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I know the secret to the quiet mind but wish I’d never learned it

theatlantic.com

141–150 of 189 posts

Re: I know the secret to the quiet mind but wish I’d never learned it

#141

A few years ago I got some kind of brain illness. Doctors were unable to come up with a strong diagnosis, which is apparently quite common for such cases. One of the effects of the illness was that I essentially became stupid. I couldn’t focus on anything (even trivial activities like watching television), I couldn’t compose emails, I would get disoriented easily. It was absolutely terrifying not knowing whether or n…

> 1. Like any other industry, 90% of medical “experts” are totally incompetent. Yeah, I've come to the same conclusion. When I was a kid it took 2 years to diagnose my, frankly quite textbook, hypothyroidism. Know who first diagnosed it? A friend of my mother's who worked the toll booth at the airport. Her dog had it, you see, so she recognized the symptoms. My mother had to go full Karen mode on a doctor to get them…

Veterinarians are no different.

Was abroad in a tropical climate to wait out COVID. Took our dog. 10 days before traveling back home, I see a engorged tick walking on the living room floor of our Airbnb. I was terrified because we have small children. But having grown up in a tropical country with a dog that would be full of ticks sometimes, I didn't think about our dog much.

On the 6 hour plane home, our dog is basically mute. He's very good traveling, but never that good.

We finally get home. He's not eating. He's sitting curled up by the door. I thought he missed the huge patio of our tropical house and the outdoors. Finally, when his favorite visitor came and he didn't even flinch, I knew something was really wrong.

Unfortunately, I had waited too long to take action: The day before the vet appt, my partner called me freaking out saying our puppy's eyes were rolling back and he was barely moving. I rushed him to a VEG clinic, where they ran all kinds of diagnosis.

I told the doctors where we had been, what I had seen, our dog's behaviour in the prior days etc. At this point i start requesting all the diagnostic results because a close person to me is a vet in said tropical country, and she could literally diagnose our dog.... over WHATSAPP. Her assessment was immediate and direct: My dog has babesia, and had gone into shock because the parasite had eaten all his white blood cells and platelets.

Doctors in the US were not quite on board yet. They first asked a million questions on what my dog had eaten. They were convinced that something was wrong with his stomach because he wasn't eating and also I believe there was tissue inflammation / sensitivity (which was also explained by other factors related to tick disease). They did run a tick panel and came back negative. They were not convinced by the babesia hypothesis. It detected no antibodies for it. (IIRC, My contact had told me that was common in situations where the virus had obliterated the immune system and the body had not had enough time to manufacture antibodies which could be detected by the test.)

Then starts the cachopony of errors. My dog breed is known to have heart murmurs. His murmur was present prior to the trip, and i had test results from the vet in the tropical country which showed the murmur had magically gone from a 1 to a 5 in about 1 week, so they started saying he had a heart problem. (nevermind that the heart behaves erratically when blood is poisoned by foreign invader).

Next day, they start saying it could be heart disease coupled with genetic issue. They want to do genetic tests. I say no.

At this point i have to discharge our dog because the clinic will close for the weekend. I take the dog to my vet. There they say its some kind of cancer (!!). They insist i do a biopsy...

By now my dog is stable but I still needed an Echo to be able to complete the diagnosis puzzle and avoid hospitalization at a major nearby hospital.. Took him to another VEG that was open, for diagnostics. This was covid, so i was sitting outside in the bitter cold with a sick dog. After a 5 hour wait they give me my results and sent me on my way, no directions on what to give our dog to keep him stable.

Next day, our dog deteriorated rapidly, and I was forced to do what I had been trying to avoid: get him admitted at the animal hospital. Signed off on a minimum admission of $2.5k. But hey, at least they didn't redo all tests (they wanted to).

Finally the resident infectious disease expert onsite requested a full tick panel (the IDEXX24 standard panel does not screen for babesia). Babesia is confirmed almost 5 days later.

Final bill $4500.

VEG did reimburse me almost $1000 because the managing director agreed it was borderline malpractice to discharge my dog from the 2nd location without a proper plan. I should be clear, although the doctors at the 1st VEG location were waaay off making up diagnoses as fast as they could think them, at least they did not hand me the dog and tell me... "good luck" , which is what the 2nd location did. And the experience with them from a financial standpoint was not adversarial. Both locations were forthcoming with costs. Very much unlike the hospital, which made me feel bad for.... trying to get any sort budget, before admission.

TL-DR: To a hammer, everything looks like a nail.

A clinic does well with broken bones, foreign objects in the belly, and the like. They don't do well with infectious diseases, even those that are quite common elsewhere, particularly for those that they never see at home.

Re: I know the secret to the quiet mind but wish I’d never learned it

#142

A few years ago I got some kind of brain illness. Doctors were unable to come up with a strong diagnosis, which is apparently quite common for such cases. One of the effects of the illness was that I essentially became stupid. I couldn’t focus on anything (even trivial activities like watching television), I couldn’t compose emails, I would get disoriented easily. It was absolutely terrifying not knowing whether or n…

>90% of medical “experts” are totally incompetent. My wife had breast cancer, muliple lumps irregular shaped, the only answer was full mastectomy, except the oncologist wanted to do a biopsy before they did they surgery. "Why?" I asked, "You already said that the safest option is to perform the mastectomy, right?" The doctor replied, "Well, yes but we'd like to know what we are facing before we got in." Me, "Will it…

This story has a major plot hole.

If you were so certain the biopsy was unnecessary and harmful, why didn’t you just refuse it, seek a second opinion (especially as you evidently are portraying the doctor as a villian).

Also your last paragraph doesn’t even read well as preteen fall fiction.

Re: I know the secret to the quiet mind but wish I’d never learned it

#143

Earlier quoted context omitted.

While I have no particular position, my brother is a molecular biologist and bioinformatics guy who has been published in nature, featured in NYT, etc. A true scientific nerds nerd, and he endlessly ridiculed the poor science and poor scientific understanding of people on the M.D. track that he interacted with in labs while he was doing research. I do have this anecdote from deep personal experience though... pediatr…

It’s a bit of a misunderstanding of the role of doctors as well IMO. Apart from a small fraction of them they aren’t scientists or researchers and aren’t supposed to be. And the human body is complex, problems can arise which can’t easily be understood. The expectation that every doctor is House and we’ll each get millions of dollar of diagnostics is wrong. There’s also a reason why experiments in science require an…

They get paid as if they are super experts even when most of them aren't. People wouldn't complain about the skills of doctors if they just earned 100k a year or so. I don't understand why USA doesn't just open up the floodgates and stop the requirement for doctors to get a bachelors before starting their doctors degree and with that get way more doctors and push down wages.

Re: I know the secret to the quiet mind but wish I’d never learned it

#144

A few years ago I got some kind of brain illness. Doctors were unable to come up with a strong diagnosis, which is apparently quite common for such cases. One of the effects of the illness was that I essentially became stupid. I couldn’t focus on anything (even trivial activities like watching television), I couldn’t compose emails, I would get disoriented easily. It was absolutely terrifying not knowing whether or n…

> 1. Like any other industry, 90% of medical “experts” are totally incompetent. Yeah, I've come to the same conclusion. When I was a kid it took 2 years to diagnose my, frankly quite textbook, hypothyroidism. Know who first diagnosed it? A friend of my mother's who worked the toll booth at the airport. Her dog had it, you see, so she recognized the symptoms. My mother had to go full Karen mode on a doctor to get them…

Richard Feynman in What Do You Care What Other People Think? says something similar happened with his first wife Arlene who contracted tuberculosis. If we trust his account, then it went something like this:

Arlene presented with bumps on her neck and the doctors couldn't figure it out. In his free time Feynman read medical textbooks in the Princeton library, and the first thing in the book is tuberculosis, which it describes as being "very easy to diagnose." Feynman assumes if its so easy and the doctors can't figure it out then it has to be something much rarer, something like Hodgkin's lymphoma. He asks the doctor about Hodgkin's, and the doctor admits it is a possibility.

> When she went to the county hospital, the doctor wrote the following diagnosis: “Hodgkin’s disease?” So I realized that the doctor didn’t know any more than I did about this problem.

After several months the doctors order a biopsy of her neck and pretty easily confirm it was tuberculosis. Feynman concludes that he made a huge mistake assuming they ruled out the easiest diagnosis.

Re: I know the secret to the quiet mind but wish I’d never learned it

#145

Earlier quoted context omitted.

Ok, but doing a little research on pubmed in March of 2020 allowed me to see all the research that had already been done on SARS, that showed spread within apartment complexes and indicated these sorts of diseases were almost certainly airborne rather than spread by droplets. And a lot of "outsider" aerosol experts were saying that all year. Still it took the CDC months and months to admit it. When the experts start…

Sadly, the bar, and duration required for the science you describe is higher than "a little research on pubmed...on SARS". I'm a little flummoxed by the description of not rushing science as political.

It's not scientific to assume spread is not airborne, then tell everyone to assume spread is not airborne, until research confirms beyond a reasonable doubt that it's airborne. Science isn't about pretending that the first guess that comes into your head is the truth until proven otherwise.

Re: I know the secret to the quiet mind but wish I’d never learned it

#146

A few years ago I got some kind of brain illness. Doctors were unable to come up with a strong diagnosis, which is apparently quite common for such cases. One of the effects of the illness was that I essentially became stupid. I couldn’t focus on anything (even trivial activities like watching television), I couldn’t compose emails, I would get disoriented easily. It was absolutely terrifying not knowing whether or n…

>> 1. Like any other industry, 90% of medical “experts” are totally incompetent. I would need data to accept this, not anecdote. There is a tendency for smart people to think they know better than experts.

> There is a tendency for smart people to think they know better than experts.

They probably do. People hate to recognize this because it goes against most western notions of the value of work ethic, but a couple stddev of intelligence is, in many cases, more valuable than many years of experience. Sad but true.

Re: I know the secret to the quiet mind but wish I’d never learned it

#147
post #92

Earlier quoted context omitted.

> Is that really the doctors fault? It seemed that most of the doctors I had to deal with were incompetent either because they were lazy or stupid. Realistically maybe they were just overworked, but the effect was the same. I’m not really interested in assigning “fault” here - that’s just a factual observation I made.

Are you qualified to evaluate competence in that field? What specific criteria did you use?

If there were specific criteria that I could share in an HN comment, they would be used for hiring and immediately collapse under Goodhart’s law. Your question is almost tautologically bad - If I were able to answer it in a brief HN post, my answer would be bullshit.

You can accurately probe competence by asking people questions about their thought process, their current hypotheses, etc. If there are $BIGNUMBER tests for competence, you only need to ask $SMALLNUMBER of them to make an accurate determination as long as the person being asked doesn’t know them ahead of time! This is the same trick many zero-knowledge proof algorithms use.

Re: I know the secret to the quiet mind but wish I’d never learned it

#148

A few years ago I got some kind of brain illness. Doctors were unable to come up with a strong diagnosis, which is apparently quite common for such cases. One of the effects of the illness was that I essentially became stupid. I couldn’t focus on anything (even trivial activities like watching television), I couldn’t compose emails, I would get disoriented easily. It was absolutely terrifying not knowing whether or n…

Did you also hear a sound like a bass guitar string snapping when this happened?

No, but this is a very interesting question. Why do you ask?

Re: I know the secret to the quiet mind but wish I’d never learned it

#149

Earlier quoted context omitted.

With doctors, you are your own doctor and the doctors you see are subcontractors. First appointment is a job interview. That’s the best way to think of it IMO. I guess I’m privileged to have the money to do this. Google helps you know what it could be, but you need to do a fair bit of research and critical thinking. Unfortunately if you are sick this is the last thing you want to do!

I'm all for taking charge of your own health priorities, but don't go too far to the other side of the spectrum. Witness all the "shade tree epidemiologists" that came out of the woodwork last year. One or two Facebook conspiracy videos, and they were suddenly health care experts, confidently spouting off COVID-19 facts they picked up from the YouTube channels of Crystal Energy Lady or Vitality Supplement Guy. Doing…

Unironically, becoming a crystal healing hippy is probably better for you on expectation than subjecting yourself to the iatrogenic interventions the median doctor will probably subject you to. The same is true of e.g. faith based healing. It doesn’t matter if it literally does nothing except make you feel a bit better - that’s probably better than going to the doctor for most conditions.

Beyond that, doing a bit of research yourself will almost certainly give you better info than listening to whatever bullshit the CDC puts out for mass consumption. This isn’t specific to coronavirus or anything - this has always been true. Establishment medical organizations already have shit results, and it’s not going to get better when you throw political appointments in the mix. Same is true of health recs from other government bodies like USDA. Their health recs change constantly with no evidentiary basis.

Re: I know the secret to the quiet mind but wish I’d never learned it

#150
A good point to make is that unlike most other professions, negligent -or downright dangerous- doctors are not naturally flushed out of the profession by market mechanisms that keep other professions in check.

As documented by Marty Makari's book "Unaccountable", state boards rarely if ever sanction doctors for negligence. First, bad doctors are protected by a code of omerta from public exposure [1]. This is often because the bad doctors are the ones that deal with the awful hours / patients / cases, no one else wishes to deal with.

In the rare instance sanctions happen, they simply go to another state and continue to practice [2]

Therefore, you are far more likely to end up with an incompetent doctor... than you would like to think.

[1] https://www.wsj.com/articles/SB10000872396390444709004577652...

[2] https://www.baltimoresun.com/citypaper/bcp-cms-1-1378603-mig...

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