[zefalt]

I don't know why some people on hackernews have such a bias for deriding physicians. If you don't like the care you get, go somewhere else and get another opinion. Of course the bell curve of probabilities exist in medicine...just like it exists in every other field or more broadly the universe.

This article is about the potential downsides of radical transparency...not just the default level of transparency. For many years/decades, records have always been available to patients upon request. This new immediate availability is something entirely different and brings about another set of problems.

Imagine having 15 minutes to see a patient, document on the chart, order labs/imaging, and provide disposition to a patient. Then, they have free reign to message you regarding some irrelevant piece of data in the chart or labwork that you need to respond to. Too much patient access does have problems, and I can provide you some mundane examples. I documented about an excoriation in one of my charts, and the patient calls back complaining that I called them a skin picker and wanted me to change my documentation. If you google excoriation, you do not get the medical definition or understanding of the word but a link to excoriation disorder. Another patient wonders why their eosinophil percentage is 0.1% above the upper limit of normal.

To me, the chart serves more as a note to colleagues who have the relevant understanding to piece together what happened during the visit. Giving patients immediate access to their charts will have very little benefit in my opinion given the high prevalence of EMRs and easy access to charts for anyone that actually cares.

To say that most doctors are terrible is one of the worst takes I've read. Most doctors are probably average, and their average medical knowledge is likely a standard deviation or two above the average patient.

The whole death by medical error thing is also of uncertain evidence. See: https://www.mcgill.ca/oss/article/critical-thinking-health/m...

[areoform]

    > The whole death by medical error thing is also of uncertain evidence. See: https://www.mcgill.ca/oss/article/critical-thinking-health/m...

I've read the McGill article before; what it fails to mention is that the analysis has been performed multiple times by multiple parties and the results have repeatedly converged on the same point: somewhere between tens of thousands of human beings to one hundred fifty thousand human beings (at the very least) have their lives cut short because someone messed up. These statistics are for the US alone. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070928/ https://effectivehealthcare.ahrq.gov/products/diagnostic-err...

And more often than not, their colleagues who spot the mistake don't report it, a fact that's neatly labelled as a "disclosure gap" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793994/

It is perfectly reasonable to argue that the estimates are wrong. In that case, the solution is quite simple. Record data on misdiagnosis and physician failure, but that's a solution that the AMA has opposed (while talking about the ethical duty of disclosing medical error, of course).

    > The AMA and the American Hospital Association vehemently opposed an attempt by President Bill Clinton to create a mandatory reporting system for serious errors. The groups launched a multimillion-dollar advertising campaign that said mandatory reporting would drive medical errors underground. From 2000 to 2002, they spent $81 million on lobbying efforts, according to campaign statistics collected by the Center for Responsive Politics.
    
   > Mandatory reporting was dead on arrival.

https://www.kxan.com/investigations/a-long-time-before-congr...

There is no other civilian profession where death at this wide a scale is acceptable. Or, is taken as a matter of due course.

There is no other civilian profession where this has been the norm for centuries.

Every time a plane crashes, we perform investigations, improve, and fix. Every time there's a loss of crew on a human-rated spacecraft (or a loss of an autonomous vehicle), there's an investigation to fix what happened. Every time a bridge or a building collapses due to structural deficiencies, there's an effort to study what went wrong and how to fix it.

These reflexive investigations are pervasive everywhere. Except medicine.

Every single time the veil has been lifted, there has been something deeply ugly underneath. For example, doctors are the reason why so many women end up falling prey to Goop, because medical professionals fail — at a systemic level — to take their concerns seriously. The problem exists everywhere from the GP level to surgery,

    > While associations were consistent across most subgroups, patient sex significantly modified this association, with worse outcomes for female patients treated by male surgeons (compared with female patients treated by female surgeons: aOR, 1.15; 95% CI, 1.10-1.20) but not male patients treated by female surgeons (compared with male patients treated by male surgeons: aOR, 0.99; 95% CI, 0.95-1.03) (P for interaction = .004).

https://www.researchgate.net/profile/Angela-Jerath/publicati...

For non-technical readers,

https://www.health.harvard.edu/blog/women-and-pain-dispariti...

https://healthjournalism.org/blog/2018/11/women-more-often-m...

https://www.smithsonianmag.com/smart-news/western-medicines-...

https://www.nytimes.com/2022/03/28/well/live/gaslighting-doc...

The problem is fractal and replicates across societal out-groups (and to a lesser degree for in-groups). For example, doctors saying things like, "black people have thicker skins,"

https://www.aamc.org/news-insights/how-we-fail-black-patient...

https://batten.virginia.edu/about/news/black-americans-are-s...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/

Pick your out-group for a given society and you'll find systemic medical failure. The in-group is rarely much better off; they're still subject to the same capriciousness, merely to a lesser degree. See: the systemic failure of doctors to diagnose heart disease, https://www.bhf.org.uk/informationsupport/heart-matters-maga...

    > It looked at NHS data over nine years, which involved 243 NHS hospitals, and about 600,000 heart attack cases. Around one third, 198,534 patients, were initially misdiagnosed.

If you're on the receiving end of care, it becomes very clear, very quickly that there's something wrong with the picture.

When a field is this deficient, radical reform is necessary to save lives.

[zefalt]

> I welcome the day artificial intelligence makes most doctors obsolete.

Guess you deleted this part.

When this becomes reality, let me know. If a better system existed given the current set of parameters, I believe it would have come into existence. Give me any medical condition, and I would take my chances in the US healthcare system over any other option.

My argument is not that physicians are error proof or that they don't cause harm through errors. It is to refute your claim that "most doctors are terrible".

Your AI system would only be accurate at diagnosis if it has all the pertinent data and unlimited resources. Patients often provide an unclear history, their symptoms are not common for their underlying condition, and there are not enough resources to do a full workup for every complaint.

Regarding your second link regarding misdiagnosis in emergency rooms, you just need to look at the PERC rule or the HEART score that ED physicians use for evaluating for pulmonary embolus or acute coronary syndrome to get a somewhat clearer picture of the deviation. Even with scores of zero, there will be a substantial amount of missed diagnoses. Not everyone who goes to the emergency room is going get a full cardiac evaluation or a CT angiogram of the chest if their symptoms don't suggest the illness. There are not enough resources to do this.

https://www.mdcalc.com/calc/347/perc-rule-pulmonary-embolism

https://www.mdcalc.com/calc/1752/heart-score-major-cardiac-e...

Of course other civilian professions don't have death rates this high. They don't deal with dying people every day. Again, I'm not claiming that the medical field is perfect as it is. I just believe you are mischaracterizing data for which there are many intricacies.

You are also throwing out a lot of strawmen regarding race and sex which bears little relevance to your initial claim.

Regarding your final piece of data about the amount of misdiagnosed heart attack cases, look at the following sentence in the same article

> It estimated that, if heart attack patients were correctly diagnosed initially then – over the decade of study – over 250 deaths per year might have been prevented.

250 * 9 = 2250 preventable deaths over a 9 year period.

Far less alarming than the data you present of 198,534 missed diagnoses.

[what-the-grump]

A small piece of stone fell off the facade of a building in NYC, killed someone like 50 years ago, now we spend billions up-keeping buildings every year. How the hell is anything in the medical industry not held to at least that standard.

And then people wonder why mask mandates don’t work, and there is a mistrust of vaccines and doctors.