GPs do not exist in a vacuum. They follow the advice dictated by the authorities. And the whole point of that advice is to be conservative. They aren't there to prescribe you the latest drugs or try some new cutting edge technique. They are there to present the best practice at that particular point in time. You know that whole saving lives part.

And so in your case. You are coming to see your GP and are presenting some analysis that you read off the internet and are now upset that they didn't jump up and down in amazement. Well sure. They probably get that 100x a day and 99.99% of the information is probably wrong.

> upset that they didn't jump up and down in amazement

There's that aggression again.

No, I'm upset about paying someone who mocked me and decided not to do any work because I was too pathetic for someone of his/her status.

I am an expert in my field. Many people I work with suggest things that I know to be wrong. I have NEVER mocked or acted vengeful. If they choose to continue with their ideas that I disagree with, that's their right. Is it really that hard to be respectful?

In every event that I've related in my posts, it was the doctor who was unwilling to give the most basic level of respect.

I can totally relate. I sustained a wrist injury about 10 years ago from physical trauma which requires me to wear wrist braces constantly to this day so help manage the pain, weakness, and shaking. I’ve seen more doctors than I can count about it and I’ve yet to even receive a diagnosis. They just all assume I have carpal tunnel despite numerous tests which say otherwise just because I’m a programmer. When their carpal tunnel theory doesn’t pan out they just give up yet somehow every single one of them won’t admit they don’t know what’s wrong. I’ve researched as much medical material regarding my issue as I can and take notes to present to them since I’m not educated enough in the medical domain to go beyond potential causes so I present those notes along with diagrams of the pain locations and locked muscles as well as photographs of related skin conditions. And even then when I do research and present my findings to help guide them along the way I still have to fight them to even attempt further diagnostic techniques. It’s a frustrating issue and it’s something I’ve been wracking my brain with on how to help address it in anyway I can.

I think that many MDs see physical issues as only physical, but in my experience an injury from physical trauma may have an impact on the mind as well.

I suffered chronic headaches for years after I broke my maxilla. All exams and imaging were negative. Physical therapy helped, but the problem would always come back. This is when I decided to stop visiting MDs (neurologists, psychiatrists, traumatologists). I also tried alternative therapies (i.e. acupuncture), but the effect lasted hours or days at most.

I completely relate to you about trying to find any possible solution. In my case, not finding solutions added layers of frustration and other negative emotions to the problem that didn't help.

I started looking at the psychological aspects of pain after a HN post with this article [1]. That triggered a lot of reading in psychology, and I also started practicing yoga and meditation. This path led me to many discoveries about myself, since it taught me to pay attention to my mind and body in a different way. Being able to recognize triggers was crucial to find a solution. I can say that I never have headaches now.

Feel free to shoot me an email if you're interested in more references and or other details of my experience.

[1]: http://aaroniba.net/how-i-cured-my-rsi-pain

Have you had physical therapy?

Do you engage in regular exercise that stretches and strengthens your hands, wrists, and forearms?

Since were on a thread of medical advice with minimal scientific double blind controlled studies costing millions of dollars, check out acupuncture and get a grounding mat to sleep on. 120$ not much to lose and it’s helped many people I know. And ofc mandatory no brained eat healthy and lift weights be able to do 50 push-ups , do yoga etc. work towards doing the splits over 3 year period of practice each week

Could you rephrase your last sentence? Was that self-description or a suggestion, and what was that about the splits?

Have you seen a neurologist?

To be fair here, it's not the people with the best self-control, best logic or best analytical minds, it's the best memorizers that become doctors.

Also, depending on the country, the job may be extreme hours, low pay (GPs in particular), and huge stress coming from legal risk. While that does not excuse general assholery, after hearing a lot of stories from the field, including from my brother who's just finishing his medical degree, I'm much more sympathetic to even rude doctors. Theirs is a thankless profession.

>Theirs is a thankless profession.

That seems like a nice outline of the symptoms, but can we get a diagnosis?

:P

Seen the average size of a GP's house in the UK? It's not a coincidence that they often have expensive hobbies like flying, yachting, etc..

GPs earn about £50,000 to £80,000.

Incorrect:

'The average GP earns an average salary of £90,000, but doctors can earn more by linking up surgeries, making record earnings by managing tens of thousands of patients. Figures revealed more than 200 ‘Super GPs’ in the NHS earned more than £200,000 a year in 2015/16. Four were on salaries between £400,000 and £450,000 while 11 were paid between £300,000 and £350,000 a year.'

'Britain’s highest earning GP paid at least £700,000 a year'

https://inews.co.uk/news/health/nhs-britain-highest-paid-gp-...

I understand there are those for whom criticism of the NHS is sacrilege, but the current situation doesn't look much like sustainable socialised medicine to me.

Your comment violates HN's guidelines and I suppose code of conduct if there is one.

And that is perfect for almost every single one of the cases they will ever see.

I don't think that's a fair statement because the logical analysis helps so much with memorization, viz the story telling technique, and vice versa, the aptitude for logistics will not pan out without a keen memory. A lot of the required memory goes to logical connections not merely to longish Latin names under picture book illustrations.

Story telling has nothing to do with logic. It's just making stuff up. Not really something I would look for in my doctor ... even if it helps him remember.

I don't see a story in your post. It's incoherent and doesn't connect. The conclusion must be incoherent.

> it's the best memorizers that become doctors.

Ridiculous comment. I'm embarrassed for you. Remember to say that to all the great doctors that are constantly saving lives, inventing new treatments, and being ridiculed by their own community when trying to introduce change.

I agree with dcbadacd.

That's a feature, not a bug.

Maybe in the emergency room, but not for a non-emergency doctor. I'm generally not looking for the person who can diagnose and treat me the fastest, I'm looking for the person who can diagnose and treat me the best. Consequently, in the emergency room I'm looking for a memorizer, but the other 97% of the time I'm looking for a researcher.

> I'm generally not looking for the person who can diagnose and treat me the fastest

Not directly but you relay on the system that can diagnose and treat you cheapest and, since manhours is always most expensive item, fastest.

I see your point, but also you do not give health advice to other people as a profession. It's more akin to the mechanic dealing with people coming in with cars that almost all have the same issues, but then every now and then somebody reads something online about some extravagant maybe-it's-lupus kind of diagnosis, and they just roll their eyes.

That assumes the expert has actually given an answer to my questions, in which case, you'd be 100% right. Even a "we don't know why this happens yet, here's what we know about it: ..." would be more than satisfactory. Just give me something!

But when the expert has nothing to say, yet mocks my questions and even just my reporting of what is happening to me, as he very eagerly waits for me to leave so he can get paid... Then there's not much more I can do than read on the Internet.

Some throw in a veiled insult by suggesting I should be sent to a psych ward for my "panic attacks." You might say it's not an insult, but I accepted the psychiatric evaluation once - and then a whole team of psychiatrists determined after 2 weeks that I was genuinely sick with stomach issues, and called that doctor up and asked him what the hell he was doing sending me to them when I had real physiological issues.

The truth is, most patients will accept the doctor's advice if the doctor can give an answer, any answer that's genuine. "We checked out the inflammation and we don't know why it's there, we'll keep working on it." <--- GREAT. Even the most "annoying" and inquisitive patients will accept this answer. The problem occurs when the doctor thinks him/herself too good to work with the patients by giving answers like this.

I'm absolutely not trying to belittle your experience -- it sounds horrible, and it is something I have met, and that my spouse has met. She was crying after she had met a doctor that examined her, because the doctor had made fun of her, in no uncertain words implying her symptoms were fictitious.

My point was more generally about how doctors are a lot like the car mechanics of people. So when none of the usual things show up as wrong, they just assume your electronics are shot (for humans, "you're crazy") and move on.

Yes. I lost a mother in law due to that.

She had legit signs of heart disease. Got told repeatedly it was diet. Went out to work and, hard core as she was, powered through a heart attack.

Damage was terminal. She lived a few more years.

Hard core again, she got tired of being zapped back to life, asked them to turn it off. I had to intervene and force it.

She lived another blissful month.

Through the whole thing, it was, "woman, you know nothing" right and left. I basically became full time patient advocate, and wish I was in that role earlier.

>I'm absolutely not trying to belittle your experience

I understand, I didn't think that you were. I agree with the point you made that maybe doctors who are trying to work might be impeded by a patient who disagrees. But I think that is a much smaller problem since the doctor can quickly be vindicated when the treatment he or she advises works, or the disagreeing patient leaves.

> Even the most "annoying" and inquisitive patients will accept this answer

but in the United States, often times they won't accept it and instead will give the physician a low survey score, which ties directly to their financial reimbursement.

This is a big problem.

https://www.theatlantic.com/health/archive/2015/04/the-probl...

True. But the situation describe further up this sub-thread wasn't a one off. This was an ongoing pattern of failed diagnosis and then mocking of the patient (i.e., the one who is ill and seeking relief) by those who promise relief and then failed him.

They should have been apologizing. Instead they stuck with a cycle of insanity. If the even fairly common imagine how many diagnoses are missed; imagine how many new and important discoveries delayed. Because of overblown egos and lack of empathy?

Chronic Lyme disease sufferers get the same response all the time. All the symptoms are dismissed as purely psychological. The lack of respect causes a lot of suffering in itself, but since it also means that patients who believe their doctors won't find ones who will actually treat them for the actual medical issues, it causes immense physical suffering. I've done a lot of reading of the core research into Lyme, and the certainty of mainstream physicians who handle patients this way is based largely on being too lazy to read that same research.

> Chronic Lyme disease sufferers get the same response all the time

I think that varies from country to country.

> Many people I work with suggest things that I know to be wrong. I have NEVER mocked or acted vengeful.

Then again you probably are not approached daily by dozens of humans with their meatware problems and human attitudes.

If you understand doctors to be salaried pattern recognizers and procedures applicators in various stages of burnout and adjust your expectations accordingly then you will rarely be disappointed.

Disclaimer: I'm not a doctor but I met a few as a patient and patient's family member.

>I have NEVER mocked or acted vengeful.

Do you get it constantly every day? Do you get people telling you that you should rewrite your app in Android because they heard about it once? Do you get someone telling you that you should move from your amazon servers to the cloud? Do you get someone asking why you don't move your TV service to phones and not a tv box?

I don't think those are analogous. People make suggestions about their own health, for their own perceived benefit. That, I get every single day, 24/7 - and so does every professional in every field.

If it was THEIR app, they would ask about different hosting providers - and I would explain why or why not because it's my job.

You are on the right side of this discussion.

I have experienced the same, and it is ugly.

There are many constructive ways to have discussions like that. Mocking, suggesting, psych are not among them.

GPs are tier 1 support.

Problem is, most of the times doctor don't help you. I solved all my health problems by myself, by debugging my body (literally). Doctors don't believe you and they fail badly because of it. Doctors are useful when you have a clearly recognized symptom and there is a known procedure to solve the problem.

But that's terrible honestly.

I have a medical degree (but I do not practice medicine), and this is spot on. I wouldn't generalize it to the entire profession, but many doctors behave as you describe.

Generalists tend to be more humble w.r.t. not knowing everything, but specialists are often bad offenders.

Oh. But they are scientists, or should be, in the sense that the scientific method is their #1 tool.

- have a theory, that is a preliminary diagnosis.

- look for and listen for evidence. Speak with the patient. Run some tests.

- do the symptoms support the diagnosis?

-- yes? Ok. Prescribe.

-- no? Repeat step 2. Keep looking. Keep listening.

The doctors you describe don't fail because they are (per you) not scientists. They fail because they presume that they know all; that there is nothing beyond the reach of tbeir expertise. With that mind set they ignore facts in order to avoid saying, "I don't know" or "I'm not sure."

Put another way, think of how many doctors are slapping open palm to forehead and thinking "I saw that 1,000 and I ignored it." I'm not sure intentional ignorance falls under "do no harm."

Medical doctors ARE scientists. They are just forced from the system (insurance companies, health ministries, etc) to classify symptoms/diseases and act appropriately.

It is a very regulated work and if you act out of the prescribed guidelines you risk your license. Sorry, no physician I know who studies for 10+ years will ever risk that to please a patient. Unfortunately or not, I leave it to others.

Doctors in that sense, and similarly lawyers, seem like the best candidates to be replaced by ML/AI.

Why aren't we on this yet? (or are we?) That would be one of the best applications of AI, with wide benefits for civilians the world over but also causing social upheaval and thus facing resistance from the humans it attempts to supplant.

In my experience, we don't need ML/AI to replace doctors. A good flowchart would do it. When your condition is on their standard list of diseases, the medical system (at least here in the UK) is a marvel of bureaucracy. Everybody works together with perfect coordination, to deliver the standard treatment at the lowest cost possible. Patient time or comfort isn't a priority, but it gets results. But as soon as you stray from their flowchart, the system is completely useless. Nobody is allowed to think for themselves, because any deviation from procedure would make the bureaucracy machine break down. As far as I can tell, the main purpose of the extensive doctor training is to raise barriers to entry and keep doctor wages up.

1. Because the health industry is about as regulated as it gets so even if ML/AI is possible there is zero chance of it being allowed to replace the advice of a doctor.

2. Because most people like seeing their doctor and talking to someone about their issues. There isn't exactly an appetite for disruption here.

I make reasonable use of: https://en.wikipedia.org/wiki/Dr_Fox_Pharmacy

When I want a medicine that requires a Dr's prescription, I can go and fill out a survey on their site. A real Dr (presumably) makes the actual prescription and my drugs show up. I am much happier for not seeing a doctor or talking to someone about my issues.

The survey I take isn't traditional ML/AI, but it's definitely AI, as it boots me out of the process if I answer some of the questions incorrectly.

Anyway, my point is: there's already disruption here, and it's awesome.

That's not awesome that you hacked the system to prescribe yourself anything you want. At best you're going to get the least efficient path to treatment. At worst you could miss a serious condition and kill yourself.

I am using the system directly as it is intended to be used, exactly as the UK government is intending it is to be used. I'm not sure what you think the hack is here. How the process works is detailed here:

https://www.doctorfox.co.uk/how-it-works.html

And you can see how they're regulated in the UK here:

https://www.doctorfox.co.uk/regulation.html

> 1. Because the health industry is about as regulated as it gets so even if ML/AI is possible there is zero chance of it being allowed to replace the advice of a doctor.

i.e. the necessity of an identifiable scapegoat if things turn out badly

> 2. Because most people like seeing their doctor and talking to someone about their issues. There isn't exactly an appetite for disruption here.

Maybe a certain type of person who craves an authority figure of some sort to soothe their fears, but I'd have to see evidence of this. Most people I know hate going to the doctor, and dislike and distrust the doctor they end up seeing as often as not. Having a friendly doctor that you've been seeing most of your life, that other members of your family see, and that you get Christmas cards from is a class thing (at least in the US) that maybe 10-15% of people get.

To add to your second point: some conditions, such as mental health illnesses, require personal contact. Also, many people need to feel reassured when they're sick. An algorithm is not going to provide that, no matter how you dress it up.

> There isn't exactly an appetite for disruption here.

Apple has already begun doing it in baby-steps, doing it well so far and is lauded for it.

> The first expert systems were created in the 1970s and then proliferated in the 1980s. Expert systems were among the first truly successful forms of artificial intelligence (AI) software.

~https://en.wikipedia.org/wiki/Expert_system

Applications include diagnosis and some systems are listed: CADUCEUS, MYCIN, PUFF, Mistral, Eydenet, Kaleidos.

Facebook announced that they are using ML to fix compilation errors just yesterday. They said they were contracting out companies to build ASICS for the AI. We are a long way from AI making good medical decisions.

Good doctors are aware of their ignorance. At least in the UK continued training of GPs with the latest medical practice is normal. How quickly these findings find their way in to the latest medical practice is another question.

> At least in the UK continued training of GPs with the latest medical practice is normal

At least within the NHS, my (unfortunately vast and varied) experience has been very different - GPs' knowledge varies dramatically, and many have no idea how the medications they prescribe actually work. In general, I'd say they conservative are very outdated; although to be fair, a lot of NICE guidance fits that description, and that's what they have to follow.

As well as GPs, I've found consultants across multiple disciplines to have similarly outdated ways, and occasionally a shocking lack of knowledge - even about diagnoses they make.

Maybe your experience is more on the private side? My own experience there is much smaller, but I have found private GPs and consultants to be much more up-to-date and knowledgeable.

That's sad to hear.

Thankfully I haven't had too much personal experience with doctors in the UK for anything serious. I have several friends and family members who are doctors, so my experience comes from talking with them. They're probably not representative, judging from your comment.

A doctor stands before a judge due to a malpractice lawsuit. Do you think they will be interested in whatever novel research he used to justify his decisions? They're going to ask what the established best practice is and why he thought the patient was special enough to deviate from it. I seriously doubt that research will better than the articles references by the numerous guidelines.

Any non-standard decision is risky.

>Any non-standard decision is risky.

I disagree, there are many potential non-bog-standard decisions that are not risky and certainly better than mocking you and doing literally nothing (while still getting paid).

Also: "we don't know why this happens" and a bit of two-sided discussion is satisfactory for most people.

This matches my experience exactly, even with some of the best doctors in the country: very good at passing exams, not so good at lateral thinking.

> Unfortunately medical doctors are not scientists.

at least average/bad doctors aren't

I do agreee and have actually asked many people before if they believe doctors are scientists. The sad answer is many people assume that they are (or should be). There are also researcher-clinicians who practice medicine with patients and are actively involved in research. They are much more likely to be in touch with the latest findings in that field (rather than a standard GP /doctor). I think if you had something that the medical community cant deal with the best thing to do is to do a lit review and take a stack of papers to them although i understand it's not easy for members of the public (especially with a medical ailment) to critically review scientific research. Hopefully, the latest move by the EU to remove paywalls from academic journals means more people from the general public start reading them.