4 ms·

It seems like as a culture we have a lot of weird baggage around dealing with doctors. It makes me wonder if it has something to do with our fear of our own mor

by smeej 2y ago

It seems like as a culture we have a lot of weird baggage around dealing with doctors. It makes me wonder if it has something to do with our fear of our own mortality and unwillingness to talk about death or something. I remember my classmates who went on to med school and became doctors. They were bright, but I don't remember their being extraordinarily so. Their classwork mostly seemed to involve a lot of memorization of facts, following rules and procedures, not so much thinking creatively or solving problems. But now that they have MD after their names, we expect them to be familiar with a thousand different kinds of possible nuance? While operating in a system that only gives them 15 minutes per patient to hear what's going on and come up with a plan? It almost seems unreasonable and unfair of us, but they expect that of us too. If we dare to question their assessment (again, after 15 minutes with the patient), we're "questioning their authority," even if we're advanced degree holders ourselves, and a stay-at-home parent who has spent nearly every waking moment with the patient or reading about research relevant to the patient's symptoms. I know for every one medical research journalist like the author of the article, there are 10,000 exhausted working single parents armed with Doctor Google and a story about Kim from Accounting's niece's best friend's little brother who had a similar symptom one time, but it really seems like there should be a way to communicate when there really is something unusual going on. Maybe it needs to be like customer support, where there isn't just one tier of doctor. Maybe there should be a system to filter actual complex cases up layers of specialty. But the customer support experience normally sucks, so maybe the model just doesn't work. I don't know. There just has to be something that could make it better than this.

jozzas 2y ago
> Maybe there should be a system to filter actual complex cases up layers of specialty I mean, this is normally your GP referring you to a specialist, and 99% of the time that works. But when your specialist doesn't even know enough to know where to refer you next you end up in a weird space that is incredibly challenging to navigate. It would be good if there was an "expert diagnosticians" group that you could go to when even specialists are stumped. They could help navigate referrals to specialists, tests-of-treatment and enrollment in trials (which is a whole other minefield).
_carbyau_ 2y ago
From my point of view, the GP -> Specialist pathway is already the "Customer Support" model. The GPs seem to be rote symptoms&statistics memorisers who can't actually reason about the human body the way old school doctors used to. If anyone is ripe for computers to take their jobs it's them. I would love to see Dr House, suffer his wit and actually get fucking help for once.
- smeej 2y ago
  It's not enough tiers, though, because (at least in my experience and the sense I get from other people) the specialists still have only mastered the 20% of issues that account for 80% of cases. I'd love to see two more Pareto levels, at least. Like, an "advanced practice specialist" could cover the next 4% of things to pick up 16% more of the cases. And maybe one last tier that covers 0.8% of things that account for 3.2% of cases. Granted, this still leaves 75.2% of the entire list of bizarre possible things that could go wrong hard to diagnose and treat, and that will be hard for the 0.8% of patients where something insanely weird is happening, but with a bit of humility about what it's even possible for our scientific knowledge to cover about "all the possible things that could ever go wrong," and in recognition that we'll essentially always just be doing the best we can to help people and we may not be able to help everyone, those seem like decent target numbers to me.

by smeej 2y ago

jozzas 2y ago

> Maybe there should be a system to filter actual complex cases up layers of specialty I mean, this is normally your GP referring you to a specialist, and 99% of the time that works. But when your specialist doesn't even know enough to know where to refer you next you end up in a weird space that is incredibly challenging to navigate. It would be good if there was an "expert diagnosticians" group that you could go to when even specialists are stumped. They could help navigate referrals to specialists, tests-of-treatment and enrollment in trials (which is a whole other minefield).

_carbyau_ 2y ago

From my point of view, the GP -> Specialist pathway is already the "Customer Support" model. The GPs seem to be rote symptoms&statistics memorisers who can't actually reason about the human body the way old school doctors used to. If anyone is ripe for computers to take their jobs it's them. I would love to see Dr House, suffer his wit and actually get fucking help for once.

smeej 2y ago
It's not enough tiers, though, because (at least in my experience and the sense I get from other people) the specialists still have only mastered the 20% of issues that account for 80% of cases. I'd love to see two more Pareto levels, at least. Like, an "advanced practice specialist" could cover the next 4% of things to pick up 16% more of the cases. And maybe one last tier that covers 0.8% of things that account for 3.2% of cases. Granted, this still leaves 75.2% of the entire list of bizarre possible things that could go wrong hard to diagnose and treat, and that will be hard for the 0.8% of patients where something insanely weird is happening, but with a bit of humility about what it's even possible for our scientific knowledge to cover about "all the possible things that could ever go wrong," and in recognition that we'll essentially always just be doing the best we can to help people and we may not be able to help everyone, those seem like decent target numbers to me.