I wouldn't assume that - just because the money isn't coming from your pocket directly, it's inevitable there are doctors that milk the system. But you'd think bureaucrats whose job it is to assess the legitimacy of requests to the NHS (or equivalent institution in your own country) for payment might be harder to swindle than your typical patient.
Truth is that modern medicine still knows much less than is often assumed, let alone individual doctors. There's an absurd amount of potential for LLMs here.
> There's an absurd amount of potential for LLMs here.
The problem is not that doctors are stupid, the problem is that a lot of ailments are just not easily diagnosed. Even if the doctor has one (or more) suspicions what the red rash on your skin is, there just aren't any tests for many conditions. Many diseases are only diagnosed by symptoms and the underlying cause is unknown.
And even if you get a diagnosis, there is often nothing you can do.
LLMs are not going to magically come up with cures.
https://coinbrain.com/coins/bnb-0xb131f5e8ec273af4652eecdd87...
This will change everything
There aren't any tests that the doctor has on hand, because the doctor is a unit in the medical system designed to provision affordable care instead of a scientist attempting to cure you. It would be too expensive to test you, especially for something that will probably go away on its own.
Everyone who talks to the patient, who touches them, and who is consulted by the doctor, gets to charge. Yup, that means if another doctor happens to walk by, and confirms what he just told me, he gets to charge me again (double).
Feels like theatre every time I go to the doctor, so I just tell the secretary "I'm talking to you and Doc, no one else", and just quietly stare at anyone else who pops in.
Usually insurance covers this stuff, but I was uninsured when I discovered it .
This is accurate. Years ago I had a kidney stone and the GP asked for an IVU (Intravenous urography) image to make sure about the size. The report prepared by the radiologist had the statement "operation is required".
When I got back to my GP just laughed sarcastically and told me that it was nothing to be worried of. He also said "the radiologist just wanted to return the favor, in case the GP wanted to operate". He was sick of this scheme too, but there was nothing he could do.
I was so pissed by this I created a way to find experts. People that actually studied the issue, have actual publish papers on the topic. What I found was no one cared. No one wanted "experts" - they want a specialist that is in their network and close.
Example of searching for mohs surgury. https://www.opendoctor.io/research/?research_papers=mohs&zip...
I struggled with back pain and told to go to a neurologist and informed my GP where I would and wouldn't go. The doc I was referred to was a no-go since I know him personally and he's a lying piece of shit in his personal life, I'm not trusting him with my back! Docs could NOT understand. "But he's so nice." Screw that.
Time and again, family and friends settle. I understand the insurance component, but even then, can you not find better?
And thank you for your work. It's very cool.
In US healthcare you have to be your own advocate and be willing to push. The system breaks down if you don't have a routine and obvious illness.
Now dentists...when we had money we went to a family friend. He still totally f'd us and did unnecessary work. It's only now that I have a cash only country dentist that I trust my dentist again. Crazy part is the cash only dentist ends up being cheaper than my previous copay/premiums insurance dentists.
My wife and I have both had to see various specialists. Some had very long wait times, many didn't, and of those that did, we were (fortunately) able to call around to different clinics to find one that wasn't too bad.
The exceptions are part of that data set
Really...
A few minutes research suggests it's not that expensive. (As little as ~2000/year).
However, that is beside the point. Believe me, I hate explaining simple, simple things--but the person I was responding to is probably comfortably middle or upper-middle class and could afford a miserable 2000/year on a doctor. He doesn't have to become "rich enough", and almost 100 percent of the people in this thread don't have to either.
2 k is a lot for even those at the 50th percentile and extremely significant for those below it.
Min wage earners make about 30k, so that 2k is 6.6% of thier income....
I mean, the wait times sometimes are, but they vary by province. More conservative provinces have worse wait times. That is not surprising given that the provincial conservative government are all actively attempting to sabotage public healthcare so we can move to an American style system. A system where we will all pay more, and still see similar wait times anyway.
MAID is not actively proposed as a way to save resources.
This feels like a pretty glaring generalization. If we look at the actual data, the story becomes a little more nuanced [1]. "Conservative" provinces have wait times that are a couple of days to a couple of weeks higher than national average (assuming we call BC, AB, SK and MB "conservative" [2]), but then again almost all of the maritimes provinces (which are considered strongly liberal-leaning) have abysmally bad wait times relative to the average (10-20 weeks worse).
Overall, the average is ~half a year anyways, which is pretty rough regardless.
[1] - https://www.fraserinstitute.org/file/waiting-your-turn-2021-... [2] - https://en.wikipedia.org/wiki/2021_Canadian_federal_election, "Results by province and territory
And nice lies dude. They all have over double the national average!
Don’t use Fraser institute for sources. They are a far right “think” tank. If they posted it, it’s a lie or misrepresentation.
I'm not aware of the reverse (admittedly, that would require more than just $$).
The reason to go to Mexico is price. The reason to go to the U.S. is quality.
How about for Canada vs the U.S.?
If you're a Canadian citizen, Canadian healthcare is cheaper, but generally has much longer wait times.
U.S. healthcare is much more expensive, but much more quickly available, and specialty care (e.g., rare disease treatment) is much better.
She will be able to see a psychiatrist "when one is available in the fall."
https://web.archive.org/web/20230809170345/https://www.thegl...
Getting a routine gynecological appointment for my wife any time in the next six months is impossible. I gave up on trying to get an appointment with an allergist for myself, even after getting a referral. What you describe is common in the US too, even for those with means. I cannot imagine what it is like for somebody who doesn't have money and insurance.
I wanted to get a sleep study done to get to the bottom of my occasional insomnia. My PCP at the time put in the pulmonologist referral (because this hospital network required a referral to get a sleep study done, which is insane in its own right, but that's neither here nor there).
This was in January. His next available appointment? March! For a friggin sleep study! And I have a HDHP + HSA and was going to pay full boat!
(He also prescribed me with an antipsychotic that can double as a sleep aid at low dosages, which I didn't take because five minutes of research into it made it obvious that taking that for extended periods of time is bad news bears. I stopped seeing him after that.)
(For those looking for answers like I was, I eventually stumbled upon Cognitive Behavioral Therapy for Insomnia, or CBT-I. It's essentially a rigid sliding window-style sleep schedule plus challenge therapy to make you rethink how you approach sleep. I've been doing this for six months now and it has been transformational. Best part? No meds!)
[1] Or shit, even a PCP that accepts new patients.
Really, you just engaged in deception and promulgation of propaganda intended to push people toward neofascist ideology.
Shame on you.
Went from nothing/reluctance to popular for some segments of the population
100% the same thing on this side of the pond, US healthcare isn’t special here.
To be fair, doctors are usually overworked and on a human level I understand that the system is a bit broken, but it's still infuriating when it's your health that is suffering.
It gave me a new perspective on that kind of work. From my/our point of view, I was the most important person in the room and my problems really really matter.
From the doctor or dentists POV, I'm one a long long list of people they're seeing that day. It's a health care production line, and even if they have the inclination to be equally caring about everyone - which is a rare quality, because a good medical professionals are only in it for the money - they just don't have the time.
This is not an excuse unprofessional behaviour. But it made me realise that self-advocacy works because you're asking - maybe demanding - more than the production line gives you by default.
Also, medicine is incredibly complicated. And the research is often very low quality.
And that's not taking into account Big Pharma trying to tout its products, whether or not they're suitable or effective.
The most depressing thing recently has been the professional response to Covid. In the UK countless doctors have aggressively given up masking, even in settings with immunocompromised patients.
It's really made it obvious that some doctors are just in it for the money, a good few are phoning it in, surprisingly many have quite irrational beliefs, and the caring expert professionals are much rarer than they should be.
It’s just “extraordinary”.
People have weird habits, weird diets, are exposed to weird chemicals in small amounts over extended periods of time, etc. There are all kinds of genetic factors where something can be really minor for most people and debilitating for others. There are all kinds or problems or diseases that people can have, and there can be weird combinations that interact or provide an overall confusing array of symptoms. And it's all mixed up with the patient's brain, which may be exacerbating or compensating in all kinds of ways (psychologically or through behaviors that the patient develops).
It may be because they see a wider range of illnesses and this empathy/awareness might not work well with the patients are of varying ethnicity and race but they’re pretty good if you look past the exterior - shabby offices, gruff manner.
That's with 3 different people and a handful of different doctors. They are actually pretty eager to look inside your stomach out here heheh. I'm really sorry to hear that happened to your friend though! I hope they're doing better now!
Private healthcare is basically broken out the gate, public healthcare can be much better but it still does need to be funded.
Much of Europe went wild assuming that we would always have 5 to 7 workers per person retired to care for, and I won’t be surprised if we get down to 1 to 2 in the next 50 years.
That’s a type of system collapse people aren’t prepared for.
Clearly both systems have benefits and drawbacks.
The main complaint about the UK system that people quote is "it takes a while to see a doctor" but that's true about most people here in the US as well. If you have not top-line insurance or live in a slightly rural area or a million other things.
Not sure if this practice is just shit or if all of them are. They then have the audacity to strike too. I've had absolutely zero sympathy for them since the months long ordeal of being in pain and taking pills that made me feel worse rather than better. Fucking disgraceful is what it has become.
Humans don't have a full understanding of everything, and in fact it's quite the opposite, in that we don't understand almost everything. Almost all paths are untrodden. It's fine to look where others haven't and come up with your own theories and ideas, as long as you retain a healthy skepticism and back things up with data as much as you can.
Science and exploration should not use fear of social reprisal as a guide.
Until COVID came around and unearthed the absolute hoards of dO yOuR oWn ReSeArCh imbeciles. Now the sensible practice of getting a second opinion and exploring other options/doctors has been mixed up with the kooks: extreme politics and actual conspiracy theories, to the point where it’s hard to take any of it seriously.
When someone now says they don’t trust doctors, you have to dig deeper to understand if it’s someone genuinely seeking out other options, or if it’s one of Those People who’ve gone off the deep end.
For example, Western health authorities used to be absolutely certain that viruses could not be airborne (outside of very specific medical procedures), even though they did not have any good reason or evidence to back that up: it was just an old idea that happened to fit in with their priors, so generations of experts kept parroting it until horror unfolded.
God didn’t do it
Gravity is the curvature of spacetime
Things are not attracted to the planet through static electricity
Covid is real
Vaccines work
Rich mother fuckers do NOT have our best interests at heart
Intelligent aliens have not visited earth
People are called conspiracy nuts for being conspiracy nuts. Not for “taking less trodden paths”. Getting real tired of the HNs new “wahh wahh, we’re such major victims for believing stupid shit and being called out on it!” And just trying to paint it as “less trodden paths”.
It’s impossible to take anything in your post seriously because it’s entirely conspiracy theorist copy pasta.
“I’m the victim here for daring to believe the earth is flat and we’re being lied to by the governments, who’s engaged in a massive conspiracy that’s millions of people large, and costs more than the planets gdp to keep alive so as to convince people that’s gods not real”
You’re being called a conspiracy nut because you are one. The only victims are the people in shouting dictance of the bullshit spewing from your mouth.
Similarly, I will certainly and absolutely NOT stop calling out conspiracy theorist propaganda just because conspiracy nuts don’t like it.
If you don’t like being called out for posting conspiracy propaganda, don’t post it, and don’t defend it.
So go away!
You went ham on someone sharing a comment about their son's dentists. Maybe touch grass and stop being so angry, eh? The only conspiracy 'nut' here is you, who is inserting themselves by going "look at me, look at me" at someone sharing their experience.
>I will certainly and absolutely NOT stop calling out
I feel sorry for everyone in your family who has to suffer this.
It is never used in the spirit of promoting insightful discussion.
Instead it is used to shut down a line of inquiry in its tracks. It’s like calling someone an anti-semite.
It is used as a soft form of censorship, to disqualify the mere idea of engaging in the specifics of an argument.
If someone dismisses a comment by implying it is a conspiracy instead of offering a substantive rebuttal of why the comment is mistaken, it reduces the quality of the entire community.
I think we can do better, but more people need to call out this bad behavior.
I reserve the right to dismiss low-quality posts with a low-quality answer. And yes, that's a judgement call. There is no way around that.
People get called conspiracy nuts when they make big claims with no real evidence. That is the opposite of 'science and exploration'. The difference is always evidence. Go on a conspiracy site and ask for hard evidence of anything and they will get very upset.
On the other hand, from the administrator's perspective:
"Your team of four people treat about one patient a week, why am I paying your salaries again?"
In our universe, I probably won't receive that much medical care in my lifetime.
(But I know I was lucky - my oncologist could order a river to reverse itself and it probably would.)
I don't really know how it works in the US but here in Brazil it's actually pretty easy to order laboratory tests and imaging studies. There's taxpayer funded public health care but it can't handle the demands of the entire population so people would rather pay for the ultrasound or CT scan than wait two years for the government to provide it. An ultrasound costs about $30, an MRI costs about $150 and the price of a CT scan is somewhere between those two.
Don't even get me started on diseases where we have medication that sort of works with tons of side effect where no significant progress has been made for decades. If you're alergic to the said medication or your side effects make it a no go, tough luck!
But this is true for every thing in the planet. Data modelling, computer programming, building, everything. Name something that the unusual is not more complicated and difficult to do.
Why would anyone think that it would not be true for the health field??
I think the problem is people think health is magical and everything is known. Because they choose not to educate themselves.
The problem is most doctors have absolutely no humility and will never admit to not knowing something. I don't see that behavior among engineers.
That is incredibly surprising.
Sometimes (when possible) you just reset yourself: stop all medications for some days, so that the collateral effects are gone and you're left with the original condition (aggravated, of course, because you left the one medication that was working with the 3 others that were just giving you wrong symptoms), and then another "expert" begins from the "start".
The practice of medicine is not science. The practice of medicine can be informed by science - to a degree that is almost entirely up to the practitioner. ; but it remains more art than science. The distinction is similar to that between an aviation maintenance and aerospace engineering.
Sometimes doctors are just out of their depth.
Which is which though? As I understand it, aviation maintenance is quite rigorous, systematic, and informed by and taking into account every mistake made in the past.
When you compare their behaviors to IT it all starts making sense.
Honestly of all the professions that could be enhanced by AI, medicine has the most to gain. An AI can remember a much larger data set than any human and look for correlations among many more dimensions.
They are so unreasonably effective for being, fundamentally, word predictors.
As do I.
a lot of the 'magic' around being human evaporates when you have to quantify the 'worth' of any particular organ
untangling this closed-source blob always reveals secrets: 2023 just had an update to anatomy! https://www.urmc.rochester.edu/news/story/newly-discovered-a...
Hopefully medical science will keep advancing rapidly here..
I’m hoping AI systems can help. A good medical AI should be able to stay abreast of all the research, know your personal medical history and suggest and evaluate any and all medical tests that are needed. Doctors will hate it, but I expect AIs will give much more accurate diagnoses than humans before long.
It's a really ideal use case for AI - not only figuring these things out but also doing things like clinical trial and research matching.
In neurology at least, I think a lot of the problem is that everyone is hyper-specialized. Luckily for us, my wife's insurance company convinced a generalist neurologist to come out of retirement and examine her, which put us on the path to effective treatment. But yes, that whole experience completely soured me on blind trust in the medical profession
Doctors tend to believe that female patients exaggerate pain in comparison to male patients, in accordance with stereotypes that portray men as "stoic" and women as "emotional". The bias is systemic, with female doctors often assuming the stereotype too[1].
You can trace this bias back through medical literature which (often subconsciously) reiterates these stereotypes[2]. It shows up in many statistics, such as the difference in wait times for analgesics: women reporting pain had to wait an average of 30% longer than men.[3]
But a key cause of the problem is worse than just assumption of stereotypes: it's that modern medicine still knows far more about men than it does women. For centuries, the primary medical research and literature was done by men, about men, for the treatment of men. Most of the clinical trials performed in the 20th century enrolled far fewer women than men, and often _none at all_.[4]
Of course, gender is not the only bias that shows up in medicine. Age, race, (dis)ability, body shape, and economic/social status are all useful factors to keep in mind when considering why certain people, even entire sectors of society, aren't getting the treatment they should.
- [1] https://www.dovepress.com/the-roles-of-gender-and-profession... - [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845507/ - [3] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1553-2712... - [4] https://www.theguardian.com/lifeandstyle/2019/nov/13/the-fem...
But to be honest: There are also some motivated and honest doctors. If you find one of these, stick to them.
Also the very standard cases, they can mess up very badly.
"The system is at the same time incredible and awful."
The science behind the medicine is awesome, but the standard implementation is horrible and not up to at all, where we could be.
1. Don't mouthbreathe and don't overbreathe. See "Breath - The New Science of A Lost Art" by James Nestor for why and how.
2. Don't eat sugar, it's a chronic poison. See https://www.youtube.com/watch?v=dBnniua6-oM
3. Min. 1 hr of physical activity per day. Your body is not meant to sit all the time.
4. Avoid noise of the city life as much as you can. It leads to chronic stress and thus chronic diseases. Noise-cancelling earphones may help.
Ask anybody who’s experienced a “chronic” illness about the “experts” and they’ll tell you a tale or two. The experts are great until they have a case that is unusual. The don’t have the time or knowledge to treat you properly. You get passed from “expert” to “expert” each time having your hopes dashed. You start feeling like a conspiracy nut chatting with other patients online sharing what’s anecdotally helped. After running into this issue more than once I’ve lost all blind trust in medical experts. I’ll verify what they tell me as best I can and get second opinions if necessary. In one case I was passed up the chain of experts until I finally found the right one myself after a year, and it still blows my mind that this wasn’t the first referral. The system is at the same time incredible and awful.