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That's a sweeping generalization unsupported by facts. In reality you'll find the vast majority of GPs are highly intelligent and quite good at problem solving

by rl3 9mo ago

That's a sweeping generalization unsupported by facts. In reality you'll find the vast majority of GPs are highly intelligent and quite good at problem solving. In fact, I'd go so far as to say their training is so intensive and expansive that laypeople who make such comments are profoundly lacking in awareness on the topic. Physicians are still human, so like anything there's of course bad ones, specialists included. There's also healthcare systems with various degrees of dysfunction and incentives that don't necessarily align with the patient. None of that means GPs are somehow less competent at solving problems; not only is it an insult but it's ridiculous on the face of it.

vidarh 9mo ago
Maybe they are, but for most of my interactions with GP's in recent years, and several with specialists, for anything much beyond the very basics, I've had to educate them, and it didn't require much knowledge to exceeds theirs on specific conditions. In one case, a specialist made arguments that were trivially logically fallacious and went directly against the evidence from treatment outcomes. In other cases, sheer stupidity of pattern matching with rational thinking seemingly totally turned off. E.g. hearing I'd had a sinus infection for a long time, and insisting that this meant it was chronic and chronic meant the solution was steroids rather than antibiotic, despite a previous course having done nothing, and despite the fact that an antibiotic course had removed most of the symptoms both indicating the opposite - in the end, after bypassing my GP at the time and explaining and begging an advance nurse practitioner, I got two more courses of antibiotic and the infection finally fully went. I'm sure all of them could have done better, and that a lot of it is down to dysfunction, such as too little time allotted to actually look at things properly, but some of the interactions (the logical fallacy in particular) have also clearly been down to sheer ignorance. I also expect they'd eventually get there, but doing your own reading and guiding things in the right direction can often short-circuit a lot of bullshit that might even deliver good outcomes in a cost effective way on a population level (e.g. I'm sure the guidance on chronic sinus issues is right the vast majority of time - most bacterial sinus infections either clear by themselves or are stopped early enough not to "pattern match" as chronic), but might cause you lots of misery in the meantime...
- threethirtytwo 9mo ago
  Your personal experience is anecdotal and thus not as reliable as statistical facts. This alone is not a good metric. However your anecdotal experience is not only inline with my own experience. It is actually inline with the facts as well. When the person your responding to said that what you wasn’t backed up by facts I’m going to tell you straight up that, that statement was utter bullshit. Everything you’re saying here is true and generally true and something many many patients experience.
  - rl3 9mo ago
    >When the person your responding to said that what you wasn’t backed up by facts I’m going to tell you straight up that, that statement was utter bullshit. The person you just replied to here isn't the same person I replied to.
threethirtytwo 9mo ago
> In reality you'll find the vast majority of GPs are highly intelligent and quite good at problem solving. Is this statement supported by facts? If anything this statement is just your internal sentiment. If you claim it’s not supported by facts the proper thing you should do is offer facts to counter his statement. Don’t claim his statement isn’t supported by facts than make a counter claim without facts yourself. https://www.statnews.com/2023/07/21/misdiagnoses-cost-the-u-s-800000-deaths-and-serious-disabilities-annually-study/ https://www.statnews.com/2023/07/21/misdiagnoses-cost-the-u-... Read that fact. 800,000 deaths from misdiagnosis a year is pretty pathetic. And this is just deaths. I can guarantee you the amount of mistakes unreported that don’t result in deaths dwarfs that number. Boeing the air plane manufacurwe who was responsible for the crashing Boeing 737 mcas units have BETTER outcomes than this. In the year that those planes crashed you have a 135x better survival rate of getting on a 737 max then you are getting an important diagnosis from a doctor and not dying from a misdiagnosis. Yet doctors are universally respected and Boeing as a corporation was universally reviled that year. I will say this GPs are in general not very competent. They are about as competent and trust worthy as a car mechanic. There are good ones, bad ones, and also ones that bullshit and lie. Don’t expect anything more than that, and this is supported by facts.
- rl3 9mo ago
  >Is this statement supported by facts? Yeah, the main fact here is called medical school.[0] >Read that fact. 800,000 deaths from misdiagnosis a year is pretty pathetic. And this is just deaths. Okay, and if that somehow flows from GPs (but not specialists!) being uniquely poor at problem solving relative to all other types of physicians—irrespective of wider issues inherent in the U.S. healthcare system—then I stand corrected. >135x better survival rate of getting on a 737 max The human body isn't a 737. >I will say this GPs are in general not very competent. They are about as competent and trust worthy as a car mechanic. Ignorant. [0] https://medstudenthandbook.hms.harvard.edu/md-program-objectives https://medstudenthandbook.hms.harvard.edu/md-program-object...
  - threethirtytwo 9mo ago
    How is going to medical school a measurement of problem solving ability? You need to cite a metric involving ACTUAL problem solving. For example, a misdiagnosis is a FAILURE at solving a problem. Instead you say “medical school” and cite the Harvard handbook as if everyone went to Harvard and that the medical book was a quantitative metric on problem solving success or failure. Come on man. Numbers. Not manuals. > The human body isn't a 737 Are you joking? You know a 737 is responsible for ensuring the survival of human bodies hurdling through the air at hundreds of miles per hour at altitudes higher than Mount Everest? The fact that your risk of dying is lower going through that then getting a correct diagnosis from a doctor is quite pathetic. This statement you made here is manipulative. You know what I mean by that comparison. Don’t try to spin it like I'm not talking about human lives. > Ignorant. Being a car mechanic is a respectable profession. They get the typical respect of any other occupation and nothing beyond that. I’m saying doctors deserve EXACTLY the same thing. The problem is doctors sometimes get more than that and that is not deserved at all. Respect is earned and the profession itself doesn’t earn enough of that respect. Are you yourself a doctor? If so your response speaks volumes about the treatment your patients will get.
wookmaster 9mo ago
You followed up a sweeping generalization with a sweeping generalization and a touch of bias. I imagine the issue with problem solving more lays in the system doctors are stuck in and the complete lack of time they have to spend on patients.
- rl3 9mo ago
  >You followed up a sweeping generalization with a sweeping generalization and a touch of bias. As opposed to what, proving that GPs are highly trained, not inherently inferior to other types of physicians, and regularly conduct complex problem solving? Heck, while I'm at it I may as well attempt to prove the sky is blue. >I imagine the issue with problem solving more lays in the system doctors are stuck in and the complete lack of time they have to spend on patients. Bingo.
nostrademons 9mo ago
Even if they are good at problem solving, a series of 10-minute appointments spaced out in 2-3 month intervals while they deal with a case load of hundreds of other patients will not let them do it. That's the environment that most GPs work under in the modern U.S. health care system. Pay for concierge medicine and a private physician and you get great health care. That's not what ordinary health insurance pays for.
- rl3 9mo ago
  That's the crux of it. My only point was it's nothing intrinsic to training or ability; they're often hamstrung by the larger system.

by rl3 9mo ago

vidarh 9mo ago

Maybe they are, but for most of my interactions with GP's in recent years, and several with specialists, for anything much beyond the very basics, I've had to educate them, and it didn't require much knowledge to exceeds theirs on specific conditions. In one case, a specialist made arguments that were trivially logically fallacious and went directly against the evidence from treatment outcomes. In other cases, sheer stupidity of pattern matching with rational thinking seemingly totally turned off. E.g. hearing I'd had a sinus infection for a long time, and insisting that this meant it was chronic and chronic meant the solution was steroids rather than antibiotic, despite a previous course having done nothing, and despite the fact that an antibiotic course had removed most of the symptoms both indicating the opposite - in the end, after bypassing my GP at the time and explaining and begging an advance nurse practitioner, I got two more courses of antibiotic and the infection finally fully went. I'm sure all of them could have done better, and that a lot of it is down to dysfunction, such as too little time allotted to actually look at things properly, but some of the interactions (the logical fallacy in particular) have also clearly been down to sheer ignorance. I also expect they'd eventually get there, but doing your own reading and guiding things in the right direction can often short-circuit a lot of bullshit that might even deliver good outcomes in a cost effective way on a population level (e.g. I'm sure the guidance on chronic sinus issues is right the vast majority of time - most bacterial sinus infections either clear by themselves or are stopped early enough not to "pattern match" as chronic), but might cause you lots of misery in the meantime...

threethirtytwo 9mo ago
Your personal experience is anecdotal and thus not as reliable as statistical facts. This alone is not a good metric. However your anecdotal experience is not only inline with my own experience. It is actually inline with the facts as well. When the person your responding to said that what you wasn’t backed up by facts I’m going to tell you straight up that, that statement was utter bullshit. Everything you’re saying here is true and generally true and something many many patients experience.
- rl3 9mo ago
  >When the person your responding to said that what you wasn’t backed up by facts I’m going to tell you straight up that, that statement was utter bullshit. The person you just replied to here isn't the same person I replied to.

threethirtytwo 9mo ago

> In reality you'll find the vast majority of GPs are highly intelligent and quite good at problem solving. Is this statement supported by facts? If anything this statement is just your internal sentiment. If you claim it’s not supported by facts the proper thing you should do is offer facts to counter his statement. Don’t claim his statement isn’t supported by facts than make a counter claim without facts yourself. https://www.statnews.com/2023/07/21/misdiagnoses-cost-the-u-s-800000-deaths-and-serious-disabilities-annually-study/ https://www.statnews.com/2023/07/21/misdiagnoses-cost-the-u-... Read that fact. 800,000 deaths from misdiagnosis a year is pretty pathetic. And this is just deaths. I can guarantee you the amount of mistakes unreported that don’t result in deaths dwarfs that number. Boeing the air plane manufacurwe who was responsible for the crashing Boeing 737 mcas units have BETTER outcomes than this. In the year that those planes crashed you have a 135x better survival rate of getting on a 737 max then you are getting an important diagnosis from a doctor and not dying from a misdiagnosis. Yet doctors are universally respected and Boeing as a corporation was universally reviled that year. I will say this GPs are in general not very competent. They are about as competent and trust worthy as a car mechanic. There are good ones, bad ones, and also ones that bullshit and lie. Don’t expect anything more than that, and this is supported by facts.

rl3 9mo ago
>Is this statement supported by facts? Yeah, the main fact here is called medical school.[0] >Read that fact. 800,000 deaths from misdiagnosis a year is pretty pathetic. And this is just deaths. Okay, and if that somehow flows from GPs (but not specialists!) being uniquely poor at problem solving relative to all other types of physicians—irrespective of wider issues inherent in the U.S. healthcare system—then I stand corrected. >135x better survival rate of getting on a 737 max The human body isn't a 737. >I will say this GPs are in general not very competent. They are about as competent and trust worthy as a car mechanic. Ignorant. [0] https://medstudenthandbook.hms.harvard.edu/md-program-objectives https://medstudenthandbook.hms.harvard.edu/md-program-object...
- threethirtytwo 9mo ago
  How is going to medical school a measurement of problem solving ability? You need to cite a metric involving ACTUAL problem solving. For example, a misdiagnosis is a FAILURE at solving a problem. Instead you say “medical school” and cite the Harvard handbook as if everyone went to Harvard and that the medical book was a quantitative metric on problem solving success or failure. Come on man. Numbers. Not manuals. > The human body isn't a 737 Are you joking? You know a 737 is responsible for ensuring the survival of human bodies hurdling through the air at hundreds of miles per hour at altitudes higher than Mount Everest? The fact that your risk of dying is lower going through that then getting a correct diagnosis from a doctor is quite pathetic. This statement you made here is manipulative. You know what I mean by that comparison. Don’t try to spin it like I'm not talking about human lives. > Ignorant. Being a car mechanic is a respectable profession. They get the typical respect of any other occupation and nothing beyond that. I’m saying doctors deserve EXACTLY the same thing. The problem is doctors sometimes get more than that and that is not deserved at all. Respect is earned and the profession itself doesn’t earn enough of that respect. Are you yourself a doctor? If so your response speaks volumes about the treatment your patients will get.

wookmaster 9mo ago

You followed up a sweeping generalization with a sweeping generalization and a touch of bias. I imagine the issue with problem solving more lays in the system doctors are stuck in and the complete lack of time they have to spend on patients.

rl3 9mo ago
>You followed up a sweeping generalization with a sweeping generalization and a touch of bias. As opposed to what, proving that GPs are highly trained, not inherently inferior to other types of physicians, and regularly conduct complex problem solving? Heck, while I'm at it I may as well attempt to prove the sky is blue. >I imagine the issue with problem solving more lays in the system doctors are stuck in and the complete lack of time they have to spend on patients. Bingo.

nostrademons 9mo ago

Even if they are good at problem solving, a series of 10-minute appointments spaced out in 2-3 month intervals while they deal with a case load of hundreds of other patients will not let them do it. That's the environment that most GPs work under in the modern U.S. health care system. Pay for concierge medicine and a private physician and you get great health care. That's not what ordinary health insurance pays for.

rl3 9mo ago
That's the crux of it. My only point was it's nothing intrinsic to training or ability; they're often hamstrung by the larger system.