Comment by jacquesm | Hacker News Reader

Comment by jacquesm | Hacker News Reader

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Do you second guess your mechanic in an auto workshop? (I do, but then again, I've restored a couple of cars from the ground up). How about a contractor, an engineer or someone working on a high voltage line? Maybe the pilot of the airplane that you're taking to your holiday destination or the cook in the restaurant where you ate yesterday? Based on a reading of the literature you could easily become an armchair expert in just about anything. But that does not give you the years of practical experience that typically go with the territory and that should count for something.

Doctors are emphatically not con artists.

I applaud you wife's reasoned decision, clearly she is in control of her own destiny and her decision (if by unfortunate chance it is the wrong one) will mostly affect her and her immediate family.

But if we spend a good sized fortune and several years educating someone I really wonder why we'd bother with that if all that it would take to counteract all that effort and knowledge would be a lay persons reading of the medical literature. Most of which is not exactly written for easy consumption by the general public.

Whether you're in a risk group for certain cancers depends on a lot of factors and you'd need to know all of those to make a weighted decision. This is not always as easy as applying the general case to yourself calling it a day.

Age and sex are obviously the big ones but there are many (not sure how many) contributing factors that may cause doctors to be more concerned about one individual than another. We call those people specialists because we recognize that the amount of knowledge required is typically larger than what one person can acquire in a lifetime.

The time when I'm going to trust my own interpretation of a pile of google'd medical papers over a qualified specialist is still a while away.

In the meantime I'm terribly happy I'm not a medical doctor, I'd hate to have to continuously defend each and every minor decision to a general public that I'd be trying to help in an already time-constrained practice. It's hard enough when non-technical (read: totally clueless) customers question evaluations of technical issues based on some popular text they've been reading, at least there are usually no lives on the line.

You make a bunch of really good points. However, there is a need for patients to learn the right questions to ask of doctors.

"How do you know this is the right treatment?" and "What happens if we do nothing?" are two good questions.

Doctors are overwhelmingly not con artists or stupid, but they do make mistakes and they do have to keep up with changing science.

This is especially important with doctors. They're science based, they're educated, the stuff they do has plausible mechanism of action. But this is exactly the time we need better science; double blinded studies etc. See, for example, knee arthroscopy which was found after controlled studies with sham operations to be no more effective than the sham for many people.

I'm all for doctors informing their patients and for a proper dialogue. Obviously it is a lot simpler to be treated for a broken arm or a gallbladder infection than for something as invasive as cancer or something that is hard to diagnose.

Screening (especially um-necessary screening) is doing more harm than good. But who to screen and who not to screen is still a specialist decision and depending on your locality more or less care will go into the making of that decision. Categorically rejecting screening before you're 50 if you're in a risk group is not smart (not saying the OP's better half is, but these things tend to be complex).

The doctor-patient dialogue is a tricky affair and I think that somewhere along the line doctors lost the ability to clearly communicate with patients about their treatments and the necessity thereof. On top of that doctors now see so many patients that there simply isn't time enough to have a proper conversation with every patient.

Those things are the crux of the problem here, not that doctors are out to make money of unsuspecting citizens or that they would perform procedures or generate referrals because there is money in it. Though I'm sure that occurs the Hippocratic oath is still very much a part of medical education.

http://en.wikipedia.org/wiki/Hippocratic_Oath

> See, for example, knee arthroscopy which was found after controlled studies with sham operations to be no more effective than the sham for many people.

I noticed a 'many' in that sentence, that's a bit of wiggle room there, if it were a really ineffective treatment there would be an 'all' in there. So now the question becomes one of degree and how to tell the people for whom that treatment is effective from the ones for whom it isn't.

On another note, the communications problem in part stems from the vast body of knowledge in modern medicine, two specialists already have a hard time communicating their ideas to one another, a doctor explaining the intricacies of some treatment to a patient would have to be at least as good an educator as a doctor, however education is typically not their specialism.

>Whether you're in a risk group for certain cancers depends on a lot of factors and you'd need to know all of those to make a weighted decision. This is not always as easy as applying the general case to yourself calling it a day.

It is a different topic, but I have a very strong impression that it is the norm for doctors under time pressure to apply the general case and call it a day. That is not necessarily a bad place to begin, as doctor's often say, "common things are common". I do not have a problem with that.

The question then becomes whether doctors are actually skilled at analyzing contra-indications in a logical fashion. I have substantial experience suggesting the answer is N-O.

Here is a paraphrase of a real world conversation my wife had with more than one doctor(!) on a different topic: Patient: "My back still hurts. I have been doing everything you suggested for 6 weeks." Doctor: "Hmmm. Can you touch your toes?" Patient: "Yes. <Demonstrating>" Doctor: "You seem fine." Patient: "No. My back still hurts. I used to be able to almost touch my elbows to my toes." Doctor: "Your range of motion is within healthy norms." Patient: "Not my norms." Doctor: "Have you tried walking every day?" Patient: "Like you suggested? Every day for the last 6 weeks, yes." Doctor: "You have what is called 'normal back pain'. Take more ibuprofen. It will eventually go away."

Does someone need to go to school to accomplish this tour de force of medical reasoning?

My personal opinion is that when Watson (or moral equivalent) sits next to the doctor with the patient, there will be a vast improvement in medical care. There will a dispassionate source for possible diagnoses for patient who happen to fall outside the bell curve.

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