A doctor faces a patient whose problem has resisted decision-tree diagnosis—decision trees augmented by intangibles of experience and judgement, sure. The patient wants some creative debugging, which might at least fail differently. Will they get their wish? Not likely: what’s in it for the doctor? The patient has some power of exit, not much help against a cartel. To this patient, to first order, Phil Goetz is right, and your points partly elaborate why he’s right and partly list higher-order corrections.
(I did my best to put it dispassionately, but I’m rather angry about this.)
Um… what so you’d rather have diagnoses that are not based upon data? Or a diagnosis which is made up versus no diagnosis? I don’t quite understand what you mean. Illnesses in the human body cannot be solved in the same way as an engineering problem, particularly at the margins. Most of the medical knowledge that could be derived without careful and large clinical trials is already known—I’m not sure what you expect a single doctor to do.
Furthermore, note that most patients will not die undiagnosed—bar situations, such as in geriatric patients, where many things are so suboptimal that you just can’t sort out what is killing them and what is just background noise. It is very rare that “creative debugging” would be of any use at all.
Secondly, many patients in a terminal situation often what more medicine. They feel that not treating with aggressive chemotherapy or some such treatment is giving up. This is not always the case, it is often in terminal illnesses that palliative care is the best option and avoiding aggressive treatment will in fact lead to a longer life. No amount of debugging will change that.
Let me stress once again that it is not often a patient will die where a diagnosis has not been achieved where the correct diagnosis would have materially changed the outcome.
A doctor faces a patient whose problem has resisted decision-tree diagnosis—decision trees augmented by intangibles of experience and judgement, sure. The patient wants some creative debugging, which might at least fail differently. Will they get their wish? Not likely: what’s in it for the doctor? The patient has some power of exit, not much help against a cartel. To this patient, to first order, Phil Goetz is right, and your points partly elaborate why he’s right and partly list higher-order corrections.
(I did my best to put it dispassionately, but I’m rather angry about this.)
Um… what so you’d rather have diagnoses that are not based upon data? Or a diagnosis which is made up versus no diagnosis? I don’t quite understand what you mean. Illnesses in the human body cannot be solved in the same way as an engineering problem, particularly at the margins. Most of the medical knowledge that could be derived without careful and large clinical trials is already known—I’m not sure what you expect a single doctor to do.
Furthermore, note that most patients will not die undiagnosed—bar situations, such as in geriatric patients, where many things are so suboptimal that you just can’t sort out what is killing them and what is just background noise. It is very rare that “creative debugging” would be of any use at all.
Secondly, many patients in a terminal situation often what more medicine. They feel that not treating with aggressive chemotherapy or some such treatment is giving up. This is not always the case, it is often in terminal illnesses that palliative care is the best option and avoiding aggressive treatment will in fact lead to a longer life. No amount of debugging will change that.
Let me stress once again that it is not often a patient will die where a diagnosis has not been achieved where the correct diagnosis would have materially changed the outcome.