4 ms·

The best doctors are the ones who listen carefully to the patient before dispensing their expert opinion. Very few do. Perhaps that’s just because they’re jade

The best doctors are the ones who listen carefully to the patient before dispensing their expert opinion. Very few do. Perhaps that’s just because they’re jaded from having to deal with the public all day long…

joelfried 3y ago
I agree with you - listening is very important. I worked in an ophthalmology practice when I was quite young many years ago. The head of the practice often had over 50 patients a day (one of my responsibilities was pulling the folders for all daily patients from the wall-o'-folders; this was in the age everything was on paper). 50 patients over 8 hours gives you less than 10 minutes per patient. I suspect a nontrivial part of the problem is being rushed.
- azinman2 3y ago
  Regulation could help solve that. You shouldn’t see so many patients in a day unless you also double your working hours. I’m surprised this was many years ago. Now this pressure exists because medical school is so expensive and people need to pay off their loans. Want to see improvements in care? Make medical school free / cheap.
  - joelfried 3y ago
    It's also extremely long. Assuming a 3 year residency the average Doctor doesn't even start practicing until 31.[1] So you've not just got a house's worth of debt without a house, you've also lost a decade to training. I'd love improvements in care, but nobody is going to fix this problem. It's too lucrative for everyone else involved. [1] https://averagedoctor.com/the-average-age-of-doctors-graduating-medical-school/ https://averagedoctor.com/the-average-age-of-doctors-graduat...
swader999 3y ago
Figure out how they are paid and that will tell you much. In Alberta they get paid by the visit and many are using ten minute appointments as the norm. Often takes six weeks for me to get an appointment with my family doc.
- Zenzero 3y ago
  It goes further than this. As an employee, a doctor is pressured into this kind of schedule. They don't like it any more than you do.
Zenzero 3y ago
HN is going to select for a very small subset of the population, so unfortunately people's experiences have to be interpreted in that light. A massive chunk of my caseload is the direct result of people not listening to basic instructions. Between people not listening and people who don't understand shockingly basic fundamentals of health, you become jaded. Add to that the active disincentives to doctors really digging into cases, and we end up where we are. It feels much of my knowledge goes unused and wasted. As an aside, I have messed around with chat gpt 4 for how well it can mimic what I know. My personal experience is that I can see how it would impress non-medically trained people, but to my eyes it has a long way to go. It struggles to accurately rank differentials. Also once you press deeper into decision making it gets really scary. It was consistently presenting treatment plans that would have killed patients if followed. I would love more than anything to have AI cut down some of our work but I was really disappointed with how it currently performs. Hopefully improvements keep coming.
- xanderlewis 3y ago
  > I can see how it would impress non-medically trained people, but to my eyes it has a long way to go I think this is spot on. It's easy (with this kind of technology and amount of data) to superficially mimic expertise. It looks impressive at first, but when scrutinised by a real expert it becomes clear how superficial it really is.
  - TesterVetter 3y ago
    [dead]
- caeril 3y ago
  > people not listening to basic instructions. Unless the basic instructions are "put down the fork, you piece of shit fat fuck", you aren't doing your job. Presumably, you know that ~80% of medical costs are due to chronic illness, and you also know that ~80% of chronic illness is attributed to obesity, correct? Unless you are fat-shaming 64% of your patients, you are committing malpractice. Unless you are agitating for the hospital cafeteria to remove the Hostess cakes and sodas, you are committing malpractice. But that's not what you people do, is it? You prescribe metformin, statins, beta-blockers, and write angry posts on hackernews that they're not compliant with their medication schedule. You dance around the root cause of 64% of your patient visits because if you addressed the root cause, your billables would decline. Your entire profession is predicated on keeping your own patients sick, and prescribing workarounds to the root cause of 64% of them. And the remaining 36% of them, who are sick through no fault of their own, are waiting weeks just to see you, because you refuse to do the right thing and tell your patients that their wives are going to fuck the poolboy because they're too fat to see their own dick. "Patch Adams" has destroyed the medical industry. Your ridiculous concern for "bedside manner", and being nice and polite, is killing Americans in droves, and you guys are more than happy to scoop up the profits in drawing out the process as long as possible, but not fixing it.

joelfried 3y ago

I agree with you - listening is very important. I worked in an ophthalmology practice when I was quite young many years ago. The head of the practice often had over 50 patients a day (one of my responsibilities was pulling the folders for all daily patients from the wall-o'-folders; this was in the age everything was on paper). 50 patients over 8 hours gives you less than 10 minutes per patient. I suspect a nontrivial part of the problem is being rushed.

azinman2 3y ago
Regulation could help solve that. You shouldn’t see so many patients in a day unless you also double your working hours. I’m surprised this was many years ago. Now this pressure exists because medical school is so expensive and people need to pay off their loans. Want to see improvements in care? Make medical school free / cheap.
- joelfried 3y ago
  It's also extremely long. Assuming a 3 year residency the average Doctor doesn't even start practicing until 31.[1] So you've not just got a house's worth of debt without a house, you've also lost a decade to training. I'd love improvements in care, but nobody is going to fix this problem. It's too lucrative for everyone else involved. [1] https://averagedoctor.com/the-average-age-of-doctors-graduating-medical-school/ https://averagedoctor.com/the-average-age-of-doctors-graduat...

swader999 3y ago

Figure out how they are paid and that will tell you much. In Alberta they get paid by the visit and many are using ten minute appointments as the norm. Often takes six weeks for me to get an appointment with my family doc.

Zenzero 3y ago
It goes further than this. As an employee, a doctor is pressured into this kind of schedule. They don't like it any more than you do.

Zenzero 3y ago

HN is going to select for a very small subset of the population, so unfortunately people's experiences have to be interpreted in that light. A massive chunk of my caseload is the direct result of people not listening to basic instructions. Between people not listening and people who don't understand shockingly basic fundamentals of health, you become jaded. Add to that the active disincentives to doctors really digging into cases, and we end up where we are. It feels much of my knowledge goes unused and wasted. As an aside, I have messed around with chat gpt 4 for how well it can mimic what I know. My personal experience is that I can see how it would impress non-medically trained people, but to my eyes it has a long way to go. It struggles to accurately rank differentials. Also once you press deeper into decision making it gets really scary. It was consistently presenting treatment plans that would have killed patients if followed. I would love more than anything to have AI cut down some of our work but I was really disappointed with how it currently performs. Hopefully improvements keep coming.

xanderlewis 3y ago
> I can see how it would impress non-medically trained people, but to my eyes it has a long way to go I think this is spot on. It's easy (with this kind of technology and amount of data) to superficially mimic expertise. It looks impressive at first, but when scrutinised by a real expert it becomes clear how superficial it really is.
- TesterVetter 3y ago
  [dead]
caeril 3y ago
> people not listening to basic instructions. Unless the basic instructions are "put down the fork, you piece of shit fat fuck", you aren't doing your job. Presumably, you know that ~80% of medical costs are due to chronic illness, and you also know that ~80% of chronic illness is attributed to obesity, correct? Unless you are fat-shaming 64% of your patients, you are committing malpractice. Unless you are agitating for the hospital cafeteria to remove the Hostess cakes and sodas, you are committing malpractice. But that's not what you people do, is it? You prescribe metformin, statins, beta-blockers, and write angry posts on hackernews that they're not compliant with their medication schedule. You dance around the root cause of 64% of your patient visits because if you addressed the root cause, your billables would decline. Your entire profession is predicated on keeping your own patients sick, and prescribing workarounds to the root cause of 64% of them. And the remaining 36% of them, who are sick through no fault of their own, are waiting weeks just to see you, because you refuse to do the right thing and tell your patients that their wives are going to fuck the poolboy because they're too fat to see their own dick. "Patch Adams" has destroyed the medical industry. Your ridiculous concern for "bedside manner", and being nice and polite, is killing Americans in droves, and you guys are more than happy to scoop up the profits in drawing out the process as long as possible, but not fixing it.