On this note: WebMD is not a doctor but has the same issue. There's no differentiating between a real emergency issue and a CYA liability one.

As an aside, an EKG is not remotely the most important part of diagnosis for myocardial infarction; that's the job of the person taking the history. (Myocardial infarction cannot be diagnosed purely from ECG.)

We need a musk like character to shake the medical diagnosis status quo.

ps: I don't want to spend my life obsessing about monitoring my vitals but I'd still prefer to have the option rather than relying on blind faith.

The cost benefit trade off for additional testing isn't just about dollars spent performing the tests. Its about how many thousands of hours of people's lives will be spent in pointless worry and how many additional people will be made sick or killed by testing Vs the additional people that could be saved by additional testing.

You first to trust your life and your loved ones to the SpaceX or Tesla of the medical world.

But - disruption! Fake it till you make it!

They have those online. If you're in your 30s and have a reasonably healthy lifestyle and don't smoke, then your risk of dying from a cardiac event over a ten year period is likely somewhere between 0.25% and 0.5%, depending on how much you exercise and genetic factors.

If anything, Bayesian logic is what leads doctors to ignore signs of heart attacks in young people in the first place.

Now, people move around more, are less likely to see the same physician for years on end, are less likely to see the same physician as their relatives who may live elsewhere, etc.

I don't know how to fix it, but I think these changes are a very big part of the problem. I don't care how brilliant and dedicated you are, having less overall context is going to undermine your ability to draw accurate conclusions about what's really going on.

But I'm old-ish and I remember when it was pretty normal for Mom to show up with all three kids and a couple of their cousins and get them all treated at the same time. In contrast, in recent years, I routinely hear that people in the family pass the same crud around repeatedly because they get treated as individuals and it leads to recurrent or chronic issues. I've also dealt enough with chronic health stuff that I'm quite confident that when doctors decide "This is your normal. Just get used to it." it becomes self-fulfilling prophecy.

From what I gather, obesity and chronic health issues are vastly more common than they used to be. To my mind, that's probably evidence that something has gone very wrong with our health mental models/practices overall and the change in how we interact with physicians is probably just one grain of sand in a beach of changes. (However, it will also be confounded by medical advances leading to people malingering when, historically, they would have simply died. We often can't cure them, but we can keep them alive longer than we used to.)

But I'm sure that's a case of "Other people won't necessarily see what I see and if they don't, there will be no winning them over." (shrug)

Obesity, perhaps, but chronic health issues? Not really - and a tremendous number of those went untreated. A huge number of people in the past lived with perpetual pain and disabilities.

Because I'm disabled and the internet is a thing, I'm very aware of the existence of people on disability, on multiple meds and not doing much with their lives. Historically, we simply didn't have the resources to support such people.

I'm thinking of those folks -- not simply people living with pain and limitations, but people who historically would have simply died because if it was going to kill you to keep on keeping on, then you were going to die because disability payments, etc, simply did not exist like they do today.

You say this because you are unaware of the risks of overscreening, overtesting and overdiagnosis. Pre-test probability is important to take into consideration. Getting patients worked up over a 0.00001% chance event causes undue stress.

One example: the humble chest X-ray. You may think the main risk is radiation, but IMO you'd be wrong to think that. The main risk is finding something. We call them incidentalomas. You would never have found it if you didn't do the CXR. It would never have caused you worry or morbidity. But now we know it's there, you need to get a lung biopsy. And that leads to a pneumothorax. That leads to a longer stay in hospital. That leads to time off work. You end up with no benefit to a patient who now has less trust in the medical system because they got a pneumothorax for nothing.

A brain aneurysm poses a certain level of risk based on its size and location. So let's say you have an asymptomatic aneurysm with an annual mortality risk of 0.5%.

Now let's say you decide to randomly have a full body MRI and the aneurysm is discovered. A neurosurgeon tells you that you can have an operation to clip or coil the aneurysm with a 10% risk of fatality due to its location. Do you have the op?

Apparently most people do, despite the overall odds of immediate death. A 0.5% annual risk of death would ride most people out to their age of natural death rather than the 10% risk of the op, but people hate having even a tiny risk hanging over their head long term.

As such, there's a school of thought that you shouldn't have such types of screening (or at least to not know the results if they are minor) unless you are symptomatic.

It hurts to quantify it this way, but the pot to fund health care is not bottomless in either a pure public or privately insured system. It needs to be spread across the entire population, and across all of the potential issues an individual may face.

Have you read much about overtreatment in cardiology? There's currently a minor scandal in the US about unnecessary cardiac procedures being performed. [cardiology overtreatment] is a good Google search term for this.

It's easy, on a message board, to say "I want the extra attention, damn the cost". That's especially true when you just read an article about a "widowmaker heart attack", so that the upside of excess attention is the only thing about the issue that's cognitively available to you. But these procedures can do harm as well as good.

My SO nearly died because she was "too young" to have a thrombophlebitis, yet every signs pointed to that, yet they could have simply tested for it. She not only is incredibly lucky that a better doctor was not too far and heard her complains, she was incredibly lucky that even though it took so long for her to be treated correctly, that she still have her legs.

Maybe over treatment is an issue, maybe cardiology is an inexact science right now and it's impossible to get a good diagnosis. It doesn't change the fact that misdiagnosis is bad and we should do everything we can to improve this, in every side of the coins, including mentioning when doctor just prefer to ignore conditions, because it's unlikely.

On the other hand it’s ressonable as a patient not to care what it’s like being a doctor, your job as the patient is to be honest, give complete answers, and advocate for yourself. I’m not interested in a public policy perspective as dictated by the realities of insurance company profit, hospital profit, pharmaceutical company and medical device company profit, and so on.

It’s the same thing with letting an intern take their turn with the scalpal. If it’s someone I care about under the knife, I’m making sure the surgeon got enough sleep and no intern or first year resident who’s half asleep touches the person I care about. Arguments that “they have to learn somehow” are reasonable, but so is my reaction that it’s your problem, not mine. I don’t care about how you’re educated, or your burdens except as they impact results.

Life is unfair, utilitarian calculations must be made, but that sets up an adversarial relationship on one level, and only a fool ignores that. You feel free to fight for public policy, I’m fighting for the people I care about, not their doctors. That’s also part of life being unfair.

I've encountered patient advocacy groups who are actively, and passionately, pushing for the wrong thing, that while emotively satisfying, will not help the problem they're trying to solve.

In that last vein, I’ve been in that position. A girlfriend from years ago had a nasty rash on her arm, and a series of dermatologists gave her a series of exams and creams. I did some research and concluded that it was probably an allergic reaction. I talked to her latest dermatologist who agreed it could be that, and I suggested taking s daily allergy pill. It worked.

Sometimes having the time and inclination to do research is more than a busy doctor brings to the table. If you’re skeptical, and understand that cherrypicking symptoms from a list and screaming “oh god it’s a tumor,” is unhelpful, then research is useful.

A heart attack is not actually your heart stopping. It’s caused by a lack of oxygen to the heart tissue, causing pain and damage. It is often not immediately fatal.

It can lead, sooner or later, to cardiac arrest, which is when your heart stops completely, and often is fatal.

I learned some things from that were never clear before. It’s more about the journey than the goal. I was running on a treadmill and started after recovering from surgery. I started at an 8 minute mile pace and could barely run a mile. My goal was to increase the distance instead of speed and gradually worked up to a 10k (50 mins) 5 days a week. Then I was able to work on speed and resistance here and there. I have asthma and remember running through an attack on one occasion to make my distance goal and break from a performance plateau.

At the time I was eating a lot of fatty, greasy, meaty foods. The foods were heavy and high in cholesterol. I had tried the ketosis diet the summer before and lost 25 pounds, but I was not intentionally practicing any diet at this time I was running.

You don’t achieve performance over night. It’s similar to programming in that it takes practice solving hard problems and listening deeply to your environment. With enough practice and persistence you make goal and are changed as a result.

But this is part of my tone in my above messages. I've seen doctors lie. I did have swollen ankles and hands. When mentioned to them, they'd say "yes that's a cardiovascular issue" just to switch stance the minute after.

They, too, have biases.