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Comment by sethammons | Hacker News Reader

My wife had gone through half a dozen doctors or more over a decade, giving them the same description of her issues. They never correctly diagnosed the issue. We typed her descriptions into chatgpt and it suggested multiple sclerosis. It was right. It must be what other folks feel when they talk to tech support, but I've never, not once, been impressed by a doctor and have found them lacking in nearly every interaction.

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The best doctors are the ones who listen carefully to the patient before dispensing their expert opinion. Very few do.

Perhaps that’s just because they’re jaded from having to deal with the public all day long…

I agree with you - listening is very important.

I worked in an ophthalmology practice when I was quite young many years ago. The head of the practice often had over 50 patients a day (one of my responsibilities was pulling the folders for all daily patients from the wall-o'-folders; this was in the age everything was on paper).

50 patients over 8 hours gives you less than 10 minutes per patient. I suspect a nontrivial part of the problem is being rushed.

Regulation could help solve that. You shouldn’t see so many patients in a day unless you also double your working hours.

I’m surprised this was many years ago. Now this pressure exists because medical school is so expensive and people need to pay off their loans. Want to see improvements in care? Make medical school free / cheap.

It's also extremely long. Assuming a 3 year residency the average Doctor doesn't even start practicing until 31.[1] So you've not just got a house's worth of debt without a house, you've also lost a decade to training.

I'd love improvements in care, but nobody is going to fix this problem. It's too lucrative for everyone else involved.

[1] https://averagedoctor.com/the-average-age-of-doctors-graduat...

Figure out how they are paid and that will tell you much. In Alberta they get paid by the visit and many are using ten minute appointments as the norm. Often takes six weeks for me to get an appointment with my family doc.

It goes further than this. As an employee, a doctor is pressured into this kind of schedule. They don't like it any more than you do.

HN is going to select for a very small subset of the population, so unfortunately people's experiences have to be interpreted in that light.

A massive chunk of my caseload is the direct result of people not listening to basic instructions. Between people not listening and people who don't understand shockingly basic fundamentals of health, you become jaded.

Add to that the active disincentives to doctors really digging into cases, and we end up where we are. It feels much of my knowledge goes unused and wasted.

As an aside, I have messed around with chat gpt 4 for how well it can mimic what I know. My personal experience is that I can see how it would impress non-medically trained people, but to my eyes it has a long way to go. It struggles to accurately rank differentials. Also once you press deeper into decision making it gets really scary. It was consistently presenting treatment plans that would have killed patients if followed. I would love more than anything to have AI cut down some of our work but I was really disappointed with how it currently performs. Hopefully improvements keep coming.

> I can see how it would impress non-medically trained people, but to my eyes it has a long way to go

I think this is spot on. It's easy (with this kind of technology and amount of data) to superficially mimic expertise. It looks impressive at first, but when scrutinised by a real expert it becomes clear how superficial it really is.

> people not listening to basic instructions.

Unless the basic instructions are "put down the fork, you piece of shit fat fuck", you aren't doing your job.

Presumably, you know that ~80% of medical costs are due to chronic illness, and you also know that ~80% of chronic illness is attributed to obesity, correct?

Unless you are fat-shaming 64% of your patients, you are committing malpractice.

Unless you are agitating for the hospital cafeteria to remove the Hostess cakes and sodas, you are committing malpractice.

But that's not what you people do, is it? You prescribe metformin, statins, beta-blockers, and write angry posts on hackernews that they're not compliant with their medication schedule. You dance around the root cause of 64% of your patient visits because if you addressed the root cause, your billables would decline.

Your entire profession is predicated on keeping your own patients sick, and prescribing workarounds to the root cause of 64% of them. And the remaining 36% of them, who are sick through no fault of their own, are waiting weeks just to see you, because you refuse to do the right thing and tell your patients that their wives are going to fuck the poolboy because they're too fat to see their own dick.

"Patch Adams" has destroyed the medical industry. Your ridiculous concern for "bedside manner", and being nice and polite, is killing Americans in droves, and you guys are more than happy to scoop up the profits in drawing out the process as long as possible, but not fixing it.

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It's certainly unsurprising that a representative of the profession that misdiagnosed my mother's hematoma as a tumor - while she was bleeding internally at a rate of 1 unit per hour - would lack in both reading comprehension and math skills.

I wish you luck, too. Keep murdering Americans at a rate of 240,000 annually due to your own mistakes while considering yourselves the good guys. NBC medical dramas will continue to carry water for you, so your public image will be forever untarnished as the Great American Heroes you were destined to be.

Ah the root cause is found. If you don't want your seething anger to continue to consume you into adulthood it would be best for you to seek extensive therapy.

It's unfortunate how well-adjusted adults on HN seem to be increasingly outnumbered by angry children from reddit.

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>> This may be shocking for you, but it is indeed possible for a person to experience justifiable anger in their forties.

Justifiable does not make it a healthy obsession.

Justifiable resentments destroy people.

You broke the site guidelines more than once in this thread.

Flamewar comments will get you banned here, regardless of how wrong someone else is or you feel they are.

If you'd please review https://news.ycombinator.com/newsguidelines.html and not do this again, we'd aprpeciate it.

Sorry, dang.

I know the guidelines, it's just so hard to not get baited sometimes. I'll do better.

You broke the site guidelines more than once in this thread.

Flamewar comments will get you banned here, regardless of how wrong someone else is or you feel they are.

If you'd please review https://news.ycombinator.com/newsguidelines.html and not do this again, we'd aprpeciate it.

The way med school works by definition is that it filters for very conformant hard working individuals and then fills them up with the most common symptoms, diseases and treatments and turns them into human dictionaries. There are of course many exceptions to that rule, but if you look at medical textbooks that is the structure most of them follow. A human competing on who's the best dictionary is a terrible way to solve this problem although it might have historically been helpful.

I recently had a retinal detachment, not entirely sure why, no doctor can tell me anything useful besides you must have been stressed, but I got it lasered despite my better judgement, because I knew fixating something in the eye somewhat arbitrarily must cause problems, so it left me with blurriness and aniseikonia(a condition with one eye seeing things smaller).

I don't need an LLM for that, just the right google queries do the trick. This is by far not the only issue I have with doctors, but my experience with doctors has been vastly different between exceptional doctors and people with absolutely no interest into any kind of in depth root cause analysis, but the vast majority of them has been in the latter category.

> I don't need an LLM for that, just the right google queries do the trick.

LLMs are clearly superior at presenting the information and have tangible room for improvement, whereas Google has regressed over the last decade and is getting more brittle by the day.

Open technology (LLMs) are going to offer much more robust and reproducible solutions to such questions as "here are my symptoms, what's wrong with me?" than Google.

You can nitpick my statements all you want and I will probably agree with you, but the overarching takeaway should be that LLMs are a much better solution, especially for laypeople who cannot use Google effectively.

LLMs are excellent at presenting more common diagnoses first. With Google you can easily find some rare and scary disease that fits your symptoms, that trips up a lot of casual Googlers.

Sometimes when you look at studies, those rare diagnosis turn out to be really common, just not part of the standard curriculum. In those cases LLMs perform more like a normal doctor giving you all the normal junk a doctor would say.

What google needs is a "search journals" toggle on its normal search, not related to scholar.google.com since those results are also different.

You’re unlikely to find anything useful because everything has been SEOed up af. Useful results, if not already in the SEOed sites, are buried pages deep into the search. Content explosion did not start with generative AI, so search quality has been deteriorating for quite a while.

In my experience (just having used it the other day to look at a blood test) ChatGPT is quick to tell a healthy person they are sick.

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