Man Discovers Shocking Secret - Doctors Hate Him

[Xant]

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[Teeth]

I have got two roommates who study medicine and I have asked them before about how medical research is conducted, and at least in the Netherlands they appear to get a similarly solid basis in research comparable to many gamma fields. Another roommate studies bio-medical research, which is a separate education, as I presume it is in most countries, heavily focused on conducting research. Research is coordinated within academic hospitals, which employ several controlling boards and specialists like statisticians to supplement the doctors and researching staff.

Overall it sounded reasonably sound and it is not like I see any way to avoid having to trust on a doctor. I am a fan of second opinions, but that is really all I can do. Publication biases are everywhere, and I am not about to do my own research in other fields.

[Xant]

You shouldn't completely disregard a professional opinion, of course. In fact, you should rely on it heavily; but it's your health you're talking about, do you really want to die or not get treated because a bored doctor made a stupid statistical error?

So it's worth knowing some of this stuff, it might be relevant to you some day -- or someone you know.

What you can do is ask for the UpToDate report of your diagnosis. It provides a summary of research based on disease, i.e., for disease X, these treatments are recommended because of study A, B and C and the physiological facts D, E and F. It includes counter-indications and risks from these treatments because of X, Y, and Z. And it isn't just a literature dump, it's summarized and treatment options are graded - and the summaries are usually written by researchers in the field of the illness. It's pretty much a meta-analysis, and the least you can do is have a look at yours, taking into account all the previous statistics (e.g. the fact that 93% of doctors reported practicing defensive medicine).

[Kafein]

Having a somewhat higher IQ doesn't make them above average in any meaningful way when it comes to taking care of people's health.

Also, it's amusing that some of you seem to think I'll be upset somehow that you spam and don't care -- obviously I knew that the vast majority of cRPGites would be too dumb to get anything of value from my post, but it is, objectively, interesting information for anyone intelligent. You're not the target audience, so spam away!

Preaching in the desert is not done in vain if the sand can hear you.

I have got two roommates who study medicine and I have asked them before about how medical research is conducted, and at least in the Netherlands they appear to get a similarly solid basis in research comparable to many gamma fields. Another roommate studies bio-medical research, which is a separate education, as I presume it is in most countries, heavily focused on conducting research. Research is coordinated within academic hospitals, which employ several controlling boards and specialists like statisticians to supplement the doctors and researching staff.

Just because when describing an organization it sounds okay doesn't mean it lacks a design problem. Such problems aren't vegan, they don't advertise themselves at the first opportunity. Large scale medical studies require lots of doctors interacting directly with real patients. And there is a fundamental difference in how doctors and statisticians (or anybody with a math background for that matter) operate and think about problems. For the doctors, every patient is different and requires specific care. This attitude can easily make the statisticians pull their hair out because their jobs consist in finding patterns across patients.

Overall it sounded reasonably sound and it is not like I see any way to avoid having to trust on a doctor. I am a fan of second opinions, but that is really all I can do. Publication biases are everywhere, and I am not about to do my own research in other fields.

For most people it's entirely useless, but if you start getting into health problems, asking directly for up to date diagnostics may affect your treatment. And in any case it will reassure you.

[Xant]

Medical research in academic hospitals differs drastically from the day-to-day in average hospitals.

The biggest problem for individual patients might be the fact that dealing with people becomes routine. Doctors get bored and annoyed just like everyone else, and if they've just dealt with some paranoid person(s) who think they have the symptoms of every disease, they're less likely to take you seriously. Even normally, if you have some rare condition, you'll likely get treated for the common cause of your symptoms without anyone being too interested in being 100% sure.

Interestingly enough, the information I posted in the OP is entirely useless to the "tl;dr" people because they wouldn't be able to utilize it in any case, so nothing is lost there -- but for 1% of people, it's something to think about.

[Teeth]

What you can do is ask for the UpToDate report of your diagnosis. It provides a summary of research based on disease, i.e., for disease X, these treatments are recommended because of study A, B and C and the physiological facts D, E and F. It includes counter-indications and risks from these treatments because of X, Y, and Z. And it isn't just a literature dump, it's summarized and treatment options are graded - and the summaries are usually written by researchers in the field of the illness. It's pretty much a meta-analysis, and the least you can do is have a look at yours, taking into account all the previous statistics (e.g. the fact that 93% of doctors reported practicing defensive medicine).

I thought you mentioned this UpToDate thing is for the US, but it looks to be internationally accessible. Pretty impressive body of work and I guess I could take a look at it if I run into some serious health stuff.

[Bronto]

Preaching in the desert is not done in vain if the sand can hear you.

LOL! Sand doesn't have ears!!!!

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[Kafein]

LOL! Sand doesn't have ears!!!!

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I think you might be the only person to actually understand what I'm trying to say here.

[Kalam]

I agree. Medical professionals need better statistical literacy, drug advertising could use more regulation, the last vestiges of those following the 'clinical' school of thought in regards to diagnoses should be stamped out in favor of evidence based algorithmic care, and all medical facilities should share (privacy is an issue: how do you keep patient data safe?) all their medical records that are then subjected to rigorous analysis.

However, as horrible as all this is, I do not trust the average citizen (in regards to medical decisions) as much as I trust the average physician. Not that I'm advocating total trust in your physician, just that you should put as much trust in your physician as your mechanic or plumber. Never judge your physician by how nice she is or how often she seems to comfort you. That's the stupidity that drives the private practice market.

I've never seen a patient properly judge a physician's assistant on diagnostic skill, let alone a Doctor.

I would also assign more trust to someone that discussed diagnoses and treatments as possibilities rather than certainties.

Yes, you should do your own research, but most people have no idea how to analyze research, and Dunning-Kruger Effect is a bitch.

That all said, I think it would be useful to give people a checklist of subjects to learn in order to have a better general idea of when a physician may be mistaken.

[Xant]

Two definitions of intelligence I like are "being able to choose actions that steer the future toward outcomes ranked higher in your preferences" or "being able to squeeze the future into a narrow range of possibilities."

Or, alternatively:
(1) the ability to precisely realize one of the members of a small set of possible future worlds that have a higher preference over the vast set of all other possible worlds with lower preference; while
(2) using fewer resources than the other alternatives paths for getting there; and in the
(3) most diverse domains as possible.

Accordingly, when we discuss the intelligence of medical professionals, we run into two different possible problems from the perspective of the patient.

One: the doctor may simply not be very intelligent. Yes, it's true, doctors have quite a bit higher IQ on average than a plumber, but IQ only measures one aspect of intelligence -- a high IQ is required to be intelligent, but a high IQ is not a guarantee of intelligence.
Two: you're just another patient in a long queue of patients. How highly does your doctor really rank your good health in his preferences? How much of his limited mental energy is he likely to spend to make sure the future is threaded through the eye of a needle that it needs to pass through to make sure the outcome is your continued well-being? Depending on your condition, it could be a massive needle with a huge eye that almost no effort is required to go through, or it could be a tiny needle with an even tinier eye, where the doctor will truly have to be exceptional for you to survive (or for your condition to be cured). A person can be as intelligent as anyone, but if they aren't willing to use the full powers of their intellect for your sake, that does you little good.

So, then; we have (1) ability and we have (2) investment or interest. For the difficult cases (contained within this definition are cases that aren't difficult to treat per se but are often mistaken for something else) you need your doctor to have both 1 and 2. Note that this applies, to a lesser extent, to even something like the common flu. Sure, you might not die if your physician doesn't give it his best, but you could get better sooner. Hence why it's important to not hero-worship, to not just transfer final responsibility to someone else, but to treat the doctor as you would another craftsman, like Kalam says: let them do their work, but be the final judge. You wouldn't take back your car if it was broken even if a mechanic told you it's working perfectly fine now. Likewise, if you're told your car needs an expensive part X, you'd be wise to get a second opinion or do your own research before trusting one mechanic blindly.

[Paul]

Yeah, common sense dictates if you don't think your doctor does good work, go to another one. But why write about that like it's some dramatic insight?

[Xant]

Because knowing whether "your doctor does good work" isn't as simple as checking whether your car still runs after a visit to the mechanic. The whole point is finding out whether your doctor does good work or not. How are you going to magically realize that your doctor is recommending an option for you that isn't ideal because they're afraid of getting sued, or that they've overestimated your chances of having breast cancer, if you don't know what and where to look for? And the first step, obviously, is to doubt.

[Paul]

Often enough it is simple. Example, my father's knee hurt after volleyball. His doctor only does xrays and bullshit acupuncture+acid injections, clearly for cash cowing reasons. I tell my dad to change to a doctor that at least does a decent imaging diagnostic. He doesn't even believe in the chinese shit.

[Xant]

Why did you have to tell it to your dad if it's simple?

[Paul]

Because he secretly wants to stop with volleyball and needs an excuse.