Comment by dimal | Hacker News Reader

Comment by dimal | Hacker News Reader

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Maybe you don’t want creativity in the ICU, but as a patient with chronic health issues, I do want creative clinicians. Over and over my entire life, I’ve gone to doctors with health issuesand watched as they mentally plug my symptoms into a flowchart that they learned in medical school, then they find that the symptoms don’t match anything that a standard protocol can treat, then they shrug their shoulders and say they can’t do anything. The latest case of this has been severe blood glucose drops in the middle of the night that wake me up with a pounding heartbeat. I waited four months for an appointment with an endocrinologist, then was told I don’t have “true hypoglycemia” because it’s not corrected by eating. End of story. No curiosity. No help. Goodbye. Again.

Sorry, this is not acceptable. The only time I’ve gotten decent medical care for my chronic issues was when I was making enough money to pay for a doctor who only worked fee for service. He would troubleshoot things like an engineer, because he was a former engineer. He improved the quality of my life immeasurably.

I think there’s a difference between “evidence-based” and using only 100% manualized protocols. If medical science was better and actually had answers for everything, sure, let’s stick to the manuals. But medical knowledge isn’t even close to being that thorough. Clinicians need to be able to think on their feet when they look in the manual and there’s nothing there. Otherwise, you’re failing patients.

Completely agree. Any educated layperson can figure out and follow a clinical decision tree. I mean it can work in your favor if you know you need something and know how to get the decision tree to give you what you want, but otherwise clinicians should definitely be actual experts and not just meat following something a computer could do

> Any educated layperson can figure out and follow a clinical decision tree.

12-15h a day, 6 days a week with not even a lunch break? You're sorely mistaken. It takes an expert to follow clinical workflows.

Are all doctors working these hours? I thought these were the hours for residency, not the average general practitioner or specialist working outside of a hospital. If they’re working 15 hours a day, why are they only open 8?

What I meant is that I can follow it for myself, not do it for others. I don't have the training to know every medical decision tree by heart, but I can look up ones for problems I have and apply them.

I am a bit biased because I have several medical professionals in my family, but a common refrain is definitely that most doctors/nurses aren't going to be that engaged and helpful, and are more of a input/output device to navigate rather than someone you want to completely defer to.

You still have the problem of writing a sufficiently detailed tree. I had a blood test last year and when I discussed the result with the doc, he asked me the clinic location where the blood was taken, because then he could estimate time between blood draw and lab test and interpret the result accordingly.

It’s your blood usually tested immediately? At least my hospital gives me results right away (well, say within 30 minutes).

It might be different where you live, but where I am, the vast majority of blood tests are not done at the hospital. Family doctors and lab test centres do it.

I think you just made my point about a sufficiently detailed tree.

GP orders test. I go to a test center to get the blood drawn. They have couriers taking samples to labs a few times per day.

Yes, it's so tiresome and frustrating. I once had a period of a few months where my sleep was down to around 5 hours/night (normally I would get 8-9), I was exhausted and my body just wouldn't sleep more than that. Went to a doctor who offered a couple of thoughts "some people only need that much sleep" and "there's only one thing it could be, but that's not what it is". He wasn't even going to test the "one thing" until I asked if he would. Turns out he was correct that that wasn't what it was, but obviously there was at least one other thing. My sleep ended up returning to normal though I still have similar periods where I can't get enough sleep.

The only medical practitioners I've found willing to be more curious and to take a more holistic approach are naturopaths. I have had some notable improvements in my chronic health issues working with them, though I am a little uncomfortable with them given their general openness to things that seem pretty questionable to me (like homeopathy).

The fact that they’re more open to believing that anything might work cuts both ways :)

I think when dealing with chronic issues, it might be better to optimize for luck. [0] A little ridiculousness like homeopathy might be worth it to find the thing that actually works.

[0] https://www.lesswrong.com/posts/fFY2HeC9i2Tx8FEnK/luck-based...

Thank you for this link. Well written and mirrors a lot of my experiences though I am still looking for my 'miracle cure'. I think this could be helpful for sharing with other people in my life who don't understand why someone would stray from an empirically/scientifically sanctioned approach.

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