5 ms·

I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they tal

by tansey 13y ago

I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as long as possible, they will give me some generic intuitive advice, but they have no real insight because they are not in the business of maximizing the lifetime of healthy cars. Doctors are kind of the same way. They see patients who have problems and need them fixed. If you walk into a doctor's office and say your family has a history of heart disease and you're concerned, they'll run a standard diagnostic to see if there is a problem. If there isn't, they'll give you generic advice. Outside of that, they are not really likely to have much insight into how to prevent heart disease in your specific case. Maybe you'll get lucky and the doctor will have recently read a relevant paper. This seems to me like a problem that you're better off having answered by a medical researcher rather than a physician in the trenches. Researchers are the ones who are taking the long view on outcomes in patients. Keeping with the same analogy, you're probably better off talking to a mechanical engineer at a car company about maximizing the life of your currently healthy transmission. Also, I generally see this as a problem that will be best addressed by machine learning researchers collaborating with medical researchers. Then again, I'm an ML PhD student working on health applications, so I'm biased. :)

danpat 13y ago
Small backstory and a question for you. My fiancée is a psychiatric nurse practitioner. Recently, we were having dinner with a few of her colleagues, and they were complaining about the overwhelming number of new medications coming to market, and how they could never remember all the interactions, what to use for what, which ones were new, which had been retired, etc, etc. As a CS person, I piped up and suggested, tongue in cheek, that the computers were going to take their jobs. This led to a healthy discussion about the human practitioners role in a time when the amount of information they're expected to know is rapidly expanding. What's your take in the future role of the human in diagnosing and prescribing in a situation like this?
- mhurron 13y ago
  Doctors offices already have something similar, at least for interactions.
  - girvo 13y ago
    So does my pharmacy, interestingly enough.
- tzm 13y ago
  Technically, it's inevitable. Information will be more actionable. http://www-03.ibm.com/innovation/us/watson/watson_in_healthcare.shtml http://www-03.ibm.com/innovation/us/watson/watson_in_healthc... Practically, I think the role of humans will be to create a more human experience and to provide specialized knowledge centers.
claudiusd 13y ago
I love your analogy, but I think you drew the wrong conclusion. Doctors don't have an incentive to prevent you from getting sicker any more than your mechanic has an incentive for keeping your car out of the shop. Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease? Now this isn't to say that doctors are bad people who want to make you sick... on the contrary, most of the doctors I know are more passionate about helping people than making money. They are, however, subject to whims of the hospital they work for, which I can almost guarantee is more interested in making a buck than keeping you healthy. This is true of all large companies though, and as Clayton Christensen has taught us, this sort of marginal thinking usually leads to disruptive innovation by a start-up. <shameless_plug> Want to disrupt health care? Omada Health is hiring! http://omadahealth.com/jobs http://omadahealth.com/jobs </shameless_plug>
- bdesimone 13y ago
  > Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease? Woah woah woah there. Are you really saying doctors don't read the latest research so that they can make a greater profit? Really? You could have at least picked a more realistic example of misaligned incentives in medicine... e.g. using a more expensive drill bit during a surgery because you know that the surgical rep will take you out to a nice dinner every time he's in town. There's a huge population of doctors. Some ethical. Some unethical. But I believe the profession does a pretty admirable job of stamping out immoral behavior when it finds it.
  - graeme 13y ago
    The OP phrased it badly, but the point is sound. Suppose a doctor has a choice of two activities: 1. Read research, unpaid 2. Treat patient, paid The doctor clearly has an incentive to focus on treating disease. They do read research, but they would surely read even more if they were paid directly to do so. There's nothing nefarious in this, it happens in any industry. We do more of the things we're paid to do, and less of the things we're not.
crusso 13y ago
Even the front side of your analogy is broken. Mechanics are great sources of information on how to drive so you can maximize the life of your engine. It's like you haven't had a conversation with a mechanic before. Likewise with doctors. I have had 4 doctors in my family (3 still alive), and I've spent many the family meal talking with them about health, longevity, and the mechanical/biology/chemistry behind how your body works and when it works best.
- reedlaw 13y ago
  Your interactions with mechanics and doctors imply a closer relationship than perhaps that of the OP. My typical experience with is closer to the OP's--that is they have a lot of vehicles/patients to see and don't go in to too much detail on each visit.
  - sliverstorm 13y ago
    Many of them don't go into detail because 99% of customers don't give the slightest fuck. Show genuine interest, strike up conversation, and you can sometimes get a lot out of them. In any case, service life in cars is usually determined by a couple key things: The design of the system, driving conditions, and service. You may feel like you're being blown off when the mechanic says "obey the service intervals and avoid short trips", but that's 99.9% of what you can do to make the car last. (Special corner cases are widely-understood and well-documented, such as the impact of very high operating temperatures in automatic transmissions during towing)
  - jimgardener 13y ago
    my mom(who was a primary school teacher) had been a diabetic for about 10 years.The doctors who treated her told her to eat more wheat based meals instead of rice based ones and told her to increase the dosage of tablets when sugar level crossed 200 .No doctor ever told her about carb counting which IMO, was the first thing she should have been told.I came upon carb counting from some articles on the internet.She is trying this for the last couple of years and now her ppbs is 107.
    - 13y ago
caycep 13y ago
The big professional associates generally put out a set of consensus guidelines that are aimed at giving "physicians in the trenches" a (relatively) easy interface as to "best practices" in terms of preventative medicine and risk reduction. That being said, this is a matter of separating the noise from the signal in the population which is quite hard. AFAIK, and I am probably missing a few, but the only real long term modifiers are aspirin, low blood pressure, and high fiber/low cholesterol/low glycemic index foods. Everything else - there isn't enough data to separate noise from signal except for a few specific cases (someone found a gene polymorphism or mutation to something specific, i.e. the risk of blue converse sneakers or something like that)
JoshTriplett 13y ago
To some extent that's unavoidable past a certain point. Your doctor can give you lots of advice on living past 40 or 60. If you want to live past 90-100, there are far too few examples to go by, and you start seeing the kind of "what worked for me" random advice that you see from the ones who managed it. And if you want to live past ~120, you'll hit some of the species-wide hard limits we don't know how to solve yet. At that point the answer for most doctors really is "that happens", unless you're one of the folks trying to solve the fundamental problems of longevity, which past that point have very little overlap with the problems doctors solve on a regular basis.
pcrh 13y ago
The issue is that you're an individual, whereas the "standard of care" that your doctor is duty-bound to provide is based on population studies. Your doctor may be able to adapt this care to your specific case if you have obvious specific secondary conditions. Ideally, your doctor would be able to tailor your care to your genetics, your lifestyle as well as to your medical history. That is the goal of "personalized medicine". This will likely become more and more common-place over the next decade or two, in particular with respect to the genetic aspect. But for now it remains too expensive and uncertain to be rolled-out by HMOs and national healthcare systems. So you end up with "generic" advice, which is in fact in most cases the best they can do.
bambax 13y ago
Agreed. In my experience doctors are fixated on symptoms and seem to be saying "if you have no symtoms you're wasting my time". I would say they're right. There are enough sick people to keep them busy, why would they spend time with healthy people? If you're healthy (as in, no symptoms) then managing your lifestyle should be your business, not your doctor's, and most advice is obvious anyway (don't eat or drink too much, avoid processed food and all manners of sodas whenever possible, sleep well, exercise). Regarding lifestyle choices, I also think doctors have seen many people getting sick that seemed to be doing everything right, they're not sure what's best. It's very possible stress is a main contributor to poor health, and just worrying too much about it is bad in itself.

by tansey 13y ago

danpat 13y ago

Small backstory and a question for you. My fiancée is a psychiatric nurse practitioner. Recently, we were having dinner with a few of her colleagues, and they were complaining about the overwhelming number of new medications coming to market, and how they could never remember all the interactions, what to use for what, which ones were new, which had been retired, etc, etc. As a CS person, I piped up and suggested, tongue in cheek, that the computers were going to take their jobs. This led to a healthy discussion about the human practitioners role in a time when the amount of information they're expected to know is rapidly expanding. What's your take in the future role of the human in diagnosing and prescribing in a situation like this?

mhurron 13y ago
Doctors offices already have something similar, at least for interactions.
- girvo 13y ago
  So does my pharmacy, interestingly enough.
tzm 13y ago
Technically, it's inevitable. Information will be more actionable. http://www-03.ibm.com/innovation/us/watson/watson_in_healthcare.shtml http://www-03.ibm.com/innovation/us/watson/watson_in_healthc... Practically, I think the role of humans will be to create a more human experience and to provide specialized knowledge centers.

claudiusd 13y ago

I love your analogy, but I think you drew the wrong conclusion. Doctors don't have an incentive to prevent you from getting sicker any more than your mechanic has an incentive for keeping your car out of the shop. Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease? Now this isn't to say that doctors are bad people who want to make you sick... on the contrary, most of the doctors I know are more passionate about helping people than making money. They are, however, subject to whims of the hospital they work for, which I can almost guarantee is more interested in making a buck than keeping you healthy. This is true of all large companies though, and as Clayton Christensen has taught us, this sort of marginal thinking usually leads to disruptive innovation by a start-up. <shameless_plug> Want to disrupt health care? Omada Health is hiring! http://omadahealth.com/jobs http://omadahealth.com/jobs </shameless_plug>

bdesimone 13y ago
> Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease? Woah woah woah there. Are you really saying doctors don't read the latest research so that they can make a greater profit? Really? You could have at least picked a more realistic example of misaligned incentives in medicine... e.g. using a more expensive drill bit during a surgery because you know that the surgical rep will take you out to a nice dinner every time he's in town. There's a huge population of doctors. Some ethical. Some unethical. But I believe the profession does a pretty admirable job of stamping out immoral behavior when it finds it.
- graeme 13y ago
  The OP phrased it badly, but the point is sound. Suppose a doctor has a choice of two activities: 1. Read research, unpaid 2. Treat patient, paid The doctor clearly has an incentive to focus on treating disease. They do read research, but they would surely read even more if they were paid directly to do so. There's nothing nefarious in this, it happens in any industry. We do more of the things we're paid to do, and less of the things we're not.

crusso 13y ago

Even the front side of your analogy is broken. Mechanics are great sources of information on how to drive so you can maximize the life of your engine. It's like you haven't had a conversation with a mechanic before. Likewise with doctors. I have had 4 doctors in my family (3 still alive), and I've spent many the family meal talking with them about health, longevity, and the mechanical/biology/chemistry behind how your body works and when it works best.

reedlaw 13y ago
Your interactions with mechanics and doctors imply a closer relationship than perhaps that of the OP. My typical experience with is closer to the OP's--that is they have a lot of vehicles/patients to see and don't go in to too much detail on each visit.
- sliverstorm 13y ago
  Many of them don't go into detail because 99% of customers don't give the slightest fuck. Show genuine interest, strike up conversation, and you can sometimes get a lot out of them. In any case, service life in cars is usually determined by a couple key things: The design of the system, driving conditions, and service. You may feel like you're being blown off when the mechanic says "obey the service intervals and avoid short trips", but that's 99.9% of what you can do to make the car last. (Special corner cases are widely-understood and well-documented, such as the impact of very high operating temperatures in automatic transmissions during towing)
- jimgardener 13y ago
  my mom(who was a primary school teacher) had been a diabetic for about 10 years.The doctors who treated her told her to eat more wheat based meals instead of rice based ones and told her to increase the dosage of tablets when sugar level crossed 200 .No doctor ever told her about carb counting which IMO, was the first thing she should have been told.I came upon carb counting from some articles on the internet.She is trying this for the last couple of years and now her ppbs is 107.
  - 13y ago

caycep 13y ago

The big professional associates generally put out a set of consensus guidelines that are aimed at giving "physicians in the trenches" a (relatively) easy interface as to "best practices" in terms of preventative medicine and risk reduction. That being said, this is a matter of separating the noise from the signal in the population which is quite hard. AFAIK, and I am probably missing a few, but the only real long term modifiers are aspirin, low blood pressure, and high fiber/low cholesterol/low glycemic index foods. Everything else - there isn't enough data to separate noise from signal except for a few specific cases (someone found a gene polymorphism or mutation to something specific, i.e. the risk of blue converse sneakers or something like that)

JoshTriplett 13y ago

To some extent that's unavoidable past a certain point. Your doctor can give you lots of advice on living past 40 or 60. If you want to live past 90-100, there are far too few examples to go by, and you start seeing the kind of "what worked for me" random advice that you see from the ones who managed it. And if you want to live past ~120, you'll hit some of the species-wide hard limits we don't know how to solve yet. At that point the answer for most doctors really is "that happens", unless you're one of the folks trying to solve the fundamental problems of longevity, which past that point have very little overlap with the problems doctors solve on a regular basis.

pcrh 13y ago

The issue is that you're an individual, whereas the "standard of care" that your doctor is duty-bound to provide is based on population studies. Your doctor may be able to adapt this care to your specific case if you have obvious specific secondary conditions. Ideally, your doctor would be able to tailor your care to your genetics, your lifestyle as well as to your medical history. That is the goal of "personalized medicine". This will likely become more and more common-place over the next decade or two, in particular with respect to the genetic aspect. But for now it remains too expensive and uncertain to be rolled-out by HMOs and national healthcare systems. So you end up with "generic" advice, which is in fact in most cases the best they can do.

bambax 13y ago

Agreed. In my experience doctors are fixated on symptoms and seem to be saying "if you have no symtoms you're wasting my time". I would say they're right. There are enough sick people to keep them busy, why would they spend time with healthy people? If you're healthy (as in, no symptoms) then managing your lifestyle should be your business, not your doctor's, and most advice is obvious anyway (don't eat or drink too much, avoid processed food and all manners of sodas whenever possible, sleep well, exercise). Regarding lifestyle choices, I also think doctors have seen many people getting sick that seemed to be doing everything right, they're not sure what's best. It's very possible stress is a main contributor to poor health, and just worrying too much about it is bad in itself.