Comment by mistermann | Hacker News Reader

Comment by mistermann | Hacker News Reader

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The key phrase being "that meets the modern standard of care", as opposed to most current available knowledge. Aka "good enough".

And just as there's no realistic way for doctors to stay completely current (I expect specialists in a specific field would often have trouble staying current even there), I'd have to see some pretty extraordinary proof to get me to believe doctors are confirmed to be comprehensively up to date on all "modern standard of care" medical knowledge.

> Patients do not tolerate care that’s compromised by unknown unknowns–unless it’s truly unknown to all of medical science–and the medical and legal professions do not tolerate it either.

Good lord, if one is connected to the internet or reads the newspaper this is so obviously false it is shocking someone would make the claim. And in Canada, you take what little medical care you get and you like it.

Luckily, the vast majority of patients are utterly uninformed, so this theory would rarely be put to the test.

> Is it to add to your doctor’s fund of knowledge so as to change his or her assessment of your condition or the treatment that you are offered? This scenario is ethically impermissible for your doctor; it has nothing to do with ego.

Wow. So, you literally can't even believe a scenario can possibly exist where any patient might be aware of studies related to a particular ailment, and that upon informing the doctor of it's existence, the doctor could then go read the study for him/herself and incorporate the knowledge into their practice?

Please tell me this is a misunderstanding between us.

edit: fixed a backwards phrase

There are some misconceptions to be tackled here:

> The key phrase being "that meets the modern standard of care", as opposed to most current available knowledge. Aka "good enough".

This is a gross mischaracterization of what it means to provide the standard of care.

> And just as there's no realistic way for doctors to stay completely current (I doubt specialists in a field have trouble staying current there), I'd have to see some pretty extraordinary proof to get me to believe doctors are confirmed to be comprehensively up to date on all "modern standard of care" medical knowledge.

Each physician has their scope of practice. Outside of their scope of practice, they are expected to refer to or consult another professional. Within their scope of practice, they are absolutely required to be up-to-date in their knowledge. This includes the obligation to recognize when a patient's needs exceed their scope of practice.

> And in Canada, you take what little medical care you get and you like it.

More medical care is not better medical care. A number of pioneering efforts to use resources wisely first developed in Canada are now internationally recognized. They represent impactful advances in improving the quality of care. See, for example, the Ottawa Ankle Rules.

> Luckily, the vast majority of patients are utterly uninformed, so this theory would rarely be put to the test.

Contrary to your assertions, the majority of my patients ask pertinent questions and participate meaningfully in their own care. This has been the case regardless of their level of education and general health literacy.

> Wow. So, you literally can't even believe a scenario can possibly exist where any patient might be aware of studies related to a particular ailment, and that upon informing the doctor of it's existence, the doctor could then go read the study for him/herself and incorporate the knowledge into their practice?

Feel free to recommend studies for your doctor's reading list. There's no reason your doctor should be averse to that--it's no different from recommending a novel. However, if delivering appropriate care to you requires the reading of studies the existence of which your doctor is not even aware, then your doctor is no more qualified to provide that care after reading one or even a small number of studies. Have no expectation that your treatment will change after recommending a paper any more than it might after recommending a novel.

> There's no reason your doctor should be averse to that

This must be where we've crossed wires - you're talking about how things should be, I'm talking about how they sometimes/often are.

> it's no different from recommending a novel

Except one can result in the doctor learning something new about medicine. Unless medicine is somehow the one magical profession where there is no gradient of competency - all practitioners are perfect.

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