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Comment by Waterluvian | Hacker News Reader

My son when 3 had a fall and a few teeth were bent. Went to our local dentist who mostly had a wait and see opinion. But then calls a day later and says they’ve decided they should just come out. Two top front teeth. Would have no top front teeth for years.

I went into engineer mode and while I acknowledged I didn’t have domain expertise, I asked questions and probed the whole situation. Very unsatisfactory, meandering answers.

This was a deeply distressing experience. For the first time ever I did the “call in a personal favour” thing and asked my dad to reach out a family friend, a former cosmetic dentist and former head of the province’s dental association for a second opinion.

He saw my son a few hours later and he was just livid about the diagnosis. That it was possible they’d have to come out but it’s impossible to know this for at least a few more weeks or more.

In a few months the teeth returned 100% to normal and firmed right up as the ligaments healed.

I’m not a conspiracy nut. I believe in listening to experts (but ultimately making an informed decision). I believe in modern medicine. But that experience shook me and forever changed my trust in the dental industry.

My feeling is that the nature of dentistry leaves a lot of room for subjectivity and COVID left a lot of dental chairs empty.

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>> I’m not a conspiracy nut. I believe in listening to experts (but ultimately making an informed decision). I believe in modern medicine. But that experience shook me and forever changed my trust in the dental industry.

Ask anybody who’s experienced a “chronic” illness about the “experts” and they’ll tell you a tale or two. The experts are great until they have a case that is unusual. The don’t have the time or knowledge to treat you properly. You get passed from “expert” to “expert” each time having your hopes dashed. You start feeling like a conspiracy nut chatting with other patients online sharing what’s anecdotally helped. After running into this issue more than once I’ve lost all blind trust in medical experts. I’ll verify what they tell me as best I can and get second opinions if necessary. In one case I was passed up the chain of experts until I finally found the right one myself after a year, and it still blows my mind that this wasn’t the first referral. The system is at the same time incredible and awful.

Same experience here. My analysis is it's a money milking scheme between groups of doctors. Pass you around so everyone gets a cut and they cross refer people to scratch each other's backs. Surgeon refers you to pain management and pain management refers you to surgeon. Add in a physical therapist, testing facility, and chiropractor and you got a pretty lucrative meshnet of referrals going.

Tbf in my case this was NHS so no money to be made by referrals afaik. It mostly seems to be a lack of up-to date knowledge paired with a reluctance to take the initiative and research the latest information for a specific case. As a substitute they refer you up the chain where the same problem also exists.

> NHS so no money to be made by referrals afaik

I wouldn't assume that - just because the money isn't coming from your pocket directly, it's inevitable there are doctors that milk the system. But you'd think bureaucrats whose job it is to assess the legitimacy of requests to the NHS (or equivalent institution in your own country) for payment might be harder to swindle than your typical patient.

Hanlons razor

While this might happen, it's certainly a tiny minority of cases. In most cases it's just too big of an ego to admit that they really don't know, and not willing (private practice) or unable to (employed by a big hospital) spend the large amount of time needed to raise the chance of finding the cause from 0% to maybe 2%.

Truth is that modern medicine still knows much less than is often assumed, let alone individual doctors. There's an absurd amount of potential for LLMs here.

I was with you until the last sentence:

> There's an absurd amount of potential for LLMs here.

The problem is not that doctors are stupid, the problem is that a lot of ailments are just not easily diagnosed. Even if the doctor has one (or more) suspicions what the red rash on your skin is, there just aren't any tests for many conditions. Many diseases are only diagnosed by symptoms and the underlying cause is unknown.

And even if you get a diagnosis, there is often nothing you can do.

LLMs are not going to magically come up with cures.

Is LLM the new web3, where people just keep throwing it as a solution for every problem they encounter? Seems like it... Maybe soon they will throw LK-99 at every problem?

LK-99 is already on the blockchain

https://coinbrain.com/coins/bnb-0xb131f5e8ec273af4652eecdd87...

This will change everything

People always default to whatever the new thing is being somewhat magical. Radiation as a medical cure all didn’t age particularly well, but it’s not like the same people are falling into the trap. It’s been common across many generations and cultures, I doubt it’s going to change any time soon.

> Even if the doctor has one (or more) suspicions what the red rash on your skin is, there just aren't any tests for many conditions.

There aren't any tests that the doctor has on hand, because the doctor is a unit in the medical system designed to provision affordable care instead of a scientist attempting to cure you. It would be too expensive to test you, especially for something that will probably go away on its own.

If various scans were more readily available, quick and cheap, I wonder how far these guesswork scenarios would be improved? Rather than having to get a referral and separate appointment and waiting period for bloodwork or colonoscopy or whatever else.

Read HIPAA when you get the chance; Specifically how to calculate cost.

Everyone who talks to the patient, who touches them, and who is consulted by the doctor, gets to charge. Yup, that means if another doctor happens to walk by, and confirms what he just told me, he gets to charge me again (double).

Feels like theatre every time I go to the doctor, so I just tell the secretary "I'm talking to you and Doc, no one else", and just quietly stare at anyone else who pops in.

Usually insurance covers this stuff, but I was uninsured when I discovered it .

> My analysis is it's a money milking scheme between groups of doctors. Pass you around so everyone gets a cut and they cross refer people to scratch each other's backs.

This is accurate. Years ago I had a kidney stone and the GP asked for an IVU (Intravenous urography) image to make sure about the size. The report prepared by the radiologist had the statement "operation is required".

When I got back to my GP just laughed sarcastically and told me that it was nothing to be worried of. He also said "the radiologist just wanted to return the favor, in case the GP wanted to operate". He was sick of this scheme too, but there was nothing he could do.

Most of the complaints I read in this conversation have been about people NOT getting referred for scans when they've reported discomfort!

"The experts are great until they have a case that is unusual. "

I was so pissed by this I created a way to find experts. People that actually studied the issue, have actual publish papers on the topic. What I found was no one cared. No one wanted "experts" - they want a specialist that is in their network and close.

Example of searching for mohs surgury. https://www.opendoctor.io/research/?research_papers=mohs&zip...

Interesting service, thanks for sharing. I think most people are looking for their GP to be able to refer them to the correct specialist which seems fair. It shouldn’t be on the patient to try to find them. But good website nonetheless! (FYI it doesn’t display great on mobile Safari - content too wide so there is horizontal scrolling).

If this is in the US it would make sense that people are really bound by their insurance provider as to who they are allowed to see cheaply.

Wow this is awesome. You should post this as it’s own show HN thingy.

This is great, thank you.

I've often been struck dumb by the passive nature of so many people when facing health problems. My dad had multiple myeloma and was satisfied with local hosp. Nope. Made him go to Yale and the Dana Farber. He got the best care possible.

I struggled with back pain and told to go to a neurologist and informed my GP where I would and wouldn't go. The doc I was referred to was a no-go since I know him personally and he's a lying piece of shit in his personal life, I'm not trusting him with my back! Docs could NOT understand. "But he's so nice." Screw that.

Time and again, family and friends settle. I understand the insurance component, but even then, can you not find better?

And thank you for your work. It's very cool.

awesome stuff, how hard would it be to expand to other countries? I'm from Australia :)

Very cool resource, bookmarked. I hope I don't need it anytime soon, and I hope it's still there when I do.

This is very true. I had a SO with severe chronic gastric pain and they got passed around by doctors for years. One jerk wrote "drug seeking behavior" into her file and that made things even worse. Finally someone took her seriously, got imagery done, and discovered surgery was necessary.

In US healthcare you have to be your own advocate and be willing to push. The system breaks down if you don't have a routine and obvious illness.

Now imagine doing this on Canadian healthcare, having to wait months or years for each appointment, and nowadays they try to talk you into MAID to save resources…

Yeah that's a hyperbolic exaggeration.

I know HN is a privileged place but people should recognize that the “worst case” of Canadian/European healthcare wait times is already the reality for many if not most Americans.. You shouldn’t base your understanding of American health care on personal experience if you work for a big company that provides a nice health insurance plan.

I have jank government insurance and this is not true. When I got out of prison and had no insurance I went to the city's clinics. Wait times have never been an issue (at most was two weeks for specialist). The doctors in the clinic were also friggin amazing doctors/people. I had a ton of shame around getting out of prison, some much shame about needing to get tests ran for HIV/Hep from being in prison but they were so good about it all (all came out negative so woohoo).

Now dentists...when we had money we went to a family friend. He still totally f'd us and did unnecessary work. It's only now that I have a cash only country dentist that I trust my dentist again. Crazy part is the cash only dentist ends up being cheaper than my previous copay/premiums insurance dentists.

I'm always surprised when people leave comments like these, based on nothing but N=1 anecdata. You don't have any authority to say something like "this is not true" with regards to the whole of the American healthcare experience. Compared to my own personal experience, yours was uncommonly-good. Wait times for specialists for my SO's heart condition are routinely several months out.

What this demonstrates is that wait times are widely variable by specialty and region. Arguments like "for most Americans" are wrong on their face, because most Americans don't live in the same area or have the same issues.

My wife and I have both had to see various specialists. Some had very long wait times, many didn't, and of those that did, we were (fortunately) able to call around to different clinics to find one that wasn't too bad.

"Most" comes from the actual data

The exceptions are part of that data set

Really...

To be fair, their statement of n=1 is more evidence than the other person posted (comment without any evidence). Although both are weak.

I mean, n=1 of a guy that had a good experience -- n=roughly 28,000,000 with no health insurance at all. These don't seem like two sides of the same coin in my view.

I'd the original comment actually mentioned that and laid out a theory behind it, that would be different (is that health insurance or dental insurance?). Even your comment about uninsured people doesn't fully connect the dots or explain what their experiences are, as some people in these comments are stating that cash dentists are cheaper/easier to deal with than with insurance. I have had experiences that also back this up.

Absolutely true, and that is if you even have a family doctor to refer you to a specialist. For those who had the luck to lose their family doctor (mine through retirement), it is impossible to find one that takes new patients. Many retired during covid, many more only work part time. The Canadian health care is a disaster at this point, and those who have a family doctor have no clue how awful this is.

In the US it's not easy to find a primary care provider also. When we moved couple of years ago and called a local medical center to establish a primary care provider, we were given answers like "we have the nearest appointments in 6-8 months". If you have something urgent, there's telemedicine line where you can talk to advice nurse or if there's something really urgent, get an appointment with an urgent care doctor. But all primary care providers seem to be booked solid for months. And given how many patients they'd have and how often they see each one, establishing any kind of personal care relationship is out of the question. How personal can it be if you can see you doctor twice a year for 20 minutes? I think the only solution is go get rich enough so you can afford personal concierge doctors or however it is called (no idea since I'm not rich enough).

rich enough so you can afford personal concierge

A few minutes research suggests it's not that expensive. (As little as ~2000/year).

For most people, that's expensive.

No, it isn't. Most people pay about that much for their cable. For the bottom 20 percent, yes, it is a budget-buster.

However, that is beside the point. Believe me, I hate explaining simple, simple things--but the person I was responding to is probably comfortably middle or upper-middle class and could afford a miserable 2000/year on a doctor. He doesn't have to become "rich enough", and almost 100 percent of the people in this thread don't have to either.

Average canadian income is 60k

2 k is a lot for even those at the 50th percentile and extremely significant for those below it.

Min wage earners make about 30k, so that 2k is 6.6% of thier income....

What I can find around me with a quick look sounds like about ~$400/m, or $4800/yr - which I could handle if I had to, but it would sting (especially as I still would have to pay my regular health insurance, of course). And there doesn't seem to be all that much choice - at least in places where I know to look.

This is not true.

I mean, the wait times sometimes are, but they vary by province. More conservative provinces have worse wait times. That is not surprising given that the provincial conservative government are all actively attempting to sabotage public healthcare so we can move to an American style system. A system where we will all pay more, and still see similar wait times anyway.

MAID is not actively proposed as a way to save resources.

> More conservative provinces have worse wait times.

This feels like a pretty glaring generalization. If we look at the actual data, the story becomes a little more nuanced [1]. "Conservative" provinces have wait times that are a couple of days to a couple of weeks higher than national average (assuming we call BC, AB, SK and MB "conservative" [2]), but then again almost all of the maritimes provinces (which are considered strongly liberal-leaning) have abysmally bad wait times relative to the average (10-20 weeks worse).

Overall, the average is ~half a year anyways, which is pretty rough regardless.

[1] - https://www.fraserinstitute.org/file/waiting-your-turn-2021-... [2] - https://en.wikipedia.org/wiki/2021_Canadian_federal_election, "Results by province and territory

AB, SK and MB are conservative with high rates of Trump flags.

And nice lies dude. They all have over double the national average!

Don’t use Fraser institute for sources. They are a far right “think” tank. If they posted it, it’s a lie or misrepresentation.

Favorably comparing the US health system to the Canadian one is an interesting take indeed…

I know people in Canada who come to the US for healthcare (better care for specialties, shorter wait times).

I'm not aware of the reverse (admittedly, that would require more than just $$).

And Americans go to Mexico for healthcare, I'm not aware of the reverse, I guess that means Mexico has the best healthcare in the world.

I actually drove someone across the border from Mexico to the U.S. for healthcare (voluntourism injury).

The reason to go to Mexico is price. The reason to go to the U.S. is quality.

How about for Canada vs the U.S.?

If you're a Canadian citizen, Canadian healthcare is cheaper, but generally has much longer wait times.

U.S. healthcare is much more expensive, but much more quickly available, and specialty care (e.g., rare disease treatment) is much better.

Then there's this - When a woman went to the hospital for help with suicidal ideation, a clinician told her the waits to see a psychiatrist are long, "the system is broken", and "have you considered [assisted suicide?]...MAID would be a more “comfortable” process during which she would be given sedating benzodiazepines among other drugs."

She will be able to see a psychiatrist "when one is available in the fall."

https://web.archive.org/web/20230809170345/https://www.thegl...

I live in the US. I am a software engineer making more than a half a million annually. I have access to tremendous resources and can advocate for myself and my family. I live in a college town because of my wife's career. It is not a big city, but is also not rural middle of nowhere.

Getting a routine gynecological appointment for my wife any time in the next six months is impossible. I gave up on trying to get an appointment with an allergist for myself, even after getting a referral. What you describe is common in the US too, even for those with means. I cannot imagine what it is like for somebody who doesn't have money and insurance.

Preach.

I wanted to get a sleep study done to get to the bottom of my occasional insomnia. My PCP at the time put in the pulmonologist referral (because this hospital network required a referral to get a sleep study done, which is insane in its own right, but that's neither here nor there).

This was in January. His next available appointment? March! For a friggin sleep study! And I have a HDHP + HSA and was going to pay full boat!

(He also prescribed me with an antipsychotic that can double as a sleep aid at low dosages, which I didn't take because five minutes of research into it made it obvious that taking that for extended periods of time is bad news bears. I stopped seeing him after that.)

(For those looking for answers like I was, I eventually stumbled upon Cognitive Behavioral Therapy for Insomnia, or CBT-I. It's essentially a rigid sliding window-style sleep schedule plus challenge therapy to make you rethink how you approach sleep. I've been doing this for six months now and it has been transformational. Best part? No meds!)

FYI: I'm not a doctor and this isn't medical advice, but you can buy an APAP machine over the counter with money in your HSA, then hack around in it to figure out if you have sleep apnea and how bad it is if so

My wife got a sleep study done within 2 weeks of booking one, after she asked to be put on a cancellation list. Her actual appointment time was for end of October, scheduled about a month ago. You may need to be proactive and ask to be put on one, for some reason no one mentioned to her that there is one.

Well, no need to imagine any longer my friend. I have neither money nor insurance. My experience is identical to yours...other than that whole allergist thing. That's not something I would seek out answers on, as it is simple to figure out at home, and when you do get to an allergist, you will likely hear something very useless like "yeah you're allergic to at least some degree to these 17-25 different things; please try to limit exposure". :-D

If you think waiting for months is a Canada-only problem, you clearly haven't tried to get a specialist appointment[1] in much of the US. And that's with good insurance.

[1] Or shit, even a PCP that accepts new patients.

No one is talking anyone into going the MAID route, that's just some far right conservative party bs.

Really, you just engaged in deception and promulgation of propaganda intended to push people toward neofascist ideology.

Shame on you.

MAID == Medical assistance in dying (assisted suicide)

Went from nothing/reluctance to popular for some segments of the population

> In US healthcare you have to be your own advocate and be willing to push. The system breaks down if you don't have a routine and obvious illness.

100% the same thing on this side of the pond, US healthcare isn’t special here.

How is this problem specific to the US? I live in Germany and hear exactly the same problem of needing to be your own advocate in northern Europe.

Also in Europe and most doctors just want to get you out of the office. I've met only a few doctors who actually care and will work with you to figure out the issue. The equivalent in software engineering would be waiting for my client to tell me what line to change in what file.

To be fair, doctors are usually overworked and on a human level I understand that the system is a bit broken, but it's still infuriating when it's your health that is suffering.

The internal term is "Treat and street". Get them out on the street as quick as possible .

You got the street - the treat is some yummy meds.

I had this when I got shingles on my neck. I hadn’t even got through the door when the doctor had made the diagnosis based on eyeballing my obvious visual symptoms. She was right as it happened but it was my fastest ever doctors visit

It's not specific to the US. It's the problem of doctors seeing every particular patient for literally minutes and having zero incentive to dig deeper. 90% of the problems are of the nature that is either covered by standard remedies or will pass by itself with time. If you have one of the 10%, you need to have good luck to encounter an extra-ordinary doctor that would take personal interest in your problem, usually while all incentives point to "give the standard answer and move on" behavior.

I once had extended work done at a dentist. It took a few hours, some of which involved sitting around and waiting for things to happen.

It gave me a new perspective on that kind of work. From my/our point of view, I was the most important person in the room and my problems really really matter.

From the doctor or dentists POV, I'm one a long long list of people they're seeing that day. It's a health care production line, and even if they have the inclination to be equally caring about everyone - which is a rare quality, because a good medical professionals are only in it for the money - they just don't have the time.

This is not an excuse unprofessional behaviour. But it made me realise that self-advocacy works because you're asking - maybe demanding - more than the production line gives you by default.

Also, medicine is incredibly complicated. And the research is often very low quality.

And that's not taking into account Big Pharma trying to tout its products, whether or not they're suitable or effective.

The most depressing thing recently has been the professional response to Covid. In the UK countless doctors have aggressively given up masking, even in settings with immunocompromised patients.

It's really made it obvious that some doctors are just in it for the money, a good few are phoning it in, surprisingly many have quite irrational beliefs, and the caring expert professionals are much rarer than they should be.

>extra-ordinary

It’s just “extraordinary”.

While there's some truth here, medical diagnosis and treatment can be really hard.

People have weird habits, weird diets, are exposed to weird chemicals in small amounts over extended periods of time, etc. There are all kinds of genetic factors where something can be really minor for most people and debilitating for others. There are all kinds or problems or diseases that people can have, and there can be weird combinations that interact or provide an overall confusing array of symptoms. And it's all mixed up with the patient's brain, which may be exacerbating or compensating in all kinds of ways (psychologically or through behaviors that the patient develops).

That sounds very much like someone I know. She had pain in her stomach that doctors in the US just refused to examine in depth. One prescribed her pain-killers and another steroid. She asked more tests but they declined. Her father is a doctor in India and when she finally told him (after a few months of suffering) about her ordeal, he asked her to come immediately to India. After some reluctance, she flew down, and the first thing they did after reviewing her reports was a simple ultrasound. They discovered a tumour in her stomach. Operated and removed it and luckily it was not cancerous. The irony is that when her father asked her to come down to India, she refused initially arguing that the US was at the forefront of medical science in the world. She now understands that doctors matter too. (And unfortunately doctor behaviour in the US is very much influenced by insurance provider policies).

100%. I’m in India now after years in the US. Indian doctors I’ve interacted with (for my kid) are just better at empathy and analysis.

It may be because they see a wider range of illnesses and this empathy/awareness might not work well with the patients are of varying ethnicity and race but they’re pretty good if you look past the exterior - shabby offices, gruff manner.

That's pretty funny because every time I've interacted with a stomach doctor, it pretty much went from introducing themselves to the patient (one time myself) to "let's get you scheduled for an EGD and/or a colonoscopy!"

That's with 3 different people and a handful of different doctors. They are actually pretty eager to look inside your stomach out here heheh. I'm really sorry to hear that happened to your friend though! I hope they're doing better now!

I moved from the U.K. to the US and the situation is even worse in the UK. Unless you’re bleeding or have cancer it’s basically “please go away”.

So much he said she said is the UK better than us with healthcare or not?!

It's better in that it's free, but it's been defunded so much that it's beginning to fall apart.

Private healthcare is basically broken out the gate, public healthcare can be much better but it still does need to be funded.

I would say it’s been defunded relative to the expected pensioner to worker ratio.

Much of Europe went wild assuming that we would always have 5 to 7 workers per person retired to care for, and I won’t be surprised if we get down to 1 to 2 in the next 50 years.

That’s a type of system collapse people aren’t prepared for.

If it were possible to answer that with a simple yes or a no, it wouldn’t be such a perennial debate.

Clearly both systems have benefits and drawbacks.

It's a perrenial debate due to ideology, not actual stats. The UK, despite the struggles the NIH has with.... everything, still has better outcomes than the US. This is JUST "outcomes" btw, as the UK also rates significantly higher than the US in "access to care". The US also has nearly twice as many "deaths that could be prevented by timely access to healthcare".

The main complaint about the UK system that people quote is "it takes a while to see a doctor" but that's true about most people here in the US as well. If you have not top-line insurance or live in a slightly rural area or a million other things.

As of recently, doctors refuse to see you in person even when you tell them you're chronically having abdominal pains. They're doing this telephone medicine now. They kept prescribing PPIs and insisting its indigestion (it wasn't).

Not sure if this practice is just shit or if all of them are. They then have the audacity to strike too. I've had absolutely zero sympathy for them since the months long ordeal of being in pain and taking pills that made me feel worse rather than better. Fucking disgraceful is what it has become.

I had a sudden onset of extreme pain 2 years and 3 months ago. I've seen 13 doctors in this time, had 2 major surgeries and lots of different therapies, and this one of my main takeaways. In our system, you are forced to become a "general contractor" of your health. I understand the nature of my problem, and I've had a lot of improvement, but I'm still nailing down the particular patholog(ies). The doctors that stand out are the ones who take the time to review your records, and come to the appointment prepared. I've had two. I blame the insurance companies for extracting more and more profit from the system, causing doctors to spend just as little time as possible on, you know, something as silly as patients.

This whole fear of being labeled a "conspiracy nut" for exploring less trodden paths needs to end. Calling people conspiracy nuts for looking behind curtains they shouldn't was a good tactic by various entities to cover up secrets and misdeeds, but it has spilled over into the non political arena and poisoned everything.

Humans don't have a full understanding of everything, and in fact it's quite the opposite, in that we don't understand almost everything. Almost all paths are untrodden. It's fine to look where others haven't and come up with your own theories and ideas, as long as you retain a healthy skepticism and back things up with data as much as you can.

Science and exploration should not use fear of social reprisal as a guide.

I’m torn about this now. I used to cautiously support the practice of double checking your doc, but not wholeheartedly because of all the various quacks: essential oil moms, natural/spiritual healers, psychics, supplement sellers, crystal therapists, “old school” (pre-COVID) antivaxers and so on, muddying the water.

Until COVID came around and unearthed the absolute hoards of dO yOuR oWn ReSeArCh imbeciles. Now the sensible practice of getting a second opinion and exploring other options/doctors has been mixed up with the kooks: extreme politics and actual conspiracy theories, to the point where it’s hard to take any of it seriously.

When someone now says they don’t trust doctors, you have to dig deeper to understand if it’s someone genuinely seeking out other options, or if it’s one of Those People who’ve gone off the deep end.

The pandemic revealed the degree to which any respectable field can harbour extremely dangerous kookery without realising it.

For example, Western health authorities used to be absolutely certain that viruses could not be airborne (outside of very specific medical procedures), even though they did not have any good reason or evidence to back that up: it was just an old idea that happened to fit in with their priors, so generations of experts kept parroting it until horror unfolded.

Completely agree: couldn't believe the amount of conspiracy theorist doctors that pushed untested "vaccines" to a whole cohort of people which were at 0% effective risk from COVID.

The earth is not 6000 years old

God didn’t do it

Gravity is the curvature of spacetime

Things are not attracted to the planet through static electricity

Covid is real

Vaccines work

Rich mother fuckers do NOT have our best interests at heart

Intelligent aliens have not visited earth

People are called conspiracy nuts for being conspiracy nuts. Not for “taking less trodden paths”. Getting real tired of the HNs new “wahh wahh, we’re such major victims for believing stupid shit and being called out on it!” And just trying to paint it as “less trodden paths”.

You are arguing with a straw man. Nothing in my post suggested support for any of those things. That's why I included the terms skepticism and data.

Add to that list, some version of the lab leak theory is plausible, but there was an attempt to make it sound like a conspiracy theory.

I don’t think it is possible to end the derogatory use of the term conspiracy theorist universally, but I do have some hope that we can put a stop to it’s use as an ad hominem here on Hacker News.

It is never used in the spirit of promoting insightful discussion.

Instead it is used to shut down a line of inquiry in its tracks. It’s like calling someone an anti-semite.

It is used as a soft form of censorship, to disqualify the mere idea of engaging in the specifics of an argument.

If someone dismisses a comment by implying it is a conspiracy instead of offering a substantive rebuttal of why the comment is mistaken, it reduces the quality of the entire community.

I think we can do better, but more people need to call out this bad behavior.

What you're suggesting leads to an offense/defense asymmetry. Spouting a conspiracy theory usually takes very little effort from the poster, they're either intimately familiar with it already or they just copy-paste the talking points from somewhere else (or both). Expecting others to write a deep rebuttal every time takes a lot of time, it basically amounts to a DDOS attack.

I reserve the right to dismiss low-quality posts with a low-quality answer. And yes, that's a judgement call. There is no way around that.

Pretty sad that you have to state the obvious ey? Amazed daily by the closed-mindedness on HN.

This whole fear of being labeled a "conspiracy nut" for exploring less trodden paths needs to end

People get called conspiracy nuts when they make big claims with no real evidence. That is the opposite of 'science and exploration'. The difference is always evidence. Go on a conspiracy site and ask for hard evidence of anything and they will get very upset.

House, MD was a fictional show on how the medical system is supposed to work, with abundant detective work and testing of hypotheses and pursuing a solution until one is found.

On the other hand, from the administrator's perspective:

"Your team of four people treat about one patient a week, why am I paying your salaries again?"

In our universe, I probably won't receive that much medical care in my lifetime.

If you ever get cancer... Maybe it's just that I lucked into getting the most aggressive oncologists, but on more than one occasion I was sent to get an MRI or CT on the spur of the moment. There were times when it was scheduled out as well - but along the lines of "come back in six months; we'll schedule the CT for the week before".

(But I know I was lucky - my oncologist could order a river to reverse itself and it probably would.)

Your profile and your user name seem to imply you’ve changed the direction of your career? Glad you’re alive, by the way.

Yeah. There's a finite amount of resources and a literally never ending avalanche of patients. At some point they're going to have to make a cold calculation.

I don't really know how it works in the US but here in Brazil it's actually pretty easy to order laboratory tests and imaging studies. There's taxpayer funded public health care but it can't handle the demands of the entire population so people would rather pay for the ultrasound or CT scan than wait two years for the government to provide it. An ultrasound costs about $30, an MRI costs about $150 and the price of a CT scan is somewhere between those two.

1000% they have optimized for the things that they see often and most of the times they don't even consider what else could be going on (even if they maybe know about it). Ultimately it's on you to understand what they are saying and to decide if what they're saying makes sense. When in doubt you should never ever be afraid to ask for a 2nd, 3rd, 4th and so on opinion.

Don't even get me started on diseases where we have medication that sort of works with tons of side effect where no significant progress has been made for decades. If you're alergic to the said medication or your side effects make it a no go, tough luck!

> The experts are great until they have a case that is unusual.

But this is true for every thing in the planet. Data modelling, computer programming, building, everything. Name something that the unusual is not more complicated and difficult to do.

Why would anyone think that it would not be true for the health field??

I think the problem is people think health is magical and everything is known. Because they choose not to educate themselves.

> I think the problem is people think health is magical and everything is known.

The problem is most doctors have absolutely no humility and will never admit to not knowing something. I don't see that behavior among engineers.

"The problem is most doctors have absolutely no humility and will never admit to not knowing something. I don't see that behavior among engineers."

That is incredibly surprising.

Really? Because I see it a lot in "engineers" in tech. They're right, you're wrong and that's how it plays out.

I mean that behavior is literally HN incarnate, so you might be exhibiting exactly that in this comment.

This. But the deep trouble kicks in when you're prescribed some treatment (a wrong one), your situation gets worst, and then the next "expert" has to deal with the original condition plus the new symptoms.

Sometimes (when possible) you just reset yourself: stop all medications for some days, so that the collateral effects are gone and you're left with the original condition (aggravated, of course, because you left the one medication that was working with the 3 others that were just giving you wrong symptoms), and then another "expert" begins from the "start".

One thing that I think people need to understand is the distinction between science and the practice of medicine.

The practice of medicine is not science. The practice of medicine can be informed by science - to a degree that is almost entirely up to the practitioner. ; but it remains more art than science. The distinction is similar to that between an aviation maintenance and aerospace engineering.

Sometimes doctors are just out of their depth.

Do doctors know this? We need to tell them they need to practice at the art, to get better at it.

They are bound by regulations and liability, your typical GPs and even the specialists can't greenlight experiments outside of big research hospitals. Medicine and clinical diagnosis are heavily regulated. That's also why you rarely see single author papers in practical clinical medicine. Doctors are busy people, with horrendous work life balance. Most software engineers have it way easier, you get to choose your tools and you get to choose where you want to work. In the business of software engineering, a sufficiently senior engineer can get away with a lot of nonsense without risk of lawsuits.

HIPPA doesn’t allow it (yet?), you have to do it yourself.

> aviation maintenance and aerospace engineering

Which is which though? As I understand it, aviation maintenance is quite rigorous, systematic, and informed by and taking into account every mistake made in the past.

Absolutely right! Maybe the most regulated industry in the US, but not positive.

Doctors are technicians. Technicians with a large toolkit, but technicians nonetheless.

When you compare their behaviors to IT it all starts making sense.

Add to that the fact that experience matters a lot too. The more variety of cases a doctor sees, the more the chances are that their diagnosis is going to be useful.

Yes and no, the more a doctor sees a particular diagnosis the less likely they are to consider anything else.

Honestly of all the professions that could be enhanced by AI, medicine has the most to gain. An AI can remember a much larger data set than any human and look for correlations among many more dimensions.

Yes that's what I think as well. And it's sad that medical data being weaponized against you is the thing that takes more sound bytes than how medical data collection can improve diagnosis and healthcare. But with the way medical industry, insurance industry etc are we cant blame people for worrying about data collection specially in a country like the US where you can become destitute without medical insurance

The great thing is even LLMs who only take text input still can yield better results than doctors. Think about a healthcare system which utilizes transformers working on images etc.

Being a doctor is like debugging a unique humongous software application with thousands of years of organic patchwork added by a godlike AI which just generates random code and watches the failed experiments die, no source code to any of it just the final binary, no debugger that lets you kill the process and dump its memory or trace its execution, just a bunch of test cases that cost lots of money to run and may yield false positives and false negatives making every bug some sort of heisenbug which may or may not show up when you try to reproduce it and reduces you to guessing with some percentage of certainty fuzzy logic, and even if you do manage to figure anything out in your desperate attempt to fix it you're reduced to essentially inserting event objects into the software's internal event system and hoping it produces the desired effects as it circulates throughout the entire system while hoping it won't adversely affect anything else and it's not even guaranteed to make anything better, or alternatively you pry the program open very carefully while it's running and cut code sections which grew tumorous or stitch together other sections which are leaking precious data or remodel the pipes so the data flows more efficiently, all to hopefully fix the problem while praying to god your attempt to fix it didn't actually make it worse because some malware randomly made it into the program while you worked on it.

Not only that but you need to provide expertise more on the timelines of a customer support agent rather than a software developer or researcher.

Yeah. It's like a never ending stream of bug reports coming in constantly and you have like ten minutes to make sense of each and every one amidst that chaos and do something about all of it because if you don't there isn't gonna be enough time to see them all and the godlike AI's operating system is gonna start killing the buggiest of the processes assigned to you before you've even figured out what's wrong and when that happens the report is closed forever and there's nothing you can do anymore. The same bugs show up in the programs over and over again every single day and there's no permanent solution, no permanent fix at the source code level that would end the suffering of all of those programs. Just constant swimming against the current. You don't even fully understand the system you're trying to fix, it's like ancient technology left to you by a long gone alien civilization and the best you can do is reverse engineer bits and pieces of it from the outside in and top down so you can do some very educated guesswork based on research that's way too expensive to be reproduced or replicated in any way, research that doesn't produce exact predictions like physics but rather purely statistical statements like "in case of A associated with conditions B if you do C you'll fix D% of the programs". Everything is framed like this, everything, you're never fully certain, everything has risk, there's even a chance the research you're basing all of this on is just completely made up or tainted by conflicts of interest or something equally stupid.

And if you make a mistake that other people feel you really shouldn't have and it damages the thing, you get sued into oblivion.

And much like software development, it will all soon be done by ChatGPT.

Local models integrated into EMR systems could be a great tool for doctors but not ChatGPT. I really don't recommend feeding confidential medical information into a corporation's computer. At least doctors are ethically obligated to maintain confidentiality.

To be clear, I'm just using ChatGPT as a (slightly tongue in cheek) shorthand for LLMs in general, but I do think there is a large potential for them within medicine.

They are so unreasonably effective for being, fundamentally, word predictors.

> I do think there is a large potential for them within medicine

As do I.

ChatGPT correctly identified my wife's condition in a couple seconds when a dozen doctors failed to for over a decade. Less than half a percent of people suffer from this condition, but enough do that doctors should have thought about it. All I did was write down the symptoms and poof. It was actually really frustrating that doctors were mystified but this tech gave us a new (and ultimately correct) path of inquiry. I felt robbed of all that time. My trust in doctors is at an all-time low, but her medication is effective, so something in the system works.

Thanks, gonna keep this in mind!

It took four years after graduation for me to obtain enough knowledge and training to help my own mother with her chronic pain. I literally did not know what to do until relatively recently. Other doctors didn't either and they tried everything.

I also nearly died myself about 2 years ago. Appendicitis of all things. Unusual presentation. I didn't see it. Surgeons didn't see it. Gastroenterologists didn't see it. Ultrasounds were inconclusive. I couldn't believe it when I saw the CT scan. I underwent surgery. Twice. The infection would not go away despite 5 intravenous antibiotics 24/7. They wanted to operate a third time and I became convinced I would die if I went under the knife again. Then they somehow managed to fly in an interventional radiologist who found and drained a few abscesses. 40 days I was at the hospital.

I feel so grateful to be alive.

thats why i majored in biomed engineering but stopped short of going into medical school

a lot of the 'magic' around being human evaporates when you have to quantify the 'worth' of any particular organ

untangling this closed-source blob always reveals secrets: 2023 just had an update to anatomy! https://www.urmc.rochester.edu/news/story/newly-discovered-a...

“Have you tried turning it off and on again?” Doesn’t have quite the same applicability. I imagine quite a lot of medical issues could be solved if reboots were simpler.

For sure. A friend of mine went to med school and chose the general practitioner path. One time I was hanging out at their place, so I leafed through some of the GP journals on the coffee table. It seemed much more akin to car repair than to science.

yeah, I was just thinking about this today. Doctors seem less like engineers and more like QA testers or PMs trying to fix bugs since there's nobody better suited to the job available.

Hopefully medical science will keep advancing rapidly here..

I doubt doctors will get better at this in our lifetimes. As we discover ever more about the human body, how are doctors expected to keep up with the research on top of everything else?

I’m hoping AI systems can help. A good medical AI should be able to stay abreast of all the research, know your personal medical history and suggest and evaluate any and all medical tests that are needed. Doctors will hate it, but I expect AIs will give much more accurate diagnoses than humans before long.

Just some statistics can help. My family doctor has some kind of awful green screen practice software but amazingly it has prognosis statistics for certain lab diagnostic results. Makes for better discussion about treatment plans.

I agree. Doctors' performance will remain the same as it has for thousands of years: overall, not so good. But, they've been using AI systems for well near a decade, especially in triage and real-time transcriptions. I haven't met many that don't love AI already in their day to day work.

This is the place where I'm really hopeful that AI can help people sooner rather than later. A lot of these diagnoses just involve large-scale, complex pattern matching - the problem is that docs don't know what pattern to look for because the diagnoses are rare, and they're often not asking the right questions for the same reason. I knew someone who had an extremely rare genetic disorder (her family represents about half the people diagnosed) and just by sheer, dumb luck, her doctor happened to know the single doctor at NIH who specialized in it.

It's a really ideal use case for AI - not only figuring these things out but also doing things like clinical trial and research matching.

I had a neurologist tell me that the scans he'd performed proved that there was nothing wrong with my wife, and he didn't know why she was choosing to act as though she had a neurological issue.

In neurology at least, I think a lot of the problem is that everyone is hyper-specialized. Luckily for us, my wife's insurance company convinced a generalist neurologist to come out of retirement and examine her, which put us on the path to effective treatment. But yes, that whole experience completely soured me on blind trust in the medical profession

It's particularly bad when it comes to treating women.

Doctors tend to believe that female patients exaggerate pain in comparison to male patients, in accordance with stereotypes that portray men as "stoic" and women as "emotional". The bias is systemic, with female doctors often assuming the stereotype too[1].

You can trace this bias back through medical literature which (often subconsciously) reiterates these stereotypes[2]. It shows up in many statistics, such as the difference in wait times for analgesics: women reporting pain had to wait an average of 30% longer than men.[3]

But a key cause of the problem is worse than just assumption of stereotypes: it's that modern medicine still knows far more about men than it does women. For centuries, the primary medical research and literature was done by men, about men, for the treatment of men. Most of the clinical trials performed in the 20th century enrolled far fewer women than men, and often _none at all_.[4]

Of course, gender is not the only bias that shows up in medicine. Age, race, (dis)ability, body shape, and economic/social status are all useful factors to keep in mind when considering why certain people, even entire sectors of society, aren't getting the treatment they should.

- [1] https://www.dovepress.com/the-roles-of-gender-and-profession... - [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845507/ - [3] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1553-2712... - [4] https://www.theguardian.com/lifeandstyle/2019/nov/13/the-fem...

Yes, wanted to write the same. I met many of those experts, and some of them try even blame the patient as some kind of "psycho" when the symptoms dont match any text book definitions.

But to be honest: There are also some motivated and honest doctors. If you find one of these, stick to them.

"The experts are great until they have a case that is unusual."

Also the very standard cases, they can mess up very badly.

"The system is at the same time incredible and awful."

The science behind the medicine is awesome, but the standard implementation is horrible and not up to at all, where we could be.

Modern healthcare is very bad at treating chronic illnesses. Symtomatic treatment is not a cure. I believe if people would live by these simple rules chronic diseases would be actually prevented and cured (in order of importance and effectiveness):

1. Don't mouthbreathe and don't overbreathe. See "Breath - The New Science of A Lost Art" by James Nestor for why and how.

2. Don't eat sugar, it's a chronic poison. See https://www.youtube.com/watch?v=dBnniua6-oM

3. Min. 1 hr of physical activity per day. Your body is not meant to sit all the time.

4. Avoid noise of the city life as much as you can. It leads to chronic stress and thus chronic diseases. Noise-cancelling earphones may help.

The same is true for healthcare generally in my experience. Very bad advice is often given.

I can't really common about the US, but here in the UK the quality of healthcare is shocking bad. Although we may have the opposite problem, where instead of doing unnecessary procedures to increase costs, the NHS generally tries to avoid doing anything unless you're dying.

I had some pain in my abdomen a few years back and had persistently elevated liver enzymes. My doctor told continuously told me not worry about it and would say the pain was probably because I was sitting funny and other nonsense. In their opinion I was too young to have liver problems so there was no point in doing any further tests.

Fed up, I decided to do my own research and pay for my own tests. From this I found out that I have a fairly rare generic condition which makes me highly predisposed to liver disease and NAFLD. Certainly not the end of the world, but it pissed me off a bit because the disease could have progressed had I taken their advice and simply ignored it.

Around this time I also had a family friend who was the same age as me. She went to the doctors repeatedly over the course of a year describing several symptoms she was experiencing just to be dismissed. Turns out she actually had cervical cancer, but they never ran any tests and kept telling her it was probably nothing to worry about. By the time she found out she had cancer it was stage four and she died a few weeks later. She was 28 and had two kids.

Like you I believe in listening to experts. Most experts know what they're talking about and generally give good advice, but it's important to keep in mind the conditions experts operate in. Here in the UK the NHS has neither the time or money to give you high quality healthcare. It doesn't really matter if you see the best doctor in the world, if they can't spent the time and money running the tests you need you're not going to get a good diagnosis.

>The same is true for healthcare generally in my experience. Very bad advice is often given.

I have seen this in my personal life time and again. I have seen it in my professional life time and again.

The only way though the mine field is to take personal ownership over your Healthcare, you need to learn more about what ailes you than the doctors know. You need to be confident in this knowledge enough to challenge them and walk out to receive better care at any moment. This is why people say that healthcare us such a trap in the US particularly. If you are injured and incapacitated you can't advocate for yourself, and if you don't have the support infrastructure in place in your personal life we are just one medical event away from financial and physical ruin.

[Canadian here, for context]

> The only way though the mine field is to take personal ownership over your Healthcare

Shortly after graduating from university, when I no longer had access to student health, I started hunting for a regular family physician. The guy I found... my first "let's get to know each other/annual physical" kind of appointment he said "Look, I don't know if you noticed but there are a lot of people out in the waiting room. My staff here is great, but things happen. Maybe they call you with test results and you miss the voicemail. Maybe the lab forgets to send the results. Maybe the fax from the lab gets stuck to another piece of paper. We're all human here, and I try really hard to treat each one of my patients as a real human and not just a list of symptoms on a page. If I'm going to be your doctor, there's only one thing I ask: be your own advocate. If you're expecting to hear back from us and you don't, or if you feel like we've missed something, or you have questions, or... anything really, please don't hesitate to follow up. I promise I'm going to do my best to look after your health, but you care about it more than anyone else in the world. Does that work for you?"

He was, by far, the best damned doctor I've ever had. And then, apparently, one day he had a serious family emergency back home and vanished, never to return :(.

Damn right!

He know the realities of the system and is doing his best to get his patients good care.

It's like my first day of high school. I had a history teacher. The entire first class of history in high school was devoted to knowing yourself. He told us in basic terms how our bodies worked, that we shouldn't try to dp homework after a big meal, how we should use our resources, how we should be respectful, how learning the laws and history of our country could personally impact or protect us from injustice.

He treated us like equal human beings he truly wanted to help, not just work he had to do that day.

You're doctor did the same, blessings on him.

This is true for every kind of professional including realtors, lawyers, and financial advisors, just to name a few. At the end of the day everyone you hire is just doing a job, and it’s on you to learn enough to know that they are doing it to your satisfaction.

True, but those professionals don't take the hippocratic oath.

>> It doesn't really matter if you see the best doctor in the world, if they can't spent the time and money running the tests you need you're not going to get a good diagnosis.

Everyone in the UK should get to experience a private consultation just once. The difference between the rushed 10mins you get with the NHS and the considered 30mins you get private is amazing. You leave feeling like you’ve been taken care of and all your questions have been answered. It’s only when you see this you can see just how bad the quality of care in the NHS is at the moment. We need to stop equating the NHS with the people that work for it and start calling it out for how god awful it is. We’ve made it a dirty that can’t be criticised properly when it sorely needs to be.

I believe the NHS is seriously under-funded, the Tory government is responsible, and healthcare is suffering as a result.

However, I do want to provide an anecdote to illustrate that private healthcare is not perfect. I had some persistent pain in my foot. Realized I wouldn't get anywhere with the NHS so I went private. The person I saw had an excellent manner. They suggested some fairly gnarly surgery. Said I should think about it and in the meantime they gave me an anti-inflammatory injection. My problem cleared up in about two weeks. What was wrong: I have really really wide feet (seriously; they are wider than the widest setting on the foot measuring device they use at shoe shops.) I didn't know this. I was wearing Chuck Taylors, which are very narrow, and they were pinching my feet. I didn't wear my Chucks over the two weeks and I figured out what was wrong in that time. What I learned: everyone has a toolbox they want to reach into. In this case I was seen by a surgeon so they of course turned to surgery as solution. Always be your own advocate, to the best of your ability, in healthcare. (I thought the surgeon might have said something about the width of my feet given they spent so much time looking at feet.)

These feet looked like the nicest weekend ever, probably. (To the surgeon.)

As a percentage of GDP, the UK has the 6th highest healthcare spending of OECD countries, on par with Switzerland. The UK is not an outlier in terms of spending.

https://stats.oecd.org/Index.aspx?DataSetCode=SHA

Some of that is probably down to the dysfunctional models that have been brought in (in the name of 'cost saving' or 'efficiency' or what ever nonsense) - like Blair's PFI model where they signed up to pay £80 billion to private investors over the long term for what amounted to £13bn of actual investment... This seems to have continued under the Tories and the UK public are on the hook to continue to pay huge repayments to private companies for decades to provide services that could have just been publicly funded in the first place...

Much more detail on funding problems here: https://nhsfunding.info/nhs-crisis-making/

Long ago I broke my collarbone in a bicycle race. It's a common injury in the sport so I got a referral to a surgeon from another racer who'd had a fracture of his own surgically repaired. To my surprise, she took a very conservative course of action. The clavicle had broken pretty cleanly in half and the outer half had settled in about an inch inward underneath the inner half. You might think that would be a good candidate for surgery so the bone could have been moved back into the old position with the help of a plate. But she thought it would be best if I came back in a few weeks and see if it had healed on its own. To my amazement, it did heal so that now I have a weird knob in my clavicle but the bone feels as strong as the never broken side. The recovery was tough though and took years. At times I wished I'd had it surgically repaired but now I admire my surgeon's restraint. She correctly diagnosed that I didn't need surgery to recover even though she had no personal relationship to me and a financial incentive to operate. But I also saw that since she operated on my friend that she would operate if she deemed it necessary. Thus I believe that she actually evaluated each case carefully on its own. Unfortunately, the tendency towards pushing patients into lucrative active interventions (like surgeries) does seem common even if it isn't the rule.

My Canadian experience with that injury was basically the surgeon would operate on me if I wanted, and that would get me back to 100% faster, but it's more invasive and largely unnecessary unless your everyday life required faster healing (e.g. you job depends on it). Which it didn't because I had a desk job.

There might be an age component to it: the risk of it not healing correctly increases with age.

>The difference between the rushed 10mins you get with the NHS and the considered 30mins you get private is amazing. You leave feeling like you’ve been taken care of and all your questions have been answered.

This is true for fairly simple cases. But when something is complex or very serious you want a true multidisciplinary team that sees the most cases per annum - that is the NHS.

A private consultant in a nice office with a very nice efficient secretary is great for their particular expertise but outside of that poor. This is based on more experience personally and with family than I would wish anyone to have.

> From this I found out that I have a fairly rare generic condition which makes me highly predisposed to liver disease and NAFLD. Certainly not the end of the world, but it pissed me off a bit because the disease could have progressed had I taken their advice and simply ignored it.

I was diagnosed after a blood test (in the US) but they just put me on a statin (high cholesterol medication) that fixed only what the blood test showed and did not treat the problem. Now I’m having to, with 10 fewer years than when learned it, drastically adjust my life and diet to ensure I won’t develop additional complications.

Why are we so hilariously bad at treating chronic problems?

Btw through generic genealogy, I’ve managed to pinpoint which branch of my family that this comes from and they’re all from Yorkshire. Given how rare it is, there is a nonzero chance we are cousins of some sort if you have semi-recent ancestral origins there.

Statins reduce cholesterol production. What were you hoping for?

I lived in Argentina for a few years. There are plenty of problems with their public healthcare system that pretty much mirror any country with a troubled economy, but one day a work colleague recommended I visit the Favoloro Institute. I’ve never seen such an impressive healthcare organization in my life.

They time their appointments ever 2 minutes so you’re expected to arrive early. Once you start, they wiz you around to about a dozen tests including getting hooked up to electrodes while running on a treadmill. After less than an hour you see a doctor who goes through everything for about 15 very detailed and thoughtful minutes.

The entire thing is FREE! Completely publicly funded.

I don’t know much about healthcare but this type of thing always struck me as a missing apparatus of healthcare in the US. Although apparently Favoloro (who invented some kind of bypass surgery) founded the Institute after being inspired by the Cleveland Clinic.

Would love to hear other people’s thoughts on this because I tell that story all the time!

Interesting. I too lived abroad in argentina for a few years... the healthcare there is actually pretty impressive. I had my tonsils removed, I had a crown put on my molar, dermatolgist appointments, etc. Even a podatrist and custom orthotics... From now on... anything major - I am flying back to get things done.

USA healthcare system burns me out.

That sounds like what private clinics offer around here, certainly not for free, but they tend to perform an onslaught of tests.

I don't know how effective it is, and how much of it is theater.

> I don't know how effective it is, and how much of it is theater.

They may not know either.

Most of our research is studying how well treatments work on "patients that came in with _____ symptoms and we found test X Y and Z was outside of the normal range".

Does that mean you should use the same treatments when you have X Y and Z out of range but without symptoms? We often don't know.

This sounds much like the annual health check-ups that are done here in Japan. They're paid for by your employer, and involve a battery of tests on many things: blood work, stool/urine samples, chest x-ray, abdominal ultrasound, hearing and eye checks, etc.

> after being inspired by the Cleveland Clinic.

Interesting. I was considering commenting that your experience sounds a lot like the VIP (using the term loosely here, it's much more accessible than "multi-millionaire") care available at the Mayo Clinic. You can accomplish in a day or two what would typically take months to years in many areas of the US, including mine.

Good for you figuring this out. I always point out to my wife that an expert with a financial benefit in the advice they are giving you is potentially more dangerous than an amateur.

If you are a dentist, "more dentistry" is likely to resonate with them as a solution, especially if that means they charge for doing the work. No different than if you ask a software developer if you should hire them to automate some process. A true pro may say "nah it's not worth it for you" but that's rare...

It's fashionable to dunk on folks who "do their own research" but I admire that more than those who are proud of unquestionably taking direction from vested parties.

I think the “do your own research” label conflates two categories: people who are shopping for a comforting answer, and people who want to be informed and make conscious decisions. I don’t have to be a dental expert to know that something isn’t adding up and to seek a second opinion.

I think it's easy to come up with such delineation after the fact, but OP was looking for a more comforting answer. By the sound of it, they just didn't like the implications of the initial diagnosis. It wasn't about facts not adding up.

The reality is that modern medicine is absolutely amazing, but there are also many interventions backed by shoddy science or no science at all. Sometimes, "doing your own research" exposes such lapses. Sometimes, it sends you off the deep end and you end up chasing ghosts. To allow the former, you need to tolerate some of the latter.

And yeah, sometimes the shoddy science involves interventions so basic and so common that you'd think they're sorted out. Consider that Europe and the US take wildly divergent views on topics such as wisdom teeth, colonoscopies, or the value of flu vaccines.

"Science literacy" doesn't shield you from being wrong. Maybe it helps, but there's no shortage of Nobel laureates who believe in conspiracy theories or promote dubious medical treatments. Talking about "science literacy" is usually just how geeks convince themselves that their beliefs can't be wrong.

It’s funny how every generation of modern medicine acts like this time they know 100% what the correct answers are while we all scoff at how wrong they got it just a few decades ago.

Every generation the advice on which way to put your kid to sleep flip flops.

It would be shamefully foolish to disregard all the incredible advances and technologies that modern medicine offers. It would be equally shamefully foolish to think it’s not still deeply flawed.

This is true across more domains than medicine - especially in IT, the absolute assurance that those idiots 5 years ago were brain dead but now we’ve solved all the things.

It strikes me as unfortunate that for a lot of things like home repairs/renovations its pretty normal to get 3+ different opinions/bids.. but for our health its usually your regular doctor, and at most a 2nd opinion in some cases.

We'll make life changing decisions based on the opinion/advice of 1 individual, while shopping around on a home project or car repair that's +/- $5k.

It seems again like a combination of shortage of medical workers and the indirect nature of medical payment. If I knew up front that walking in and getting 3 medical opinions would cost me X, and I didn't need any pre-approval from insurance, or risk denials.. I'd just go do it more. But the system is so opaque that I don't know I can get those answers readily, or believe the numbers are real and won't result in random bills later.

Further, the next step after figuring out the cost of getting options would then e getting a quote for the actual resulting medical care recommends is opaque due to differing payment %s & co-pays by procedure, etc.

My go-to question isn’t “should I do X” but more like “would you do X if this was you” - with good providers it gets closer to the heart of the matter.

Something your comment overlooked is the overall availability and the required timeline for something health related is usually quite different than home maintenance or car troubles.

I had a really bad sprain about two years ago to the point where my partner had to help me on and off the toilet. Eventually I took off work, went to urgent care, and paid $200 for them to basically say "well it's not broken, we could do an MRI otherwise we don't know what you want us to do". Booking an appointment with a GP would have taken around a month. They won't be able to do anything long term but will recommend a physical therapist. All said and done it's probably a $5-10k ordeal and weeks until I could actually see any progress, plus work time missed. Big surprise, I didn't actually end up going to see a doctor. Recovery sucked and some movements still aren't quite right.

In an ideal world, what would you say should have happened?

Instead of being blown off and told "I don't know what you want us to do" after being triaged, some helpful direction on next steps I can take would have been nice. Something like "Yes, we can do an MRI but that'll be expensive. We can make an appointment for you for physical therapy. Also here's some minimal tips we have to make recovery a bit better." It's a sprain, I imagine that's pretty common, but most people don't know what to do. To be shuffled out as soon as possible seems pretty irresponsible to me.

> Further, the next step after figuring out the cost of getting options would then e getting a quote for the actual resulting medical care recommends is opaque due to differing payment %s & co-pays by procedure, etc.

There’s nothing more quintessentially American than “not knowing how much you are going to pay for something until you owe it.” You go for a hospital visit and nobody has even a remote, order-of-magnitude idea of what you are going to pay. But you have to sign a doc right away that says “you agree to pay whatever number we eventually come up with!” And then you slowly get dozens of bills from individual doctors and hospital workers over the next 4 months. It’s absurd.

> I always point out to my wife that an expert with a financial benefit in the advice they are giving you is potentially more dangerous than an amateur.

Indeed. In my country we have a public healthcare system. I also have private insurance, which I use sometimes because you can get consultations and tests much faster; but I wouldn't do anything invasive with the private insurance before getting an opinion from a public doctor first. The incentives aren't well aligned in private healthcare. For me, the combo (trust diganoses from the public system more, but use private when convenient) seems to work well.

Public healthcare doesn't cover dentists, though, and to be honest, from other people's experience, I don't trust them much. I haven't visited one in over 20 years, and so far I haven't experienced pain or any other annoying symptoms other than some slight gum bleeding once per year or so which seems to resolve by itself by brushing and flossing more thoroughly than normal for a few days. I know it's risky and this may come to bite me later. Fingers crossed.

>>I believe in listening to experts (but ultimately making an informed decision).

The problem for the most part in all industries is we have moved from a system of experts to a system of credentials. Now one would say that in order to get a credential in something one must be an "expert" but this is far far from the truth, there are all kinds of competing incentives to ensure an ever increasing supply of "credentialed" professionals that have nothing to do with validation of their expertise in a given field or subject.

It does not matter if it something like an electrician, or brain surgeon, from teaching, to physics, and everything in between including medicine, we favor credentials now not expertise

Largely the consumer public simply looks to see if this person as the correct credential. license, etc for the given job... Consumers often lack the resources, information, or decisions tree in most instances to look for any indicators of actual knowledge in the field beyond that credential

> Consumers often lack the resources, information, or decisions tree in most instances to look for any indicators of actual knowledge in the field beyond that credential

This is true. I have no clue how to check the expertise of my dentist, apart from using my own mental bullshit detector (of limited use here) and reading reviews by others (also of questionable use, because who reviews their dentist? And where?).

The analogous problem exists for certain kinds of expensive products with the property that they usually work well, but sometimes become flaky. Think a washing machine. Who posts a review about their washing machine four years post-date that it's still going strong? And absence of base rate information makes absolute numbers of bad reviews mostly meaningless.

>>expensive products with the property that they usually work well, but sometimes become flaky. Think a washing machine.

that is a different problem, consumerism killed that. There used to be several media companies that focused on long term durability of "durable goods" like washing machines and such

But today most people buy new appliances not when they fail but when they need to upgrade to the latest technology, or because new government regulations makes them unfeasible to use / service, or because the Calendar function on their smart fridge does not work with google cloud anymore (true story), etc...

That may be true for a lot of folks, but that's not the only issue.

From my experience, the biggest issue is that a lot of the appliances and other gadgets we have these days are very complex. You have to be an electrical engineers, software engineer and a mechanical engineer, or a big service company that employs all three, to be able to fix anything.

Additionally it's sometimes really difficult to find service manuals for a lot of these things. If your doodat is flashing error code E-71-X1-C and the user manual you have just says "call for service", what are you going to do about it? You typically need pretty serious google-fu magic to find enough information to start figuring out what's wrong.

When my dryer broke several years ago I think I found the proper service manual for it on a site that looked exactly like a SEO spam site and seriously sketchy. Downloading the PDF I was praying my anti-virus application was up-to-date.

> If your doodat is flashing error code E-71-X1-C and the user manual you have just says "call for service", what are you going to do about it?

Call for service.

Systems of experts are hard to scale since you need experts that you know are experts to vouch for experts. Systems of credentials that are at least theoretically assigned by experts are the next best thing, but obviously not ideal.

It’s at least better than the populist solution of anti-experts chosen on the basis of charisma or “truthiness.”

your last part is a false dilemma, because there are methods that do not required a system of credentials and also do not require populism

Your first part is more challenging because what you find is the people with true expertise in their field are often far to busy and/or have no interest in validating other experts so the people doing the validation at best are on the lowest end of the spectrum of "experts" which naturally causes the spectrum to expand.

Further you will find in many many many fields the method of obtain a credential is has no connection to another expert vouching for you, it is matter of simply passing some kind of standardized test, and completing a required amount of training

For example one that has been in the recent news is Airline Pilots where you have to have a fix number of flight hours to be a commercial pilots, many pilots get those hours by fly pipe or other utility line check operations which is done a clear day, fixed altitude, fixed path and with limited deviation. So the value of those hours would be far less than the same person flying in varied conditions, in varied locations, etc.

90% of dentistry revenue is a scam.

But at the same time it is very important to brush you teeth twice a day and floss weekly. You should also avoid sugary food as much as possible.

Dentistry is much like Realtors, they like to take credit for very little actual work.

"If I'm not here to confirm people are brushing regularly everyone would lose all their teeth"

"I'm so glad I could sell your house for 500k. Without me you may have never sold it"

Surely floss daily should be the advice? It only takes an extra minute when you are brushing so there’s no reason not to.

For the same reason you don’t brush 10 times a day. It isn’t significantly more effective than once a week and we all have better things to do.

Was wondering if you knew any RCTs or solid studies...

Dentistry in general seems averse to doing RCTs.

> floss weekly

For me daily makes a big difference. If I leave it until weekly my gums will start to suffer for it.

I use the little floss picks, as they're much easier to manage for me than floss, and - here's something - they're reusable. Rinse them off like you would your toothbrush and you can keep those suckers going for a long time. You can also get them made from bio-plastic, so that they'll degrade once they go to landfill.

Do you get those ones that are thinner than normal floss? Because it won't be as effective if so. Tried the Listerine ones but I'm curious which brand you get that has bioplastic

This is not the brand, but they look a lot like this. https://www.amazon.com/Natural-Dental-Floss-Picks-200/dp/B08...

The double string ones are really good, as they catch a lot of gunk in the gap between them.

The sugary foods advice is true if you're talking about refined sugars, but I recall a study showing that raisins, e.g., are much better than refined flour in terms of damage to teeth. Despite having much higher sugar content.

Here's an article about the study: https://nutritionfacts.org/blog/raisins-and-dental-health/

You know what flour turns into very, very quickly in you digestive system?

Sugar.

The comment was about teeth, though, and flour/meal is abrasive, though. Not to the degree it was in prehistoric times--dental health went to hell during the transition to sedentarism, thought mostly to be due to milling introducing rocks etc. to the meal--but, setting aside that both are nutritionally probably not great, it stands to reason that the stuff mentioned in that blog post (mostly grain-derived) have more ways to stick to the surface of teeth and hang around to mess up mouth pH.

It's not just the dental industry that's like this. A lot of medicine is subjective, and a lot of doctors have poor "debugging" skills and do the equivalent of print statements to try to diagnose an issue (guess and check).

I also found this with accountants. My tax affairs are semi-complicated, and every accountant I speak with has a totally different approach and advice. I think if I went to see ten, none of the advice would overlap.

I think that's more in the domain of tax attorneys than accountants.

print statements are not a bad practice

I might expect more when it comes to my health, though

Sometimes that's the best and cheapest way to diagnose.

I have learned from personal experience to never take healthcare medicals for their words.

Always do your own research. Ask them consequences and how sure they are.

And take into consideration the impact of treatments and diagnosis to the life quality of yourself or loved ones. At times can be hard for doctors and others to look beyond their own worldview.

Personally I’ve had this eczema where I found the correct cream by reading the research on it, and later found out this is also the official advice. Most doctors here just prescribe an old cream out of habit, that contains hormones and often creates worse side effects.

But a bigger diagnosis mistake was a close family member diagnosed with a very bad gen defect that would cause liver failure within a few years. He wanted the kid to start taking unpleasant medicines to be sure. He told us to get bloodwork done (without mentioning the costs) but in the end couldn’t find enough genes that had the mistakes. He wanted to do even more bloodwork being convinced there needed to be 2 genes with the defect, but I clearly told him he was going in uncharted territory, after doing the extra bloodwork he had to come back and agree he was wrong.

One defect gene was found and in extreme health circumstances liver values were found that matched the pattern of a certain disease. Which is why he was convinced it was wrong.

He was a well intentioned doctor, but these academics doctors get obsessed with analysing and diagnosis without always understanding the costs for the patients. Although they try to. In the meantime our family thought the kid was going to die for months and made significant unnecessary costs.

Oh yeah I had really bad skin flaking, they would orescibe all kinds of hormone or steroid based creams that would next to nothing.

One search on Reddit and many people just said to use petrolium gel. Bam fixed it up in two days! Costs me about $3 a year to control this now.

petrolatum is underappreciated as a moisturizer imo. Too cheap for a good marketing budget.

Most of the expensive moisturizers is going to be 80-90% petrolatum and a bunch of crap that's more likely to irritate than help (but smells nice!).

Don't get me started on "non-greasy" formulations... it's the greasiness that makes it work!

Pro-tip: put your moisturizer on just after washing. You want to trap in all that water!

> I’m not a conspiracy nut

where would be the conspiracy in your experience anyway?

> But that experience shook me and forever changed my trust in the dental industry.

don't trust any industry. industry is always about making money and keeping a comfortable status quo. sometimes this is achieved through conspiracies.

My kids had insurance through their mom, because she made shitty pay, but good benefits. She lost her job and put them on state medicaid plan. Suddenly my son who has never had a cavity in his life needed 6 fillings.

I took him to my dentist who found a single tooth that may have a cavity but it's too early to be sure. A year later he's had one filling. And that one was not any of the teeth the other dentist wanted to drill. He flosses in public bathrooms.

They obviously was a cash grab and were going to just drill the fuck out of his mouth to maximize medicaid payments.

Was military in the past, so on tricare. Base dentist was busy so they referred me off base to a local dental clinic for my regular cleaning.

That local dentist I guess saw a blank check when I walked in the door and tried to convince me I had 5 cavities that needed filling. I told him to finish just the cleaning and I’d check back in with my military dentist.

Military dentist later looked me over again and said I had one slowly developing potential cavity to keep an eye on. That’s it.

A lot of dentists are apparently unethical hack shops.

I feel like dentistry in particular is one of the least rigorous of medical sciences.

From my point of view (patient), I feels like dentists base their treatment recommendations on how much kickback they’re getting from medical corporations (Invisalign anyone?) and biased papers.

I wonder why dentistry is so far removed from the rest of the medical profession on this. Not that MDs are immune to the above but it feels to me like it’s not as bad as in dentistry.

I don't feel the same, a lot of other medical professions are very similar to dentistry. Deal with a chronic plantar fasciitis and you'll see exactly what I mean, clueless experts everywhere with nowhere near the amount of rigor you would expect.

Anyways beyond that, dentistry sits in a very interesting position where there isn't a whole lot that can be done (without major breakthrough). It's why so much is based on preventative measure. It's also why the field feels "antiquated" in a way, we're still using simple instruments to scrape the teeth (or inside the tooth when it comes to root canals), or yanking the entire tooth out. We haven't got much farther than cavemen using stones to clean plaque in that way, besides the pain mitigation.

It's the one field that is ripe for revolutionary improvements if it weren't for corporations constantly pushing their garbage studies.

Invisalign works pretty well, though. I'm pretty pleased it was "pushed" on me. I had some messed up teeth. 12 months of trays later and I my teeth are more or less in the right place now.

What bothers me is that it’s a commercial product that is pushed very hard and where dentists have a financial incentive in you getting the treatment they’re recommending.

It might work, but the conflict of interest is there and you’ll never know if there wasn’t a superior/cheaper/more suitable alternative.

Ditto Oral B toothbrushes. Or Pedigree Pal at vets.

I saw a private dentist for the first time roughly a year ago. I was under the impression that I had 10+ fillings, and prior to lockdowns a dentist had told me I needed at least 2 more, which I assumed would still be the case.

He said he could see no indication of decay that would need treatment, and all the 'fillings' I had were more like sealants in the enamel, none of which reached the dentin, and any of them could have been avoided by a more wait and see approach.

I saw 5+ dentists on the public health system that all had the same cavalier approach, and it's hard to assume it wasn't to line their own pockets.

Once I had bad pain and went to a dentist, he pulled out a tooth. Later I heard it's absolutely last ditch and replacement teeth are finicky and will make your life much more problematic.

Thankfully it's just enough to the side to not be visible so I am getting away without one. (Though I think it's also problematic long term, because remaining teeth would shift.)

Never again to trust a dentist, no matter if it's a private clinic in developed country with supposedly great healthcare. Always talk, discuss and research and ask around enough to make own judgement...

Dental implant while costly are wonderful if you have sufficiently dense jawbone, they feel like a real teeth.

My dentist also told me that tooth extraction is a last-ditch effort. But that come sooner than you would like; after one rounds of antibiotics, if the pain come back but there are no apparent mechanical defect in the tooth yet the roots are blurry on the x-rays, the probability that a root canal treatment would be successful is quite small and extraction followed by an implant is your best bet.

Thank you for insight. Perhaps I heard or understood wrong. Almost sure I was not prescribed antibiotics before extraction that time but to be fair I may be forgetting, it was 4-5 years ago. I guess an implant becomes difficult after so long but I should look it up and see what dentists around say probably.

I’m missing quite a few teeth not mostly biologically but had two that grew in weird and had to be extracted. Found an amazing dentist that’s on the local board and they’re not pushy about implants but does say don’t wait too long since it’ll end up costing more if the other teeth move. He’s also managed to save a tooth my last dentist absolutely demolished trying to put a crown on it.

It’s hard to shop around for dentists but when you find a good one it’s life changing.

> I believe in modern medicine. But that experience shook me and forever changed my trust in the dental industry.

This can be applied to almost everything. Looking at average software developers around, I see people with 10 years of experience who have no idea how anything works, they just copy paste the same CRUD APIs for their whole career, never really learning anything, trying to understand, just coasting through corporate life. Half of people are worse than 'average' person, this applies to everything and it's especially evident with doctors. They'll just tell you to wait and see, take vitamins or straight out ignore you. They might not know any better, or just think they know everything, you never know because you're not an expert. As an example of this I highly recommend reading Wired's article on Lee Holloway.

Exactly my own experience with a Guillain Barré syndrome.

Went full engineer and finally met the right people.

Medicine is a marvel, but it’s a opportunity cost. You meet with people who have 10 minutes to pattern match you, which works for probably close to all the cases they see, until it doesn’t, and it’s you.

Similar story here. I went to a dentist, who with a sad look told me that all my wisdom teeth needed pulling. She recommended me to an oral surgeon who agreed and wanted to do the surgery, but not without first handing me a letter to sign which stated that I would not sue her if I lost feelings in my face or developed some kind of permanent pain.

Seemed fine to me, but my father insisted to ask a friend of his who is a dentist. Turns out my wisdom teeth were completely fine and none needed pulling. My pain just stemmed from me grinding my teeth at night.

> grinding my teeth

For which magnesium (try different types of Mg-salts) helps many! (never heard that from a dentist, again, possssibllyy because the solution is not sold in their shop)

I'm not from the U.S. but I was that kid. I broke my teeth when I was 6. My dad took me to the local dentist who told me to "leave him as it is" for a decade.

Except my teeth were my second teeth, and they were half broken. I was walking around with half-blackened by the rot teeth, which caused all sorts of health problems on top of all the bullying and the first kiss kids tend to take came to me after I fixed the teeth.

And don't get me started with my chronic illness that I've been looking for diagnosis for the last 10+ years.

I have a tooth with a root-canal treatment that I dont trust. But several dentists say all is fine.

the dentist regularly examined you and doubled down on "leave him as it is" thoughout a decade?

while a dentist should of course make sure to double check if its the permanent teeth and all that, I feel that your dad did not really fulfill his role as a proper parent here

I was probably four when I fell against the sandbox in the playground and knocked one of my top front teeth right out. I carried it inside to the teacher, who had me bite on a paper towel to stop the bleeding and sent me home with the tooth wrapped in another paper towel in my pocket.

About a week later I fell against a large wooden block in the classroom and knocked the other top front tooth clean out.

I went for something over a year without top front teeth, but my adult teeth came in early, so it wasn't 2 or 3 years like it might have been.

This was a long time ago, and I still have both the adult teeth, although one of them died when I got hit in the face with a football in the third grade.

All to say that n=1 but it likely wouldn't have been the worst thing if the two teeth had come out.

You need a mouth guard

It was worse than that -- the football thing happened when I had old-school braces, and my lips were literally smashed onto the railroad tracks, so much so that I had to walk to the drinking fountain and pry/peel my lips off the braces, with an accompanying rush of blood. Good times!

I'm a grown-ass adult now, and I haven't had issues like this since my late teens.

My friend it seems to me like you should be wearing mouthguards more often, with how often you seem to get your front teeth hit somehow!

Thank you to share you story. Well no need to go into conspiracy it’s what is happening and you can see it in our field. Look at all the Oracle consultants out there. :) I would never recommend Oracle for anything. But how can a non tech guy know? All the non tech companies use it, even the top 500… So even more impossible to see that as a non tech guy.

I am sure you came across many staff engineers with +10 years of exp that will give weird ideas too and architecture decisions, tech choice etc.. it’s everywhere not just for dentists.

> I believe in listening to experts (but ultimately making an informed decision).

The whole point of consulting a professional is so they can provide you with the necessary information to make important decisions. It's up to them to explain things to you so that you understand well enough to make an informed decision.

Unsatisfactory, meandering answers means you aren't getting the information you need to decide and you should absolutely seek another professional until you find one you trust. In fact, when we don't know something, the professional thing to do is to admit it and refer you to another professional who does.

Believing that absolutely everything in the US, including medicine and food, is negatively impacted by the drive for more profit, does not make you a conspiracy nut; it is the defining characteristic of the US economy.

> My feeling is that the nature of dentistry leaves a lot of room for subjectivity and COVID left a lot of dental chairs empty.

It’s stated at the bottom that the original article is from 1997. COVID doesn’t factor into it.

Everyone made fun of people that said, "I did my own research" during Covid, but if you've been failed by the medical system once, you're used to this.

> I’m not a conspiracy nut. I believe in listening to experts (but ultimately making an informed decision). I believe in modern medicine. But that experience shook me and forever changed my trust in the dental industry.

This is the same thing with doctors for any difficult disease to treat. You will tons of different opinions based on the same facts that are available to them.

It makes you seriously wonder what kind of expertise is that in the end?

Sadly there is no conspiracy needed. The for profit health care model is a significant contributor.

Dentists are also business people, and there are strong monetary incentives for them to upsell.

That's not to defend the behavior, but I think we should acknowledge the problem is systemic and that a non profit healthcare approach would be more appropriate for the vast majority of situations.

I had a friend in 2014 who said her orthodontist wanted to pull 3 of her molars in order for her teeth to ever be straight. She went to another orthodontist who said "WTF, your condition doesn't even need metal braces, you can use the clear aligners", and was angry that the other one wanted to pull her teeth... Always get a second opinion.

> I believe in modern medicine.

It's completely reasonable to believe in modern medicine, but also to remember that humans are imperfect and have all sorts of biases and limitations when practicing modern medicine. Add on top of that how most health care systems make things much more difficult than they need to be, for both the doctor and the patient.

In The Netherlands, going for a second opinion is a right (under insurance). And my experience with a dentist who wanted to suddenly remove a molar (without asking me, he already had the anesthetic ready) left me bewildered. Especially since it was a dentist organization for people with anxiety. NB: I have needle phobia, but not dentist phobia. Then he started to guilt trip me cause he already grabbed the anesthetic, but I said that didn't work on me. He threatened it'd be billed, not sure whether that happened in the end but if I was consciously aware of it I wouldn't have paid. Tho I'd just lost my father and got into a long term relationship as well, so my mind was elsewhere.

Then I went to a different dentist (I had to cause I moved) and he had the wait and see approach. I didn't tell you yet that I had a chronic inflammation (abscess) under the molar. A year or so later, I finally went to the dental stomatologist and he suggested oxazepam. What an experience (both the drug and the removal of the inflammation). Then the healing process came. And I even had some stomach pains from all the ibuprofen (too long w/o stomach protector). Ever since that I always use a stomach protector with ibuprofen, just to be sure. No stomach protector, no ibuprofen.

We were very happy with this dentist. Since it became a bit too impractical we now are at yet another dentist who's in our neighborhood and literally next to our kid's school. Very practical, but we were happier with the previous dentist.

Now our 3 year old has damage on all 4 of his milk canines, having damaged tooth enamel. We don't know what or why, only difference I can tell with his older sister is he's been going on with breastfeeding longer, and he liked chewing on stuff more than her (his teeth and mouth also have a bit different form; more my wife's than mine). The rest seems fine. The dentist guilt tripped us into that I'd probably not been brushing his teeth well enough (because of COVID my wife was waiting with our daughter, she'd have given him a firm reply but I just listened and took it in), but I'm pretty sure we did this correct (perhaps too well?); twice a day since his first tooth showed up. So I'm considering going for a second opinion.

The beauty is my kids are freely insured for teeth until their 18th in The Netherlands, after that they're on their own. But until then, the government takes care of their costs. I know it ain't like that in certain other (even rich) countries.

I have had a lot of work done on my mouth. I consider all dentists as incompetent, swindling, quacks until they prove otherwise.

My current dentist's niche is NOT performing anything that is unnecessary. A lot of people are taken aback when they say everything looks good. Makes for a great culture in his office.

>For the first time ever I did the “call in a personal favour” thing and asked my dad to reach out a family friend, a former cosmetic dentist and former head of the province’s dental association for a second opinion.

Why aren't you using connections on a daily basis to get reliable services?

I think in general it's safe to take a cynical view on every vendors aptitude. Many, if not most, people are terrible at their jobs and it's your job to find the good ones and hold onto them

Did you consider seeing a doctor? Dentists are sort of doctors, but MDs with teeth specialties could be better, I’m sure your GP could have given you a rec.

(Edit: it turns out orthodontist is not like ophthalmologist).

Where did you hear that? Most Orthodontists do not have MDs...

Did you mean an oral surgeon?

Ugh, probably.

All of the orthodontists I quickly searched in my area have DMDs from dental schools.

the whole discipline is based on interpretation of symptoms. the job of a doctor is exactly like debugging a live system except when it crashes you don't get to restart it. they actually investigate by testing their suspected diagnostic on you. they literally give you a medicine and don't know if it will work. that's their normal process.

I think what happened to that dentist is he changed his diagnostic because of an external factor, like realising that removing the teeth is less risky with regards to getting sued by you.

To be fair, in your story the "former head of the province’s dental association" apparently did know his craft, indicating that competence is rewarded in dentistry also...

There are a lot of doctors and dentists, and as in any field, mastership of a profession is rare. So you did the obvious and correct thing of finding someone more competent when you had doubts.

That would honestly have reinforced my trust in medicine more than do the opposite...

My son had cavities at 3, likely resulting from a lack of minerals and breastfeeding until 3.

UK NHS diagnosis was to pull 4 front top teeth out. I asked a relative (a doctor working in a public hospital but not a dentist) who advised to absolutely don't do that without even seeing him in person (COVID lockdown BS).

A local private dentist agreed and wanted 5k to fix his teeth (remove cavities, put fillings under general anesthetics).

In the end we went to Russia and got it done for 1k.

That's public healthcare for you!

His teeth have been fine for years, not long until he loses them naturally.

Same experience when I was a kid. I fell and had a milk teeth that was completely lose. The dentist just said to leave it as is.

It fixed itself as well.

> I’m not a conspiracy nut

I think that term has lost all meaning. A more appropriate term for someone who no longer blindly trusts expert consensus without question is an inquisitive skeptic who takes in expert opinions and applies reason, judgement, analysis and data to determine a course of action.

It’s becoming more and more recognized that expert consensus has become highly politicized and that the problem with blindly following the science is that science often follows the money.

Just wait until you hear about how the majority of gastroenterologists treat IBD.

Seems like the dentist could have just searched Google for how bent teeth work.

D students have to work somewhere too.

> COVID left a lot of dental chairs empty

Why?

How did he eat with bent teeth?

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