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Comment by skadamou | Hacker News Reader

I'm so sorry this happened to you and I'm glad you are starting to feel at least somewhat back to your old self. I definitely understand where this opinion of docs is coming from as there are definitely some incompetent docs out there but don't you think that your opinion is largely based around an anecdotal experience that is probably pretty abnormal? Medicine as a field is still pretty unscientific in a lot of ways. To me it feels like docs are like alchemists before the discovery of the atom/modern chemistry. They're doing the best they can with the tools at hand but their field has some fundamental gaps in knowledge. Is that really the doctors fault?

That's just my two cents. Obviously this doesn't do much to help folks dealing with poorly understood illnesses but I hope it helps balance out the "all doctors are idiots" opinion that sometimes comes up in threads like this.

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Idiots is the wrong word. They've achieved a state of the art knowledge. An idiot wouldn't get there. The problem is, most of them stopped at that. And state of the art moved on.

I think a core problem is that the incentives are to give a quick diagnosis and prescription, and if that diagnosis is wrong, move on to the next diagnosis / prescription, repeat. This is in contrast to my experience with a functional doctor, who laid out a logical plan, testing to verify hypotheses, and only after all the pieces fit together, decided on a treatment strategy.

Of course, for the majority of cases, the mainstream approach works well or well enough, but it's definitely frustrating when you fall outside of it. I think some people don't even know they're falling outside of it (e.g. long-term gastrointestinal problems), as in they've given up figuring out the root cause and have learnt to deal with their symptoms. I think the number is non-trivial (1%+?), but I can't think of any way to prove that.

> Is that really the doctors fault?

It seemed that most of the doctors I had to deal with were incompetent either because they were lazy or stupid. Realistically maybe they were just overworked, but the effect was the same. I’m not really interested in assigning “fault” here - that’s just a factual observation I made.

Are you qualified to evaluate competence in that field? What specific criteria did you use?

If there were specific criteria that I could share in an HN comment, they would be used for hiring and immediately collapse under Goodhart’s law. Your question is almost tautologically bad - If I were able to answer it in a brief HN post, my answer would be bullshit.

You can accurately probe competence by asking people questions about their thought process, their current hypotheses, etc. If there are $BIGNUMBER tests for competence, you only need to ask $SMALLNUMBER of them to make an accurate determination as long as the person being asked doesn’t know them ahead of time! This is the same trick many zero-knowledge proof algorithms use.

So you're just dodging the question and don't actually understand the medical profession.

I just pretty clearly explained why I don’t need to understand every detail of the profession to accurately estimate someone’s capability. Which part of that was confusing?

Forgive me if I’m being brusque but you’re doing the same stupid defensive BS that incompetent doctors do when you ask them a question - “oh, and where did you go to medical school?”

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