[tptacek]

All the consulting practice arguments aside, this is fundamentally a gatekeeping argument about clients staying in their lane. I'm sure doctors feel the same way about patients with weirdly specific questions about HFpEF diagnoses. Doctors have always hated "Doctor Google", and now they have to contend with "Doctor GPT". It's up to you how much sympathy to have for them.

[satvikpendem]

Not related to other types of clients, but for doctors and patients specifically, I have heard stories where doctors dismissed patients' concerns until the patients themselves googled and found out exactly what issue they had and then the doctors were much more amenable to solving it [0].

Indeed, [1]

> researchers found that searching symptoms online modestly boosted patients’ ability to accurately diagnose health issues without increasing their anxiety or misleading them to seek care inappropriately [...] the results of this survey study challenge the common belief among clinicians and policy-makers that using the Internet to search for health information is harmful.

[0] https://www.cbc.ca/radio/whitecoat/man-googles-rash-discover...

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8084564/

[goosejuice]

It's not at all difficult for a scientifically literate person to be more up to date on the literature of something they have, or could have, than even a specialist in that broad area. There's too many disorders and not enough time.

I have something that about a quarter percent of individuals have in the US. A young specialist would know how to treat based on guidelines but beyond that there's little benefit in keeping up to date with the latest research unless it's a special interest for them (unlikely).

Good physicans are willing to read what their patients send them and adjust the care accordingly. Prevention in particular is problematic in the US. Informed patients will have better outcomes.

[bunderbunder]

My PCP and I have a really good rapport, and so when I stated having weird confusing health problems they were quite happy to hear what I was finding in PubMed and then share their thoughts on it, and together we figured things out and got my situation handled. I thought it was a nicely complementary situation: they didn’t have the time to do a literature dive, and I didn’t have the expertise to fully understand what I was reading.

But I bet what happens more often is patients showing up with random unsubstantiated crap they found on Reddit or a content farm, and I can understand health care providers getting worn down by that sort of thing. I have a family member who believed he had Morgellon’s Disease, and talking to him about it was exhausting.

[zahlman]

> Morgellons (/mɔːrˈɡɛlənz/) is the informal name of a self-diagnosed, scientifically unsubstantiated skin condition in which individuals have sores that they believe contain fibrous material.[1][2] Morgellons is not well understood, but the general medical consensus is that it is a form of delusional parasitosis,[3] on the psychiatric spectrum.[4]

Your family member... mistakenly believed that he had a psychiatric condition involving a mistaken belief?

[bunderbunder]

No, he believed he had Technicolor skin parasites. Suggesting it might be a psychiatric condition was a good way to start a nasty fight.

[DANmode]

I’ve observed people in this “community” from a distance.

Does your family member have the sores?

[kukkeliskuu]

I think this is similar in other fields, and appears to be related to your self-esteem. Some junior (and sometimes even senior) developers may have hard time accepting improvements on their design and code. If you are identified with your code, you may be unwilling to listen to suggestions from others. If you are confident, you will happily accept and consider suggestions from others and are able to admit that anything can be improved, and others can give you valuable insight.

Similarly, it appears that some doctors are willing to accept that they have limited amount of time to learn about specific topics, and that a research-oriented and intelligent patient very interested in few topics can easily know more about it. In such a case a conducive mutual learning experience may happen.

One doctor told me that what he is offering is statistical advice, because some diseases may be very rare and so it makes sense to rule out more common diseases first.

Other doctors may become defensive, if they have the idea that the doctor has the authority and patients should just accept that.

[Groxx]

which includes me / my parents, though we found a thankfully excellent primary care doctor while I was growing up who took the new information in stride and chased promising paths we managed to find. we learned a lot from each other in the process.

doctors don't generally have the time or inclination to spend unpaid time doing specialized research for one of their many patients. competent layman efforts are generally huge wastes of time compared to asking a specialist, but in the absence of a specialist they can still be extremely useful, and specialists don't know everything either. plus there aren't always specialists, whether affordable/accessible or sometimes existent at all.

[rafaelmn]

I don't think the analogy holds up at all. A doctor usually has a very small time window to deal with your problem and then switches to the next patient.

If I'm working on your project I'm usually dedicated to it 8 hours a day for months.

I do agree this is not new, I had clients with some development experience come up with off the cuff suggestions that just waste everyone's time and are really disrespectful (like how bad at my job do you think I am if you think I didn't try the obvious approach you came up with while listening to the problem). But AI is going to make this much worse.

[qsort]

As someone who does consulting, it's more about the attitude than the tool itself. Clients trying to understand the problem by themselves with whatever tools they can use are generally well-disposed and easy to work with. Those who email you stuff like "Why don't you have chatgpt do this???" as if it's a revolutionary thought are mostly a PITA. I assume doctors feel largely the same.

[tptacek]

I feel like my consulting bona fides are also pretty strong, and while I get how annoying this must feel, it's hard for me personally to be irritated either at clients or at frontier models for enabling clients to do this.

To me it's more like the board, in some small way, being shaken up, and what I mostly see is an opportunity for consultancies to excel at interfacing with clients who come to them with LLM code and LLM-generated ideas.

[qsort]

Sure, that's a great point. If the LLM code/ideas they come with are actually valuable, they tend to fall into the first bucket though.

I'm not saying we need to dismiss people for using LLMs at all, for better or for worse we live in a world where LLMs are here to stay. The annoying people would have found a way to be annoying even without AI, I'm sure.

[bitwize]

My doctor actually appreciates that I go to primary and other reliable sources, read up on my conditions, and understand the standard of care and other appropriate courses of action. What he can't stand is people who "do their own research" on, like, InfoWars.

I treat my doctor as a subject matter expert/collaborator, which means that if I come to him with (for example) "what if it's lupus?" and he says "it's probably not lupus", I usually let the matter drop.

[Calavar]

I think you hit the nail on the head with the analogy to Doctor GPT, but I think you missed it with gatekeeping. I don't think it's about gatekeeping at all.

A freelance developer (or a doctor) is familiar with working within a particular framework and process flow. For any new feature, you start by generating user stories, work out a high level architecure, think about about how to integrate that into your existing codebase, and then write the code. It's mostly a unidirectional flow.

When the client starts giving you code, it turns into a bidirectional flow. You can't just copy/paste the code and call it done. You have to go in the reverse direction: read the code to parse out what the high level architecture is, which user stories it implements and which it does not. After that you have to go back in the forward direction to actually adapt and integrate the code. The client thinks they've made the developer's job easier, but they've actually doubled the cognitive load. This is stressful and frustrating for the developer.

[goosejuice]

> This is stressful and frustrating for the developer.

Charge more and/or set expectations up front.

[fetztfetzig]

There is a big difference between a client that thinks for themself, researches and challenges a professionals assesment or a client that wants to dictate or participate in the implementation process. In case of medical services we would talk about a patient that wants to do the operation...