[Rebuff5007]

I've heard a lot of such anecdotes. I'm not saying its ill-intentioned, but the skeptic in me is cautious that this is the type of reasoning which propels the anti-vax movement.

I wish / hope the medical community will address stories like this before people lose trust in them entirely. How frequent are mis-diagnosis like this? How often is "user research" helping or hurting the process of getting good health outcomes? Are there medical boards that are sending PSAs to help doctors improve common mis-diagnosis? Whats the role of LLMs in all of this?

[jtbayly]

I think the ultimate answer is that people must take responsibility for their own health and that of their children and loved ones. That includes research and double-checking your doctors. True, the result is that a good number of people will be convinced they have something (eg. autism) that they don't. But the anecdotes are piled up into giant mountains at this point. A good number of people in my family have had at least one doctor that has been useless in dealing with a particular problem. It required trying to figure out what was wrong, then finding a doctor that could help before there were correct diagnoses and treatments.

[ethbr1]

Patients should always advocate for their own care.

This includes researching their own condition, looking into alternate diagnoses/treatments, discussing them with a physician, and potentially getting a second opinion.

Especially the second opinion. There are good and bad physicians everywhere.

But advocating also does not mean ignoring a physician's response. If they say it's unlikely to be X because of Y, consider what they're saying!

Physicians are working from a deep well of experience in treating the most frequent problems, and some will be more or less curious about alternate hypotheses.

When it comes down to it, House-style medical mysteries are mysteries because they're uncommon. For every "doc missed Lyme disease" story there are many more "it's just flu."

[qiine]

> Patients should always advocate for their own care. This includes researching their own condition

I believe you do not fully appreciate how long and exhausting this is especially when sick...

[pardon_me]

Nothing he stated suggests this. Not giving a nod to how difficult it is doesn't mean people don't care. Unfortunately it is still true, we all have to advocate for our own care and pay attention to ourselves. The fact that this negatively affects the people who need the most care and attention is a harrowing part of humanity we often gloss over.

[ethbr1]

A boxing referee says "Protect yourself at all times."

They do this not because it isn't their job to protect fighters from illegal blows, but because the consequences of illegal blows are sometimes unfixable.

An encouragement for patients to co-own their own care isn't a removal of a physician's responsibility.

It's an acknowledgement that (1) physicians are human, fallible, and not omniscient, (2) most health systems have imperfect information sync'ing across multiple parties, and (3) no one is going to care more about you than you (although others might be much more informed and capable).

Self-advocacy isn't a requirement for good care -- it's due diligence and personal responsibility for a plan with serious consequences.

If a doc misses a diagnosis and a patient didn't spend any effort themselves, is that solely the doctor's fault?

PS to parent's insinuation: 20 years in the industry and 15 years of managed cancer in immediate family, but what do I know?

[qiine]

I see.

My question is, since you understand this very well, how successful are patients (that manage the effort) at both acquiring scientifically accurate knowledge and improving their health meaningfully?

And maybe share some tips like good knowledge databases?

[chneu]

This applies to all areas of life, not just medicine.

We trade away our knowledge and skills for convenience. We throw money at doctors so they'll solve the issue. We throw money at plumbers to turn a valve. We throw money at farmers to grow our veggies.

Then we wonder why we need help to do basic things.

[geekasm]

> researching their own condition what a joke. so if I am sufferring with cancer, I should learn the lay of the land, treatments available ... wow. if I need to do everything, what am I paying for ?

[pardon_me]

Face-time. Their knowledge, training, and ability to write letters. Just because it's expensive, doesn't mean they are spending their evenings researching possible patient conditions and expanding their knowledge. Some might, but this isn't TV.

Anyway, what are you paid for? Guessing a programmer, you just sit in a chair all day and press buttons on a magical box. As your customer, why am I having to explain what product I want and what my requirements are? Why don't you have all my answers immediately? How dare you suggest a different specialism? You made a mistake?!?

[mcny]

But we are idiots.

There's a reason why flour has iron and salt has iodine, right? Individual responsibility simply does not scale.

[nostrademons]

We are idiots who will bear the consequences of our own idiocy. The big issue with all transactions done under significant information asymmetry is moral hazard. The person performing the service has far less incentive to ensure a good outcome past the conclusion of the transaction than the person who lives with the outcome.

Applies doubly now that many health care interactions are transactional and you won't even see the same doctor again.

On a systemic level, the likely outcome is just that people who manage their health better will survive, while people who don't will die. Evolution in action. Managing your health means paying attention when something is wrong and seeking out the right specialist to fix it, while also discarding specialists who won't help you fix it.

[estearum]

> We are idiots who will bear the consequences of our own idiocy

This is just factually not true. Healthy people subsidize the unhealthy (even those made unhealthy by their own idiocy) to a truly absurd degree.

[ericd]

Well, the biggest consequences aren't financial, they're losing your quality of life, or your life itself.

[SketchySeaBeast]

But the effects aren't just financial, look in an ER. People who for one reason or another haven't been able to take care of themselves in the emergency room for things that aren't an emergency, and it means your standard of care is going to take a hit.

[estearum]

Sure?

[smeej]

Neither does collective responsibility, for the same reason, particularly in any sort of representative government. Or did you expect people to pause being idiots as soon as they stepped into the ballot box to choose the people they wanted to have collective responsibility?

[glenstein]

>But the anecdotes are piled up into giant mountains at this point

This is disorganized thinking. Anecdotes about what? Does my uncle having an argument with his doctor over needing more painkillers, combine with an anecdote about my sister disagreeing with a midwife over how big her baby would be, combined with my friend outliving their stage 4 cancer prognosis all add up to "therefore I'm going to disregard nutrition recommendations"? Even if they were all right and the doctors were all wrong, they still wouldn't aggregate in a particular direction the way that a study on processed foods does.

And frankly it overlooks psychological and sociological dynamics that drive this kind of anecdotal reporting, which I think are more about tribal group emotional support in response to information complexity.

In fact, reasoning from separate instances that are importantly factually different is a signature line of reasoning used by alien abduction conspiracy theorists. They treat the cultural phenomenon of "millions" of people reporting UFOs or abduction experiences over decades as "proof" of aliens writ large, when the truth is they are helplessly incompetent interpreters of social data.

[jtbayly]

You can tell me that I'm as crazy as people who believe they've been abducted, but I'm still going to be my own health advocate. :)

[BobaFloutist]

As of course you should be. Doctors, who are generally pretty caring and empathetic humans, try to invoke the mantra "You can't care about your patient's health more than they do" due to how deeply frustrating it is to try to treat someone who's not invested in the outcome.

It's when "being your own health advocate" turns into "being your own doctor" that the system starts to break down.

[uncletaco]

They’re not saying you’re crazy they’re saying you may be helplessly incompetent when it comes to interpreting social data. You probably aren’t a good reader either if crazy was your takeaway.

[demosito666]

> Does my uncle having an argument with his doctor over needing more painkillers, combine with an anecdote about my sister disagreeing with a midwife over how big her baby would be, combined with my friend outliving their stage 4 cancer prognosis all add up to "therefore I'm going to disregard nutrition recommendations"?

Not sure about your sister and uncle, but from my observations the anecdotes combine into “doctor does not have time and/or doesn’t care”. People rightfully give exactly zero fucks about Bayes theorem, national health policy, insurance companies, social dynamics or whatever when the doctor prescribes Alvedon after 5 minutes of listening to indistinct story of a patient with a complicated condition which would likely be solved with additional tests and dedicated time. ChatGPT is at least not in a hurry.

[Gareth321]

> I wish / hope the medical community will address stories like this before people lose trust in them entirely.

Too late for me. I have a similar story. ChatGPT helped me diagnose an issue which I had been suffering with my whole life. I'm a new person now. GPs don't have the time to spend hours investigating symptoms for patients. ChatGPT can provide accurate diagnoses in seconds. These tools should be in wide use today by GPs. Since they refuse, patients will take matters into their own hands.

FYI, there are now studies showing ChatGPT outperforms doctors in diagnosis. (https://www.uvahealth.com/news/does-ai-improve-doctors-diagn...) I can believe it.

[linsomniac]

GPs don't have time to do the investigation, but they also have biases.

My own story is one of bias. I spent much of the last 3 years with sinus infections (the part I wasn't on antibiotics). I went to a couple ENTs and one observed allergic reaction in my sinuses, did a small allergy panel, but that came back negative. He ultimately wanted to put me on a CPAP and nebulizer treatments. I fed all the data I got into ChatGPT deep research and it came back with an NIH study that said 25% of people in a study had localized allergic reactions that would show up one place, but not show up elsewhere on the body in an allergy test. I asked my ENT about it and he said "That's not how allergies work."

I decided to just try second generation allergy tablets to see if they helped, since that was an easy experiment. It's been over 6 months since I've had a sinus infection, where before this I couldn't go 6 weeks after antibiotics without a reoccurrence.

[BobaFloutist]

There are over a million licensed physicians in the US. If we assume that each one interacts with five patients per weekday, then in the six months since you had this experience, that would conservatively be six-hundred-million patient interactions in that time.

Now, obviously none of this math would actually hold up to any scrutiny, and there's a bevy of reasons that the quality of those interactions would not be random. But just as a sense of scale, and bearing in mind that a lot of people will easily remember a single egregious interaction for the rest of their life, and (very reasonably!) be eager to share their experience with others, it would require a frankly statistically impossibly low error rate to not be able to fill threads like these with anecdotes of the most heinous, unpleasant, ignorant, and incompetent anecdotes anyone could ever imagine.

And this is just looking at the sheer scale of medical care, completely ignoring the long hours and stressful situations many doctors work in, patients' imperfect memories and one-sided recollections (that doctors can never correct), and the fundamental truth that medicine is always, always a mixture of probabilistic and intuitive judgement calls that can easily, routinely be wrong, because it's almost never possible to know for sure what's happening in s given body, let alone what will happen.

That E.N.T. wasn't up to date on the latest research on allergies. They also weren't an allergy specialist. They also were the one with the knowledge, skills, and insight to consider and test for allergies in the first place.

Imagine if we held literally any other field to the standard we hold doctors. It's, on the one hand, fair, because they do something so important and dangerous and get compensated comparitively well. But on the other hand, they're humans with incomplete, flawed information, channeling an absurdly broad and deep well of still insufficient education that they're responsible for keeping up-to-date while looking at a unique system in unique circumstances and trying to figure out what, if anything, is going wrong. It's frankly impressive that they do as well as they do.

[ctoth]

If you fully accept everything BobaFloutist says, what do you do differently?

Nothing. You just... feel more sympathetic to doctors and less confident that your own experience meant anything.

Notice what's absent: any engagement with whether the AI-assisted approach actually worked, whether there's a systemic issue with ENTs not being current on allergy research, whether patients should try OTC interventions as cheap experiments, whether the 25% localized-reaction finding is real and undertaught.

The actual medical question and its resolution get zero attention.

Also though...

You are sort of just telling people "sometimes stuff is going to not work out, oh also there's this thing that can help, and you probably shouldn't use it?"

What is the action you would like people to take after reading your comment? Not use ChatGPT to attempt to solve things they have had issues solving with their human doctors?

[afavour]

> The study, from UVA Health’s Andrew S. Parsons, MD, MPH and colleagues, enlisted 50 physicians in family medicine, internal medicine and emergency medicine to put Chat GPT Plus to the test. Half were randomly assigned to use Chat GPT Plus to diagnose complex cases, while the other half relied on conventional methods such as medical reference sites

This is not ChatGPT outperforming doctors. It is doctors using ChatGPT.

[ryandrake]

For every one "ChatGPT accurately diagnosed my weird disease" anecdote, how many cases of "ChatGPT hallucinated obvious bullshit we ignored" are there? 100? 10,000? We'll never know, because nobody goes online to write about the failure cases.

[ctoth]

> nobody goes online to write about the failure cases.

Why wouldn't they? This would seem to be engagement bait for a certain type of Anti-AI person? Why would you expect this to be the case? "My dad died because he used that dumb machine" -- surely these will be everywhere right?

Let's make our beliefs pay rent in anticipated experiences!

[ryandrake]

Failure cases aren't just "patient died." They also include all the times where ChatGPT's "advice" aligned with their doctor's advice, and when ChatGPT's advice was just totally wrong and the patient correctly ignored it. Nobody knows how numerous these cases are.

[ctoth]

So your failure cases are now "it agreed with the doctor" and "the patient correctly identified bad advice."

Where's the failure?

[ryandrake]

These are failures to provide useful advice over and above what could be gotten from a professional. In the sense that ChatGPT is providing net-neutral (maybe slightly positive since it confirms the doctor's diagnosis) or net-negative benefits (in the case that it's just wasting the user's time with garbage).

[estearum]

This is a doctor feeding the LLM a case scenario, which means the hard part of identifying relevant signal from the extremely noisy and highly subjective human patient is already done.

[Workaccount2]

The problem doctors have is that 99/100 times ABC is caused by xyz, so they prescribe 123 and the problem goes away.

Overtime, as a human, the doctors just turn into ABC -> 123 machines.

[wookmaster]

If you keep hearing anecdotes at what point is it statistically important ? IBM 15 years ago was selling a story about a search engine they created specifically for the medical field(they had it on jeopardy) where doctors spent 10 years before they figured this poor patients issue. They plugged the original doctors notes into it and the 4th result was the issue they took a decade to figure out. Memorizing dozens of medical books and being able to recall and correlate all that information in a human brain is a rare skill to be good at. The medical system works hard to ensure everyone going through can memorize but clearly search engines/llms can be a massive help here.

[utopiah]

> If you keep hearing anecdotes at what point is it statistically important ?

Fair question but one has to keep in mind about ALL the other situations we do NOT hear about, namely all the failed attempts that did take time from professionals. It doesn't the successful attempts are not justified, solely that a LOT of positive anecdotes might give the wrong impressions that they are not radically most negative ones that are simply not shared. It's hard to draw conclusions either way without both.

[542354234235]

I hear about people winning the lottery all the time. There were two $100m+ winners just this week. The anecdotes just keep piling up! That doesn't mean the lottery is a valid investment tool. People just do not understand how statistically insignificant anecdotes are in a sufficiently large dataset. Just for the US population, a 1 in a million chance of something happening to a person should happen enough to be reported on a new person every weekday of the year.

[wookmaster]

The opposite is true also, if no company is paid or eager to dig into it, it could be significant and we don't know.

[ryandrake]

You guys are getting downvoted but you're 100% right. You never hear the stories about someone typing symptoms into ChatGPT and getting back wrong, bullshit answers--or the exact answer their doctor would have told them. Because those stories are boring. You only hear about the miraculous cases where ChatGPT accurately diagnosed an unusual condition. What's the ratio of miracle:bullshit? 1:100? 1:10,000?

[utopiah]

> You guys are getting downvoted but you're 100% right.

Classic HN. /s

[MetaWhirledPeas]

> the skeptic in me is cautious that this is the type of reasoning which propels the anti-vax movement

I think there's a difference between questioning your doctor, and questioning advice given by almost every doctor. There are plenty of bad doctors out there, or maybe just doctors who are bad fits for their patients. They don't always listen or pay close attention to your history. And in spite of their education they don't always choose the correct diagnosis.

I also think there's an ever-increasing difference between AI health research and old-school WebMD research.

[diydsp]

I can see why, but this is doc+patient in collab. And driven by using science in the form of applying llm-as-database-of-symptoms-and-treatments.

Anti-vax otoh is driven by ignorance and failure to trust science in the form of neither doctors, nor new types of science. Plus, anti-vax works like flat earth; a signaling mechanism of poor epostemic judgment."

[nasmorn]

Every second doctor is a below average doctor. Some are outright idiots that just became doctors because their parents expected it of them. They somehow finished med school and now they sick at their job. Have you ever interacted with doctors? In a hospital rotation where you see a different one every week. And they all tell you entirely different things with absolute confidence of a prophet after looking at your file for 2 min and talking another 3?

Even good doctors have a real hard time convincing the bad doctors to do their job right. Never mind some random patient with a slightly less obvious diagnosis.

This is nothing like anti vax, because it is not implying a failing of medical science. It just states that enough doctors are bad enough at their job that user research is useful. To realize you need to go to a better doctor

[comboy]

I also don't know. Additional point to consider: vast majority of doctors have no clue about Bayes theorem.

[emeril]

well, to the credit of Bayes, dementia is likely a safe choice (depending on age/etc.) but dementia is largely a diagnosis of exclusion and most doctors, besides being unfamiliar with Bayes, are also just plain lazy and/or dumb and shouldn't immediately jump to the most likely explanation when it's one with the worst prognosis and fewest treatments...

[biofox]

I work in biomed. Every textbook on epidemiology or medical statistics that I've picked up has had a section on Bayes, so I'm not inclined to believe this.

[robrenaud]

Here is research about doctors interpreting test results. It seems to favor GP's view that many doctors struggle to weigh test specificity and sensitivity vs disease base rate.

https://bmjopen.bmj.com/content/bmjopen/5/7/e008155.full.pdf

[MattRix]

The fact is that doctors are human, so they have cognitive biases and make mistakes and sometimes miss things, just like all other humans.

[adventured]

Humans are extraordinarily lazy sometimes too. A good LLM does not possess that flaw.

A doctor can also have an in-the-moment negatively impactful context: depression, exhaustion, or any number of life events going on, all of which can drastically impact their performance. Doctors get depressed like everybody else. They can care less due to something affecting them. These are not problems a good LLM has.

[kraftman]

I'm on some anti rejection meds post-transplant and chatgptd some of my symptoms and it said they were most likely caused by my meds. Two different nephrologists told me that the meds I'm on didn't cause those symptoms before looking it up themselves and confirming they do. I think LLMs have a place in this as far as being able to quick come up with hyphotesese that can be looked into and confirmed/disproved. If I hadn't had chatGPT, I wouldnt have brought it or my team would have just blamed lifestyle rather than meds.

[g947o]

Linking this anecdote to anti-vaxxing really seems a stretch, and I would like to see the reasoning behind that. My impression is that anti-vaxxers have more issues with vaccines themselves than with doctors who recommend them

[glenstein]

I think that completely misreads a comment that was already painstakingly clear, they're specifically talking about the phenomenon of reasoning by anecdote. It wasn't a one-to-one equivalence between LLM driven medicine consultations and the full range of dynamics found in the anti-vax movement. Remember to engage in charitable interpretation.

[yesitcan]

“Asking inquisitive questions and thinking for themselves? Must be an anti-vaxxer!”

[jtbayly]

They are closely related. The authority of the medical establishment is more and more questioned. And whenever it is correctly questioned, they lose a bit of their authority. It is only their authority that gets people vaccinated.

[arethuza]

"My impression is that anti-vaxxers have more issues" - I think you could have left it at that!

[herpdyderp]

The fact is that many doctors do suck. Nearly all of my family members have terrible doctor stories, one even won a huge malpractice law suit. We can’t hide the real problems because we’re afraid of anti-vaxxers.

[destitude]

You must not be involved in the medical field to realize how bad it is especially when it come to diagnosis.

[MSFT_Edging]

Generally the medical system is in a bad place. Doctors are often frustrated with patients who demand more attention to their problems. You can even see it for yourself on doctor subreddits when things like Fibromyalgia is brought up. They ridicule these patients for trying to figure out why their quality of life has dropped like a rock.

I think similar to tech, Doctors are attracted to the money, not the work. The AMA(I think, possibly another org) artificially restricts the number of slots for new doctors restricting doctor supply while private equity squeezes hospitals and buys up private practices. The failure doctors sit on the side of insurance trying to prevent care from being performed and it's up to the doctor who has the time/energy to fight insurance and the hospital to figure out what's wrong.

[nradov]

The AMA has no authority over the number of slots for new doctors. The primary bottleneck is the number of residency slots. Teaching hospitals are free to add more slots but generally refuse to do so due to financial constraints without more funding from Medicare. At one point the AMA lobbied Congress to restrict that funding but they reversed that position some years back. If you want more doctors then ask your members of Congress to boost residency funding.

https://savegme.org/

[bethekidyouwant]

Did you get the flu shot this year tho? Be honest.

[DuperPower]

yea specially because he is not saying what diagnosis It was, if you want to say doctors were unscientific at least be scientific and give the proper medical account of the symptoms and diagnosis

[virgil_disgr4ce]

> cautious that this is the type of reasoning which propels the anti-vax movement

I hear you but there are two fundamentally different things:

1. Distrust of / disbelief in science 2. Doctors not incentivized to spend more than a few minutes on any given patients

There are many many anecdotes related to the second, many here in this thread. I have my own as well.

I can talk to ChatGPT/whatever at any time, for any amount of time, and present in *EXHAUSTIVE* detail every single datapoint I have about my illness/problem/whatever.

If I was a billionaire I assume I could pay a super-smart, highly-experienced human doctor to accommodate the same.

But short of that, we have GPs who have no incentive to spend any time on you. That doesn't mean they're bad people. I'm sure the vast majority have absolutely the best of intentions. But it's simply infeasible, economically or otherwise, for them to give you the time necessary to actually solve your problem.

I don't know what the solution to this is. I don't know nearly enough about the insurance and health industries to imagine what kind of structure could address this. But I am guessing that this might be what is meant by "outcome-based medicine," i.e., your job isn't done until the patient actually gets the desired outcome.

Right now my GP has every incentive to say "meh" and send me home after a 3-minute visit. As a result I more or less stopped bothering making doctor appointments for certain things.

[otabdeveloper4]

> ...this is the type of reasoning which propels the anti-vax movement.

So what? Am I supposed to clutch pearls and turn off my brain at the stopword now?

[ToucanLoucan]

> How frequent are mis-diagnosis like this?

The anecdote in question is not about mis-diagnosis, it's about a delayed diagnosis. And yeah, the inquiry sent a doctor down three paths, one of which led to a diagnosis, so let's be clear: no, the doctor didn't get it completely on their own, and: ChatGPT was, at best, 33% correct.

The biggest problem in medicine right now (that's creating a lot of the issues people have with it I'd claim) is twofold:

- Engaging with it is expensive, which raises the expectations of quality of service substantially on the part of the patients and their families

- Virtually every doctor I've ever talked to complains about the same things: insufficient time to give proper care and attention to patients, and the overbearingness of insurance companies. And these two lead into each other: so much of your doc's time is spent documenting your case. Basically every hour of patient work on their part requires a second hour of charting to document it. Imagine having to write documentation for an hour for every hour of coding you did, I bet you'd be behind a lot too. Add to it how overworked and stretched every medical profession is from nursing to doctors themselves, and you have a recipe for a really shitty experience on the part of the patients, a lot of whom, like doctors, spend an inordinate amount of time fighting with insurance companies.

> How often is "user research" helping or hurting the process of getting good health outcomes?

Depends on the quality of the research. In the case of this anecdote, I would say middling. I would also say though if the anecdotes of numerous medical professionals I've heard speak on the topic are to be believed, this is an outlier in regard to it actually being good. The majority of "patient research" that shows up is new parents upset about a vaccine schedule they don't understand, and half-baked conspiracy theories from Facebook. Often both at once.

That said, any professional, doctors included, can benefit from more information from whomever they're serving. I have a great relationship with my mechanic because by the time I take my car to him, I've already ruled out a bunch of obvious stuff, and I arrive with detailed notes on what I've done, what I've tried, what I've replaced, and most importantly: I'm honest about it. I point exactly where my knowledge on the vehicle ends, and hope he can fill in the blanks, or at least he'll know where to start poking. The problem there is the vast majority of the time, people don't approach doctors as "professionals who know more than me who can help me solve a problem," they approach them as ideological enemies and/or gatekeepers of whatever they think they need, which isn't helpful and creates conflict.

> Are there medical boards that are sending PSAs to help doctors improve common mis-diagnosis?

Doctors have shitloads of journals and reading materials that are good for them to go through, which also factors into their overworked-ness but nevertheless; yes.

> Whats the role of LLMs in all of this?

Honestly I see a lot of applications of them in the insurance side of things, unless we wanted to do something cool and like, get a decent healthcare system going.

[cael450]

I'm married to a provider. It is absolutely insane what she has to do for insurance. She's not a doctor, but she oversees extensive therapy for 5-10 kids at a time. Insurance companies completely dictate what she can and can't do, and frequently she is unable to do more in-depth, best-practice analysis because insurance won't pay for it. So her industry ends up doing a lot of therapy based on educated guesswork. Every few months, she has to create a 100+ page report for insurance. And on top of it, insurance denies the first submissions all the time which then cause her to burn a bunch of time on calls with the company appealing the peer review. And the "peer review" is almost always done by people who have no background in her field. It's basically akin to a cardiologist reviewing a family therapist's notes and deciding what is or isn't necessary. Except that my wife's job can be the difference between a child ever talking or not, or between a child being institutionalized or not when they become an adult. People who think private insurance companies are more efficient than government-run healthcare are nuts. Private insurance companies are way worse and actively degrade the quality of care.

[smeej]

> Insurance companies completely dictate what she can and can't do, and frequently she is unable to do more in-depth, best-practice analysis because insurance won't pay for it.

The distinction between "can't do" and "can't get paid for" seems to get lost a lot with medical providers. I'm not saying this is necessarily what's happening with your wife, but I've had it happen to me where someone says, "I can't do this test. Your insurance won't pay for it," and then I ask what it costs and it's a few hundred or a couple thousand dollars and I say, "That's OK. I'll just pay for the test myself," and something short-circuits and they still can't understand that they can do it.

The most egregious example was a prescription I needed that my insurance wouldn't approve. It was $49 without insurance. But the pharmacy wouldn't sell it to me even though my doctor had prescribed it because they couldn't figure out how to take my money directly when I did have insurance.

I get that when insurance doesn't cover something, most patients won't opt to pay for it anyway, but it feels like we need more reminders on both the patient and the provider side that this doesn't mean it can't be done.

[ToucanLoucan]

> The distinction between "can't do" and "can't get paid for" seems to get lost a lot with medical providers. I'm not saying this is necessarily what's happening with your wife, but I've had it happen to me where someone says, "I can't do this test. Your insurance won't pay for it," and then I ask what it costs and it's a few hundred or a couple thousand dollars and I say, "That's OK. I'll just pay for the test myself," and something short-circuits and they still can't understand that they can do it.

Tell me you've never lived in poverty without telling me.

An unexpected expense of several hundred to a couple thousand dollars, for most of my lived life both as a child and a young adult, would've ruined me. If it was crucial, it would've been done, and I would've been hounded by medical billing and/or gone a few weeks without something else I need.

This is inhumanity, plain as.

[smeej]

This would be comical but for the years I did live in poverty. In what world does my being able to afford it now mean I've somehow always been well off?

This is ignorance, plain as.

[nradov]

I generally agree (and sympathize with your wife), but let's not present an overly rosy view of government run healthcare or single-payer systems. In many countries with such systems, extensive therapy simply isn't available at all because the government refuses to pay for it. Every healthcare system has limited resources and care is always going to be rationed, the only question is how we do the rationing.

[cael450]

Government run healthcare can be done well or it can be done poorly. I’ve lived under both kinds and I would take the bad over America’s system. In Japan, I had to have a ton of cardiac work done, and it was done faster than I’d get it here.

[ToucanLoucan]

Every healthcare system has problems, yes. However the spectre of medical debt and bankruptcy is a uniquely American one, so, IMHO, even if we moved to single-payer healthcare and every other problem stayed the same, but we no longer shoved people into the capitalist fuck-barrel for things completely outside their control, I think that's an unmitigated, massive improvement.

[nradov]

Well now you're talking about a different problem and moving the goalposts. It would be impossible for every other problem to stay the same under a single-payer system. That would solve some existing problems and create other new problems. In particular the need to hold down government budgets would necessarily force increased care rationing and longer queues. Whether that would be a net positive or negative is a complex question with no clear answers.

The statistics you see about bankruptcy due to medical debt are highly misleading. While it is a problem, very few consumers are directly forced into bankruptcy by medical expenses. What tends to happen is that serious medical problems leave them unable to work and then with no income and then with no income all of their debts pile up. What we really need there is a better disability welfare system to keep consumers afloat.

[ToucanLoucan]

> Well now you're talking about a different problem and moving the goalposts.

I am absolutely not. I am reacting to what's been replied to what I've said. In common vernacular, this is called a "conversation."

To recap: the person who replied to me left a long comment about the various strugglings and limitations of healthcare when subjected to the whims of insurance companies. You then replied:

> I generally agree (and sympathize with your wife), but let's not present an overly rosy view of government run healthcare or single-payer systems. In many countries with such systems, extensive therapy simply isn't available at all because the government refuses to pay for it. Every healthcare system has limited resources and care is always going to be rationed, the only question is how we do the rationing.

Which, at least how I read it, attempts to lay the blame for the lack of availability of extensive therapies at the feet of a government's unwillingness to pay, citing that every system has limited resources and care is always being rationed.

I countered, implying that while that may or may not be true, that lack of availability is effectively status quo for the majority of Americans under our much more expensive, and highly exploitative insurance-and-pay-based healthcare system, and that, even if those issues around lack of availability persisted through a transition to a single-payer healthcare system, it would at least alleviate us from the uniquely American scourge of people being sent to the poorhouse, sometimes poor-lack-of-house, for suffering illnesses or injuries they are in no way responsible for which in my mind is still a huge improvement.

> The statistics you see about bankruptcy due to medical debt are highly misleading. While it is a problem, very few consumers are directly forced into bankruptcy by medical expenses. What tends to happen is that serious medical problems leave them unable to work and then with no income and then with no income all of their debts pile up.

I mean we can expand this if you like into a larger conversation about how insurance itself being tied to employment and everyone being kept broke on purpose to incentivize them to take on debt to survive, placing them on a debt treadmill their entire lives which has been demonstrably shown to reduce quality and length of life, as well as introducing the notion that missing any amount of work for no matter how valid a reason has the potential to ruin your life, is probably a highly un-optimal and inhumane way to structure a society.

> What we really need there is a better disability welfare system to keep consumers afloat.

On that at least, we can agree.

[threethirtytwo]

I get where you’re coming from. I would argue the mistakes doctors make and the amount of times they are wrong literally dwarfs the amount of anti vaxers in existence.

Also the anti vax movement isn’t completely wrong. It’s now confirmed (officially) that the covid-19 vaccine isn’t completely safe and there are risks taking it that don’t exist in say something like the flu shot. The risk is small but very real and quite deadly. Source: https://med.stanford.edu/news/all-news/2025/12/myocarditis-v... This was something many many doctors originally claimed was completely safe.

The role of LLMs is they take the human bias out of the picture. They are trained on formal medical literature and actual online anecdotal accounts of patients who will take a shit on doctors if need be (the type of criticism a doctor rarely gets in person). The generalization that comes from these two disparate sets of data is actually often superior to a doctor.

Key word is “often”. Less often (but still often in general) the generalization can be an hallucination.

Your post irked me because I almost got the sense that there’s a sort of prestige, admiration and respect given to doctors that in my opinion is unearned. Doctors in my opinion are like car mechanics and that’s the level of treatment they deserve. They aren’t universally good, a lot of them are shitty, a lot are manipulative and there’s a lot of great car mechanics I respect as well. That’s a fair outlook they deserve… but instead I see them get these levels of respect that matches mother Theresa as if they devoted their careers to saving lives and not money.

No one and I mean no one should trust the medical establishment or any doctor by default. They are like car mechanics and should be judged on a case by case basis.

You know for the parent post, how much money do you think those fucking doctors got to make a wrong diagnosis of dementia? Well over 700 for less than an hour of there time. And they don’t even have the kindness to offer the patient a refund for incompetence on their part.

How much did ChatGPT charge?

[moshegramovsky]

> This was something many many doctors originally claimed was completely safe.

I never heard any doctors claim any of the covid vaccines were completely safe. Do you mind if I ask which doctors, exactly? Not institutions, not vibes, not headlines. Individual doctors. Medicine is not a hive mind, and collapsing disagreement, uncertainty, and bad messaging into “many doctors” is doing rhetorical work that the evidence has to earn.

> The role of LLMs is they take the human bias out of the picture.

That is simply false. LLMs are trained on human writing, human incentives, and human errors. They can weaken certain authority and social pressures, which is valuable, but they do not escape bias. They average it. Sometimes that helps. Sometimes it produces very confident nonsense.

> Your post irked me because I almost got the sense that there’s a sort of prestige, admiration and respect given to doctors that in my opinion is unearned. Doctors in my opinion are like car mechanics and that’s the level of treatment they deserve.

> No one and I mean no one should trust the medical establishment or any doctor by default. They are like car mechanics and should be judged on a case by case basis.

You are entitled to that opinion, but I wanted to kiss the surgeon who removed my daughter’s gangrenous appendix. That reaction was not to their supposed prestige, it was recognition that someone applied years of hard won skill correctly at a moment where failure had permanent consequences.

Doctors make mistakes. Some are incompetent. Some are cynical. None of that justifies treating the entire profession as functionally equivalent to a trade whose failures usually cost money rather than lives.

And if doctors are car mechanics, then patients are machines. That framing strips the humanity from all of us. That is nihilism.

No one should trust doctors by default. Agreed. But no one should distrust them by default either. Judgment works when it is applied case by case, not when it is replaced with blanket contempt.

[threethirtytwo]

> I never heard any doctors claim any of the covid vaccines were completely safe. Do you mind if I ask which doctors, exactly? Not institutions, not vibes, not headlines. Individual doctors. Medicine is not a hive mind, and collapsing disagreement, uncertainty, and bad messaging into “many doctors” is doing rhetorical work that the evidence has to earn.

There’s no data here. Many aspects of life are not covered by science because trials are expensive and we have to go with vibes.

And even on just vibes we often can get accurate judgements. Do you need clinical trials to confirm there’s a ground when you leap off your bed? No. Only vibes unfortunately.

If you ask people (who are not doctors) to remember this time they will likely tell you this is what they remember. I also do have tons of anecdotal accounts of doctors saying the Covid 19 vaccine is safe and you can find many yourself by searching. Here’s one: https://fb.watch/Evzwfkc6Mp/?mibextid=wwXIfr

The pediatrician failed to communicate the risks of the vaccine above and made the claim it was safe.

At the time to my knowledge the actual risks of the vaccine were not fully known and the safety was not fully validated. The overarching intuition was that the risk of detrimental of effects from the vaccine was less than the risk+consequence of dying from Covid. That is still the underlying logic (and best official practice) today even with the knowledge about the heart risk covid vaccines pose.

This doctor above did not communicate this risk at all. And this was just from a random google search. Anecdotal but the fact that I found one just from a casual search is telling. These people are not miracle workers.

> That is simply false. LLMs are trained on human writing, human incentives, and human errors. They can weaken certain authority and social pressures, which is valuable, but they do not escape bias. They average it. Sometimes that helps. Sometimes it produces very confident nonsense.

No it’s not false. Most of the writing on human medical stuff is scientific in nature. Formalized with experimental trials which is the strongest form of truth humanity has both practically and theoretically. This “medical science” is even more accurate than other black box sciences like psychology as clinical trials have ultra high thresholds and even test for causality (in contrast to much of science only covers correlation and assumes causality through probabilistic reasoning)

This combined with anecdotal evidence that the LLM digests in aggregate is a formidable force. We as humans cannot quantify all anecdotal evidence. For example, I heard anecdotal evidence of heart issues with rna vaccines BEFORE the science confirmed it and LLMs were able to aggregate this sentiment through sheer volumetric training on all complaints of the vaccine online and confirm the same thing BEFORE that Stanford confirmation was available.

> You are entitled to that opinion, but I wanted to kiss the surgeon who removed my daughter’s gangrenous appendix. That reaction was not to their supposed prestige, it was recognition that someone applied years of hard won skill correctly at a moment where failure had permanent consequences.

Sure I applaud that. True hero work for that surgeon. I’m talking about the profession in aggregate. In aggregate in the US 800000k patients die or get permanently injured from a misdiagnosis every year. Physicians fuck up and it’s not occasionally. It’s often and all the fucking time. You were safer getting on the 737 max the year before they diagnosed the mcas errors then you are NOT getting a misdiagnosis and dying from a doctor. Those engineers despite widespread criticism did more for your life and safety than doctors in general. That is not only a miracle of engineering but it also speaks volumes of the medical profession itself which DOES not get equivalent criticism for mistakes. That 800000k statistic is swept under the rug like car accidents.

I am entitled to my own opinion just as you are to yours but I’m making a bigger claim here. My opinion is not just an opinion. It’s a ground truth general fact backed up by numbers.

> And if doctors are car mechanics, then patients are machines. That framing strips the humanity from all of us. That is nihilism.

There is nothing wrong with car mechanics. It’s an occupation and it’s needed. And those cars if they fail they can cause accidents that involve our very lives.

But car mechanics are fallible and that fallibility is encoded into the respect they get. Of course there are individual mechanics who are great and on a case by case basis we pay those mechanics more respect.

Doctors need to be treated the same way. It’s not nilhism. It’s a quantitative analysis grounded in reality. The only piece of evidence you provided me in your counter is your daughter’s life being saved. That evidence warrants respect for the single doctor who saved your daughter’s life and not for the profession in general. The numbers agree with me.

And treatment for say the corporation responsible for the mcas failures and the profession responsible for medical misdiagnosis that killed people is disproportionate. Your own sentiment and respect for doctors in general is one piece of evidence for this.

[moshegramovsky]

> If you ask people (who are not doctors) to remember this time they will likely tell you this is what they remember. I also do have tons of anecdotal accounts of doctors saying the Covid 19 vaccine is safe and you can find many yourself by searching. Here’s one: https://fb.watch/Evzwfkc6Mp/?mibextid=wwXIfr

> No it’s not false. Most of the writing on human medical stuff is scientific in nature. Formalized with experimental trials which is the strongest form of truth humanity has both practically and theoretically. This “medical science” is even more accurate than other black box sciences like psychology as clinical trials have ultra high thresholds and even test for causality (in contrast to much of science only covers correlation and assumes causality through probabilistic reasoning)

Sorry, but these kinds of remarks wreck your credibility and make it impossible for me to take you seriously.

[threethirtytwo]

If you disagree with me then it is better to say you disagree and state your reasoning why. If the reasoning is too foundational than it is better to state it as such and exit.

Saying something like my "credibility is wrecked" and impossible to take me "seriously" crosses a line into deliberate attack and insult. It's like calling me an idiot but staying technically within the HN rules. You didn't need to go there and breaking those rules in spirit is just as bad imo.

Yeah I agree I think the conversation is over. I suggest we don't talk to each other again as I don't really appreciate how you shut down the conversation with deliberate and targeted attacks.