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Help Wanted: America’s love affair with amateur advice

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Re: Help Wanted: America’s love affair with amateur advice

#41

Post by secabeen »

DoreenMichele wrote: post #2

Q: What qualifies this group for the position of beacon to the masses? A: Not a blessed thing. If you pay a psychiatrist, you have to worry that they have a conflict of interest. If you really get well, you won't need them anymore. They have an inherent motive to help you only enough to take credit for things going better, not enough to set you free from needing their services. If you turn to family, coworkers, or fr…

It's something you can worry about, but you don't necessarily need to. When I have seen therapists, one of the things we discussed at the first meeting was our projection for how long the engagement would be. I asked, and was told that in most cases, both parties reach a point where they feel that further engagement is not necessary. And that's exactly what happened. We met twice a month for about 4 months, and after that, we both agreed that things were improved, and I had built strategies to help deal with my issue, and I stopped.

It's a concern, but one that can be addressed head on. Many good therapists are over-booked anyways, so their incentive to keep you on is low, as there are other people who want additional appointments and can't get them.

Re: Help Wanted: America’s love affair with amateur advice

#42

Post by sheepmullet »

matt4077 wrote: post #40
sheepmullet wrote: post #38

Earlier quoted context omitted.

> but upon closer examination it falls apart as quite simply an irrational fear Yet you didn’t actually explain where it falls apart. Valid malpractice claims are reasonably common in other much more measurable types of medicine. It’s often a good idea to get a second or third opinion when you see a normal doctor. To be wary of a branch of medicine like psychiatry with its far fewer checks and balances seems prudent.

Malpractice is mostly about errors of negligence. The accusation here was about intentional behaviour, which would actually be criminal.

> The accusation here was about intentional behaviour, which would actually be criminal.

Is that the accusation? My understanding is the parent was trying to say that incentives can bias a professionals decision making.

Re: Help Wanted: America’s love affair with amateur advice

#43

Post by gammateam »

DoreenMichele wrote: post #2

Q: What qualifies this group for the position of beacon to the masses? A: Not a blessed thing. If you pay a psychiatrist, you have to worry that they have a conflict of interest. If you really get well, you won't need them anymore. They have an inherent motive to help you only enough to take credit for things going better, not enough to set you free from needing their services. If you turn to family, coworkers, or fr…

I recently experienced something like this:

My patent attorney notified me that I had a small window to do X, and Y, or I can do Z later but it doesn't have the efficacy of X and Y.

What I knew was that my patent attorney just told me that I have to pay him four or five figures NOW or else. And that has the hallmarks of a bad investment, scams, or conflicts of interest.

Well, for different reasons, I was introduced to a seasoned "Non Practicing Entity" who also told me it was really important to do X and Y.

I went back to my patent attorney and did it. Granted, this wasn't amateur advice in the least bit, but you're right that it is unlikely to find someone to talk to whose personal biases would be more aligned.

Re: Help Wanted: America’s love affair with amateur advice

#44

Post by TheOtherHobbes »

askafriend wrote: post #28
DoreenMichele wrote: post #19

Earlier quoted context omitted.

Conflict of interest means you can never be sure why they recommended X, not that X was recommended with malice aforethought. That's precisely why it's such a thorny issue. People with malice aforethought are relatively easy to root out compared to people who mean well, but can't quite get it right for reasons no one can quite put their finger on.

How far do you take this kind of logic though? Do you never go to a dentist because you can never be sure they're fixing your teeth? You don't know if they're superficially treating your teeth just enough to warrant another visit instead of "fixing" them once and for all. Do you never hire an engineer onto your team at work? You can never be sure if they're putting bugs into their code on purpose for job security. I…

Well - "drill and fill" (i.e. unnecessary work, supposedly for medical reasons, but actually just for cash) is a recognised problem in the dental industry, at least in the UK.

Some dentists even had their contracts changed to encourage them away from the practice.

https://healthmedia.blog.gov.uk/2016/11/14/drill-and-fill-cu...

Realistically, blind faith in professionals is as unrealistic as blind paranoia.

I don't think it's possible to say "Of course we should trust psychiatrists" in one sentence and then add "But of course we don't really know much about mental illness anyway" in the next. The reality is that pharma in general has a mixed reputation, and psychiatric drug treatments have a very spotty scientific record - as do the various kinds of talking cure.

Psychiatrists probably won't encourage session dependency, but psychotherapists might - especially in countries where you can hang out a shingle with no training or background at all.

Getting help for difficult personal and emotional issues can be a minefield, with minimal consumer protection. You literally have more guarantees that your toaster is going to work as advertised.

Re: Help Wanted: America’s love affair with amateur advice

#45

Post by btilly »

criley2 wrote: post #14
DoreenMichele wrote: post #2

Q: What qualifies this group for the position of beacon to the masses? A: Not a blessed thing. If you pay a psychiatrist, you have to worry that they have a conflict of interest. If you really get well, you won't need them anymore. They have an inherent motive to help you only enough to take credit for things going better, not enough to set you free from needing their services. If you turn to family, coworkers, or fr…

A psychiatrist that behaves as you describe is literally engaging in malpractice. You are a perfect example of what the article describes: your rationalization process for mistrusting experts seems rational at first glance, but upon closer examination it falls apart as quite simply an irrational fear used to rationalize not trusting an expert. The thing about free advice online is that... you didn't go to school for…

You are providing an example of why people wind up reasonably overreacting to when they reject experts.

The fact that someone is an expert makes them an authority figure. Whether or not they are effective is an independent question. In some areas it does. In others it doesn't. As long as that person follows the standards of practice for their profession.

Believe it or not, a significant fraction of medical treatments offered have no quantifiable evidence saying whether or not they work. Admittedly a lot fewer than used to be the case since the movement towards insisting on evidence-based approaches in medicine started in the 1990s. But it has not reached all areas of medicine yet.

In particular there is no evidence that talk-based therapy is better than a placebo (such as acupuncture) at treating basic conditions like depression. See http://theconversation.com/counselling-doesnt-work-in-the-lo... for a random link verifying this.

Now if this shocks you, then reflect on the fact that within my lifetime, therapy gave large numbers of people false memory of abuse that didn't happen, psychiatry subjected large numbers of people to electroshock therapy despite a lack of evidence that it worked. If you go back just a little further, to my parent's lifetime, tens of thousands of people had their brains very literally scrambled in frontal lobotomies (usually with an ice pick inserted through the eye socket).

So here is the problem. There are lots of experts who you really should listen to. If you have cancer, don't be like Steve Jobs. But there are also plenty of professions whose practitioners who can be safely disregarded even though by all outwards appearances they are are just as expert. In a situation like this, can you blame people for identifying the wrong professions as ignorable?

Unfortunately for your argument, available experimental evidence indicates that the example that you're responding to is one of the ones that actually IS ignorable.

Re: Help Wanted: America’s love affair with amateur advice

#46

Post by icebraining »

Domenic_S wrote: post #17
DoreenMichele wrote: post #2

Q: What qualifies this group for the position of beacon to the masses? A: Not a blessed thing. If you pay a psychiatrist, you have to worry that they have a conflict of interest. If you really get well, you won't need them anymore. They have an inherent motive to help you only enough to take credit for things going better, not enough to set you free from needing their services. If you turn to family, coworkers, or fr…

If you pay a programmer, you have to worry that they have a conflict of interest. If they finish the job, you won't need them anymore.

I see you've worked with BobX!

http://thedailywtf.com/articles/We-Use-BobX

Re: Help Wanted: America’s love affair with amateur advice

#47

Post by CM30 »

DoreenMichele wrote: post #2

Q: What qualifies this group for the position of beacon to the masses? A: Not a blessed thing. If you pay a psychiatrist, you have to worry that they have a conflict of interest. If you really get well, you won't need them anymore. They have an inherent motive to help you only enough to take credit for things going better, not enough to set you free from needing their services. If you turn to family, coworkers, or fr…

> If you pay a psychiatrist, you have to worry that they have a conflict of interest. If you really get well, you won't need them anymore. They have an inherent motive to help you only enough to take credit for things going better, not enough to set you free from needing their services.

Is that really different to any professional providing one to one services or what not? After all, you could say every tutor in existence has the exact same incentives; the better you do at whatever you're learning, the less you need to see them or pay them for their services.

Yet no one really thinks their music teacher or fitness coach or what not wants them to struggle for the extra money. Same goes with driving schools and instructors. The better the student and instructor do, the less the latter get paid.

Regardless, it doesn't really work out in quite the cynical way you think it will here. For professionals in fields like this, it's helping people and making them better at what they're learning or asking for help with that boosts their reputation and gets them more business in future.

Re: Help Wanted: America’s love affair with amateur advice

#48

Post by sjg007 »

DoreenMichele wrote: post #9
sjg007 wrote: post #8

Earlier quoted context omitted.

I think you are overly worried that a psychiatrist would have a conflict of interest. A psychiatrist is an MD, they practice psychopharmacology. Even a psychologist would have no reason to keep you untreated. There are plenty of patients who need help and a shortage of mental health professionals in general.

They don't have a great track of curing people. They tend to help people "manage" their mental health issues. Color me unimpressed.

Certainly, it can be management of a complex disease basically. A depressive episode might be temporary or it might be longer lasting or even treatment resistant. Diabetes is a complex disease as well that is in most cases (but not all) managed.

Re: Help Wanted: America’s love affair with amateur advice

#49

Post by [deleted] »

criley2 wrote: post #20
DoreenMichele wrote: post #18

Earlier quoted context omitted.

A psychiatrist that behaves as you describe is literally engaging in malpractice. Not if he is giving the standard advice everyone in the industry gives. There are lots of conditions where the standard expectation is that "people like you don't really get well" and "symptom management is the name of the game." It would be considered malpractice to even tell people with certain diagnoses that you will shoot for curing…

Not if he is giving the standard advice everyone in the industry gives. There are lots of conditions where the standard expectation is that "people like you don't really get well" and "symptom management is the name of the game." It would be considered malpractice to even tell people with certain diagnoses that you will shoot for curing them. This is not a fair summary of your previous point. You previously implied t…

[deleted]

Re: Help Wanted: America’s love affair with amateur advice

#50

Post by chickenfries »

TheOtherHobbes wrote: post #44
askafriend wrote: post #28

Earlier quoted context omitted.

How far do you take this kind of logic though? Do you never go to a dentist because you can never be sure they're fixing your teeth? You don't know if they're superficially treating your teeth just enough to warrant another visit instead of "fixing" them once and for all. Do you never hire an engineer onto your team at work? You can never be sure if they're putting bugs into their code on purpose for job security. I…

Well - "drill and fill" (i.e. unnecessary work, supposedly for medical reasons, but actually just for cash) is a recognised problem in the dental industry, at least in the UK. Some dentists even had their contracts changed to encourage them away from the practice. https://healthmedia.blog.gov.uk/2016/11/14/drill-and-fill-cu... Realistically, blind faith in professionals is as unrealistic as blind paranoia. I don't th…

Your last point seems so obvious. It’s much easier to toast bread than it is to treat chronic mental illness. Of course your toaster roasts bread. Doctors can’t cure plenty of things, despite all of our efforts. Psychiatry is an even younger field than modern medicine. You have tons of consumer protection in psychiatry.
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