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by phobosanomaly 2087 days ago
I think it's a great story, and provides a lot of points to think about. I only question the way you think of the physician's role. I think arrogance is not exactly what's going on here.

Confusion, dizziness, lightheadedness are tremendously vague symptoms, and the workup for dizziness alone is extensive.

Put yourself in the doctor's shoes. Here is an article from the American Academy of Family Physicians on how to work-up a patient who presents with dizziness.

https://www.aafp.org/afp/2017/0201/p154.html

It's not that simple, and there are lots, and lots of things that could be going on. How do you know for sure that your symptoms were caused by Vitamin D? I don't see any evidence that confusion, dizziness, lightheadedness are common presenting symptoms of vitamin D deficiency at all. According to the Cleveland Clinic, those aren't presenting symptoms of Vitamin D deficiency. Therefore, an AI wouldn't be any more likely to catch it than a real person.

https://my.clevelandclinic.org/health/articles/15050-vitamin...

There's nothing in your comment that makes me think your symptoms weren't caused by Carbon Monoxide poisoning from running a heater in your less-than-sunny place of residence. Or maybe it's eye-strain from sitting inside staring at a computer too long. Or neck issues from sitting at a computer for too long. Or maybe you really were dehydrated, and for some reason you drink more fluids in your home country. Maybe you're smoking too much weed. Or maybe you're depressed by being away from home. Or maybe you were doing a lot of cocaine and didn't mention it. Maybe you had a stroke. Or you have early-onset dementia, or sleep apnea, or a psychological problem, or an aneurysm, or any one of a million things.

Medicine is hard. There are a lot of variables. The human body and its environment isn't a perfectly-reducible system you can step-through in an IDE. The only point I'm trying to make is that doctors are trying to figure out exactly what is going on inside of an incredibly complex system that is heavily influenced by the external environment, and they can't always conjure up a precise answer immediately.

1 comments

Arrogance because the GP, neuro and cardio all made completely different diagnoses (conveniently from within their field of expertise) based on 15 minute visits and prescribed non-trivial medications. Putting a 24-year old on beta blockers, topamax, cipro and a couple more I had to stop on day 2, just to see if that fixes it, sends you down a spiral of side effects that make the original symptom far murkier.

Even if the algorithmic approach is accurate for 80% of cases, the suggestions it gives you for the 20% makes treatment extremely frustrating. If you are in those 20% then treatment by an experienced, more fluid doctor is night and day. Unfortunately, there seem to be fewer of those in the US than in other countries, probably because of litigation risk you mentioned before.

I think you have a really, valid point and part of that is also probably a consequence of the structure of the healthcare system itself:

"Although the United States is renowned for its leadership in biomedical research, its cutting-edge medical technology, and its hospitals and specialists, problems with ensuring Americans’ access to the system and providing quality care have been a long-standing concern of policy makers and the public (Berwick et al., 2008; Brook, 2011b; Fineberg, 2012). Higher mortality rates from diseases, and even from transportation-related injuries and homicides, may be traceable in part to failings in the health care system."

National Research Council (US); Institute of Medicine (US); Woolf SH, Aron L, editors. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Washington (DC): National Academies Press (US); 2013. 4, Public Health and Medical Care Systems. Available from: https://www.ncbi.nlm.nih.gov/books/NBK154484/

We're much better at moonshots, that just keeping most folks healthy.