7 ms·

I come from a long line of docs, though I'm a software dev. Let me tell you that the vast majority of patients can easily be sorted into these pre-formed catego

by tsax 12y ago

I come from a long line of docs, though I'm a software dev. Let me tell you that the vast majority of patients can easily be sorted into these pre-formed category bins. Rare conditions are rare by definition. Most of medicine is dreary repetition.

AceJohnny2 12y ago
This ought to be highlighted, before people start an echo chamber of "doctor's don't know what they're doing!" that ultimately undermines everyone (guess what argument the anti-vaxxers use). A string of anecdotes of "I double-checked and it turned out the doctor was wrong" remains less than a trickle compared to the flood of patients doctors have to deal with, and a tiny fraction of the hypochondriacs they must deal with. Our medical system is broken enough without adding doubts on the competence of its medical professionals. By all means, people should double-check what the doctors say, but realize the much worse consequences of sowing doubt.
- DanBC 12y ago
  There are some useful questions patients can ask. "What happens if we do nothing? If we do watchful waiting?" "What happens if I don't take these meds?" "How likely is that bad event? Tell me in terms of numbers per 10,000 people rather than percentages".
  - Normati 12y ago
    Another useful one is to ask him to explain his reasoning. If he can't justify his decisions, then he's probably using instinct which is unreliable in the case of rare diseases, or he doesn't know how to diagnose known diseases which means he's incompetent. Some people are offended when you challenge them for reasons for their advice, but I think that's because they aren't confident in it themselves or feel superior. Doctors shouldn't be in either of those positions and should be willing to tell you how they came to their conclusions.
    - amedstudent1 12y ago
      Whilst on the whole I agree with you, the amount of doctors I know that would react (quite strongly) negatively to that is quite high, so anyone who takes your advice should be prepared. The most common response I've seen to your question was the doctor reminding the patient "there is always something called a second opinion", a couple of times though I noticed them taking the time to explain it.
  - saurik 12y ago
    Why is "numbers per 10,000 people" meaningfully different than taking the percentage and multiplying it by 100?
    - DanBC 12y ago
      Doctors and patients do not know what you mean when you say "your risk has gone up 50%". When you say "in a group of ten thousand people we would expect 4 to experience this thing. But in a group of 10,000 people who eat peas we expect about 6 people to experience this thing". Gerd Gigerenzer has a book explainin it better than I do.
- chadillac 12y ago
  This highlights the importance of a second and third opinion as well. As the joke goes, "what do you call the guy that graduated last in his class at medical school? Doctor." Doctor's aren't machines, they're more like mechanics, they see a symptom, use their knowledge to make an educated guess essentially, and then work from there. If their knowledge is soft it's likely an incorrect diagnoses could just be exacerbated by incorrect treatment. Get another opinion, and then another, the next problem is deciding on siding with consensus or outlier.
toomuchtodo 12y ago
> Most of medicine is dreary repetition. Hence why we can automate away most of the problems with it.
- tsax 12y ago
  Yes, which is also why The Checklist Manifesto was so successful.
JacobJans 12y ago
It's exactly this attitude that turns me off of a lot of doctors. It dehumanizes the experience of being a patient. First you are put in a bin, then the doctor basically runs you through a check list. It's really unfortunate that nearly 100% of the bins are disease or a disorder. A typical interaction with a doctor involves finding out which disease bin you should be in, and then putting you in there. Once you're there, they're not concerned with making you healthier, or looking at the variety of options that could improve your life. They're just concerned with doing the standard operating procedure for dealing with the disease. Instead of being a person, the patient becomes a checklist. Many doctors don't even see you. They see the bin you're in, and the many potential bins you could potentially be in. What if half the bins were about great physical health? And what if the doctors worked just as hard to get you into one of those, as they do "treating" the diseases you might have? Ugghhh. It makes me sad thinking about how far we are from that world.
- digi_owl 12y ago
  I think it is not so much the doctor that is at fault, as the system of checks and measurements that make up modern health care. The boxes are there for the convenience of management, insurance, etc, as much as it is for the doctors.
digi_owl 12y ago
Or rare variant of common issues. Got told a story by a relative in the health care profession about a patient that complained about pains. But their location etc didn't match anything fitting the the age etc. Eventually they discovered that it was a heart condition...
mdesq 12y ago
There's a similarity of sorts here to airline pilots. What separates the decent ones from the great ones is how they handle the rare cases. There's enough dreary repetition that it's easy to be unprepared when it counts the most.

by tsax 12y ago

AceJohnny2 12y ago

This ought to be highlighted, before people start an echo chamber of "doctor's don't know what they're doing!" that ultimately undermines everyone (guess what argument the anti-vaxxers use). A string of anecdotes of "I double-checked and it turned out the doctor was wrong" remains less than a trickle compared to the flood of patients doctors have to deal with, and a tiny fraction of the hypochondriacs they must deal with. Our medical system is broken enough without adding doubts on the competence of its medical professionals. By all means, people should double-check what the doctors say, but realize the much worse consequences of sowing doubt.

DanBC 12y ago
There are some useful questions patients can ask. "What happens if we do nothing? If we do watchful waiting?" "What happens if I don't take these meds?" "How likely is that bad event? Tell me in terms of numbers per 10,000 people rather than percentages".
- Normati 12y ago
  Another useful one is to ask him to explain his reasoning. If he can't justify his decisions, then he's probably using instinct which is unreliable in the case of rare diseases, or he doesn't know how to diagnose known diseases which means he's incompetent. Some people are offended when you challenge them for reasons for their advice, but I think that's because they aren't confident in it themselves or feel superior. Doctors shouldn't be in either of those positions and should be willing to tell you how they came to their conclusions.
  - amedstudent1 12y ago
    Whilst on the whole I agree with you, the amount of doctors I know that would react (quite strongly) negatively to that is quite high, so anyone who takes your advice should be prepared. The most common response I've seen to your question was the doctor reminding the patient "there is always something called a second opinion", a couple of times though I noticed them taking the time to explain it.
- saurik 12y ago
  Why is "numbers per 10,000 people" meaningfully different than taking the percentage and multiplying it by 100?
  - DanBC 12y ago
    Doctors and patients do not know what you mean when you say "your risk has gone up 50%". When you say "in a group of ten thousand people we would expect 4 to experience this thing. But in a group of 10,000 people who eat peas we expect about 6 people to experience this thing". Gerd Gigerenzer has a book explainin it better than I do.
chadillac 12y ago
This highlights the importance of a second and third opinion as well. As the joke goes, "what do you call the guy that graduated last in his class at medical school? Doctor." Doctor's aren't machines, they're more like mechanics, they see a symptom, use their knowledge to make an educated guess essentially, and then work from there. If their knowledge is soft it's likely an incorrect diagnoses could just be exacerbated by incorrect treatment. Get another opinion, and then another, the next problem is deciding on siding with consensus or outlier.

toomuchtodo 12y ago

> Most of medicine is dreary repetition. Hence why we can automate away most of the problems with it.

tsax 12y ago
Yes, which is also why The Checklist Manifesto was so successful.

JacobJans 12y ago

It's exactly this attitude that turns me off of a lot of doctors. It dehumanizes the experience of being a patient. First you are put in a bin, then the doctor basically runs you through a check list. It's really unfortunate that nearly 100% of the bins are disease or a disorder. A typical interaction with a doctor involves finding out which disease bin you should be in, and then putting you in there. Once you're there, they're not concerned with making you healthier, or looking at the variety of options that could improve your life. They're just concerned with doing the standard operating procedure for dealing with the disease. Instead of being a person, the patient becomes a checklist. Many doctors don't even see you. They see the bin you're in, and the many potential bins you could potentially be in. What if half the bins were about great physical health? And what if the doctors worked just as hard to get you into one of those, as they do "treating" the diseases you might have? Ugghhh. It makes me sad thinking about how far we are from that world.

digi_owl 12y ago
I think it is not so much the doctor that is at fault, as the system of checks and measurements that make up modern health care. The boxes are there for the convenience of management, insurance, etc, as much as it is for the doctors.

digi_owl 12y ago

Or rare variant of common issues. Got told a story by a relative in the health care profession about a patient that complained about pains. But their location etc didn't match anything fitting the the age etc. Eventually they discovered that it was a heart condition...

mdesq 12y ago

There's a similarity of sorts here to airline pilots. What separates the decent ones from the great ones is how they handle the rare cases. There's enough dreary repetition that it's easy to be unprepared when it counts the most.