, and even if some (the doctor can't tell who) of those non-experts actually make good points.
- corethree 3y ago
  Given the amount paid by the patient to the doctor, the doctor is honor bound to listen to the patient, to consider what he said. This is not a trivial amount of money that the patient is forking over to the doctor. It's understandable from the standpoint of irritation, if the doctor is presented with the same crack pot theories all the time then it's understandable how he would ignore such theories. It's not understandable from a moral standpoint. If the doctor isn't delivering to the patient what equates to the thousands of dollars the patient forked over to him, then the doctor needs to be paid the amount he deserves. When a drunk driver kills someone on accident he is honor bound by morality to be responsible for the death. Being drunk is not excuse. Same with a doctor. If he claims he's an expert and he's paid thousands of dollars for a check up he is responsible for being right and if being right means listening to every single theory from the patient because that's what he's morally obligated to do. Not wanting to "waste time" because of "pressure" is not an excuse. Ever. Lives are at stake.
  - intended 3y ago
    If the doctor was free, would any of these things change?
    - corethree 3y ago
      A patient isn't just damaged by bad treatment. He's damaged by medical costs. He's damaged by the very thing that makes doctors rich. And often given in return incompetency. Bled dry by "experts" holding their lives hostage. https://www.cnn.com/2023/01/31/health/us-health-care-spending-global-perspective/index.html https://www.cnn.com/2023/01/31/health/us-health-care-spendin... It's disgusting. Oh and check this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139931/#:~:text=It%20is%20estimated%20that%2050,deaths%20related%20to%20opioid%20overdose.&text=(See%20Figure%201.)&text=But%20statistics%20on%20death%20do%20not%20tell%20the%20whole%20story https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139931/#:~:tex.... It's not just incompetence. Trustworthiness is also an issue.
chaxor 3y ago
They suck the *insurers* dry? Insurance is one of the major problems in the US, and they're a parasite on all of the US society, so this line of thinking is completely backwards. However, the idea that physicians should make less is reasonable, in order to get people who are more interested in the real medicine, rather than money seeking people that is often found now. Getting rid of insurance and the structures that involve it essentially solves this issue. Unfortunately, it's unlikely to occur, so sidestepping everything using capitalism is the only way forward I can see. One good example is making diagnostic tools at the house more common place. It's pretty typical to be able to purchase an entire machine for the price you will be charged at a physician's office. For instance, a good 12 lead ECG may cost about $1300 to get for your house, but it will also cost that much to get one test done at the physicians office. So it's clear that buying one for the house is the way to go, as you can do it everyday for years for the price of one time through 'the system'. It could also be much cheaper if targeting every household through economies of scale. This is true for essentially all diagnostic tools. So it's about time people just expand their first aid kits to involve some of these simple diagnostic tools, like urinalysis kits, etc. The interpretation is of course valuable, as it takes a little while to understand the output of different tools, but much of this is very capable to be automated and sold with the tool or plugged into a foss solution. Perhaps it's not ideal to some, but it's the easiest to occur in capitalistic settings and where insurance keeps costs at institutions so high.
- corethree 3y ago
  Insurance is parasitic but they are the symptom not the root of the problem. They suck insurance dry so insurance has to suck you dry. The root is low supply of doctors. Thus unhealthy competition and thus doctors and the whole industry can charge exorbitant prices. They rip off insurance so insurance in turn rips you off. Make no mistake insurance is ripping you off, but there's healthy competition in this area. One insurance company can undercut another if they could... But they can't. Because the root of the problem is the cost of care itself. Of course the reason why there's a low supply of doctors is a deliberate business maneuver made by the AmA to lower the amount of doctors by lowering the amount of medical schools. In short Doctors are the reason why there's a low supply of doctors. The problem isn't purely capitalistic. It's sort of a hybrid of capitalism and government thats what causes this problem. When doctors aka the AmA are able to influence law to give them an unfair advantage that's what is responsible for the current state of things. In fact hybrids are responsible for most of corruption. You have to keep a clear separation between business and government for a healthy free market economy as in business cannot influence government but government can influence business. The incentives are misaligned for both parties. One is profit the other is honor, thus they cannot mix.

bradknowles 3y ago

I have hypertension, as well as diabetes. I wanted my cardiologist to test me for hyperaldosteronism, because I had read it was not uncommon and could be a factor in hypertension that continues to get worse and worse, without an obvious explanation. He refused, saying that it was the job of my endocrinologist to do that test. So, I talked to my endocrinologist and he said it wasn't a normal test they do, but he was happy to do it if I wanted it. Well, the test came back positive. So they sent me in for a CAT scan of my adrenal glands to see if anything was obviously abnormal there. Which came back negative. So, now they want me to do a salt test to see how bad my hyperaldosteronism is, so that they can give me the right amount of the drug for that condition. But the key thing that set me off was that original article that said this was now recommended by cardiologists as a standard screening test. Maybe only 10% of patients have this problem, but it's common enough that it's still worthwhile screening for. So, why didn't my cardiologist screen me for it in the first place? Why didn't my endocrinologist screen me for it without me having to explicitly request it? I'm pissed. I don't want to sue anyone for malpractice, or even mention that word to any of my doctors. But I do want to convince them that they really do need to screen for this condition. Meanwhile, I'm going to continue to follow this diagnosis to see where it goes, and if they can help me get my blood pressure under better control.

corethree 3y ago
You don't know how these doctors view you. They view you as a "non-expert" as one commenter put it. Basically you're stupid to them and your thoughts are pointless. The only way to convince them is to sue. But there's nothing worth suing here for, you got the test. You can only sue if damage was done, then the doctor would be responsible for blocking the test when you explicitly requested it.
- bradknowles 3y ago
  I need to find a doctor who can be a more active partner in helping me diagnose and address my problems. If you have any suggestions in the Austin area, please let me know.
  - 3y ago

gundmc 3y ago

Part of this is by design - from medical school, doctors are quite literally taught "when you hear hoof beats think horses, not zebras." The progression and flow the decision trees in diagnosis are built to find the most common ailments in the most efficient way. It sucks for people whose conditions are further down the tree, but generally it does what it was designed to do. Hopefully technology like this can help us rethink those decision trees, or else crunch more patient-specific information to adjust the diagnosis process on an individual level more efficiently.

ProllyInfamous 3y ago
I dropped out of medical school fifteen years ago — entered another [non-tech] profession entirely - and there's one thing I always tell either of the following groups: Said to physicians: "I dropped out and I TELL EVERYBODY I KNOW you cannot pay a doctor enough for all the unnecessary sacrifices they had to make, just to prescribe you an antibiotic." ...to Non-physicians: "While I believe that you cannot pay physicians enough for their sacrifices, you should definitely investigate your own ailments, and seek multiple opinions whenever your `gut feeling` indicates `abnormal`. Physicians simply DO NOT HAVE TIME to give a fuck about your specifics. More recently, I have included (to all) "it is probably ALREADY UNETHICAL TO NOT BE CONSULTING WITH LLMs during differential diagnoses." Just my ¢¢
- Tostino 3y ago
  Not yet. Your faith in people not being led astray by the LLM is too high right now IMO. I've seen way too many people who I consider generally intelligent, completely falling for the convincing bullshit. Mostly in my online communities, but also a few times in person.

rscho 3y ago

As almost every comment of this kind on this site, you are missing the wider socioprofessional context. Yeah sure, you may find papers about plenty of things that may affect you without your doc's knowledge, perhaps even guidelines that are to be followed. The problem is that respecting every detail of every guideline all the time is pretty much impossible, and even a debatable stance. There are many committees producing guidelines left and right. Because those people's jobs are to produce guidelines, not care for people. The exact same goes for research papers, and validity for patients in practice is a difficult issue. So, docs all practice mostly from habit and experience. It's a craft supported by science, but clinical medicine itself is science as much as bricklaying is a science. But that doesn't make AI the use-all-do-all, because if everybody starts to test for every little thing, diagnostic probabilities will decrease massively and guidelines would have to adjusted in conséquence. It's a feedback loop. And also, you'd pay 5x the price for healthcare, so not realistic.

doix 3y ago
> But that doesn't make AI the use-all-do-all, because if everybody starts to test for every little thing, diagnostic probabilities will decrease massively and guidelines would have to adjusted in conséquence. It's a feedback loop. And also, you'd pay 5x the price for healthcare, so not realistic. It's hard for me to write out all my thoughts on the subject, but I completely agree with this. The paper cherry-picked difficult cases and compared how AI deals with them vs regular clinicians. I think that is something AI will excel at because there is no cost to being "wrong", as long as something it spews out is correct. In difficult to diagnose cases, that kind of makes sense. Find the answer at "any cost". But you cannot apply that to every case. If you let the AI loose on fairly simple cases, I bet it would over complicate many simple things, because it couldn't handle the nuance of people coming in and just whining about a regular cold. "Patient comes in with a headache, might be brain cancer but might be a cold" ~ type DDx.