[RScholar]

Maybe I'm just getting old, but my reaction to this article had nothing to do with LLMs but was instead that this is an indictment of the state of medicine in America. At each diagnostic milestone it seemed obvious that the conclusion didn't adequately explain the totality of the boy's condition and the search needed to continue for the real culprit. Instead it seems like each one of these diagnosticians felt they'd found the "real problem" and pushed ahead with treatment as such.

Now I'm not saying that back in the day all doctors were Gregory House or holders of forgotten knowledge, but I have to think that the lower pressure to make medicine behave like a business and deeper ties one would form with their patients would've benefitted this family. For this to have gone on for three years without getting escalated to the attention of one of the real-life Dr. Houses out there is appalling. I feel like ChatGPT got the answer right because it allowed her to input all of the minor observations from the charts; perhaps had the doctors done likewise they'd have connected the dots as well.

When I was growing up and in my early 20s you went to the doctor and they got you talking about your life, teasing out the observations you had on your own life and addressed things from there. Then about 15 years ago everything changed and doctor visits became this twisted form of speed dating where you never see the same person twice and any question or answer that takes longer than ten seconds to express is taboo. I hate it, and I can't believe that we keep moving along like it's acceptable.

[wyldfire]

> Instead it seems like each one of these diagnosticians felt they'd found the "real problem" and pushed ahead with treatment as such.

More likely that they heard hoofbeats and were content to use the effectiveness of their treatment plan as another diagnostic signal.

> When I was growing up and in my early 20s you went to the doctor and they got you talking about your life, teasing out the observations you had on your own life and addressed things from there

The history and physical are a critical part of every exam. But much less so at an urgent care where they intentionally disavow long term health to focus explicitly on acute issues.

[Ekaros]

Actually how things usually worked out in House is likely realistic. I'm not talking about the simple cases, but main cases in the show. Which took multiple false starts and wrong treatments to get to final conclusion. In non-critical cases patient is either dead or it will take months or years.

[Xyem]

Not just the US. Here in the UK, I recently went to a follow-up appointment regarding a non-healing ulcer and the NHS doctor took the dressing off and said "It is healed" despite the fact that:

1) the ulcer is deep enough that you can see the muscle below the skin fat layer (she said it no longer needed dressing!)

2) it has looked that way with nearly no change at all for nearly 3 months[1] (expected heal time is roughly 7 weeks)

3) there is a large area around the wound that is still red and inflamed (ulcers are not even regarded as healing until the inflammation is gone)

I've had to go for private care and I am currently scheduled in for minor surgery to see if a foreign object caused the ulcer and is still present, preventing it from healing. Probably no surprise to you, dear reader, that I am pursuing a case of medical negligence against the doctor.

[1] When I pointed this out to her, she said she "didn't have a crystal ball, so [she doesn't] know what will happen in the next week or month". Literally nonsense due to being a non-sequitur. I was informing about the past, not asking about the future.

[drewcoo]

Go back further when there were family doctors who knew generations of their patients' families and that's my memory as a kid. When I was in grade school, Doc Carpenter mentioned treating family members I'd never met because they were 3 generations older!

It was shocking to me that I heard about family mythos from my kindly old doctor. Luckily it was followed up with a lollipop to soothe me.

[corethree]

It stems from low supply of doctors. There aren't enough doctors because if there were more doctors they'd make less money.

[salawat]

More like hospitals refuse to self-fund residency slots. It's pretty bad when the number of doctors entering practice is fundamentally gated by residency positions funded by Congress.

[corethree]

https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope...

The lack of residency positions is the result of lobbying by the AMA. What it the American medical association?

In there words:

"The American Medical Association, founded in 1847, represents more than 190 state societies and medical specialty associations, including internal medicine, family physicians, obstetricians and gynecologists, pediatric and emergency medicine. The AMA is the largest association of physicians—both MDs and DOs—and medical students in the U.S. Our mission is to “promote the art and science of medicine and the betterment of public health.”

It's a doctors old boys club and you can join if you're a doctor.

Here's more evidence:

https://med.fsu.edu/sites/default/files/news-publications/pr...

The low supply of doctors is not a free market phenomenon. It is the result of deliberate cartel policies of the AMA for self interest.

Keep in mind an over supply of doctors is generally a good thing for society. Not a good thing for doctors who want to be super rich.

[moribvndvs]

I’m more inclined to go with the fact that medical school is extremely expensive and the process is long, laborious, and difficult but sure, ok.

[corethree]

Doesn't explain why medical costs and doctor salaries in the US are the highest in the entire freaking world and the quality of care is lowest among 1st world countries.

Don't go with your inclination. Go with evidence and logic.

I posted a reply to another person with this:

https://news.ycombinator.com/item?id=37476974

It's not well known but the root cause is cartel like policies of the AMA. Becoming a doctor (only in the US) is one of the most gate-kept professions in the world.

[moribvndvs]

I’m not white-knighting for-profit healthcare in the US, but making unqualified conspiratorial comments naturally raises suspicion. You could have lead with this, especially if it’s not well known. I can admit I only had part of the picture; high cost and length of training is a factor, but I’ll buy that it’s a symptom of deliberate manipulation. Thanks for the links.

[corethree]

Generally very knowledgeable people know about this stuff. Give it 40-60 percent of the crowd on HN. I assumed that there was enough people who know about it to just say it outright.

Still not something I would call well-known though.

This country has plenty of stuff going on that falls into the "conspiracy category" but we now know is definitively true. Plenty. Everything Snowden revealed, the fact that the bush administration manufactured the evidence to push the entire country to go to war with Iraq. Plenty. I wouldn't turn my nose away when someone says something that seems "conspiratorial" given how much shit out there that has been verified definitively.

I get it though, stuff like area 51 captured UFOs will inevitably raise an eyebrow... it's hard to tell what's real and what's crackpot bs.

[anon-3988]

Not sure how increasing the supply of doctors would help in this case? If doctors begin to earn way less money than they do now then that would create an incentive to find ways to make money, whereby increasing the amount of deceptive practices of pushing certain medicines/medical procedures to prop up sales and not cure diseases.

I personally think money have no business (pun intended) in medicine. I would go as far as say that if a trillionaire parent have a sick child that have a disease that requires 1 trillion dollar to cure, the procedure should not go through and that is immoral. Which is to say that at a governmental/societal level, yes, money should absolutely be considered and allocations should be discussed. But when it comes to each individuals, money shouldn't be considered at all.

[corethree]

>Not sure how increasing the supply of doctors would help in this case? If doctors begin to earn way less money than they do now then that would create an incentive to find ways to make money, whereby increasing the amount of deceptive practices of pushing certain medicines/medical procedures to prop up sales and not cure diseases.

You don't increase it to the point of desperation where they resort to malpractice. You increase the supply until the cost and supply becomes inline with other 1st world countries where Doctors have reasonable salaries.

Additionally the low quality of care in the US actually comes from overwork. Doctors are inundated with patients and no amount of money can increase the productivity a single person. To do work effectively the industry actually needs more people.

The overabundance of patients is what's causing the apathy the GP is witnessing above. It's easy for a doctor to feel empathy and deliver quality care for a low number of patients. For 400 patients a day? They could give a shit. Pretty soon they become desensitized and the whole thing becomes a numbers game.

[satvikpendem]

I don't necessarily understand your example, is it not more moral to let the child live than to have them die, regardless of the amount of money it takes, and is that not also making your point about not needing to consider money when trying to cure someone?

[ilyacooks]

Unfortunately it’s the same in other healthcare systems - in public UK healthcare you have 10 mins appointments with doctors from history to diagnosis to treatment plan