[escape_goat]

I do not think it true that it goes "both ways." Patients do not have a collective responsibility to doctors. Patients should not go untreated because other patients lie about their addictions. Being a doctor means exactly watching dozens of horses go in and out the door each day and saying "that's a zebra" before the zebra makes it to the exit. There's a fundamental responsibility to perform differential rather than normative diagnosis.

[s1artibartfast]

Patients do not have a collective responsibility to doctors, but I dont think doctors have the responsibility to provide a diagnosis at all.

I think people have strange and exaggerated expectations.

You don't go to a car mechanic and expect them to have all the answers and perfect accuracy. The expectation is that they will take a look and provide their fallible opinion.

[ok_dad]

Doctors should be held to higher standards than auto mechanics.

[nradov]

What standard of care are you proposing? Please be specific.

Auto mechanics frequently misdiagnose problems, especially those caused by electrical or software faults. But in the worst case they can usually just keep following the manufacturer's service manual and replacing parts in a trial-and-error process until the vehicle works again.

The human body is orders of magnitude more complex and there is no service manual. We have a few evidence-based medicine clinical practice guidelines but those cover only the simplest of cases. For anything more complex, physicians have to fall back on theory, intuition, and experience. It's not surprising that they sometimes get it wrong. And sometimes there's just no way to make a definitive diagnosis for the root cause of a patient's complaints and so treatment is necessarily symptomatic; this can be tough for patients to accept. I'm not trying to defend clinicians who make preventable errors or dismiss legitimate patient concerns but we need to be realistic about what is achievable given the current limited state of medical knowledge.

[ok_dad]

The standard here was the doctor didn’t listen to the woman. He could easily have found she was lying or not with a simple overnight visit to the hospital. Put her in there for one night, see she’s not drinking but still drunk, and that’s it. Instead, she suffered for ages.

Listening is a simple standard. Doctors don’t listen because they don’t care further than getting more patients through the door faster.

If I tell my mechanic there is a problem with the steering, he’s not going to change the oil and send my car out, he’ll check the fucking steering.

[s1artibartfast]

Did the woman come in and say "I have auto-brewery syndrome, and I want you to test me for it"?

If so, then the comparison is off. It isnt that the doctors "didn't listen", it is that they didn't correctly deduce a 1 in a million cause, based on the information they had.

[ok_dad]

She came in, the doctor asked if she had drunk alcohol, she says no, what more is there to understand? This doctor didn’t listen. If he had, even if he didn’t know about this specific disease, he could have started tests and brought in other doctors. Instead, suffering. Not hard to understand. Doctors don’t listen.

[s1artibartfast]

You can make up whatever standard you want, but it will fail when an impossible expectation collides with reality.

Reality is messy, and optimal care has a non-zero failure rate.

[ok_dad]

My standard is that doctors listen to patients, which they don’t do because they don’t respect them. They think they’re all knowing, incapable of mistakes, and let their personal biases rule. Every doctor I’ve been to has struggled to listen.

Listening is not an impossible standard.

[s1artibartfast]

I have never expereinced a doctor that doesnt listen to their patient. However most dont take everything the patient says at face value.

Processing, weighing, and interpreting what patients say is a fundamental part of their job. Sifting through crappy data and figuring out what is relevant.

You are paying them for their personal biases.

[ok_dad]

“I haven’t drank alcohol.”

The doctors interpretation:

“She’s clearly a drunk.”

Like I said elsewhere, a night in the hospital would have solved this immediately, but the doctor was unable to get past their own bias.

[adamomada]

Do you think it might sound similar to someone clueless about cars discussing an engine issue with their mechanic?

[ok_dad]

No, cars are not able to talk to the mechanic to tell them where it hurts.

[TillE]

If a particular doctor is clueless, that's what referrals are for. You don't just shrug and move on.

[azinman2]

When there are single digits for the number of people experiencing this, and many digits for those who are alcoholics, you cannot expect anything but Occam’s razor.

[s1artibartfast]

Exactly, that is where patient responsibility for their own care comes into play.