Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

nytimes.com

Post reply on HN
Print view View original

101–110 of 118 posts

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#101

Post by kenesom1 »

majos wrote: post #75
arkades wrote: post #2

> As for Huls, he is finishing up his fellowship at the hospital this summer. Wherever he ends up, he is certain he will find new cases to challenge his curiosity, cases he hopes to solve. No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read:…

For some time my read on this situation has been that the "doctor shortage" that produces 7-minute diagnoses stems from a restricted number of residency slots, which is set (I believe?) by the federal government. I had thought the AMA was influential in lobbying to keep the number of such slots low to prop up doctors' salaries, but with some research it's unclear how true this is. Anyone know? How strong a lobbying f…

"In 1997, a consortium that included the AAMC, the AMA, and other major organizations declared that [...] 'the United States is on the verge of a serious oversupply of physicians'. The consortium recommended limiting the number of residency positions funded by Medicare, a goal that was partially achieved in the Balanced Budget Act of 1997" [1]

See also the 1997 senate finance committee hearings on graduate medical education [2].

[1] http://annals.org/aim/fullarticle/717927

[2] https://www.finance.senate.gov/imo/media/doc/hrg105-901.pdf

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#102

Post by Terr_ »

mychael wrote: post #70

I have zero medical expertise, but it sounds like this situation could be improved with software. Given a database that contains an exhaustive list of every illness and symptoms: illness symptom diagnosis_symptom_set ------- ------- ---------------------- id id id name name symptom_id (FK->symptom.id) illness_id (FK->illness.id) (Pseudo SQL) SELECT diagnosis.name as name FROM diagnosis_symptom_set diagnosis_sympt JOI…

https://xkcd.com/793/

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#103

Post by tejtm »

jtbayly wrote: post #97
tejtm wrote: post #87

Hi HN Clinical research types may find this still imperfect tool to be of use none the less. https://monarchinitiative.org/disease/MONDO:0018304#phenotyp... Full disclosure: guilty guilty guilty

Is it just me or is this site exactly what several other people in the comments here are proposing as a major part of the solution? I’m not sure, since others are basically saying it’s too hard to do. Cross referencing conditions and diseases along with the scientific and common names for things could indeed be very useful!

That is the goal but it is a very wide and deep problem you won't catch me trivializing but we are chipping away at and seeing success. Our group working on laypersons synonyms because most folks with rare diseases do not know the terminology.

https://human-phenotype-ontology.github.io/2016/03/24/layper...

I should probably be more effusive about all we do as we always seem to be further along than most attempts(and we give it away), but as one of the sausage makers I always worry someone will run into something that is not fixed yet.

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#104

Post by arkades »

kenesom1 wrote: post #101
majos wrote: post #75

Earlier quoted context omitted.

For some time my read on this situation has been that the "doctor shortage" that produces 7-minute diagnoses stems from a restricted number of residency slots, which is set (I believe?) by the federal government. I had thought the AMA was influential in lobbying to keep the number of such slots low to prop up doctors' salaries, but with some research it's unclear how true this is. Anyone know? How strong a lobbying f…

"In 1997, a consortium that included the AAMC, the AMA, and other major organizations declared that [...] 'the United States is on the verge of a serious oversupply of physicians'. The consortium recommended limiting the number of residency positions funded by Medicare, a goal that was partially achieved in the Balanced Budget Act of 1997" [1] See also the 1997 senate finance committee hearings on graduate medical ed…

That’s more than twenty years out of date. I can’t help but feel it’s purposely disingenuous, considering all the top google results on the topic point to their efforts to expand residency funding:

http://lmgtfy.com/?q=ama+position+on+residency+funding

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#105

Post by kqr »

GordonS wrote: post #69
kqr wrote: post #13

> Huls hadn’t heard of Schnitzler syndrome, either. He came upon it by using the database PubMed to look for a disease that matched the patient’s symptoms. He made a list of her symptoms and abnormalities. To get the full picture, he combed through her earlier electronic medical records, now archived in an old electronic warehouse, and found that her symptoms had started maybe a decade earlier. Then he looked for a d…

> Is this database open? If so, anyone in the same situation as the daughter in this article could spend the hours, rather than hoping a professional will. I've done this with various doctors, trying to figure out what the hell is wrong with me. In my experience, as soon as you start telling them they just think you're a crazy hypochondriac who sends too much time on the internet.

I think a lot of it depends on how you present it and who you see. I have had the best results when leading the doctor on just to the point of tricking them into thinking they came up with the idea themselves. Play to their vanity!

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#106

Post by majos »

arkades wrote: post #82
majos wrote: post #75

Earlier quoted context omitted.

For some time my read on this situation has been that the "doctor shortage" that produces 7-minute diagnoses stems from a restricted number of residency slots, which is set (I believe?) by the federal government. I had thought the AMA was influential in lobbying to keep the number of such slots low to prop up doctors' salaries, but with some research it's unclear how true this is. Anyone know? How strong a lobbying f…

The AMA has actually been lobbying quite strongly to expand the number of residency spots. Doctors salaries are generally pushed from the top down by Medicare and not by general supply-and-demand principles. So these shortages don’t lead to salary bumps, they lead to inferior substitutions (expansion of mid-level practice privileges), which actually puts a downward pressure on salary while also providing worse care f…

Interesting. It seems like I was wrong about the AMA then. Is there a reason that a standalone bill cannot secure federal funding for addition residency slots, or is the stumbling block that increasing the number of residency slots will be expensive (even in federal money terms) regardless of how it's enacted?

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#107

Post by kenesom1 »

majos wrote: post #106
arkades wrote: post #82

Earlier quoted context omitted.

The AMA has actually been lobbying quite strongly to expand the number of residency spots. Doctors salaries are generally pushed from the top down by Medicare and not by general supply-and-demand principles. So these shortages don’t lead to salary bumps, they lead to inferior substitutions (expansion of mid-level practice privileges), which actually puts a downward pressure on salary while also providing worse care f…

Interesting. It seems like I was wrong about the AMA then. Is there a reason that a standalone bill cannot secure federal funding for addition residency slots, or is the stumbling block that increasing the number of residency slots will be expensive (even in federal money terms) regardless of how it's enacted?

Your comment wasn't wrong. In 1997, The AMA along with five other medical groups lobbied congress to limit the number of medicare-funded residency slots [1, 2]. This limit was enacted in the Balanced Budget Act of 1997 and hasn't changed since then [3]. Hospitals were paid hundreds of millions of dollars to voluntarily reduce the size of their resident training programs [4].

[1] http://articles.baltimoresun.com/1997-03-01/news/1997060012_...

[2] http://www.nytimes.com/1997/03/01/us/doctors-assert-there-ar...

[3] https://www.cnn.com/2017/03/13/health/train-more-doctors-res...

[4] http://www.cnn.com/HEALTH/9708/24/doctor.glut/

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#108

Post by arkades »

kenesom1 wrote: post #107
majos wrote: post #106

Earlier quoted context omitted.

Interesting. It seems like I was wrong about the AMA then. Is there a reason that a standalone bill cannot secure federal funding for addition residency slots, or is the stumbling block that increasing the number of residency slots will be expensive (even in federal money terms) regardless of how it's enacted?

Your comment wasn't wrong. In 1997, The AMA along with five other medical groups lobbied congress to limit the number of medicare-funded residency slots [1, 2]. This limit was enacted in the Balanced Budget Act of 1997 and hasn't changed since then [3]. Hospitals were paid hundreds of millions of dollars to voluntarily reduce the size of their resident training programs [4]. [1] http://articles.baltimoresun.com/1997-…

You posted this two hours after I replied with a list of google results showing you’re two decades out of date. Now it’s -clear- you’re being disingenuous, but for the life of me I cannot fathom why.

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#109

Post by kenesom1 »

arkades wrote: post #108
kenesom1 wrote: post #107

Earlier quoted context omitted.

Your comment wasn't wrong. In 1997, The AMA along with five other medical groups lobbied congress to limit the number of medicare-funded residency slots [1, 2]. This limit was enacted in the Balanced Budget Act of 1997 and hasn't changed since then [3]. Hospitals were paid hundreds of millions of dollars to voluntarily reduce the size of their resident training programs [4]. [1] http://articles.baltimoresun.com/1997-…

You posted this two hours after I replied with a list of google results showing you’re two decades out of date. Now it’s -clear- you’re being disingenuous, but for the life of me I cannot fathom why.

None of this is outdated. You're trying hard to to rewrite history with downvotes.

The 1997 cap on medicare-funded residency slots has remained in place since that time, unchanged despite population growth and an aging population. The current crisis and physician shortage is in large part a result of that two-decades-old legislation which was engineered by the AMA and other major medical groups.

Based on your comment history, you trained as a doctor, which is great and absolutely commendable [1].

However, do you feel compelled to troll and post obviously slanted information due to your personal association with the AMA?

For the record, I think doctors should get paid well and more than they currently do. Clinics should be run by physicians. But allowing guilds like the AMA to artificially restrict the availability of critical healthcare has resulted in millions of avoidable deaths and serious suffering across the entire population.

"The predicted physician shortages will result in decreased access to care for millions of individuals. [...] [A]dding one PCP per 10,000 people would reduce predicted all-cause mortality [...] by 5.31 percent. Translated nationally, this would avert 127,617 deaths." [2]

[1] https://news.ycombinator.com/item?id=16337410

[2] https://web.stanford.edu/group/sjph/cgi-bin/sjphsite/the-loo...

Re: Her Various Symptoms Seemed Unrelated, Then One Doctor Put It All Together

#110

Post by phonon »

mychael wrote: post #70

I have zero medical expertise, but it sounds like this situation could be improved with software. Given a database that contains an exhaustive list of every illness and symptoms: illness symptom diagnosis_symptom_set ------- ------- ---------------------- id id id name name symptom_id (FK->symptom.id) illness_id (FK->illness.id) (Pseudo SQL) SELECT diagnosis.name as name FROM diagnosis_symptom_set diagnosis_sympt JOI…

https://www.gideononline.com/about/gideon/ is like that for infectious diseases.
Post reply on HN