To extend on what has been said in the “possible solutions” part of the thread:
I think that having unimportant-seeming health problems checked out by a medical professional within a reasonable amount of time of them first occurring (from immediately for serious problems, such as chest pain, to perhaps a week or two for things like general aches and pains) is a ridiculously good heuristic to have in general.
Actively cultivating friends who are conscientious, intelligent, and sane enough to repeatedly tell you that you are rationalizing away an actual problem in your life is a good habit to have. Acknowledging the severity of any given large, easily fixable problem in your life does not follow automatically from noticing that such a problem exists, and having sane friends can help to alleviate this failure mode.
I have had bad luck getting doctors to take any kind of mild aches or problems seriously, because I am young (I guess.) And they always turn out to be nothing, so my heuristic is that, “if something feels slightly off with my body, it’s nothing, and a doctor will make fun of me if I ask about it.”
I realize that this heuristic is bad and will get worse as I age...
How many visits does always mean? How many fruitless visits would be worthwhile to you to make for that one visit where something bad is found? How much do you value not being worried?
Then again, if a person goes to the doctor for minor aches when they sit all day, don’t exercise, are overweight or have a terrible diet medicine won’t be of much help.
Your second paragraph seems like a pretty uncharitable hypothetical, and I’m doing my best to read your second person as generic, and not directed at me personally.
Generic is how I meant it to be. Sorry for the ambiquity. I’ll edit it.
I once had a patient who was severely obese, had congestive heart failure, asthma, COPD and her most acute problem was pneumonia with exacerbated asthma/COPD. She still tried to smoke through a window while having oxygen tubes in her nose and thought her biggest problem was that she had to take too many pills every day. Needless to say she didn’t survive. I hope this perspective helps to deal with your frustration if you encounter sceptical doctors. They’ve seen it all.
How many fruitless visits would it be worthwhile to you to make for that one visit where something bad is found?
The negative utility generated by going to a public health clinic and gaining absolutely no useful information is, for me, on the order of 50 USD, assuming an average copay of around $30, and that my time is worth around $20.
If I want to simply model the expected utility of going to a clinic by assuming that I either will or will not gain useful information from going to the doctor, I might subtract:
[$50 x p(fruitless visit)]
from
[(monetary value of information gained from a helpful visit-$20) x (1-p(fruitless visit))].
where the -$20 in the second equation is to account for the value of my time in the event of a fruitful visit.
How many visits does always mean? How many fruitless visits would be worthwhile to you to make for that one visit where something bad is found? How much do you value not being worried?
If you have recurring pain and a doctors tells you that he can’t diagnose anything that’s no reason for not worrying.
That depends on a lot of things, like what kind of a basis they have for saying so, and how much you like worrying about things that can’t be helped. Point of the quote was you should probably worry less with each fruitless visit.
The basis is usually that the doctor doesn’t know a solution for the problem.
True and it probably also means that you’re not in serious danger if they did competent investigations which should limit your worrying. If you’ve leg pain and you visit both a competent orthopedic surgeon and a physiatric doctor and they can’t help you, good luck with your leg pain, generally. Note that solving the problem doesn’t automatically mean knowing what the problem is or even knowing how to solve it, and misunderstanding this is why people love their placebo healers.
The category of things doctors can’t help me with and the category of things nobody can help me with aren’t the same.
That’s obvious, but there’s significant overlap if we’re talking about problems with the body, which is also obvious.
Note that solving the problem doesn’t automatically mean knowing what the problem is or even knowing how to solve it
Of course. On the other hand similar things go for doctors. Just because a clinical trial has shown that given certain patients a certain drug helps those patients, you don’t know why it helps them.
I plausible that some psychopharmaca work by reducing inflammation in the gut.
In addition most doctors who diagnose a problem as a misplaced vertebrae don’t look at why the vertebrae got misplaced in the first place. A misplaced vertebrae is visible on an X-ray. The underlying problem isn’t.
If you’ve leg pain and you visit both a competent orthopedic surgeon and a physiatric doctor and they can’t help you, good luck with your leg pain, generally.
If pain is your only problem and you score decently on hypnotic suggestibility a good hypnotist can remove it. In general that’s often no good solution because pain is a signal and you would want a fix for the underlying problem but simply removing pain can improving someone’s well being.
The human mind is capable of simply shutting of a pain signal.
That’s obvious, but there’s significant overlap if we’re talking about problems with the body, which is also obvious.
Doctors are essentially trained to be blind and not trained to perceive what goes on inside a body. That has advantages because the can give you treatments that work in blinded trials but it also has it’s issues.
My own primary physician can’t distinguish whether I tense up or relax in a conversation and she’s a Yoga teacher on the side, so probably more kinesthetic than average.
The night I stopped being a bioinformatic student I thought “beliefs have to pay rent” as far as my nonstandard beliefs go. I went and fixed one of those problems doctors have told me I have to live for the rest of my life because I didn’t feel as bound anymore to the scientific way of doing things.
I think that having unimportant-seeming health problems checked out by a medical professional within a reasonable amount of time of them first occurring (from immediately for serious problems, such as chest pain, to perhaps a week or two for things like general aches and pains) is a ridiculously good heuristic to have in general.
One of the things I’ve done for this is keep a list in Workflowy of minor medical issues. It still doesn’t feel worth the hassle to go to the doctor for one thing—”hey I’ve got this tiny lump on my finger, what’s up with that”—but it does feel worth it to say “hey, these are the five things I’ve noticed in the last six months, can you spend 2 minutes checking each of them out?” If four of them turn out to be harmless cysts and one of them is an actionable issue, the appointment still feels like a success.
I also don’t have a very good intuitive sense of the past, with things basically getting lumped into “the last week” or “before the last week,” and so I’ve found it very helpful to be able to say “hmm, this lump that I noticed ‘recently’ has actually been there for eight months. Maybe I should treat it as permanent instead of temporary” because it’s on a list with a date that I noticed it.
keep a list in Workflowy of minor medical issues. It still doesn’t feel worth the hassle to go to the doctor for one thing...
That seems like a great idea!
I have found that compiling written notes of one’s medical history (including not only observations about how you feel on given days, but also notes you have taken during doctor’s visits), can be another helpful thing to do. At least for me, this is largely true because it can be hard to remember the particulars of why a particular diagnosis or treatment was given to me five or more years after the fact.
To extend on what has been said in the “possible solutions” part of the thread:
I think that having unimportant-seeming health problems checked out by a medical professional within a reasonable amount of time of them first occurring (from immediately for serious problems, such as chest pain, to perhaps a week or two for things like general aches and pains) is a ridiculously good heuristic to have in general.
Actively cultivating friends who are conscientious, intelligent, and sane enough to repeatedly tell you that you are rationalizing away an actual problem in your life is a good habit to have. Acknowledging the severity of any given large, easily fixable problem in your life does not follow automatically from noticing that such a problem exists, and having sane friends can help to alleviate this failure mode.
I have had bad luck getting doctors to take any kind of mild aches or problems seriously, because I am young (I guess.) And they always turn out to be nothing, so my heuristic is that, “if something feels slightly off with my body, it’s nothing, and a doctor will make fun of me if I ask about it.”
I realize that this heuristic is bad and will get worse as I age...
How many visits does always mean? How many fruitless visits would be worthwhile to you to make for that one visit where something bad is found? How much do you value not being worried?
Then again, if a person goes to the doctor for minor aches when they sit all day, don’t exercise, are overweight or have a terrible diet medicine won’t be of much help.
Your second paragraph seems like a pretty uncharitable hypothetical, and I’m doing my best to read your second person as generic, and not directed at me personally.
Generic is how I meant it to be. Sorry for the ambiquity. I’ll edit it.
I once had a patient who was severely obese, had congestive heart failure, asthma, COPD and her most acute problem was pneumonia with exacerbated asthma/COPD. She still tried to smoke through a window while having oxygen tubes in her nose and thought her biggest problem was that she had to take too many pills every day. Needless to say she didn’t survive. I hope this perspective helps to deal with your frustration if you encounter sceptical doctors. They’ve seen it all.
The negative utility generated by going to a public health clinic and gaining absolutely no useful information is, for me, on the order of 50 USD, assuming an average copay of around $30, and that my time is worth around $20.
If I want to simply model the expected utility of going to a clinic by assuming that I either will or will not gain useful information from going to the doctor, I might subtract:
[$50 x p(fruitless visit)]
from
[(monetary value of information gained from a helpful visit-$20) x (1-p(fruitless visit))].
where the -$20 in the second equation is to account for the value of my time in the event of a fruitful visit.
If you have recurring pain and a doctors tells you that he can’t diagnose anything that’s no reason for not worrying.
That depends on a lot of things, like what kind of a basis they have for saying so, and how much you like worrying about things that can’t be helped. Point of the quote was you should probably worry less with each fruitless visit.
The basis is usually that the doctor doesn’t know a solution for the problem.
The category of things doctors can’t help me with and the category of things nobody can help me with aren’t the same.
True and it probably also means that you’re not in serious danger if they did competent investigations which should limit your worrying. If you’ve leg pain and you visit both a competent orthopedic surgeon and a physiatric doctor and they can’t help you, good luck with your leg pain, generally. Note that solving the problem doesn’t automatically mean knowing what the problem is or even knowing how to solve it, and misunderstanding this is why people love their placebo healers.
That’s obvious, but there’s significant overlap if we’re talking about problems with the body, which is also obvious.
Of course. On the other hand similar things go for doctors. Just because a clinical trial has shown that given certain patients a certain drug helps those patients, you don’t know why it helps them.
I plausible that some psychopharmaca work by reducing inflammation in the gut.
In addition most doctors who diagnose a problem as a misplaced vertebrae don’t look at why the vertebrae got misplaced in the first place. A misplaced vertebrae is visible on an X-ray. The underlying problem isn’t.
If pain is your only problem and you score decently on hypnotic suggestibility a good hypnotist can remove it. In general that’s often no good solution because pain is a signal and you would want a fix for the underlying problem but simply removing pain can improving someone’s well being.
The human mind is capable of simply shutting of a pain signal.
Doctors are essentially trained to be blind and not trained to perceive what goes on inside a body. That has advantages because the can give you treatments that work in blinded trials but it also has it’s issues.
My own primary physician can’t distinguish whether I tense up or relax in a conversation and she’s a Yoga teacher on the side, so probably more kinesthetic than average.
The night I stopped being a bioinformatic student I thought “beliefs have to pay rent” as far as my nonstandard beliefs go. I went and fixed one of those problems doctors have told me I have to live for the rest of my life because I didn’t feel as bound anymore to the scientific way of doing things.
One of the things I’ve done for this is keep a list in Workflowy of minor medical issues. It still doesn’t feel worth the hassle to go to the doctor for one thing—”hey I’ve got this tiny lump on my finger, what’s up with that”—but it does feel worth it to say “hey, these are the five things I’ve noticed in the last six months, can you spend 2 minutes checking each of them out?” If four of them turn out to be harmless cysts and one of them is an actionable issue, the appointment still feels like a success.
I also don’t have a very good intuitive sense of the past, with things basically getting lumped into “the last week” or “before the last week,” and so I’ve found it very helpful to be able to say “hmm, this lump that I noticed ‘recently’ has actually been there for eight months. Maybe I should treat it as permanent instead of temporary” because it’s on a list with a date that I noticed it.
That seems like a great idea!
I have found that compiling written notes of one’s medical history (including not only observations about how you feel on given days, but also notes you have taken during doctor’s visits), can be another helpful thing to do. At least for me, this is largely true because it can be hard to remember the particulars of why a particular diagnosis or treatment was given to me five or more years after the fact.