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Andrew Ruiz @then_there_was
, 22 tweets, 3 min read Read on Twitter
General doctors go to medical school for a few years so they can develop a broad and shallow understanding of many diseases and health solutions.

For the most part then, relative to the effort they put in, their output is relatively worthless.
A doctor's job is build a network of biological cause-and-effect events so they can quickly diagnose problems and provide an entry-level solution.

In practice, they just order a blood test and throw ibuprofen at you.
The problem is one of scale, information, and complexity.

Historically, doctors were useful because the information about medicine was scarce.

There just wasn't that much useful information in the field of medicine.
And the useful information that did exist was hard to find.

You couldn't walk to the closest library and find a book on your medical problem.

The information was scattered across universities and people.
Doctors served as an intermediary between people and the information.

What's more, because rigorous medical information wasn't kept, they had access to knowledge gained through trial-and-error.
Gradually as the field of medicine deepened, specialities emerged.

Over time, the specialists should have eventually outnumbered the generalists, as it did in mathematics.

Medicine is unlike other fields because decades later, there are still more generalists than specialists.
In theory, doctors should've continued specializing, because of the increasing depth of knowledge. Generalists should've been a rarity.

Instead they're a commonality.

Why is that?
As populations grew, the demand for doctors grew too.

But despite this, specialists could never find enough clients with problems specific to their expertise to make a decent wage.

That's why all the best specialists live in big cities

More clients to support them.
The medical industry was overwhelmed by the number of people with health problems.

So they developed a system to handle the tremendous flow of people:
1. General doctors would quickly diagnose a wide range of people.

Their broad knowledge would allow them to quickly rule out the least likely explanations.

2. After ruling out certain problems, they'd make a best guess and refer the client to a specialist.
3. The specialist would then quickly rule out the class of problems for their specialty and refer the client to the next specialist.
4. A client would gradually go through specialist after specialist and through process of elimination, eventually discover what's wrong with them, and if they were lucky, a cure.
In practice, general doctors are great at ruling out problems, but terrible at recommending specialists.

Most of the time, they make a random recommendation.

Or they err on the side of caution and make no recommendation at all.
This happens because their knowledge is shallow and their time is limited.

On average, doctors have about 15 minutes to draw deep insights between distant fields.

That's hard.

There's no time for them to dwell deeply on your health problems.

This isn't House M.D.
Patients also don't always offer the relevant information needed to make a good diagnosis.

Lack of knowledge by the doctor and patient and the lack of time are not optimal.

But specialists should be able to make up for that with their mastery.
But specialists rarely do.

The field of medicine is so deep now that when you do specialize you're limited and shaped by the ideas and tools specific to your field.

Nothing new enters your domain. And there are little incentives for doctors to learn more outside their field.
You end up with these islands of specialization that have no way of communicating with each other, except through a central administrative network that funnels patients.

But administration is not concerned with the relevance of health problems. They're concerned about efficiency
Here's the real bitch of it though.

Even the specialists are useless.

This happens for a number of reasons:
1. They lack insight into other fields that would benefit their practice.

Humans are complex.

A dermatologist would need knowledge of nutrition, hormonal systems, and the effects of UV light to eliminate someone's acne.

Most dermatologists only have knowledge of creams.
2. Most specialists end up parroting what other specialists are already doing.

No one wants to question the heterodoxy because that'd be career suicide.

And nobody wants to make a recommendation outside of the usual practice, because you'd open yourself up to lawsuits.
The result?

An ecosystem that feeds off mimicry and little risk-taking.
"Don't doctors sometimes take huge risks to save their patients?"

There's no risk if your only options are chemo or death.

There's a lot of risk if your options are lift weights or take this pill.

The latter has the weight of well-established norms.

The former is heresy.
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