It's not just medical residents. Doctors do refresh their knowledge from videos online. And they totally google for information. But I don't think it's what many people imagine when reading it.
> How can doctors tell which videos are valid and which contain bogus information?
They're doctors. They had years of training and know the basics of what they're booking up. It's closer to experienced developers looking up specific usage for some tool which they're familiar with otherwise, rather than learning from scratch.
Sure, there's going to be some extreme bad cases, but those are bad doctors in general, the source of info is not relevant.
I learned this lesson the hard way. But now I resort back to books and obscure sources for my stats training. It's slow and painful, specially when you're alone and there's nobody to answer questions about this weird aggregation function you're learning.
Or perhaps less insidiously, a lot of answers are out of date. I remember that when I did AI game programming, I wanted to build a behavior tree, so in a recent project I Google for that. I get tons of great resources for behavior trees, libraries, examples, etc.
Except there's a lot more on the cutting edge I should be considering. Maybe GOAP is the right fit. Maybe HTN. Maybe something else. Sometimes these searches turn up results that are too specific to the old way of doing things and don't lead me to the latest and greatest.
I've seen some terrible code in codebases that I just know has come from Stack Overflow (often I can trace back and find it). Some of it's for security related code, so it's fairly critical to get it right.
There's no magic to it - There's a lot more gatekeeping, training, board certification, etc. It's not perfect, but it's a darn sight better than the complete lack of professional standards that we developers are held to (myself included - I'm shipping code today that I wish I weren't, that I believe is unsafe at any speed, but thankfully I don't believe it'll be getting above .1MPH)
You can hire a developer off the street who just happened to be the CEO's nephew. You can't do that with doctors.
> In this case, I welcome putting gates around medical hiring practices. Lives are at stake.
Note that lives are also lost (and much suffering is caused) by the extremely restricted and expensive medical environment. I actually expect that we'd be better off (utilons wise) if we relaxed some of the restrictions.
100% agreed on the suffering caused. Separating the rising cost and the restrictions can be done.
Socialized, single payer, gov mandated caps, etc etc. There are lots of options. Each come with their own poisons, but far more effective in terms of overall coverage than what we have available in America without material change to the restrictions.
>Putting gates around something as basic as medicine has only resulted in the price going up.
Citation required. This is pure bullshit. Those gates aren't there just because someone said 'hey there should be a gate there.' Those gates are there to solve problems, and while they also create their own problems, that doesn't change the fact that the underlying problems are still there.
Doctors are “magically” smarter than developers. They have to clear a huge amount of training before they get to call themselves “doctors.” It’s like if someone had to reach L7 at Google before they could call themselves “developers.”
I can't seem to find an openly available PDF, but you can search sci-hub to pirate that.
From reading the abstract and the graphics, it doesn't exactly look like something you cook up in the kitchen. For instance they run the reaction in trifluoroethanol, which is flammable, toxic, irritant and possibly causes reduced fertility from exposure.
Not sure if you have access to it, but reaxsys is an amazing database for stuff like this. I've used it many times for looking for (un)safe reaction paths for particular drugs. It looks like the ``free'' version might let you get a lot of information from it.
Also, pubchem might be of help as well. This is entirely free.
Person doing simulations in plasma physics / astro physics here. I google tons of stuff every day. And I have a hard copy of https://www.nrl.navy.mil/ppd/content/nrl-plasma-formulary on my desk. And the PDF on just about any of my devices. Once every few years I ask the Navy for 20 copies and hand them out to grad students and colleagues.
When reading articles like this, here's a quick check: Replace "YouTube" with "bookstores" and see if you're still outraged. Anyone can write a book, and the bar to getting a book published has absolutely nothing to do with the book's accuracy. If "Chariots Of The Gods?" can get published, you know publishers aren't doing sanity testing or any other kind of checks for the reliability of the content. And yet doctors buy books from bookstores, and use them to learn things. How do doctors know they're not getting nonsense? Because they know what real information looks like.
This is the biggest reason for teaching the basics of a broad variety of subjects: If you know what real information looks like, and how the real field basically fits together, you're less likely to be taken in by absolute nonsense. OTOH, if you get bad information to start, you're going to evaluate all subsequent information on that standard, and reject good information because it doesn't jibe with the bad stuff you've already internalized.
I recently had an elevated D-Dimer level in my blood lab which indicates a clot of some sort. I remember sitting in the doctor’s office while my primary care doctor was reading the lab results. He literally started Googling “primary causes of D-Dimer elevation” and clicked on the link to a WebMD documentation on D-Dimer levels. That’s when I realized that’s their StackOverflow. Combined with their existing training, I assume WebMD helps them make better judgement calls (definitely compared to a lay person self-diagnosing themselves). He then said, “well, none of the top causes really apply to your situation: you didn’t have a surgery recently and it’s impossible for you to get pregnant as a guy”.
Some resources Doctors use: Medscape  which is owned by WebMD; Sources like MPR  for handy drug information and The Medical Letter  for in-depth medication reviews; UpToDate ; various journals depending on specialty, The New England Journal of Medicine being one of the most prestigious ; the Sanford Guide for infectious diseases .
Almost, but not quite right. Usually doctors and medical professionals use reference guides like Merk Drug Manual and Up To Date. They essentially fill in the gap somewhere between review articles (which can be a bit too specifically focused) and medical textbooks (which can be a bit overly broad in how they describe topics). These guides often provide the "typical" routine, but is then augmented by a physicians judgement.
She'll often does similar to verify she's not missing something obvious. In most cases, WebMD is simply agreeing with her pre-existing knowledge. Occasionally, it will present some other information - which she will research further to verify accuracy.
I watch Youtubers build things, or just playing my favorite video game and while I learn a lot from them, sometimes I learn more from the times that I disagree with them.
I was watching a video for a game I play, about a dogmatic approach to solving a particular problem and realized it had been min-maxed into the ground by bad math. By de-optimizing it a couple percent I could get 2 and a half beneficial outcomes instead of just the one. Given how time consuming the process is, it was madness to sink so much effort into solving only one problem. Of course having spotted something someone else missed, I've been staying up too late trying to validate my theory. Unfortunately my change barely made it any faster, and my first attempt to break it down into two phases didn't work out and ended up costing me more time than I had saved.
Point is, I got all new nuances and areas to explore based on watching a video that I felt was provably wrong.
There's also the compulsion that highly trained professionals have to correct false information out of a sense of pride or ego. It helps to combat misinformation when you have a fair number of "ummm, ACKSHULY"'s in your profession.
Many medical schools now use Problem Based Learning (PBL) approach. Fewer textbooks are assigned and there are fewer lectures. Students are taught to track down the resources they need, books, journals, internet resources, etc.
I work as a doctor (in the UK) in a hand injury clinic and see tens of hand and finger injuries a day, including a lot of fingers slammed in doors.
Whilst you are correct that trephining a nail (making a hole) to relieve the subungal haematoma (blood under the nail) beneath isn't a very skilled procedure, that's not why we see these patients. Most of the time, it is a simple straightforward injury requiring simple treatment. But a significant amount of the time there is an underlying open fracture of the distal phalanx (bone at end of finger) which can lead to a severe, potentially finger-threatening infection. There are also often nail bed injuries which without repair will lead to nail deformities.
There are a lot of injuries I have seen with delayed presentation where patients felt they knew what to do and wanted to save themselves the time of visiting the hospital (as there is no additional financial cost to healthcare in the UK). Many of these delays have led to severe infection requiring hospitalisation and surgery which would not have been required if they had visited promptly, or presenting past the point where we can fix e.g. a mallet finger, displaced fracture, etc.
As in all fields, there is a danger in not knowing what you don't know.
I'm a medical student in the States. Everything you said is spot on. Most of the time the presentation is straight forward and treatment fairly unremarkable. It's when nuances are introduced where medicine becomes complicated quickly. There are a plethora of patient presentations that can mimic benign illnesses while being much more insidious.
This idea that one cannot use Youtube to learn about medicine is a little silly. I use Wikipedia daily to further my understanding of diseases. Hell, it's usually the first place I go when I have a question.
I think there are a few things here. First, a lot of people go to the doctor for things that don't require a doctor at all. Your smashed fingernail is a perfect example - why would you even go to the doctor for that unless you really think your finger is fractured? Same with basic illnesses - waiting rooms are packed with people who have a basic cold and haven't even given it a week to resolve itself. This is really where telemedicine/remote doctors/whatever you want to call it should fill in the gap.
On the other hand, your ankle sprain example is a good one to use for a reason why doctors can be really important for basic things like PT. A rather large percentage of people straight up will not follow a basic PT regimen (let alone a diet/exercise change) to resolve a problem unless 1) a doctor tells them to, and 2) they are instructed on exactly what to do at regular on-site sessions. Ortho offices are packed with people who just want an MRI and some injections rather than having to actually do some work over the course of a few months to get better.
For people who are self-motivated and take care of their own health, doctors are rarely actually needed until you get to the point of needing specific tests and prescriptions. But for the other ~80ish percent of people, doctors are pretty much the only route to getting better.
You would be supprised what people can learn quickly to alieve their pain. I nearly passed out when it was explained to me by a family member who was a doctor, but within a few seconds the pain ironed my resolve. The relief was immediate, as was the tiny, if momentary, fountain of blood.
I wouldn't be surprised actually. I've done a lot of "home remedy" type stuff.
I know from first-hand experience that discussing it online is a space with a lot of pitfalls. It's difficult to gauge the level of background knowledge of your audience and challenging to provide enough warnings to make it safe and useful while not insulting anyone's intelligence when different people in the audience will have vastly different levels of background knowledge pertinent to the problem space.
That doesn't answer it at all. Why do you need to go to the doctor for something that basic? Do you also go to the doctor when you get a blister?
A 30 second google search would tell you what to do if you didn't learn this as a child (is basic health stuff like this really not taught anymore?), and it doesn't require a doctor.
Don't even know where to start with this--with all due respect this reads as textbook dunning kruger You aren't a trained medial expert. You lack the years of training and experiance somebody in the field has. Just like any other profession, that training is there to help you filter out how to properly think about the problem-space you are in and filter out all the noise. There is no-doubt a lot of unstated things that those youtube videos dont talk about that an untrained random person like yourself simply doesn't know.
You lack the internal knowledge-base that somebody with training has and therefore you are much more likely to mis-diagnose yourself, fall into an edge case that somebody with training could have easily caught, or miss something very important because it wasn't stated in the video you watched.
I dunno man... when it comes to the medial field I personally let the experts do their work. Relying on the internet, which is especially full of superstition, noise and pure bullshit when it comes to medial information, seems like setting yourself up to get hurt. But maybe that is just me...
I agree with your point of view that only trained medical experts are qualified to treat a real medical health issue. However, the mentality of completely entrusting your own life and health to someone whom you don't know whether they have good enough work ethics and compassion or not is frankly quite a big risk.
In reality, other than medical scientific knowledge and methods, effective treatments also come from having compassion and caring deeply for your patients. Unfortunately, we have to admit that not all doctors today have that. I have seen the good and the bad ones, good doctors were really good and bad doctors were also really terrible, just like in any other professions I guess. Without those human attributes though, those bad doctors can't really help anyone as it is the main force driving them to help seek the right cures for the patients. Worse, they may contribute to misdiagnoses and malpractices that are the prevalent sources for medical related accidents and deaths.
As individuals, we should all educate ourselves so we are more equipped in working together with the doctors when issues arise, rather staying in the unknown and completely leave your own fate to the hand of luck.
You pay for the experience. They have done it thousand of times, while this will be your first. I have this problem myself, that I can scan hundreds of papers and literature and get a decent picture of the current state - which makes me dangerously over-confident.
This is an important point in that, health care systems often are motivated to get you to do more unnecessary things that cost. This is particularly true at end of life stages. Not every provider is trying to do this, but some absolutely are.
Doctors are turning to medical journals to fill in gaps in their knowledge.
Doctors are referring to textbooks to fill in gaps in their knowledge.
Any doctor who isn't doing that possibly is in the wrong profession. Indeed most of what is learned in a medical degree is so the doctor can assess these sources and embrace or reject them.
Doctors attend lectures at conferences. Always have. Now cheap video distribution exists. So now sometimes virtually attending the lecture on youtube that they otherwise would have not been able to see.
Surgical techniques are often better demonstrated than described, so videoing them makes some sense. Watching videos of techniques that have the potential to be better than what you are using is a very good thing. Assessing and rejecting them if it turns out the technique isn't better is obviously what any competent human being would do.
Quality control? Hell medical journals barely have that. Ask a statistician about medical journal quality control - it's only driving policy accross all of health care...
You have to assess sources, evidence, outcomes etc. for literally anything that is new or you suspect might need revisiting. Any doctor who can't do that effectively should not be using that particular source or possibly should not be a doctor at all.
The practioners of every single complex job have "gaps in their knowledge" - nobody knows everyting. Most if not all people faced with having to perform tasks where they don't have perfect knowledge are using resources to study. Online video is just one, very effective in certain cases, way of increasing knowledge.
CNBC may not be a way of increasing knowledge based on this article and I assess a youtube video demonstrating the reading of this article is something I might reject as being useful.
I'm a current medical resident, and I have absolutely used YouTube to fill in the gaps. Just a few days ago during lunch, I watched a 3 minute video on how to remove a PICC line before taking one out of a patient. I have taken PICC lines out before, but I just wanted a quick refresher before doing another one. I've also used YouTube to improve my physical exam skills. In the real world, you just don't get enough abnormal findings in certain areas to learn quickly. For example, although ACL tears are common, I haven't seen more than a few due to the context I work in. I use YouTube to see more examples of these kinds of abnormal findings.
While I was in medical school, the vast majority of my education came from online resources, YouTube, question banks, or ancillary books that were not part of the official curriculum. If you go to any medical student in the US today, they'll be familiar with the four key resources: UWorld (massive bank of USMLE board questions), First Aid (reference text book containing key information for board exams), Pathoma (video series teaching histology and pathology created by a University of Chicago pathologist), and SketchyMedical (another video series of visual mnemonics to help you memorize microbiology and pharmacology facts). There are also community driven projects such as Zanki and Brosencephalon, which are Anki decks with 25,000+ cards containing info needed for board exams. Another popular YouTube channel is Armando Hasudungan, who illustrates medical concepts aimed towards med students.
The med school I went to and many others are moving away from the traditional lecture-based model. Lectures at my school were offered, but they were optional and attendance was usually <25% of our class as the quality was notoriously poor. My med school classmates and I found learning much, much more effective with this hands off approach. This does call in to question the value and role of a medical school today. Now that I'm a resident working with other residents who went to med schools all across the US, I'm realizing that most of us just forced our way through the official curriculum and did most of our "real" learning using the same resources I mentioned above.
> I'm a current medical resident, and I have absolutely used YouTube to fill in the gaps.
I pull up online sources pretty regularly in the back of an ambulance. Most often to look up the details of some more obscure medication or condition in the pt's medical history. Generally I try to do it out of eyeshot of the pt...
Sometimes I google home maintenance videos for information on a project, and I need to spend a lot of time looking for a certain level of quality of the source since I'm a complete amateur. I'll often want to confirm by looking for multiple videos and making sure the sources converge on some basic points since I have so little background.
But since I'm much more knowledgeable about certain programming or mathematical techniques, I can do much quicker searches to refresh my memory since my BS filter is going to go off pretty quickly, and I can verify the truth of a source based on a more extensive background.
The fear mongering in this article requires you to assume that doctors are much more like amateur carpenters clicking on links at random rather than highly trained practitioners with years of education in their field.
I have a friend in medical school who I asked about googling/etc, and he sent me a good article. Related and way less alarmist (quote from my link, not the article)
> Enter the online world of medical references that your doctor uses instead of Google: UpToDate, DynaMed, Current, and many more. These are medically sound, evidence-based databases that tell doctors most things they need to know to be able to treat just about any patient according to the most up to date guidelines.
Jfc no one is learning surgery from a video. A resident looks up an article or a textbook chapter, watches a video, then assists - and when they’re assisting, they’re better prepared because all of the above. Then they watch a video to refresh. If the video is nonsense, they’ll know right quick. They’ll assist many times before they take lead, and will take lead with a supervisor many times before ever going solo.
The headline makes it sound like someone is watching a YT video and then walking into the OR to perform an operation.
Not everything is taught in medical schools, which means there are gaps in knowledge. That can be problematic when a particular unique approach is more valid for a specific subset of patients. In those cases, the only way to learn how to perform those variational procedures might be by watching it online.
Would the surgeon feel confident with that situation? That's another question entirely.
There's a pretty cool "journal" called JOMI , which is basically peer-reviewed videos of doctors performing common procedures. I actually watched one of the videos there to assuage my fear of a fairly routine arthroscopic procdure.
I suspect this is the type of thing most doctors are interested in seeing people rely upon, rather than youtube. It's been vetted for quality. There are obviously downsides (getting procedures to appear on this is more complicated than just uploading a video to youtube), but it seems much harder to question the quality.
I used to really dislike youtube because I thought there was nothing but people goofing off and ripped TV shows on it.
Honestly people are doing serious research on it, and besides that you can get lectures or even just friendly monologues/QAs from experts on almost any subject. It was MIT's math videos that convinced me to start watching it, after that I found some of my favorite proffessor's lectures there too along with a lot of graduate level stuff from other universities. Then there where all the videos from amateur and professional scientists and musicians and so on. The basics of my personal understanding of music theory came from a nearly century old book I found in a used book store but it's grown a lot thanks to youtube.
I hate that it's controlled by a single company, and that they keep tearing down the chemistry channels but while it's still no substitute for reading papers when you get into really niche subjects (ex: molecular dynamics and computational chemistry) the educational side of youtube is surprisingly underrated.
Unless you know what to look for, the discovery on youtube for these videos is terrible. I watched a lecture from my prof, 40 minute video with a couple hundred views uploaded by an official university youtube account.
You'd expect the sidebar to be filled with similar 40 minute lectures uploaded from similar university accounts with similar low viewer counts, but instead the sidebar was filled with these zaney outlandish conspiracy theory videos. They probably got preference on the sidebar because they contained all the relevant keywords in their headings (not counting the obligatory "Hillary" or "Satan" or "Lizard person" found in most of these titles), coupled with millions of views.
Sometimes I like to imagine a youtube where it's the university lecures that get millions of views, not the far right tinfoil hat content that eventually rears it's ugly head in every sidebar feed on the site.
There is an amazing amount of fairly high quality content on youtube these days. For my personal use, it has given all the "traditional" media sources a serious run for their money. If it wasn't for my partner I could easily cancel cable, netflix, HBO, and everything else and just live off of youtube content.
To me, the coolest part about youtube is it is "direct to consumer" with no middlemen. With few exceptions, all the content I watch comes directly from regular people making videos about things they are passionate about (be it mine exploration, building stuff with CNC mills, urban exploration, documenting abandoned malls, filming their day driving a train, picking locks, etc). There isn't some production company that sets guidelines or provides funding... it is just regular people.
I do agree it is a problem that youtube is the only real player in town to host this sort of thing. Hopefully that will change over time.
The good ol' "Google the Stack Overflow" method. Except when advice is bogus people die. I frankly held doctors (and especially the very generously paid US doctors) in much higher regard until I got older and had a chance to seriously interact with a few. As far as I can tell unless the situation is blindingly clear (in which case Googling the symptoms works about as well as a doctor), they're basically guessing, often badly. To give just one example: I was once suggested a shoulder surgery (with a 6+ mo recovery period) based on an extremely blurry MRI of my shoulder where I'm pretty sure the doctor couldn't really see anything. Because why the hell not take another $20K in revenue for his practice, right? Ironically the shoulder pain went away in about 4 months after I switched my sleeping position.
I now basically avoid doctors other than for the yearly checkup or if there's something serious that Google can't fix (broken leg, or a prescription).
there isn't a "textbook" for a lot of these. AS a resident, we basically used a combo of pubmed, uptodateonline.com, and a lot of it was the time spent w/ older docs and gleaming bits and pieces of info from whichever patient happened to roll in or were scheduled that day. Haphazardly stochastic way of learning, but there it is....
I recently finished cardiac rehab but when I was on the waiting list to start my PCP told me "Just google cardiac rehab, find some videos and do them." The videos I found were from the NHS. They were very different from what cardiac rehab in the US was like, but they got me up and moving.
OK - a lot of answers here are about "doctors using online resources to fill up their knowledge gaps is totally normal" - which is a fine point. But the article is about a particular online resource not known for an a priori high standard. The more interesting question is "How can doctors tell which videos are valid and which contain bogus information?" - and it is actually a quote literally taken from the article. The situation is not very good:
For instance, one recent study found more than 68,000 videos associated with a common procedure known as a distal radius fracture immobilization. The researchers evaluated the content for their technical skill demonstrated and educational skill, and created a score. Only 16 of the videos even met basic criteria, including whether they were performed by a health-care professional or institution. Among those, the scores were mixed. In several cases, the credentials of the person performing the procedure could not be identified at all.
Even more concerning, studies are finding that the YouTube algorithm is highly ranking videos where the technique isn’t optimal. A group of researchers found that for a surgical technique called a laparoscopic cholecystectomy, about half the videos showed unsafe maneuvers.
Online epistemology is more and more important and while our culture is trying to catch up it is still behind. There is lots and lots of important phenomena (for example https://www.gwern.net/Littlewood).
I had an anaphylactic shock a few years ago and started googling the symptoms (no, I didn't have cancer after all) and ended up realizing very quickly that I should probably go to the ER and get some antihistamine, so I did. The day after I booked a meeting with a doctor and while sitting there talking about my symptoms and reasons for getting the anaphylactic shock the doctor was on google and even the same web site I was looking at the day before.
So I told him "I already know that because you're basically just reciting the very same web site I was looking at yesterday before going to the ER but I felt that I should see an actually doctor about it. So do you have any clue what could have caused the shock or should I just pay close attention to what I eat, drink etc just like it says on that web site and hope for the best that I find the food that I'm allergic to?"
He had no clue. Thank god for free healthcare (oh well, tax paid universal healthcare) in Sweden.
I find one common misconception that programmers have is "everything in the world has a root cause that we can understand". In the programming world that's mostly true.
So when a doctor or medical professional doesn't know the exact reason for something (e.g. why did I get x?) many start thinking the doctor is stupid/useless/incompetent. Well it turns out that medicine is still a very inexact science and there are many things that are not well understood.
> Take the example of a spaghetti codebase. Take the example of a spaghetti codebase.
I think this actually just further proves the GP more than correct.
Comparing the complexity of determining the root cause of some disease processes and biological processes in general to a "spaghetti codebase" just underscores the disconnect that programmers and engineers have with some of the complexity in nature. There is no manmade codebase shitty or otherwise, even large enough to approximate the complexity of understanding even some of the more rudimentary biological mechanisms, let alone extending that to actual clinical disease presentation.
In clinical medicine we don't necessarily think "the answer is in there somewhere", we don't know the answer, and further the full answer is most likely unknowable in our lifetime, so effectively as far as providing care is concerned, the answer really isn't there.
Nutrition science is hard. It has long timelines and relies largely on self-reporting and meta-analysis because it's unethical to study humans like we would mice and perform actual control studies.
That's not even getting into the monetary and political factors involved. It took decades for society to agree that smoking was bad for your health, because of all the money paid to bribe scientists, doctors, and politicians. And this was obvious. The food industry is orders of magnitude larger in monetary terms, and involves far more people, many with political influence worldwide.
It would make sense to give them a pass on not knowing correct nutritional information if they admitted they didn't know correct nutritional information. The situation that actually obtains is that they're passing off incorrect information as correct. That shouldn't be excused by the fact that knowing correct information is difficult.
It's absolutely justified to pass off the information that according to our best current knowledge is the approprate recommendation as of now - the fact that knowing the underlying correct information is difficult, and noone knows for certain if it's entirely correct or there are more nuances to be found doesn't mean that we should just shrug and act as if we have no information whatsoever. We do have some data that allows us to make useful decisions that are more likely than not to be correct. As long as that's the best we have, we should use that information.
I'm not sure it's a good idea to give doctors a pass because of how easy they are to bribe. It's a fair point that we can't allow unethical studies, but the fact that doctors and scientists are so vulnerable to bribery is a larger issue that should be addressed and would probably improve a lot more than just nutrition science/medicine. I don't see many easy answers, but giving doctors or scientists a pass for the current situation seems a bit too generous.
I don't think there is any evidence to say that doctors and scientists are any more susceptible to bribery than any other person. There are millions of doctors and scientists in this country. Are they all on the payroll? Of course not. Free pass away, unless you truly believe that one bad apple must sour the whole bunch.
I don't think people in those jobs are more susceptible to bribery, but the jobs themselves enable and support it. A person could bribe me at my job, but even if I took the money there is oversight and someone would see something was mishandled and I'd be quickly fired.
The systems in place to prevent doctors and scientists from taking money to push drugs or falsify data are failing us which is how companies regularly use scientists to get whatever results they want published and drug companies bribe doctors to prescribe harmful medications unnecessarily.
Anyone can be bribed, but not many of us could get away with it at the scale that brought us things like the opioid crises and few of us have literal lives at stake when we are tempted to act unethically.
YouTube got me through engineering school. This is just how people learn now. Books have their place but in reality I think YouTube and videos in general are a much more versatile learning tool for students or anyone for that matter. Personally, I am glad doctors are taking advantage of this new and incredibly valuable resource.
I don't really see why this is surprising or horrifying: I turn to YouTube all the time to fill gaps in my knowledge, or watch talks/lectures (I've been enjoying Strangeloop recently, along with assorted DIY content).
As for quality control, this is what our critical faculties are for. I have no data but suspect good critical thinking skills correlate well with being a good doctor, so I don't worry about these people picking up information from YouTube.
Bringing this back to programming, others have mentioned StackOverflow. StackOverflow has descended into a cesspool of crowdsourced ignorance but nevertheless it's still possible for competent developers to find useful information there.
On the flipside, if StackOverflow disappeared tomorrow, all the bad programmers finger-vomiting garbage "information" across every question would continue to be bad programmers.
10+ years ago you'd have to spend considerable time and money getting to the journal article if you even could do that and it was available in your language. Then, you'd still have dry description, not a video of an actual procedure.
(I'm still showing people scihub because they just wouldn't access the papers otherwise)
The problem that I see is not so much that the quality of videos on YouTube is lacking, it is that the quality of officially sanctioned videos is lacking. Or that the availability of officially sanctioned videos of high enough quality are not readily available to the masses.
> ..."The researchers evaluated the content for their technical skill demonstrated and educational skill, and created a score. Only 16 of the videos even met basic criteria, including whether they were performed by a health-care professional or institution."
As I understand it; professionals compared the techniques used to the techniques as they are taught in classrooms and textbooks and found that the techniques used in the video would not have resulted in a passing grade in a classroom environment.
Assuming that is true then the root cause isn't low quality YT videos. That is a symptom of the problem that the learning materials provided in classroom environments are not providing enough educational value to students in the first place.
I'm not in the medical field, but I've watched the struggle and politics of people fighting through medical school. It is grueling. If it's anything like tech then maybe 65% of it will apply in the real world and 15% you won't ever need to use in the first place. It's also going to be loaded with advanced technical jargon and put an incredible cognitive stress on students to teach otherwise simple, menial tasks while stressing statistics and verbatim policy while completely losing the spirit of those statistics and policies.
So to fix the issue, researchers should be studying these YT videos to determine what makes them so informational and engaging.
With car or computer repair videos people familiar with the subject matter will skip the non-essential information, focusing cognitive resources on the parts they need to clarify most. Students can focus on their own deficiencies without having to waste energy on arbitrary and irrelevant information.
2) Rounds and Grand Rounds
3) Curbsides / phone a friend
4) Websites are complicated by liability issues. They’re casual, but by their nature documented. It’s kind of the worst of both worlds.
I'll bet every one of them (tries to) absolve themselves from liability through the use of their posted materials. An unverifiable promise that it's somehow a more reliable source than "DuceDangler73s" youtube video on performing a colonoscopy is no comfort.
I have a feeling this is common in nearly every field these days.
While not equivalent to a medical procedure, I had some furnace issues last year. I was able to do a lot of repairs myself with a mix of reading forum posts and youtube videos. I ended up having to call a furnace tech for an issue that was outside my comfort area at the time, but I was still able to communicate my issue with him more intelligently because of the knowledge I learned from watching a few videos.
When I see my doctor, there's an understanding between us. We both know that professionals like software engineers and doctors look up the answers constantly. I don't expect him to know everything, nor is that even possible. I do trust him to know how to find the right answer, and think structurally through a set of symptoms, and debug them.
I've had GPs and consultants alike google all sorts of things (even opioid conversion charts)... I have to say, I don't like it! I know they can't know everything, but quite often it feels like it's something they should know, or at the very least have a trusted source/calculator bookmarked for.
I think haptic feedback and novel controls are just as important as the VR. How much force does it take to [do critical part of open heart surgery]? What’s the exact hand motion for [neurosurgeon technique]? It would be great if a doctor got to practice the hand motions in as near to real life conditions as possible. I suspect insurance companies will insist surgeons keep up with vr/haptic training if it is found that it increases success rates of surgey.
That's what the cadaver is for in med school. Haptic feedback developers would have to rip open hundreds of human bodies at various places and measure the force and texture to get anything vaguely accurate.
Not to mention that this would avoid all the rawness of surgery; the distinct smell of blood and shit, the warm pulsing body of the patient, oddly presented internals and what they mean, knowledge that nicking an artery could end a patients life in minutes.
Maybe the better angle is figuring out how to get more cadavers in the hands of med students or docs for practice.
Doctors are the most overrated profession of all time. Before any kind of diagnosis, medical procedure, or conversation about anything specific, I do a ton of research. I read the latest publications, the drug interactions, the human biology, etc. When I go in there and question the doctor, they usually dont know the half of what I bring up. They prescribe the same thing to the same set of symptoms basically every time, without much capacity to take in the nuances of some condition. These people need to lose their status in American society and be brought down to skepticism, half of the doctors in hospitals became doctors for the status. Computers cannot replace these people fast enough, I trust very few. If anything, I think that the recent trend of data driven medicine will expose the medical industry for what it is, most of these drugs and procedures have no positive effect on the patients. In a ton of cases, the outcomes and long term ramifications of different treatments are never recorded and analyzed on a wide scale. Very few drugs we have do anything at all but cover up the symptoms.
Patients with a serious, chronic condition are frequently more knowledgeable about it than most doctors they deal with. Yet if a patient tries to talk about that online, you can count on some ugly beat down accusing them of being nutcase antivaxxers or similar slurs.
It is also difficult to assess because as someone with a chronic illness I also know that there a lot of people who think they are more knowledgeable than doctors while they in reality most likely are overestimating single studies or don't have the full picture.
It's possible to admit you have no idea if what they say makes sense without launching into ugly and dismissive attacks based on a presumption that they can't possibly know what they are talking about. But people rarely meet that standard and typically default to asserting that whatever is currently generally accepted must be correct.
That's not at all how actual science works. Actual science admits "This is our best understanding currently. Feel free to improve upon it."
Shouldn't we be well past the abusive treatment doled out to Galileo for daring to dissent? He was eventually determined to be correct, but it was well after his death, so it did nothing to remedy his troubles.
It should be "feel free to improve upon it, if you've mastered the current understanding and know what to improve and what evidence would be required to validate that improvement."
Otherwise any joe shmoe with a youtube following can start encouraging nursing mothers to have a glass of pigs blood before bed or some other nonsense.
It's tempting to imagine expertise as something that should be equitable, but it's hard to beat the foundational knowledge of someone who had four years of biology coursework, four years of medical course work, for years of residency, then however many years still in the field, still thinking about the same problems and how to solve them, vs. someone who spent 2 hours searching google or struggling through pubmed articles and are looking to best the person providing them care.
Galileo was a university trained physicist and astronomer with over 30 years in the field, he wasn't a layman at all. In fact, a little more on Galileo.
He wasn't condemned for 'daring do dissent,' his theories had merit and supporters. Galileo just critiqued people's theories so throughly and aggressively in his letters that he pissed a lot of people off in academic italy by just dismantling their work. Eventually one prick got the inquisition on the case, the pope asked galileo to write a detailed book to set the record straight with his theories, and while galileo did that he did it by making the pope a character in his book, portrayed as complete idiot, circulated the book all over catholic Europe, and shit naturally hit the fan. Apples and oranges.
"Doctors" are an enormous field of work. Are you talking about primary care physicians, which are widely being augmented/replaced by nurse practitioners? Are you talking about specialists who are able to work out treatments plans for conditions you have that are definitely more complex than you can self treat, or are you talking about surgeons, who have an insane amount of training and stress in their job and you definitely cannot perform your own surgery.
The reason you see the same treatments and basic medicines and panels each time you go to the GP is because your problems are pedestrian compared to what doctors actually train for. Most likely, you're not even being seen by someone with an M.D. - casual checkups are often beneath their paygrade.
Doctors undergo a decade of specialized training in order to diagnose and treat issues far beyond anything that you can Just Google. Determining the factors affecting which treatments to apply, considering the tradeoffs, and making the right call are skills that AI will not achieve in our lifetime, no matter how many VC-funded tech-bro AI startups try.
If you could spend a day in the shoes of an aspiring medical resident, working 80-hour weeks and studying for board exams at the same time, you'd count your lucky stars that we don't license the software profession like we do medicine. Maybe we should.
The father of a childhood friend of mine was diagnosed with a peptic ulcer and died of stomach cancer about six months later. The stomach cancer that actually wasn't just a peptic ulcer was only diagnosed a few weeks before his death once he was hospitalized because he was dying.
Surely, differentiating between a garden-variety peptic ulcer and stomach cancer can be difficult given the symptom overlap but that's why doctors undergo a decade of specialized training, right? Alas, all the doctor he scheduled a casual checkup with could see was that this patient's pedestrian problems were beneath their paygrade. At least as far as I was told, his symptoms were dismissed out of hand and he was diagnosed with an ulcer and sent on his way without any sort of workup being done. Presumably the doctor felt that spending time diagnosing someone with such common symptoms was not what they trained for.
I guess VC-funded tech-bro AI startups don't have a monopoly on making the wrong call. (Or on hubris!)
Mostly the reason you see the same treatments is because there is no useful treatment, but they provide one anyways. Or they run a battery of tests, partly because they need to, to cover their ass from malpractice law suits, but also because its profitable for the hospital to do so.
Take the case of someone having a psychotic episode for the first time, with no prior history, who goes into the ER. The doctors will instantly put them on an anti psychotic medication. This decision will usually stop the psychosis, and means that they "fixed" the patient. But the ramifications of being put on these drugs prior to a proper diagnoses could be that the patient is never able to successfully get off them, a lifetime of drug dependence due to a split second decision. (Getting off these drugs often causes psychosis in itself, which creates a vicious life long cycle).
The medical institution bears no error in this case, they gave "treatment". Not putting the patient on medication is a risk to them, so they do it every time. The patient is uneducated in this matter, does not know that they will damage their brain, lose IQ points. The list goes on and on, it happens every day.
I hope you're not a medical professional. If an individual has a problem (mental or physical), it is never pedestrian, beneath a paygrade, or reason to avoid a personalized treatment plan. If you feel this way, go into research and do not interact with another patient ever again. Sickening attitude.
Let me be clear: there are conditions that are routine, and whose treatment is deferred to roles that are not as specialized as a doctor. That does not mean that the provider/patient interaction is any less personable just because the treatment is standardized.
Treating the sniffles does not require a personalized care plan in the majority of cases. You'll get the bog standard treatment of the symptoms, which is actually the best we can do. It would be an institutional waste to personalize that kind of care for each patient and provision an M.D. each time -- you'd actually be putting other patients at risk, with more complicated problems, who critically need that doctor's experience instead.
This post sounds hyperbolic but I’m not that far off from agreeing.
A family member went to the doctor to get a work up on a rare disease. The work up basically followed a flow chart from a specialist center that was easily accessible online.
I’m sure there’s some additional confidence from experience and knowledge of the first principles that vastly outweighs my judgement, but on the surface it didn’t seem like the doctor had obtained a skill set that should command a 2x-3x training and schooling premium.
They knew enough to know upon assessment that the standard flow chart process was appropriate, and additional follow-up or referral to the specialist was unnecessary. That is the kind of skill and training core to the profession.
IT doesn't reprovision your work laptop after you accidentally deleted a file, they follow the appropriate process for the task ("they just pulled up the system restore flow chart, what am I even paying these guys for").
It sounds like you're speaking from a place of pain and I hope it's taken care of. Nevertheless, this can be said about any profession with the internet nowadays. Becoming an expert in an obscure topic is not hard, and made even easier with a very clear vested interest in one's own health.
Its true, this can be said about any profession, but the difference is that other professions do not have peoples lives in their hands. Claiming absolute authority on a topic that is a matter of life and death, and then providing potentially mediocre or worse outcomes or an incomplete picture of the possibilities is inexcusable in 2019.
The industry as it currently is, with restricted supply of doctors, memory based entrance exams, etc makes no sense
I do not fully agree with your claim but the medical profession along with a few others, like lawyers, are self-regulating industries that set their own rules, including the rules to admission to the club.
I really dislike the idea of a club with legal powers over you, such as doctors or lawyers, that both set their own rules and control entrance to the club.
It strikes me as feudalistic and undemocratic. Oppressive. As an American I find it vaguely un-American!
One issue I take with the general practitioners I frequently come in contact with is their usage of the word "average".
In the broadest sense, there are two types of things in the world: things that tend toward (or cluster around) some kind of “natural” value, and things that don’t.
Often times, you are not briefed on the distribution of the graph which the very "average" is being derived from, viscerally it is being surmised that it follows a “Gaussian” distribution by the patient which then makes significant medical decisions based on such bits of information.
Therefore, I'd advise caution for those who'd base their medical decisions on arbitrary "averages", instead you are much better off if you were to take a look at the graph to see if the word "average" carries any meaning at all in such distributions.
It stuck with me because it's a nutshell version of the book "How to lie with statistics" in a humorous and highly memorable form. Someone with one breast, one testicle and a little penis would be a bizarre statistical outlier for the human race, but "mathematically" speaking, it's an accurate description.
It speaks to a lot of common errors of logic and it's pithy.
Medical student here. It sounds like you can do the job of a doctor, but I can't be sure yet. Case vignettes are the medical equivalent of the coding interview. Let's start with an easy question. If someone comes to you with a fever and a cough, what is your approach to their history and physical exam? What labs or imaging do you need, if any? Do they need treatment? How do you decide? If so, which drug and how long and why? How does your approach vary if the patient is 29 or 89? Or if the patient has HIV? What if the patient smoked for 20 years?
In all of these cases, I do what I laid out above, I start googling and reading multiple sources about whatever ails me. I may spend a week or so doing research to determine whether my condition is serious or not, I read all of the literature, making sure to understand when possible ailments could be really bad, but also to ground myself and understand the probability distributions of ailments taking a massive turn for the worse. Once I determine that I probably need someone to run some kind of test, or write some kind of medication, I call the doctor.
You arent some kind of high priest, I am allowed to question and understand medicine. I am also not afraid of academic publications, and attempts at belittling me for doing so come from a place of insecurity on your part.
All of that knowledge in your head is on the internet.
I am loving the troll-y nihilism! <i>Knowledge</i> and experience are the basis for prioritizing information, efficiently handling a patient's complaint(s) without doing a week of reading, and accessing reference sources when needed.
I don't trust doctors because most are in it for just the money. So, they already are going against the "oath" and then they don't know a lot of things like you mentioned. Sure, some are smart, the smart ones normally let you talk and then they research whatever it was that you have.
For regular folks? There are online places where people talk about their issues, exchange information, even hack their medical devices, but the thin line between a community of interested parties helping each other out with their health concerns and practicing medicine without a license will make it risky for spaces set up to do more than very general education. The liability issues alone would make me hesitate.