[borroka]

"On your doctor take, you do know that the other author of this post is a licensed and practicing Physician, right?" --

Your observation is indeed much more interesting than the whole article, since it shows a reasonable (and not a caricature with zero value) heuristic. You are saying that I (who may or may not be a physician, but for argument's sake let's say I am not) should not have an opinion that is different, when discussing the behavior of doctors, from the opinion expressed by a licensed and practicing physician. Valuable heuristic?

As for the article itself, my problem with is was not on the problems that reasonable heuristic can generate, but with the useless caricatures.

A doctor who does not visit any patient and simply gives aways a couple of aspirins, is criminally negligent. A doctor who does not call for an MRI for any common symptoms (think headache) that may have been caused, among many other possible causes (dehydration, stress, tension etc.), also by something much more serious (brain cancer) is using a reasonable heuristic, which sometimes may go wrong because for very aggressive cancers, a couple of weeks of delay in starting treatment or having surgery can make the difference between life and death.

A personal case. I went to a doctor with a dermatitis and the doctor recommended, guess what?, a topical steroid cream, which is recommended by dermatologist like a barber recommends a haircut. The heuristic is, dermatitis of unclear origins --> let's try a steroid cream. After I did a bit of research on my own (5 minutes, maybe less), I found out that for my conditions the steroid cream should be absolutely avoided since it makes the condition worse. The question is and I let you choose the answer: (1) was the doctor using a reasonable heuristic?; (2) was the doctor incompetent and/or an idiot; (3) was the doctor negligent (there is some overlap with (2))? Should I wait for the opinion of a "licensed and practicing Physician" or I can have my opinion?

[xelxebar]

Perhaps it could be more helpful to think of the caricatures as "spherical cow" models the author is using when trying to isolate and illustrate a particular social (?) dynamic.

Of course real-world models will be much more nuanced, but the really interesting bit is that you don't need all that nuance to produce the particular pathology outlined in the article. Specifically, selecting on "who is most right most of the time?" can end up causing your city to be covered in lava, missing a store break-in, or what-not.

There are even more levels to explore with this idea. For example, should you always ignore the heuristics and go for the earest, honest experts? Maybe. In the volcano example, the cost of a false negative is so high that you probably are okay with the incurred costs of false positives by the experts.

However, in the case of the Futurist, the false-positives incurred for a non-rock opinion might end up netting you less karma points or whatever. It's somewhat fun doing a re-read trying to evaluate the cost-benefit tradeoff yourself in each case!

[fastball]

I'm confused. You say it's a bad caricature, then provide an anecdotal example that seems to closely match the caricature.

[didibus]

I think OPs point is that the article ignores the reason why the heuristic is used in the first place, which is to optimize the process at scale.

The real cost of gathering additional data and knowledge about the circumstances in the 0.01% chance you know that you have at this point, at scale, means you'll end up with worse overall outcome by not being able to scale to all events that need the attention.

Now, if a doctor is just being lazy, doesn't check anything, says you'll be fine take Tylenol and then spends the next half hour reading a book until the next appointment. Or simply wants to go through twice as many patients to make more money. Ya sure, that's just being lazy and useless, and negligent, replace them by a rock at that point.

But if there are 100 people with initial symptoms, and only 1 doctor. And the deep dive to properly asses the likelihood of a 0.01% chance event in the case of symptom: "My hip hurts when I walk" takes multiple hours, a lab test, many follow ups, etc. While this happens and maybe out of the 100 patients waiting, some have symptoms like: "I'm actively bleeding out my mouth.". "I have spores on my skin." "I'm in so much pain I can't fall asleep." All with known much higher likelihood of something pretty bad and urgent.

That's why triage is so important. And this use of the heuristic at scale might make sense when considering the cost/time and available resources trade off.

At the individual level, it means eventually someone will get shafted by this, they'll be sent home with Tylenol, and 3 days later will have a stroke and it would have turned out they are the really rare case where hip pain could indicate a risk of stroke due to say a blood cloth.

But at a larger scale, many more people will have received the treatment they needed more urgently.

[jvanderbot]

I agree: Null-confirming signals should not be considered evidence to discard the null hypothesis. Decision trees are OK, esp those that have "wait and see" near the root. "See if it goes away" is indeed an information-seeking behavior, and a low-cost one at that.

[thatjoeoverthr]

In other words, your doctor could have been losslessly replaced with a rock that says “apply a steroid cream”, and that heuristic would have harmed you.

[coldtea]

If it had benefited thousands of others, does it matter in the larger view?

The naive alternative is the doctor always spending time to get to more nuanced advice, that will be more often than (every time the rock was as good) a waste of resources (time/money/opportunity cost), and which in a lot of cases would also be more harmful (iatrogenic harm) than the rock advice.

"But, why 'always'? It's enough that the doctor goes for more nuance when he sees a reason to!", you'll say.

Well, that's what doctors actually do. They are not glorified rocks, they are bimodal (rock mode vs looking deeper mode) - and they're most rock because (even if the miss a few 'loop deeper' cases) because it's way more efficient than the alternative (always or mostly non-rock, that is, digging deeper without first seeing strong indications that they should dig deeper).