[piterrro]

It funny to see the community here expects the human body to be treated like a deterministic function: for input X expect output Y - and that transfers to diagnosis - people expect to receive the same diagnosis from different specialists for the same issue.

Given human body complexity, the diagnosis is a compound output of the experience, knowledge gained throughout the career and diagnosis methods/equipment, the title (like Dr) is a certification imposed by the state so its "safe" to let people practice since they passed "the bar" - but that doesn't imply everyone will be treating the same.

Some specialists update their knowledge monthly, some yearly and some don't do it at all, there are so many variables in play here (geo, politics, even weather haha).

Having said that, choosing the specialist is really important, getting opinions about their practice and their speciality, you can only maximize your chance of getting the right diagnosis, but don't expect to get it right just because somebody is called a Dr.

[charles_f]

> It funny to see the community here expects the human body to be treated like a deterministic function

In a community largely made of people whose job it is to produce such functions, I'd say it's to be expected

[KingMob]

It's funny (and a little depressing), because HN routinely assumes that their world view, and thus, their domain expertise, transfers.

There's no shortage of tech people convinced they deeply understand law, medicine, philosophy, etc. despite never having read much on the topics.

[johnwalkr]

Most of my "favorited" comments on here are by software people with confident yet incorrect statements (usually by way of vastly underestimating complexity) about one of my domains of expertise.

I can't find it but one of the greatest show HN was a blog post about someone who was annoyed by his inconsistent shower temperature control. From memory, he spent a full weekend adjusting it, taking measurements, making graphs, and proposed "next steps" about prototyping better temperature control with microcontrollers and servo and pontificated about developing a product, of course controlled by software. He skipped the part where a bit of research leads you to the already common "thermostatic mixing valve".

[bpicolo]

The internet at large is full of armchair experts, it's not just a tech thing.

[nozzlegear]

People in tech have particularly big armchairs though.

[b800h]

I'm not sure what your point is. Are you saying that medicine is inherently fallible and therefore AI is more likely to make a good diagnosis - particularly a cluster of specialist AIs?

[mrlongroots]

Yeah I think the OP is muddling the point by conflating "physician's version of the diagnosis" with "The Diagnosis".

There is absolutely one "The Diagnosis". Human body is a machine, albeit a very complex one, and all measurement sources have noise. But they are all measuring one reality, and if there is a problem, there should be one explanation that all measurements align with. They can be noisy but can never be conflicting (instrument error notwithstanding).

Physicians' ability to arrive at "The Diagnosis" would vary, but it does not mean one does not exist. I am not sure if characterizing human body as derministic or not is relevant here.

[piterrro]

I think „the diagnosis” is over simplification and lots of professionals would disagree that there’s always a single one. As a patient your goal is to eliminate the symptoms of whatever is going on in your system. Often times there could be many reasons for it and only curing one can help you already. The diagnosis is a help tool to choose the roght curation method.

Thus, chasing the „right” diagnosis (whatever that is?) is pointless, as it only the outcome (reducing symptoms, stopping the damage) can tell you if the diagnosis was right, but not the only one right.

[mrlongroots]

> I think „the diagnosis” is over simplification and lots of professionals would disagree that there’s always a single one.

"The Diagnosis" does not mean "one root cause".

Situation: my car has some unexplained vibrations. 1. Mechanic A says that it is the engine mounts 2. Mechanic B says that it is some weirdness in how the exhaust assembly is hanging to the underbody 3. Mechanic C says that it is just my wife farting

I replace engine mounts and 40% of the problem is reduced. I then drive without my wife and the remaining 60% is solved.

"The Diagnosis" was: 40% mounts, 60% wife, 0% exhaust.

There is always one "The Diagnosis".

[exmadscientist]

> There is always one "The Diagnosis".

No, that is not true at all.

This is a kind of thinking a lot of programmers fall prey to. The real world, outside of code, is a very fuzzy and inherently analog place. There is very rarely one in any complex system having a complex problem needing a complex solution. At some point even the definition of diagnosis gets fuzzy.

The best demonstration of this in medicine is probably the DSM-5. What, really, is the difference between Narcissistic Personality Disorder and Borderline Personality Disorder and Generalized Anxiety Disorder? Can they overlap? (Yes.) How do you treat them? (It's not easy.) What about depression: how do you tell if someone has Major Depressive Disorder or Bipolar Depression? (Again: not easy.) In some circumstances the only way to tell the difference between the two is what drugs work: if antidepressants help, it's Major Depression; if mood stabilizers help, it's Bipolar Depression. It's kind of odd to define a One True Diagnosis by "well we fixed it this way, so it must have been that", with no other way to do it, isn't it? (What if both work? What if one works for a while, then the other works? What if treatment with antidepressants induces bipolar (hypo)mania? All of those happen!)

And that's just a few examples.

[mrlongroots]

Pyschiatry gets complicated because the failures are not mechanical. Even if you could image every single neuron in a person's head we do not have a very good way to define an algorithm for these issues. I do not have a good answer for psychiatry.

> This is a kind of thinking a lot of programmers fall prey to. The real world, outside of code, is a very fuzzy and inherently analog place.

Having said that, I would vehemently reject and push back against this, and without doubting your sincerity, characterize it as an ad hominem.

The vast majority of issues with the human body are mechanical in nature. Restricted blood flow, unwanted tissue, a broken bone, a bad valve etc. These are causal descriptions of "disease". Where causal descriptions exist, the "One True Diagnosis" principle holds. Psychiatry just happens to be unique in that it is a fuzzy science where we rely on checklists and ultimately all diagnosis is probabilistic.

EDIT:

> This is a kind of thinking a lot of programmers fall prey to. The real world, outside of code, is a very fuzzy and inherently analog place. There is very rarely one in any complex system having a complex problem needing a complex solution. At some point even the definition of diagnosis gets fuzzy.

I would also push back against this mindset in general. This is not a falsifiable claim, it is incoherence as an argument, and I do not need to be a programmer to hold this position.

That the real world is analog is irrelevant to its amenability to causal explanations. Or "fuzzy": "fuzzy" in this context just does not mean anything.

I am not trying to sound exasperated or win internet points, just impress this point on you and anyone reading this. We can write math to predict weather, make it tractable to solve using approximations, tolerate IEEE 754 weirdness, and finally tell what the clouds will do a week from now. This is nature telling us that there is a pattern to how it behaves, and it is the only weapon we have as scientists.

To say that nature is not amenable to explanations is a very defeatist thing to say: neither Newton nor Einstein nor any of the million-odd people that have built modern society would exist if nature did not have causal explanations. I urge you to reject this defeatist thinking.

[Paracompact]

Most disorders in the DSM-5 are defined by polythetic criteria, i.e. meeting X out of Y symptoms from a list for a given duration of time, or by conjunction of polythetic criteria. These definitions are socially constructed and statistically validated for pragmatic use, but very rarely have definite underlying biological markers. Especially as concerns personality disorders, these disorders can also simply be an inheritance of cultural or political baggage and prior psychoanalytic theory.

> In some circumstances the only way to tell the difference between the two is what drugs work: if antidepressants help, it's Major Depression; if mood stabilizers help, it's Bipolar Depression.

This is ridiculous. There is zero mention in the DSM-5 or ICD-11 of "if these drugs work, it's this, otherwise it's this." I would question a psychiatrist dispositively making a diagnosis on such grounds.