[arpyzo]

My experience with western medicine has been very black and white. Either you're completely broken and it's so obvious what's wrong with you that you barely need a doctor, or you're partially broken in which case doctors know very little and rely on experience, murky clues, and their gut.

This made sense once I realized doctors know much less about the human body then they pretend to. Not only is our understanding of physical health far less "advanced" than advertised, but the system is far too complex for any one doctor to comprehend. Medicine is far from the only field in which this is the case.

Computers have become too complex for any one engineer to understand in full. Leadership has always had this quality. These are fairly obvious, but I wonder if most (all?) domains of life share this. Consider the recent discovery that the varnish used on Stradivarius violins gave them their amazing sound. Hundreds of years ago, this was almost certainly discovered through luck or intuition.

In contrast to the author, I find joy in this. Not only does it reveal boundless territory waiting to be explored and discovered, but it gives meaning and purpose to being human since no technology comes close, or perhaps will ever come close, to matching the extraordinary abilities of human intuition.

[specialist]

I think of Western doctoring (diagnosis) as running an expert system. Like a game of twenty questions. If your specific conditions aren't found in your doctor's knowledge base, too bad. Maybe try another doctor, who has different experiences, different training.

I've been lucky in that two of my doctors treated my rare conditions as mysteries, puzzles to be solved. Not much like House MD, which requires an explicit explanation. But more like "Hmmm. That didn't work. Let's try this other thing I've been reading about." Instead of summarily dismissing my experience because there was not "hit" in their knowledge base.

FWIW, in the USA, at least, the combo of fee-for-service and compensation model discourages sleuthing. (But does encourage more testing, ironically.) IMHO.

[maeil]

> I've been lucky in that two of my doctors treated my rare conditions as mysteries, puzzles to be solved. Not much like House MD, which requires an explicit explanation. But more like "Hmmm. That didn't work. Let's try this other thing I've been reading about." Instead of summarily dismissing my experience because there was not "hit" in their knowledge base.

My current goal in life is to save up enough that I can afford paying a private doctor to treat my chronic condition in exactly this way. Possibly in India or another place where it won't run into many hundreds of thousands of dollars. I still have no idea how I'm going to try and find one but your description has put it into words so aptly that I'm going to take it a8nnd run with it.

My condition has left me unable to use any kind of keyboard-like device except for MacBooks and any kind of mouse-like device with physical buttons (i.e. not trackpad). Using anything else hurts both my finger joints and wrist to the point that within minutes I need to stop using them. Yet with all the doctors I've seen here it's the same; 1. Do the scans and test 2. "Well we can see some inflammation in the wrist, you need to rest more. Here, we'll prescribe some NSAIDs.". Completely ignoring the absurdity of the suggestions given that it happens within minutes and having tried resetting things completely by disavowing keyboards/mouses for a few months to little effect when resuming usage.

> FWIW, in the USA, at least, the combo of fee-for-service and compensation model discourages sleuthing. (But does encourage more testing, ironically.) IMHO.

While that may be the case, I think you're still more likely to find a doctor willing to sleuth in the US than anywhere else. The cultural factor having an even bigger impact than the profit model. Having spent many years in both East-Asia and Western-Europe, each of them have cultural factors working very strongly against it even if their compensation models should be more favorable. For the former, a big aversion against debate/answer searching in general and particularly questioning an authority while doctors are as big as an authority as you can get, ranked at the very top of the hierarchy. For the latter, a big distrust of patients and high degree of expected "self-reliance".

[mannykannot]

> In contrast to the author, I find joy in this.

As the author had a serious and mysterious chronic condition, I can understand her take on this.

[objetovoador]

> Either you're completely broken and it's so obvious what's wrong with you that you barely need a doctor, or you're partially broken in which case doctors know very little and rely on experience, murky clues, and their gut.

> This made sense once I realized doctors know much less about the human body then they pretend to.

I find myself agreeing with this so strongly. Couldn't have put it better myself.

Further - I've suffered way worse harm relying on the medical system than the disease (mycoplasma genitalium infection) I had to arduously & painstakingly diagnose on my own (and even treatment was botched by my doctor, I had to insist that I be treated with the CDC recommendation as opposed to his outdated prescription).

I don't mean to say they're useless, far from it. In acute care they're the best we've got and they often perform miracles, but for chronic issues (by definition something medicine doesn't have the capability to fix) it's so often a horrible situation.

And there's such a strong force to silence criticism of the system.

[alexvoda]

> And there's such a strong force to silence criticism of the system

This is partly because public discourse is incapable of nuance and because often those criticizing are in fact much much worse than the system being criticized.

In the early years of the internet, we naively believed the interconnectedness of the internet would solve such things. Good will, honesty, and, proper information hygiene do not scale.

[objetovoador]

> Good will, honesty, and, proper information hygiene do not scale

What does that say about "democracy" and collectivist politics more broadly?

[alexvoda]

About democracy it says that it works. Democracy does not rely on good will or on honesty, it relies on self interest.

Meanwhile, information hygiene is threat to democracy. A democracy is a careful balance, which in turn mitigates the worst outcomes of all alternatives.

As for the second part of your question, you will have to be more specific.

[maeil]

> Not only is our understanding of physical health far less "advanced" than advertised, but the system is far too complex for any one doctor to comprehend. Medicine is far from the only field in which this is the case.

This last part, along with (from a comment elsewhere)

> [...] many doctors being terrible at statistics and failure to properly use statistics means they constantly overlook otherwise obvious causes.

means this area should be the one with dozens of AI startups chomping at the bit to improve the situation. I.e. giving suggestions for possible causes of rare medical issues. Because the existing human performance in these situations is so incredibly low mostly due to the exact things that ML models excel at, it should be very easy to at least to improve on that. If it's not happening because of US regulations against "medical advice", then base it in India or wherever it'll work. I guess that makes venture funding and profitability more difficult but if you're looking to do good, this avenue has unfathomably more potential for massive positive impact than e.g. taking a job at a traditional existing non-profit. I reckon it should also be very possible to get funding from exactly such non-profits, especially those aimed at rare medical conditions. Effective altruism-oriented groups should also be interested.

If the issue is the unobtainability of data due to privacy laws, even a ChatGPT-like model trained purely on Google Scholar, medical literature and other relevant sources has enormous potential and again should readily outperform the baseline.

[tpoacher]

I would find joy too if it weren't the case that the same clueless professionals act as gatekeepers.

It becomes less comical when you find yourself needing to convey to a buffoon who thinks they're the beez kneez that they're full of shit and should be looking stuff up instead of guessing.

Speaking as a former doctor who's had way too many encounters of the sort, both before and since leaving medicine.