Sorry, I stopped reading because of the disingenuous shifting very early on.
They should be able to reliably diagnose diseases they are trained to diagnose.
Okay, agree. What’s their reliability for all diseases they are trained to diagnose?
Failure to diagnose uncommon diseases is rampant
Oh, okay, we’re going to focus on their reliability to diagnose uncommon diseases. So how do they do with that?
A survey of patients with rare diseases found that, in about half of cases, patients received at least one incorrect diagnosis, and two thirds required visits to at least three different doctors before being diagnosed.
Okay, we somehow went from general reliability, to uncommon, to rare without skipping a beat. You’re talking about different things. This lack of basic consistency undermined your credibility immediately.
I noticed this was a repeated theme of the article. Another example is equivocating between “doctors are rude” and “doctors interrupt patients.” People interrupt each other in conversation all the time! It’s a normal way of talking that doesn’t automatically make you rude.
There is no quantifiable form of “rude”. 11 second interruption times, (that by the way are not explained by irrelevant blathering. From Claude: “77% of patients (258/335) finished their initial statement within 2 minutes, and only 2% (7/335) spoke for more than 5 uninterrupted minutes. In all cases, physicians considered the information they were given to be relevant. So letting patients finish takes about two minutes for ~80% of cases, and the doctors themselves judged the information relevant. The interruptions aren’t saving meaningful time.”), plus an inverse correlation between self reported empathy scores and those of patients, plus enormous (often majority) percentages of patients reporting some form of neglect or dismissal in surveys, plus virtually ubiquitous and unidirectional anecdotes, is as strong of an empirical case for a profession being “rude” I think you are ever likely to get.
Having taken a quick look at the source for Claude’s data, it seems like a reasonable read is that the doctors are simply not well-calibrated on the relevance of the patients statements and redirect them away too quickly. Not sure this means they were ‘rude’,
The HCAHPS survey measures ‘courteousness’ by asking patients, and consistently find that in ~85% of cases, doctors are rated ‘always’ respectful and courteous. From my understanding, a further ~10% are rated as ‘usually’ respectful and courteous. This is not a perfect measure, but seems better than using interruption times as a proxy.
I also wonder about the snowball sampling approach to this. How do people with rare diseases get to know each other? I’d assume the major way is via forums for people trying to work out their rare diseases, which probably skews towards cases that haven’t been adequately handled by the doctors.
Yes, the information is generalisable. Critical care doctors would be expected to outperform PCPs on a specialised function they perform regularly, and nonetheless have very low sensitivity.
Unless you think it’s plausible PCPs would outperform critical care doctors on abdominal auscultation for detecting haemmorhages, I see no reason why it is irrelevant to the case.
The PCP could say “I don’t know this, go to a specialist to find out” or in some cases (especially the critical care doctor) the PCP may not be faced with such a case in the first place.
That doesn’t show that PCP are bad at diagnosing the cases that they do face and that they don’t send to other doctors.
Fair pushback. Although I think you are being somewhat too dismissive.
PCPs are trained to diagnose (and certainly indicate/suspect) both rare and common diseases.
The distinction between uncommon and rare is subjective. There is not an official tier system that graduates from “common” to “uncommon” to “rare”, etc. I used the word “uncommon” as a synonym for rare—“uncommon” doesn’t typically appear in literature. I can appreciate this downplays it somewhat. However, the term “rare”, I would argue, exaggerates rarity for the more common members of that category. I don’t think that pointing out a word choice that commits a connotational but not a factual error is a valid basis to dismiss the whole thing.
Sorry, I stopped reading because of the disingenuous shifting very early on.
Okay, agree. What’s their reliability for all diseases they are trained to diagnose?
Oh, okay, we’re going to focus on their reliability to diagnose uncommon diseases. So how do they do with that?
Okay, we somehow went from general reliability, to uncommon, to rare without skipping a beat. You’re talking about different things. This lack of basic consistency undermined your credibility immediately.
I noticed this was a repeated theme of the article. Another example is equivocating between “doctors are rude” and “doctors interrupt patients.” People interrupt each other in conversation all the time! It’s a normal way of talking that doesn’t automatically make you rude.
There is no quantifiable form of “rude”. 11 second interruption times, (that by the way are not explained by irrelevant blathering. From Claude: “77% of patients (258/335) finished their initial statement within 2 minutes, and only 2% (7/335) spoke for more than 5 uninterrupted minutes. In all cases, physicians considered the information they were given to be relevant. So letting patients finish takes about two minutes for ~80% of cases, and the doctors themselves judged the information relevant. The interruptions aren’t saving meaningful time.”), plus an inverse correlation between self reported empathy scores and those of patients, plus enormous (often majority) percentages of patients reporting some form of neglect or dismissal in surveys, plus virtually ubiquitous and unidirectional anecdotes, is as strong of an empirical case for a profession being “rude” I think you are ever likely to get.
Having taken a quick look at the source for Claude’s data, it seems like a reasonable read is that the doctors are simply not well-calibrated on the relevance of the patients statements and redirect them away too quickly. Not sure this means they were ‘rude’,
The HCAHPS survey measures ‘courteousness’ by asking patients, and consistently find that in ~85% of cases, doctors are rated ‘always’ respectful and courteous. From my understanding, a further ~10% are rated as ‘usually’ respectful and courteous. This is not a perfect measure, but seems better than using interruption times as a proxy.
I also wonder about the snowball sampling approach to this. How do people with rare diseases get to know each other? I’d assume the major way is via forums for people trying to work out their rare diseases, which probably skews towards cases that haven’t been adequately handled by the doctors.
I also noticed things like using behavior from non PCP doctors, like critical care doctors, to make conclusions about PCPs.
Yes, the information is generalisable. Critical care doctors would be expected to outperform PCPs on a specialised function they perform regularly, and nonetheless have very low sensitivity.
Unless you think it’s plausible PCPs would outperform critical care doctors on abdominal auscultation for detecting haemmorhages, I see no reason why it is irrelevant to the case.
The PCP could say “I don’t know this, go to a specialist to find out” or in some cases (especially the critical care doctor) the PCP may not be faced with such a case in the first place.
That doesn’t show that PCP are bad at diagnosing the cases that they do face and that they don’t send to other doctors.
Fair pushback. Although I think you are being somewhat too dismissive.
PCPs are trained to diagnose (and certainly indicate/suspect) both rare and common diseases.
The distinction between uncommon and rare is subjective. There is not an official tier system that graduates from “common” to “uncommon” to “rare”, etc. I used the word “uncommon” as a synonym for rare—“uncommon” doesn’t typically appear in literature. I can appreciate this downplays it somewhat. However, the term “rare”, I would argue, exaggerates rarity for the more common members of that category. I don’t think that pointing out a word choice that commits a connotational but not a factual error is a valid basis to dismiss the whole thing.