Comment author: Riothamus 18 August 2016 08:43:34PM 2 points [-]

I know this is banal, but ensure excellent administration.

Medical expertise is only relevant once you see the patient. Your ability to judge the evidence requires getting access to it; this means you need to be able to correctly send requests, get the data back, and keep all this attached to the correct patient.

Scheduling, filing and communication. Lacking these, medical expertise is meaningless. So get the best damn admin and IT you can possibly afford.

Comment author: anandjeyahar 19 August 2016 04:46:45AM 0 points [-]

Very valid and good point(added). I briefly touched on it before too, but mostly had individual practitioners in mind than organized hospitals with administration and support. (India is moving towards a lot more of the organized hospitals model, but IT is non-existent, administration is most seat-in-the-ass jobs)

Comment author: buybuydandavis 07 August 2016 11:03:44PM *  1 point [-]

Know the probabilities of fatal and adverse side-effects and update them with evidence(Bayes' theorem mentioned above)

Update on all relevant evidence, even if you don't have empirical data.

I would add:
Make decisions based on cost/benefit analysis, not simply probabilities. For example, low probability treatments can make perfect sense to try if they are low risk, low cost.

Know that the failure to reject a null hypothesis is not proof of the null hypothesis. It does not establish the null hypothesis. A failure to reject is simply an epistemological failure.

Comment author: anandjeyahar 08 August 2016 06:02:14AM 0 points [-]

Thanks that's clearer.. will update...

Advice to new Doctors starting practice

1 anandjeyahar 07 August 2016 08:27AM

Hi all,

Please read the Disclaimers at the end of the post first, if you're easily offended.

 

Generalists(general medicine):

  1. Get extremely unbeatable at 20 Questions(rationality link). It'll help you make your initial diagnoses(ones based on questions about symptoms) faster and more accurate.
  2. Understand probability, bayes theorem and how to apply it** This will help you interpret the test results, you ordered based on the 20 questions.
  3.  Understand base rate fallacy, and how to avoid  being over confident.
  4. Understand the upsides and downsides of the drugs you prescribe. Know the probabilities of fatal and adverse side-effects and update them with evidence(Bayes' theorem mentioned above) as you try out different brands and combinations.
  5. Know the costs and benefits of any treatment and help the patient make a good decision based on the cost-benefit analysis of treatment combined with the probabilities of outcome.
  6. Ask and Keep a history of medical records and allergies of the patient and till their grand parents.*
  7. Be willing and able to judge, when a patient is better off with a specialist. Try to keep in touch with Doctors nearby and hopeful all types of specialists.
  8. Explain the treatment options and pros and cons in easy language to the patients. It'll reduce misunderstandings and eventually dis-satisfaction with the treatment.
  9. Resist the urge to treat patients as NPCs. Involve them in the treatment process.
  10. Meditate
  11. Find a hobby, that you can keep improving on till the end of life.
  12. Be aware of the conflict of interest between the patient and the pharmaceutical companies.
  13. Have enough research skills to form opinions on base rates/probabilities in different diseases and treatment methods as needed.
  14. If you're in a big hospital setup, make sure you've the best hospital administration. 
  15. Medical expertise is only relevant once you see the patient. Your ability to judge the evidence requires getting access to it; this means you need to be able to correctly send requests, get the data back, and keep all this attached to the correct patient.Scheduling, filing and communication. Lacking these, medical expertise is meaningless. 

Specialists:

Basically the same skill sets as above. One difference is in the skill level and you should customize that as needed.

  1. For ex: You would need to be able to explain the treatment options and the probabilistic nature of the outcomes to your patients.
  2. As for research, keep a track of progress in your area in treatment methods and different outcomes on the "quality of life" for the patients after the treatment.
  3. Better applied Bayesian skills. In the sense of figuring out independent variables and their probabilities affecting the outcome.

 

Some controversial ideas(Better use your common-sense before trying out):

  1.  Experiment a little with your bio-chemistry and see how they affect your thought-processes.  To be safe, stick to biologically produced ones. For ex: injecting self with a small adrenalin dose and monitoring bodily response can help keep your thinking clear in emergency situations.
  2. Know your self biology better. For ex: male vs female differences mean the adrenalin response is different and peaks later in females.  If you think that's wrong, please go back and check your course work. Also watch this 2 hour video and come back with objections after reading the studies he quotes.
  3. Keep regularly(whatever frequency your practice and nature of work demands) checking your(for ex; hormone levels) blood states, so that you  can start regulating your self for optimal decision-making skills.
  4. If you're a woman, you'll customize practice on some of the skill sets above differently. For ex: Mastery over emotions might need more practice, while empathizing/connecting with the patient might be easier.

Disclaimers:

  1. Most of what follows is based on my experiences(either as a patient myself or a concerned relative) with Indian Doctors. Some of it may be trivial, to others, but most of it is skills a doc will need and ignored in school.
  2.  I've split it in two (specialists and generalists) but there's a fair amount of overlap.
  3. These are fairly high standards, but worth shooting for and I've kept the focus on smart rather than hard work.
  4. I've stayed from a few topics like: bedside manners/social skills, specific medical treatments and conditions(obviously, I'm not a Doctor after all) and a few others, you can add/delete(also specify/pick levels) as you see fit.
  5. Pick the skill-levels as demanded by your client population and adjust.
  6. I'm assuming generalists, don't have to deal with emergency cases, but in some parts, that's not likely then pick common emergency areas and follow specialist advice.
  7. I wrote this based on my experiences and with humans in mind, but veterinary Doctors may find some useful too.

* -- I understand this is difficult in Indian circumstances, but I've seen it being done manually(simply leaves of prescriptions organized alphabetically, link to dr.rathinavel) , so it's possible and worth the effort unless, you practice in area of highly migratory population.(for example rural vs urban areas).

**-- If you're trying to compete on availability for consultation, you'll need to be able to do this after being woken in the middle of the night.

 

I'm hoping to convert it into a rationalist skills for Doctors Wiki page, so please provide feedback, especially if you're practicing Doctors. If you don't want to post publicly email me(in profile) or comment on wordpress.

Comment author: anandjeyahar 08 May 2015 03:54:14AM 1 point [-]

Meetup : Bangalore meetup + pi-day wrap party

1 anandjeyahar 09 March 2015 11:57PM

Discussion article for the meetup : Bangalore meetup + pi-day wrap party

WHEN: 14 March 2015 11:00:32AM (+0530)

WHERE: Bangalore

Discussion article for the meetup : Bangalore meetup + pi-day wrap party

Comment author: anandjeyahar 03 March 2015 12:42:34PM 0 points [-]

I think Terry Pratchett makes this point well, in "The thief of time". Can't find the exact quote, but here goes my paraphrasing from memory

"Human beings make decisions by committee. The stomach has a mind of its, own and wants to put food in the mouth.

Comment author: anandjeyahar 03 March 2015 12:49:35PM 0 points [-]

Unreliable memory.. but here's a less opinionated, and closer to original sounding one.. although the source is dodgy.

And she felt hungry. And that also made no sense. The stomach was a bag for digesting food. It wasn't supposed to issue commands. The Auditors could survive quite well by exchanging molecules with their surroundings and making use of any local source of energy. That was a fact.

Try telling that to the stomach. She could feel it. It was sitting there, grumbling. She was being harassed by her internal organs. Why the ... why the. . why had they copied internal organs? Yuerkkk.

Frome here.

Comment author: aelephant 04 March 2013 11:58:27PM 5 points [-]

Don't forget you are not just a brain (or two brains), but also a body. A lot of intellectuals neglect the physical side of things. They might be brilliant, but how much more brilliant would they be if they ate right, exercised, dealt with stress effectively, etc.? There is also the influence on your emotional state. Maybe you feel anxious or unhappy simply because your body isn't expending energy the way it is supposed to. Sometimes you need to put the pen & paper down (or shut off the computer) and go lift something heavy or go for a run.

Comment author: anandjeyahar 03 March 2015 12:42:34PM 0 points [-]

I think Terry Pratchett makes this point well, in "The thief of time". Can't find the exact quote, but here goes my paraphrasing from memory

"Human beings make decisions by committee. The stomach has a mind of its, own and wants to put food in the mouth.

Comment author: Davidmanheim 16 February 2015 11:38:08PM 0 points [-]

My claim is that you can't come up with such a conjecture where it makes sense to change the probability away from 1/6. That is why you should not update.

Comment author: anandjeyahar 17 February 2015 03:09:24PM 0 points [-]

I disagree. I'm not sure it's provable(maybe in professional poker players??), but if you've played the bet a lot of times, you could have come up with cues* about whether your friend has got the same roll(or number on the die) as the last time or not.

  • -- not sure how verbalizable or not it is .(which implies harder to teach to someone else).
Comment author: Davidmanheim 13 February 2015 03:58:19AM 0 points [-]

OK, so "there could be cases where it is rational to update." How would you do so?

(I can't understand what an update could reasonably change. You aren't going to make the probability of any particular side more than 1/6, so what is the new probability?)

Comment author: anandjeyahar 13 February 2015 04:50:22AM 0 points [-]

OK, so "there could be cases where it is rational to update." How would you do so?

(I can't understand what an update could reasonably change. You aren't going to make the probability of any particular side more than 1/6, so what is the new probability?)

I don't know either. I can make up a scenario, based on a series of die throws, history of win-losses and guesses based on that, but that would simply be conjecture, and still may not produce a reasonable process. However, this discussion reminded me of a scene in HPMOR. (The scene where HP's critic part judges that Miss Camblebunker was not a Doctor, but an actor. (After Bellatrix is broken out of prison.))

Comment author: Davidmanheim 10 February 2015 07:02:31AM 0 points [-]

What does it mean to have uncertainty reduction taking place outside of the frame of reference of the person being asked for a decision?

In other terms, the discussion would have been the same if they replaced Naomi with a camera that is automatically used to take a picture.

Comment author: anandjeyahar 11 February 2015 03:18:06AM *  0 points [-]

What does it mean to have uncertainty reduction taking place outside of the frame of reference of the person being asked for a decision?

You're assuming humans are rational(as in the AI definition of a rational agent). We're not. So this knowledge that other person knows something for sure, that we don't know about, colours/biases one's judgement.

I am not saying one should update their beliefs based on another person knowing or not knowing, but that we do anyway, as part of perception. I would argue, that we should be learning to notice the confusion between the rational side of us vs the perceptive side which notes (the other agent's) confidence/lack there of. I know it is a hand-wavy explanation, but my point stands nevertheless. I agree with the OP that one shouldn't update their beliefs on the basis of Naomi/camera having no certainty about the outcome(of coin toss). Simply say that if it is Naomi, there could be cases where it is rational to update, though hard to actually observe/be-aware of these updations and therefore, safer to not update.

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