7 ms·

> It really is no wonder that the softer sciences have a reproducibility problem. Even Further, I think it's also indicative of medicine being full of people t

> It really is no wonder that the softer sciences have a reproducibility problem. Even Further, I think it's also indicative of medicine being full of people that have a fatalistic, passive attitude towards their patients and medical care. Medicine and health is really hard, and so many health professionals essentially believe that the only thing they can do is wait until something horrible happens before doing anything. And as the case with this woman, when something bad does happen, they bin it in their per-organized mental filing cabinet and you're fucked if they're wrong. Much like police officers, I think many get so jaded by the job that they can't be bothered to give a shit when they really should. And I really hope technology will save us from this.

collyw 12y ago
Like most professions, I am sure there are doctors who are like you describe as well as many others at they opposite end of the spectrum. Its wrong to generalize them all to be like this.
amedstudent1 12y ago
I think the other reply covers it a lot, but I find posts like yours to be very demeaning. You're essentially doing the same as someone who doesn't understand programming making declarations of how programs should be made. There is a lot going on behind the scenes and modern medicine is based on evidence, so please take the arm-chair commentary away
tjradcliffe 12y ago
It's somewhat less depressing than that, from a personal point of view, at least. Most interventions carry with them pretty significant risk. Therefore the choice is not between "do nothing and see what happens, or do something with zero risk and see if it helps", but rather "do nothing and see what happens, or do something really high risk and see if it does more harm than good." Iatrogenic disease (harm caused by interventions) is by some measures the leading cause of death in the US, outstripping heart disease and standing at more than ten times the rate of death by automobile. Under those circumstances, not doing anything until something horrible happens is not a bad policy, and the people engaged in it are not expressing cynical indifference so much as a due awareness of the real risks involved in almost any intervention. Which is, admittedly, kind of depressing, but for quite different reasons. Either way, technology and patient empowerment are likely to help.
- KyleBrandt 12y ago
  You have a source for those measures?
  - DMac87 12y ago
    Even if true, I don't know what to make of such a statement - needless interventions for ALL diseases/causes may kill a lot more than any ONE single, narrowly defined disease/cause - that says more about the classification/definition system than interventions... it's only if interventions on any ONE disease kill a significant proportion vs the disease itself that that intervention / interventions are truly dangerous...
    - smacktoward 12y ago
      The problem is that it's not just "needless interventions" that can backfire. Even in situations where an intervention could unquestionably help, there's still plenty of ways for it to go wrong. The most obvious is human error -- a well-intentioned intervention that's disastrously mis-executed -- but that's just the beginning of the list, not the end. What you have to remember is that for the vast majority of human history, medical interventions of all kinds were at least as likely to hurt the patient as they were to help them, because of our crude understanding of how the body works and how disease is communicated. A textbook example is Oliver Wendell Holmes Sr.'s classic 1843 study of puerperal fever (http://en.wikipedia.org/wiki/Oliver_Wendell_Holmes,_Sr.#Medical_reformer.2C_marriage_and_family http://en.wikipedia.org/wiki/Oliver_Wendell_Holmes,_Sr.#Medi...). It showed how doctors who were doing a completely routine intervention -- general examinations of the health of newborn babies -- were actually picking up that infection from babies who had it and then spreading it to others who did not, because they didn't sterilize their instruments and change their clothing between examinations. This seems obvious to us today, but at the time it was quite shocking, because in thousands of years of medicine doctors had never sterilized their instruments or clothing when moving from one patient to another. It never occurred to them, because none of the prevailing theories of how diseases spread called for it. So untold numbers of newborns sickened and died because of well-meaning, completely uncontroversial interventions by their doctors. Today doctors obviously do understand the role of germs in spreading disease better, and they have much improved medical technologies and practices available to them, which has helped reduce the risks of those types of interventions. But millennia of these types of unpleasant discoveries has given medicine as a profession a healthy regard for the possibility that what they think they know even today could be incomplete or flat-out wrong.
jkokenge 12y ago
It seems that health care professionals don't have a nuanced problem solving attitude. They make a diagnosis, see how this diagnosis fits into a preconceived treatment bin, then just solve from that position without understanding what's different, what's unique to each case. And, in their defense, they probably just don't have the time for that extra work. That's where I see technology as most useful....how to automate and make more efficient the redundant parts so professionals can concentrate on the important, unique parts to each patient's diagnosis.
- Nagyman 12y ago
  I agree with you and also believe this extends to the majority of professions. Even within software development, there are a significant number of people that will only solve the immediate problem in front of them in a stepwise manner, rather than using lateral thinking to evaluate if the problem should be solved in the way that's most familiar to them, or to look at it from a different perspective and solve another problem entirely (e.g. the root cause). To be fair, the majority of problems are probably addressable without thinking differently. So people get into habit/routine and that's their "job"; thinking otherwise is not a day-to-day operation. To your point, automating the redundant/repetitive problems should allow for creative problem solving where machines don't yet excel.
  - ashark 12y ago
    A lot of school administrators have PhDs, but get one to tell you how they learned about some really cool experimental results at some conference (probably publicized by someone trying to sell them something, incidentally, but that's another problem) and are trying to reproduce them at their school(s). You'll be in for a treat. A "treat". Fun bonus anecdote: One of my wife's principals was convinced the prayer jar she provided for the staff was effective because over half of the prayers the prior year had been answered. When she told me that story it damn near broke my brain.
    - learc83 12y ago
      >One of my wife's principals was convinced the prayer jar she provided for the staff was effective because over half of the prayers the prior year had been answered. Depending on the prior probability of the prayers that were answered (and those that weren't), 51% could be plenty to support the efficacy of the prayer jar.
smacktoward 12y ago
A more charitable explanation would mention how the prime directive of their profession is "first, do no harm": (http://en.wikipedia.org/wiki/Primum_non_nocere http://en.wikipedia.org/wiki/Primum_non_nocere)
deleted 12y ago
[deleted]
deleted 12y ago
[deleted]
entropydude 12y ago
I'm a doctor and former software programmer, so let me offer a counterpoint: I would disagree with your statement that medical people have a fatalistic passive attitude. In this case the decision is between 1) watching and waiting to see if the tumor grows and 2) acting immediately to take it out. The tumor in question is a meningioma, a relatively common tumor of the skull (meninges, to be precise) whose natural behavior is unpredictable (some are essentially benign, others are highly malignant). Sometimes high-risk features can be identified on MRI imaging (brain invasion, areas of tissue necrosis, rapid growth) and these will always be treated with intervention. I work at UCSF, one of the top neurosurgery programs in the world, and I can guarantee you the radiologists don't make the mistake on sizing tumors mentioned here (well maybe they do, but it is out of carelessness rather than a problem with there software. it is not hard to find anatomic landmarks to ensure you are measuring at the same level). I would argue that a small meningioma without worrisome features should definitely not be operated on because the risks of surgery are not negligible! These surgeries are no joke, they are extraordinarily complex and they are mucking around next to structures which can cause significant morbidity, neurologic deficits, and even death sometimes if they nick the wrong artery. It is well accepted practice and backed by evidence (see the WHO:tumors of the CNS publication) that the best way to decrease overall morbidity is by watching and waiting with these types of meningiomas. This is because MOST meningiomas are low-risk/benign (they are often found incidentally during autopsies for other reasons) and the risk of adverse surgical outcomes would be high if you subjected each of these people to invasive procedures when the incidence of high grade meningiomas is low. It is a population based strategy and unfortunately on an individual level you can't predict the outcome, but that is unfortunately a problem with this data. Fortunately lots of new technologies are emerging that can tease out individual differences (the so-called personalized medicine technologies) That being said the new techniques to map out anatomy to aid surgeons is very cool! And to be fair, it sounds like the patient in this article did not get great care and that some of the doctors were not following the standard of care (1 year between imaging is definitely too long).
- parennoob 12y ago
  I understand your rationale for the "wait and watch" option, and agree fully with it. > "well maybe they do, but it is out of carelessness rather than a problem with there software." I think this statement precisely illustrates the point that the parent commentator has with much of the medical community. Think about what the "carelessness" of a radiologist that you're talking so flippantly about means for a family – the anguish, sleepless nights, and feeling of morbidity and helplessness. I may be overreacting here, but I would be extremely worried if a radiologist can be careless and ruin a year or more of someone's life, possibly forcing them into opting for a highly risky surgery. If you think there is a chance that your radiologists are not measuring things properly, wouldn't it be beneficial to start a double-checking procedure of some kind whereby each MRI is checked by 2 radiologists and a doctor (or something of the kind)?

collyw 12y ago

Like most professions, I am sure there are doctors who are like you describe as well as many others at they opposite end of the spectrum. Its wrong to generalize them all to be like this.

amedstudent1 12y ago

I think the other reply covers it a lot, but I find posts like yours to be very demeaning. You're essentially doing the same as someone who doesn't understand programming making declarations of how programs should be made. There is a lot going on behind the scenes and modern medicine is based on evidence, so please take the arm-chair commentary away

tjradcliffe 12y ago

It's somewhat less depressing than that, from a personal point of view, at least. Most interventions carry with them pretty significant risk. Therefore the choice is not between "do nothing and see what happens, or do something with zero risk and see if it helps", but rather "do nothing and see what happens, or do something really high risk and see if it does more harm than good." Iatrogenic disease (harm caused by interventions) is by some measures the leading cause of death in the US, outstripping heart disease and standing at more than ten times the rate of death by automobile. Under those circumstances, not doing anything until something horrible happens is not a bad policy, and the people engaged in it are not expressing cynical indifference so much as a due awareness of the real risks involved in almost any intervention. Which is, admittedly, kind of depressing, but for quite different reasons. Either way, technology and patient empowerment are likely to help.

KyleBrandt 12y ago
You have a source for those measures?
- DMac87 12y ago
  Even if true, I don't know what to make of such a statement - needless interventions for ALL diseases/causes may kill a lot more than any ONE single, narrowly defined disease/cause - that says more about the classification/definition system than interventions... it's only if interventions on any ONE disease kill a significant proportion vs the disease itself that that intervention / interventions are truly dangerous...
  - smacktoward 12y ago
    The problem is that it's not just "needless interventions" that can backfire. Even in situations where an intervention could unquestionably help, there's still plenty of ways for it to go wrong. The most obvious is human error -- a well-intentioned intervention that's disastrously mis-executed -- but that's just the beginning of the list, not the end. What you have to remember is that for the vast majority of human history, medical interventions of all kinds were at least as likely to hurt the patient as they were to help them, because of our crude understanding of how the body works and how disease is communicated. A textbook example is Oliver Wendell Holmes Sr.'s classic 1843 study of puerperal fever (http://en.wikipedia.org/wiki/Oliver_Wendell_Holmes,_Sr.#Medical_reformer.2C_marriage_and_family http://en.wikipedia.org/wiki/Oliver_Wendell_Holmes,_Sr.#Medi...). It showed how doctors who were doing a completely routine intervention -- general examinations of the health of newborn babies -- were actually picking up that infection from babies who had it and then spreading it to others who did not, because they didn't sterilize their instruments and change their clothing between examinations. This seems obvious to us today, but at the time it was quite shocking, because in thousands of years of medicine doctors had never sterilized their instruments or clothing when moving from one patient to another. It never occurred to them, because none of the prevailing theories of how diseases spread called for it. So untold numbers of newborns sickened and died because of well-meaning, completely uncontroversial interventions by their doctors. Today doctors obviously do understand the role of germs in spreading disease better, and they have much improved medical technologies and practices available to them, which has helped reduce the risks of those types of interventions. But millennia of these types of unpleasant discoveries has given medicine as a profession a healthy regard for the possibility that what they think they know even today could be incomplete or flat-out wrong.

jkokenge 12y ago

It seems that health care professionals don't have a nuanced problem solving attitude. They make a diagnosis, see how this diagnosis fits into a preconceived treatment bin, then just solve from that position without understanding what's different, what's unique to each case. And, in their defense, they probably just don't have the time for that extra work. That's where I see technology as most useful....how to automate and make more efficient the redundant parts so professionals can concentrate on the important, unique parts to each patient's diagnosis.

Nagyman 12y ago
I agree with you and also believe this extends to the majority of professions. Even within software development, there are a significant number of people that will only solve the immediate problem in front of them in a stepwise manner, rather than using lateral thinking to evaluate if the problem should be solved in the way that's most familiar to them, or to look at it from a different perspective and solve another problem entirely (e.g. the root cause). To be fair, the majority of problems are probably addressable without thinking differently. So people get into habit/routine and that's their "job"; thinking otherwise is not a day-to-day operation. To your point, automating the redundant/repetitive problems should allow for creative problem solving where machines don't yet excel.
- ashark 12y ago
  A lot of school administrators have PhDs, but get one to tell you how they learned about some really cool experimental results at some conference (probably publicized by someone trying to sell them something, incidentally, but that's another problem) and are trying to reproduce them at their school(s). You'll be in for a treat. A "treat". Fun bonus anecdote: One of my wife's principals was convinced the prayer jar she provided for the staff was effective because over half of the prayers the prior year had been answered. When she told me that story it damn near broke my brain.
  - learc83 12y ago
    >One of my wife's principals was convinced the prayer jar she provided for the staff was effective because over half of the prayers the prior year had been answered. Depending on the prior probability of the prayers that were answered (and those that weren't), 51% could be plenty to support the efficacy of the prayer jar.

smacktoward 12y ago

A more charitable explanation would mention how the prime directive of their profession is "first, do no harm": (http://en.wikipedia.org/wiki/Primum_non_nocere http://en.wikipedia.org/wiki/Primum_non_nocere)

deleted 12y ago

[deleted]

deleted 12y ago

[deleted]

entropydude 12y ago

I'm a doctor and former software programmer, so let me offer a counterpoint: I would disagree with your statement that medical people have a fatalistic passive attitude. In this case the decision is between 1) watching and waiting to see if the tumor grows and 2) acting immediately to take it out. The tumor in question is a meningioma, a relatively common tumor of the skull (meninges, to be precise) whose natural behavior is unpredictable (some are essentially benign, others are highly malignant). Sometimes high-risk features can be identified on MRI imaging (brain invasion, areas of tissue necrosis, rapid growth) and these will always be treated with intervention. I work at UCSF, one of the top neurosurgery programs in the world, and I can guarantee you the radiologists don't make the mistake on sizing tumors mentioned here (well maybe they do, but it is out of carelessness rather than a problem with there software. it is not hard to find anatomic landmarks to ensure you are measuring at the same level). I would argue that a small meningioma without worrisome features should definitely not be operated on because the risks of surgery are not negligible! These surgeries are no joke, they are extraordinarily complex and they are mucking around next to structures which can cause significant morbidity, neurologic deficits, and even death sometimes if they nick the wrong artery. It is well accepted practice and backed by evidence (see the WHO:tumors of the CNS publication) that the best way to decrease overall morbidity is by watching and waiting with these types of meningiomas. This is because MOST meningiomas are low-risk/benign (they are often found incidentally during autopsies for other reasons) and the risk of adverse surgical outcomes would be high if you subjected each of these people to invasive procedures when the incidence of high grade meningiomas is low. It is a population based strategy and unfortunately on an individual level you can't predict the outcome, but that is unfortunately a problem with this data. Fortunately lots of new technologies are emerging that can tease out individual differences (the so-called personalized medicine technologies) That being said the new techniques to map out anatomy to aid surgeons is very cool! And to be fair, it sounds like the patient in this article did not get great care and that some of the doctors were not following the standard of care (1 year between imaging is definitely too long).

parennoob 12y ago
I understand your rationale for the "wait and watch" option, and agree fully with it. > "well maybe they do, but it is out of carelessness rather than a problem with there software." I think this statement precisely illustrates the point that the parent commentator has with much of the medical community. Think about what the "carelessness" of a radiologist that you're talking so flippantly about means for a family – the anguish, sleepless nights, and feeling of morbidity and helplessness. I may be overreacting here, but I would be extremely worried if a radiologist can be careless and ruin a year or more of someone's life, possibly forcing them into opting for a highly risky surgery. If you think there is a chance that your radiologists are not measuring things properly, wouldn't it be beneficial to start a double-checking procedure of some kind whereby each MRI is checked by 2 radiologists and a doctor (or something of the kind)?