And the Mojave solar concentrator is being shut down, from what I've heard.
The article here starts with:
Last year China installed more than half of all wind and solar added globally. In May alone, it added enough renewable energy to power Poland, installing solar panels at a rate of roughly 100 every second.
The concentrated solar plant is getting shut down because it's failing to compete with the massive rollout of photovoltaic panels. We've made solar so cheap that the old ways of gathering it are becoming redundant, which, no matter how incredibly cool it was to see a second sun rise over the horizon on the way to Vegas, is a good sign.
The California Public Utilities Commission moved last month to prevent the shutdown of the Ivanpah solar concentrator. They cite data centers, grid reliability, and the state's clean energy goals as reasons to keep it online.
The pics show renewable energy integrated with other activity (e.g. sheep grazing among solar panels); integrated into urban environments (on every rooftop and streets) and contrasted against ancient Chinese culture (e.g. temples). I think this makes the imagery substantially different from the alternative-offered US RE installations.
We’re doing better than they are. Our new power generation is about 90% renewable, theirs is 70.
The difference is just scale, China has 3x our population but very many of them had little or even no electricity available so they’re playing catch up. Americans are functionally all served by the power grid already. So of course they’re building more of it as an absolute number.
But I’d also bet they built more coal plants last year than the entire world built in a decade.
Last year, PRC new generation is functionally >100% renewable (as in over 100%), new advanced coal plants serve as cleaner coal peakers not base load. New renewables now displaces existing coal (new trend last year) - nameplate coal is up due to new plants, but actual utilization of coal down in absolute terms.
Meanwhile what doesn't get captured in accounting is US increasing fossil exports (crude, lng etc), and PRC exporting renewables. Assuming 25 year lifecycle, PRC exports solar last year displaces ~5 years worth of US fossil exports in barrels of crude equivalent (400 GW of solar = 14000TWh electricity, or 8B barrels of oil, i.e. 22m barrels per day). TLDR PRC is reducing absolute fossil use, MASSIVELY increasing global renewable use. US is simply increasing net fossil use, much of it hidden from domestic balance sheets because it's exported globally.
Anecdote: I had a friend in SF. He and I would hang out once in a while, and I always looked forward to these hangouts (we'd meet up for coffee, or go for a walk, hang out at Dolores Park, etc.). He is gay, I'm not. His perspective on things was often quite different than mine and I found that interesting. I got married, he stayed single. Even after marriage we would still hang out (though not as often as before). Then we had a child, which sucked all spare time out of my life; but even then we hung out once in a while. Then one winter there was cold/flu/COVID going around. We planned on hanging out and I unfortunately bailed on him at the last moment. This happened 2 more times. Then that bout of illnesses passed and I reached out to him to hang out again. But this time he seemed cold and distant. So I dropped it. And I didn't see him again for almost 3 years.
Then one day I ran into him while walking through Dolores Park. He didn't see me, but I hesitated and still hollered out at him, for old times' sake. He responded and walked over. We chatted a little, I gave him a parting hug and we agreed to hang out again.
A couple of weeks later we managed to hang out again. What I gathered from our meeting was that he had been miffed at what he thought was me blowing him off; and I, when I felt he was cold and distant, had misread his grief at losing his cat. We both misread each other and wasted 3 years.
Moral of the story that I took away from it was: be more forgiving. Friendships are worth the extra effort.
In the past, whenever I felt lonely and hopeless, I jumped into helping others: volunteering, helping an old neighbor garden, help someone move, etc. Helping people gave me a short-term purpose, which eventually let me ride out the low phase of life. YMMV, of course.
I have noticed that doing the sign leads to some good conversations in which I've helped someone in a small way, and that gave me a nice little dopamine boost. It's also led to about half a dozen genuine friendships over the past few months. I wonder if that's the answer, a sort of meta-solution: organizing this thing I'm doing into something that other people in the same situation can do, as a way of meeting people and getting outside their comfort zone. Like setting up a chess table in public if chess is your thing. But no, there are already public chess tables, and they'd have already done that. I don't know, just thinking out loud.
This is my go-to strategy as well. When I feel irrepressible bits of loneliness or depression, I just make some food and go out and start handing out to the needy.
Or go for a walk and find people that need a hand. People moving, lifting things, carrying things. Small little acts of being useful and helpful for a moment help.
The feeling will creep back in eventually, but at least for that time I was out and about, it's not.
> and redact info that could be harmful to others.
of course, these concerns are only applicable when these "others" are Americans and the American institutions.
Everybody else can just fend for themselves.
Whats good for the goose, should be good for the gander. If American journalists feel like there is no problem with disclosing secrets of, say, Maduro, then they should not be protecting people like Trump (just as an example).
It's a question of incentives. From what I've heard: ICE agents are incentivized to the tune of $5000 for every immigrant deported. So they go after the low-hanging fruits: the immigrants coming in for their periodic immigration court hearings, the Home Depot parking lots, etc.
This is why you hear about old grannies being arrested and deported and random immigrant workers with no criminal history being nabbed.
Basically, ICE is a group of bounty hunters and they have no qualms about breaking the law if it leads to a nice payday.
Interesting ; Do you have any official or investigative links regarding incentives per deportation?
I understand their recruitment incentives are out of this world, but have not found reliable source for per-deportation incentives, and want to make sure I argue with 100% factually supported data.
I do not, unfortunately. It's just something I heard; though it would explain why ICE is going after law-abiding immigrants instead of criminals as originally intended.
Not always, and this another reason why terms like "illegal immigrants" are so harmful. Someone who is late in renewing their work visa, for example, has committed a civil offense and could be deported by ICE, but they still aren't a criminal in the way someone who crossed the border illegally or used a fraudulent visa would be.
That is a lot less binary than angry evil people would like to portray.
If we say there are ~~11 million under documented immigrants, there are literally hundreds of thousands if not millions that e.g. Were legal until the orange orangutan decided otherwise. There are people under ambiguous laws and people in tricky cases.
This is the equivalent to saying everybody who went 57mph in 55mph zone is a criminal and should be executed.
That would certainly explain the lack of publicized confrontation. If they were mostly deporting actual criminals / gang members, one would expect more stories akin to the events today.
It sounds like you’re unfamiliar with January 6th. Many of the people active in J6th were prosecuted. Most were pardoned by Trump. I understand the GP is saying these same people have joined ICE. I’ve seen a picture of one ICE officer(?) with an SS tattoo below their ear. That should bar employment in the law enforcement but there he is.
Nowhere did I say ICE is mostly pardoned criminals. I was under the impression the administration was against criminal gangs the President isn't currently friendly with, such as newly whitewashed and perfumed ISIS leaders, former South American pardoned drug dealing ex-presidents, and such.
Got it, thanks for the clarification. I'm surprised the President of the US is friendly with criminal gangs to be honest - this forum has always said that the US espouses justice with a stern, firm hand.
My uncle had an issue with his balance and slurred speech. Doctors claimed dementia and sent him home. It kept becoming worse and worse. Then one day I entered the symptoms in ChatGPT (or was it Gemini?) and asked it for the top 3 hypotheses. The first one was related to dementia. The second was something else (I forget the long name). I took all 3 to his primary care doc who had kept ignoring the problem, and asked her to try the other 2 hypotheses. She hesitantly agreed to explore the second one, and referred him to a specialist in that area. And guess what? It was the second one! They did some surgery and now he's fine as a fiddle.
I've heard a lot of such anecdotes. I'm not saying its ill-intentioned, but the skeptic in me is cautious that this is the type of reasoning which propels the anti-vax movement.
I wish / hope the medical community will address stories like this before people lose trust in them entirely. How frequent are mis-diagnosis like this? How often is "user research" helping or hurting the process of getting good health outcomes? Are there medical boards that are sending PSAs to help doctors improve common mis-diagnosis? Whats the role of LLMs in all of this?
I think the ultimate answer is that people must take responsibility for their own health and that of their children and loved ones. That includes research and double-checking your doctors. True, the result is that a good number of people will be convinced they have something (eg. autism) that they don't. But the anecdotes are piled up into giant mountains at this point. A good number of people in my family have had at least one doctor that has been useless in dealing with a particular problem. It required trying to figure out what was wrong, then finding a doctor that could help before there were correct diagnoses and treatments.
Patients should always advocate for their own care.
This includes researching their own condition, looking into alternate diagnoses/treatments, discussing them with a physician, and potentially getting a second opinion.
Especially the second opinion. There are good and bad physicians everywhere.
But advocating also does not mean ignoring a physician's response. If they say it's unlikely to be X because of Y, consider what they're saying!
Physicians are working from a deep well of experience in treating the most frequent problems, and some will be more or less curious about alternate hypotheses.
When it comes down to it, House-style medical mysteries are mysteries because they're uncommon. For every "doc missed Lyme disease" story there are many more "it's just flu."
Nothing he stated suggests this. Not giving a nod to how difficult it is doesn't mean people don't care. Unfortunately it is still true, we all have to advocate for our own care and pay attention to ourselves. The fact that this negatively affects the people who need the most care and attention is a harrowing part of humanity we often gloss over.
A boxing referee says "Protect yourself at all times."
They do this not because it isn't their job to protect fighters from illegal blows, but because the consequences of illegal blows are sometimes unfixable.
An encouragement for patients to co-own their own care isn't a removal of a physician's responsibility.
It's an acknowledgement that (1) physicians are human, fallible, and not omniscient, (2) most health systems have imperfect information sync'ing across multiple parties, and (3) no one is going to care more about you than you (although others might be much more informed and capable).
Self-advocacy isn't a requirement for good care -- it's due diligence and personal responsibility for a plan with serious consequences.
If a doc misses a diagnosis and a patient didn't spend any effort themselves, is that solely the doctor's fault?
PS to parent's insinuation: 20 years in the industry and 15 years of managed cancer in immediate family, but what do I know?
My question is, since you understand this very well, how successful
are patients (that manage the effort) at both acquiring scientifically accurate knowledge
and improving their health meaningfully?
And maybe share some tips like good knowledge databases?
I've seen patients (both family and non) meaningfully improve their health outcomes with statistically-significant frequency primarily via 4 methods.
1. Take ownership of their own medical records, learn them, and bring them to appointments. The most common failure in the current US medical system is incomplete/missing record transfer because of disconnected systems. Physicians will almost always attempt to confirm critical details, but that doesn't help if the patient says "I don't know."
2. Learn basic medical system-level knowledge relevant to a case. E.g. college 1xx freshman-level. No need to become an expert, but if a patient is dealing with kidney issues... it's pretty important to learn the basics about what kidneys are and do.
3. Ask about alternatives. "If we didn't go with that plan, what would be your next two recommended plans, and why aren't they first?" Having that alternative context is especially helpful when visiting specialists / other parties, as the patient can more fully describe the thinking behind their treatment plan. Also when researching online, the context helps avoid obvious pitfalls. (And yes, sometimes the reason will be "Because your insurance wouldn't cover X", which is also useful to know)
4. Use second options to measure uncertainty about the primary plan (e.g. everyone agrees vs it's debatable), but don't treatment-shop. The useful piece of information is opening a discussion about specific alternatives, while also listening to reasons against them.
Peer reviewed studies are surprisingly accessible (e.g. PubMed et al.), but they're also functionally useless without basic medical knowledge and details about a specific case.
Finally, for potentially lethal and/or lengthy conditions, I'm a firm believer that any empowerment improves outcomes simply by making the patient feel more involved and in control of their care.
Almost every "that could have been avoided" case I know was a willfully-ignorant and/or disinterested patient.
This applies to all areas of life, not just medicine.
We trade away our knowledge and skills for convenience. We throw money at doctors so they'll solve the issue. We throw money at plumbers to turn a valve. We throw money at farmers to grow our veggies.
Then we wonder why we need help to do basic things.
> researching their own condition
what a joke. so if I am sufferring with cancer, I should learn the lay of the land, treatments available ... wow. if I need to do everything, what am I paying for ?
Face-time. Their knowledge, training, and ability to write letters. Just because it's expensive, doesn't mean they are spending their evenings researching possible patient conditions and expanding their knowledge. Some might, but this isn't TV.
Anyway, what are you paid for? Guessing a programmer, you just sit in a chair all day and press buttons on a magical box. As your customer, why am I having to explain what product I want and what my requirements are? Why don't you have all my answers immediately? How dare you suggest a different specialism? You made a mistake?!?
We are idiots who will bear the consequences of our own idiocy. The big issue with all transactions done under significant information asymmetry is moral hazard. The person performing the service has far less incentive to ensure a good outcome past the conclusion of the transaction than the person who lives with the outcome.
Applies doubly now that many health care interactions are transactional and you won't even see the same doctor again.
On a systemic level, the likely outcome is just that people who manage their health better will survive, while people who don't will die. Evolution in action. Managing your health means paying attention when something is wrong and seeking out the right specialist to fix it, while also discarding specialists who won't help you fix it.
But the effects aren't just financial, look in an ER. People who for one reason or another haven't been able to take care of themselves in the emergency room for things that aren't an emergency, and it means your standard of care is going to take a hit.
Neither does collective responsibility, for the same reason, particularly in any sort of representative government. Or did you expect people to pause being idiots as soon as they stepped into the ballot box to choose the people they wanted to have collective responsibility?
>But the anecdotes are piled up into giant mountains at this point
This is disorganized thinking. Anecdotes about what? Does my uncle having an argument with his doctor over needing more painkillers, combine with an anecdote about my sister disagreeing with a midwife over how big her baby would be, combined with my friend outliving their stage 4 cancer prognosis all add up to "therefore I'm going to disregard nutrition recommendations"? Even if they were all right and the doctors were all wrong, they still wouldn't aggregate in a particular direction the way that a study on processed foods does.
And frankly it overlooks psychological and sociological dynamics that drive this kind of anecdotal reporting, which I think are more about tribal group emotional support in response to information complexity.
In fact, reasoning from separate instances that are importantly factually different is a signature line of reasoning used by alien abduction conspiracy theorists. They treat the cultural phenomenon of "millions" of people reporting UFOs or abduction experiences over decades as "proof" of aliens writ large, when the truth is they are helplessly incompetent interpreters of social data.
As of course you should be. Doctors, who are generally pretty caring and empathetic humans, try to invoke the mantra "You can't care about your patient's health more than they do" due to how deeply frustrating it is to try to treat someone who's not invested in the outcome.
It's when "being your own health advocate" turns into "being your own doctor" that the system starts to break down.
They’re not saying you’re crazy they’re saying you may be helplessly incompetent when it comes to interpreting social data. You probably aren’t a good reader either if crazy was your takeaway.
> Does my uncle having an argument with his doctor over needing more painkillers, combine with an anecdote about my sister disagreeing with a midwife over how big her baby would be, combined with my friend outliving their stage 4 cancer prognosis all add up to "therefore I'm going to disregard nutrition recommendations"?
Not sure about your sister and uncle, but from my observations the anecdotes combine into “doctor does not have time and/or doesn’t care”. People rightfully give exactly zero fucks about Bayes theorem, national health policy, insurance companies, social dynamics or whatever when the doctor prescribes Alvedon after 5 minutes of listening to indistinct story of a patient with a complicated condition which would likely be solved with additional tests and dedicated time. ChatGPT is at least not in a hurry.
> I wish / hope the medical community will address stories like this before people lose trust in them entirely.
Too late for me. I have a similar story. ChatGPT helped me diagnose an issue which I had been suffering with my whole life. I'm a new person now. GPs don't have the time to spend hours investigating symptoms for patients. ChatGPT can provide accurate diagnoses in seconds. These tools should be in wide use today by GPs. Since they refuse, patients will take matters into their own hands.
GPs don't have time to do the investigation, but they also have biases.
My own story is one of bias. I spent much of the last 3 years with sinus infections (the part I wasn't on antibiotics). I went to a couple ENTs and one observed allergic reaction in my sinuses, did a small allergy panel, but that came back negative. He ultimately wanted to put me on a CPAP and nebulizer treatments. I fed all the data I got into ChatGPT deep research and it came back with an NIH study that said 25% of people in a study had localized allergic reactions that would show up one place, but not show up elsewhere on the body in an allergy test. I asked my ENT about it and he said "That's not how allergies work."
I decided to just try second generation allergy tablets to see if they helped, since that was an easy experiment. It's been over 6 months since I've had a sinus infection, where before this I couldn't go 6 weeks after antibiotics without a reoccurrence.
There are over a million licensed physicians in the US. If we assume that each one interacts with five patients per weekday, then in the six months since you had this experience, that would conservatively be six-hundred-million patient interactions in that time.
Now, obviously none of this math would actually hold up to any scrutiny, and there's a bevy of reasons that the quality of those interactions would not be random. But just as a sense of scale, and bearing in mind that a lot of people will easily remember a single egregious interaction for the rest of their life, and (very reasonably!) be eager to share their experience with others, it would require a frankly statistically impossibly low error rate to not be able to fill threads like these with anecdotes of the most heinous, unpleasant, ignorant, and incompetent anecdotes anyone could ever imagine.
And this is just looking at the sheer scale of medical care, completely ignoring the long hours and stressful situations many doctors work in, patients' imperfect memories and one-sided recollections (that doctors can never correct), and the fundamental truth that medicine is always, always a mixture of probabilistic and intuitive judgement calls that can easily, routinely be wrong, because it's almost never possible to know for sure what's happening in s given body, let alone what will happen.
That E.N.T. wasn't up to date on the latest research on allergies. They also weren't an allergy specialist. They also were the one with the knowledge, skills, and insight to consider and test for allergies in the first place.
Imagine if we held literally any other field to the standard we hold doctors. It's, on the one hand, fair, because they do something so important and dangerous and get compensated comparitively well. But on the other hand, they're humans with incomplete, flawed information, channeling an absurdly broad and deep well of still insufficient education that they're responsible for keeping up-to-date while looking at a unique system in unique circumstances and trying to figure out what, if anything, is going wrong. It's frankly impressive that they do as well as they do.
If you fully accept everything BobaFloutist says, what do you do differently?
Nothing. You just... feel more sympathetic to doctors and less confident that your own experience meant anything.
Notice what's absent: any engagement with whether the AI-assisted approach actually worked, whether there's a systemic issue with ENTs not being current on allergy research, whether patients should try OTC interventions as cheap experiments, whether the 25% localized-reaction finding is real and undertaught.
The actual medical question and its resolution get zero attention.
Also though...
You are sort of just telling people "sometimes stuff is going to not work out, oh also there's this thing that can help, and you probably shouldn't use it?"
What is the action you would like people to take after reading your comment? Not use ChatGPT to attempt to solve things they have had issues solving with their human doctors?
> The study, from UVA Health’s Andrew S. Parsons, MD, MPH and colleagues, enlisted 50 physicians in family medicine, internal medicine and emergency medicine to put Chat GPT Plus to the test. Half were randomly assigned to use Chat GPT Plus to diagnose complex cases, while the other half relied on conventional methods such as medical reference sites
This is not ChatGPT outperforming doctors. It is doctors using ChatGPT.
For every one "ChatGPT accurately diagnosed my weird disease" anecdote, how many cases of "ChatGPT hallucinated obvious bullshit we ignored" are there? 100? 10,000? We'll never know, because nobody goes online to write about the failure cases.
> nobody goes online to write about the failure cases.
Why wouldn't they? This would seem to be engagement bait for a certain type of Anti-AI person? Why would you expect this to be the case? "My dad died because he used that dumb machine" -- surely these will be everywhere right?
Let's make our beliefs pay rent in anticipated experiences!
Failure cases aren't just "patient died." They also include all the times where ChatGPT's "advice" aligned with their doctor's advice, and when ChatGPT's advice was just totally wrong and the patient correctly ignored it. Nobody knows how numerous these cases are.
These are failures to provide useful advice over and above what could be gotten from a professional. In the sense that ChatGPT is providing net-neutral (maybe slightly positive since it confirms the doctor's diagnosis) or net-negative benefits (in the case that it's just wasting the user's time with garbage).
This is a doctor feeding the LLM a case scenario, which means the hard part of identifying relevant signal from the extremely noisy and highly subjective human patient is already done.
If you keep hearing anecdotes at what point is it statistically important ? IBM 15 years ago was selling a story about a search engine they created specifically for the medical field(they had it on jeopardy) where doctors spent 10 years before they figured this poor patients issue. They plugged the original doctors notes into it and the 4th result was the issue they took a decade to figure out. Memorizing dozens of medical books and being able to recall and correlate all that information in a human brain is a rare skill to be good at. The medical system works hard to ensure everyone going through can memorize but clearly search engines/llms can be a massive help here.
> If you keep hearing anecdotes at what point is it statistically important ?
Fair question but one has to keep in mind about ALL the other situations we do NOT hear about, namely all the failed attempts that did take time from professionals. It doesn't the successful attempts are not justified, solely that a LOT of positive anecdotes might give the wrong impressions that they are not radically most negative ones that are simply not shared. It's hard to draw conclusions either way without both.
I hear about people winning the lottery all the time. There were two $100m+ winners just this week. The anecdotes just keep piling up! That doesn't mean the lottery is a valid investment tool. People just do not understand how statistically insignificant anecdotes are in a sufficiently large dataset. Just for the US population, a 1 in a million chance of something happening to a person should happen enough to be reported on a new person every weekday of the year.
You guys are getting downvoted but you're 100% right. You never hear the stories about someone typing symptoms into ChatGPT and getting back wrong, bullshit answers--or the exact answer their doctor would have told them. Because those stories are boring. You only hear about the miraculous cases where ChatGPT accurately diagnosed an unusual condition. What's the ratio of miracle:bullshit? 1:100? 1:10,000?
> the skeptic in me is cautious that this is the type of reasoning which propels the anti-vax movement
I think there's a difference between questioning your doctor, and questioning advice given by almost every doctor. There are plenty of bad doctors out there, or maybe just doctors who are bad fits for their patients. They don't always listen or pay close attention to your history. And in spite of their education they don't always choose the correct diagnosis.
I also think there's an ever-increasing difference between AI health research and old-school WebMD research.
I can see why, but this is doc+patient in collab. And driven by using science in the form of applying llm-as-database-of-symptoms-and-treatments.
Anti-vax otoh is driven by ignorance and failure to trust science in the form of neither doctors, nor new types of science. Plus, anti-vax works like flat earth; a signaling mechanism of poor epostemic judgment."
Every second doctor is a below average doctor. Some are outright idiots that just became doctors because their parents expected it of them. They somehow finished med school and now they sick at their job.
Have you ever interacted with doctors? In a hospital rotation where you see a different one every week. And they all tell you entirely different things with absolute confidence of a prophet after looking at your file for 2 min and talking another 3?
Even good doctors have a real hard time convincing the bad doctors to do their job right. Never mind some random patient with a slightly less obvious diagnosis.
This is nothing like anti vax, because it is not implying a failing of medical science. It just states that enough doctors are bad enough at their job that user research is useful. To realize you need to go to a better doctor
well, to the credit of Bayes, dementia is likely a safe choice (depending on age/etc.) but dementia is largely a diagnosis of exclusion and most doctors, besides being unfamiliar with Bayes, are also just plain lazy and/or dumb and shouldn't immediately jump to the most likely explanation when it's one with the worst prognosis and fewest treatments...
I work in biomed. Every textbook on epidemiology or medical statistics that I've picked up has had a section on Bayes, so I'm not inclined to believe this.
Here is research about doctors interpreting test results. It seems to favor GP's view that many doctors struggle to weigh test specificity and sensitivity vs disease base rate.
Humans are extraordinarily lazy sometimes too. A good LLM does not possess that flaw.
A doctor can also have an in-the-moment negatively impactful context: depression, exhaustion, or any number of life events going on, all of which can drastically impact their performance. Doctors get depressed like everybody else. They can care less due to something affecting them. These are not problems a good LLM has.
I'm on some anti rejection meds post-transplant and chatgptd some of my symptoms and it said they were most likely caused by my meds. Two different nephrologists told me that the meds I'm on didn't cause those symptoms before looking it up themselves and confirming they do. I think LLMs have a place in this as far as being able to quick come up with hyphotesese that can be looked into and confirmed/disproved. If I hadn't had chatGPT, I wouldnt have brought it or my team would have just blamed lifestyle rather than meds.
Linking this anecdote to anti-vaxxing really seems a stretch, and I would like to see the reasoning behind that. My impression is that anti-vaxxers have more issues with vaccines themselves than with doctors who recommend them
I think that completely misreads a comment that was already painstakingly clear, they're specifically talking about the phenomenon of reasoning by anecdote. It wasn't a one-to-one equivalence between LLM driven medicine consultations and the full range of dynamics found in the anti-vax movement. Remember to engage in charitable interpretation.
They are closely related. The authority of the medical establishment is more and more questioned. And whenever it is correctly questioned, they lose a bit of their authority. It is only their authority that gets people vaccinated.
The fact is that many doctors do suck. Nearly all of my family members have terrible doctor stories, one even won a huge malpractice law suit. We can’t hide the real problems because we’re afraid of anti-vaxxers.
Generally the medical system is in a bad place. Doctors are often frustrated with patients who demand more attention to their problems. You can even see it for yourself on doctor subreddits when things like Fibromyalgia is brought up. They ridicule these patients for trying to figure out why their quality of life has dropped like a rock.
I think similar to tech, Doctors are attracted to the money, not the work. The AMA(I think, possibly another org) artificially restricts the number of slots for new doctors restricting doctor supply while private equity squeezes hospitals and buys up private practices. The failure doctors sit on the side of insurance trying to prevent care from being performed and it's up to the doctor who has the time/energy to fight insurance and the hospital to figure out what's wrong.
The AMA has no authority over the number of slots for new doctors. The primary bottleneck is the number of residency slots. Teaching hospitals are free to add more slots but generally refuse to do so due to financial constraints without more funding from Medicare. At one point the AMA lobbied Congress to restrict that funding but they reversed that position some years back. If you want more doctors then ask your members of Congress to boost residency funding.
yea specially because he is not saying what diagnosis It was, if you want to say doctors were unscientific at least be scientific and give the proper medical account of the symptoms and diagnosis
> cautious that this is the type of reasoning which propels the anti-vax movement
I hear you but there are two fundamentally different things:
1. Distrust of / disbelief in science
2. Doctors not incentivized to spend more than a few minutes on any given patients
There are many many anecdotes related to the second, many here in this thread. I have my own as well.
I can talk to ChatGPT/whatever at any time, for any amount of time, and present in *EXHAUSTIVE* detail every single datapoint I have about my illness/problem/whatever.
If I was a billionaire I assume I could pay a super-smart, highly-experienced human doctor to accommodate the same.
But short of that, we have GPs who have no incentive to spend any time on you. That doesn't mean they're bad people. I'm sure the vast majority have absolutely the best of intentions. But it's simply infeasible, economically or otherwise, for them to give you the time necessary to actually solve your problem.
I don't know what the solution to this is. I don't know nearly enough about the insurance and health industries to imagine what kind of structure could address this. But I am guessing that this might be what is meant by "outcome-based medicine," i.e., your job isn't done until the patient actually gets the desired outcome.
Right now my GP has every incentive to say "meh" and send me home after a 3-minute visit. As a result I more or less stopped bothering making doctor appointments for certain things.
The anecdote in question is not about mis-diagnosis, it's about a delayed diagnosis. And yeah, the inquiry sent a doctor down three paths, one of which led to a diagnosis, so let's be clear: no, the doctor didn't get it completely on their own, and: ChatGPT was, at best, 33% correct.
The biggest problem in medicine right now (that's creating a lot of the issues people have with it I'd claim) is twofold:
- Engaging with it is expensive, which raises the expectations of quality of service substantially on the part of the patients and their families
- Virtually every doctor I've ever talked to complains about the same things: insufficient time to give proper care and attention to patients, and the overbearingness of insurance companies. And these two lead into each other: so much of your doc's time is spent documenting your case. Basically every hour of patient work on their part requires a second hour of charting to document it. Imagine having to write documentation for an hour for every hour of coding you did, I bet you'd be behind a lot too. Add to it how overworked and stretched every medical profession is from nursing to doctors themselves, and you have a recipe for a really shitty experience on the part of the patients, a lot of whom, like doctors, spend an inordinate amount of time fighting with insurance companies.
> How often is "user research" helping or hurting the process of getting good health outcomes?
Depends on the quality of the research. In the case of this anecdote, I would say middling. I would also say though if the anecdotes of numerous medical professionals I've heard speak on the topic are to be believed, this is an outlier in regard to it actually being good. The majority of "patient research" that shows up is new parents upset about a vaccine schedule they don't understand, and half-baked conspiracy theories from Facebook. Often both at once.
That said, any professional, doctors included, can benefit from more information from whomever they're serving. I have a great relationship with my mechanic because by the time I take my car to him, I've already ruled out a bunch of obvious stuff, and I arrive with detailed notes on what I've done, what I've tried, what I've replaced, and most importantly: I'm honest about it. I point exactly where my knowledge on the vehicle ends, and hope he can fill in the blanks, or at least he'll know where to start poking. The problem there is the vast majority of the time, people don't approach doctors as "professionals who know more than me who can help me solve a problem," they approach them as ideological enemies and/or gatekeepers of whatever they think they need, which isn't helpful and creates conflict.
> Are there medical boards that are sending PSAs to help doctors improve common mis-diagnosis?
Doctors have shitloads of journals and reading materials that are good for them to go through, which also factors into their overworked-ness but nevertheless; yes.
> Whats the role of LLMs in all of this?
Honestly I see a lot of applications of them in the insurance side of things, unless we wanted to do something cool and like, get a decent healthcare system going.
I'm married to a provider. It is absolutely insane what she has to do for insurance. She's not a doctor, but she oversees extensive therapy for 5-10 kids at a time. Insurance companies completely dictate what she can and can't do, and frequently she is unable to do more in-depth, best-practice analysis because insurance won't pay for it. So her industry ends up doing a lot of therapy based on educated guesswork. Every few months, she has to create a 100+ page report for insurance. And on top of it, insurance denies the first submissions all the time which then cause her to burn a bunch of time on calls with the company appealing the peer review. And the "peer review" is almost always done by people who have no background in her field. It's basically akin to a cardiologist reviewing a family therapist's notes and deciding what is or isn't necessary. Except that my wife's job can be the difference between a child ever talking or not, or between a child being institutionalized or not when they become an adult. People who think private insurance companies are more efficient than government-run healthcare are nuts. Private insurance companies are way worse and actively degrade the quality of care.
> Insurance companies completely dictate what she can and can't do, and frequently she is unable to do more in-depth, best-practice analysis because insurance won't pay for it.
The distinction between "can't do" and "can't get paid for" seems to get lost a lot with medical providers. I'm not saying this is necessarily what's happening with your wife, but I've had it happen to me where someone says, "I can't do this test. Your insurance won't pay for it," and then I ask what it costs and it's a few hundred or a couple thousand dollars and I say, "That's OK. I'll just pay for the test myself," and something short-circuits and they still can't understand that they can do it.
The most egregious example was a prescription I needed that my insurance wouldn't approve. It was $49 without insurance. But the pharmacy wouldn't sell it to me even though my doctor had prescribed it because they couldn't figure out how to take my money directly when I did have insurance.
I get that when insurance doesn't cover something, most patients won't opt to pay for it anyway, but it feels like we need more reminders on both the patient and the provider side that this doesn't mean it can't be done.
> The distinction between "can't do" and "can't get paid for" seems to get lost a lot with medical providers. I'm not saying this is necessarily what's happening with your wife, but I've had it happen to me where someone says, "I can't do this test. Your insurance won't pay for it," and then I ask what it costs and it's a few hundred or a couple thousand dollars and I say, "That's OK. I'll just pay for the test myself," and something short-circuits and they still can't understand that they can do it.
Tell me you've never lived in poverty without telling me.
An unexpected expense of several hundred to a couple thousand dollars, for most of my lived life both as a child and a young adult, would've ruined me. If it was crucial, it would've been done, and I would've been hounded by medical billing and/or gone a few weeks without something else I need.
This would be comical but for the years I did live in poverty. In what world does my being able to afford it now mean I've somehow always been well off?
I generally agree (and sympathize with your wife), but let's not present an overly rosy view of government run healthcare or single-payer systems. In many countries with such systems, extensive therapy simply isn't available at all because the government refuses to pay for it. Every healthcare system has limited resources and care is always going to be rationed, the only question is how we do the rationing.
Government run healthcare can be done well or it can be done poorly. I’ve lived under both kinds and I would take the bad over America’s system. In Japan, I had to have a ton of cardiac work done, and it was done faster than I’d get it here.
Every healthcare system has problems, yes. However the spectre of medical debt and bankruptcy is a uniquely American one, so, IMHO, even if we moved to single-payer healthcare and every other problem stayed the same, but we no longer shoved people into the capitalist fuck-barrel for things completely outside their control, I think that's an unmitigated, massive improvement.
Well now you're talking about a different problem and moving the goalposts. It would be impossible for every other problem to stay the same under a single-payer system. That would solve some existing problems and create other new problems. In particular the need to hold down government budgets would necessarily force increased care rationing and longer queues. Whether that would be a net positive or negative is a complex question with no clear answers.
The statistics you see about bankruptcy due to medical debt are highly misleading. While it is a problem, very few consumers are directly forced into bankruptcy by medical expenses. What tends to happen is that serious medical problems leave them unable to work and then with no income and then with no income all of their debts pile up. What we really need there is a better disability welfare system to keep consumers afloat.
> Well now you're talking about a different problem and moving the goalposts.
I am absolutely not. I am reacting to what's been replied to what I've said. In common vernacular, this is called a "conversation."
To recap: the person who replied to me left a long comment about the various strugglings and limitations of healthcare when subjected to the whims of insurance companies. You then replied:
> I generally agree (and sympathize with your wife), but let's not present an overly rosy view of government run healthcare or single-payer systems. In many countries with such systems, extensive therapy simply isn't available at all because the government refuses to pay for it. Every healthcare system has limited resources and care is always going to be rationed, the only question is how we do the rationing.
Which, at least how I read it, attempts to lay the blame for the lack of availability of extensive therapies at the feet of a government's unwillingness to pay, citing that every system has limited resources and care is always being rationed.
I countered, implying that while that may or may not be true, that lack of availability is effectively status quo for the majority of Americans under our much more expensive, and highly exploitative insurance-and-pay-based healthcare system, and that, even if those issues around lack of availability persisted through a transition to a single-payer healthcare system, it would at least alleviate us from the uniquely American scourge of people being sent to the poorhouse, sometimes poor-lack-of-house, for suffering illnesses or injuries they are in no way responsible for which in my mind is still a huge improvement.
> The statistics you see about bankruptcy due to medical debt are highly misleading. While it is a problem, very few consumers are directly forced into bankruptcy by medical expenses. What tends to happen is that serious medical problems leave them unable to work and then with no income and then with no income all of their debts pile up.
I mean we can expand this if you like into a larger conversation about how insurance itself being tied to employment and everyone being kept broke on purpose to incentivize them to take on debt to survive, placing them on a debt treadmill their entire lives which has been demonstrably shown to reduce quality and length of life, as well as introducing the notion that missing any amount of work for no matter how valid a reason has the potential to ruin your life, is probably a highly un-optimal and inhumane way to structure a society.
> What we really need there is a better disability welfare system to keep consumers afloat.
>> extensive therapy simply isn't available at all because the government refuses to pay for it.
I don't know any country that has banned paid healthcare just because they have government run one.
If you can pay out of your pocket for it in USA system when denied by insurance company then you would be able to afford it when denied by goverment. Since the criteria of whats necessary wouldn't shift (hospitals might even more money per patient)
I get where you’re coming from. I would argue the mistakes doctors make and the amount of times they are wrong literally dwarfs the amount of anti vaxers in existence.
Also the anti vax movement isn’t completely wrong. It’s now confirmed (officially) that the covid-19 vaccine isn’t completely safe and there are risks taking it that don’t exist in say something like the flu shot. The risk is small but very real and quite deadly. Source: https://med.stanford.edu/news/all-news/2025/12/myocarditis-v... This was something many many doctors originally claimed was completely safe.
The role of LLMs is they take the human bias out of the picture. They are trained on formal medical literature and actual online anecdotal accounts of patients who will take a shit on doctors if need be (the type of criticism a doctor rarely gets in person). The generalization that comes from these two disparate sets of data is actually often superior to a doctor.
Key word is “often”. Less often (but still often in general) the generalization can be an hallucination.
Your post irked me because I almost got the sense that there’s a sort of prestige, admiration and respect given to doctors that in my opinion is unearned. Doctors in my opinion are like car mechanics and that’s the level of treatment they deserve. They aren’t universally good, a lot of them are shitty, a lot are manipulative and there’s a lot of great car mechanics I respect as well. That’s a fair outlook they deserve… but instead I see them get these levels of respect that matches mother Theresa as if they devoted their careers to saving lives and not money.
No one and I mean no one should trust the medical establishment or any doctor by default. They are like car mechanics and should be judged on a case by case basis.
You know for the parent post, how much money do you think those fucking doctors got to make a wrong diagnosis of dementia? Well over 700 for less than an hour of there time. And they don’t even have the kindness to offer the patient a refund for incompetence on their part.
> This was something many many doctors originally claimed was completely safe.
I never heard any doctors claim any of the covid vaccines were completely safe. Do you mind if I ask which doctors, exactly? Not institutions, not vibes, not headlines. Individual doctors. Medicine is not a hive mind, and collapsing disagreement, uncertainty, and bad messaging into “many doctors” is doing rhetorical work that the evidence has to earn.
> The role of LLMs is they take the human bias out of the picture.
That is simply false. LLMs are trained on human writing, human incentives, and human errors. They can weaken certain authority and social pressures, which is valuable, but they do not escape bias. They average it. Sometimes that helps. Sometimes it produces very confident nonsense.
> Your post irked me because I almost got the sense that there’s a sort of prestige, admiration and respect given to doctors that in my opinion is unearned. Doctors in my opinion are like car mechanics and that’s the level of treatment they deserve.
> No one and I mean no one should trust the medical establishment or any doctor by default. They are like car mechanics and should be judged on a case by case basis.
You are entitled to that opinion, but I wanted to kiss the surgeon who removed my daughter’s gangrenous appendix. That reaction was not to their supposed prestige, it was recognition that someone applied years of hard won skill correctly at a moment where failure had permanent consequences.
Doctors make mistakes. Some are incompetent. Some are cynical. None of that justifies treating the entire profession as functionally equivalent to a trade whose failures usually cost money rather than lives.
And if doctors are car mechanics, then patients are machines. That framing strips the humanity from all of us. That is nihilism.
No one should trust doctors by default. Agreed. But no one should distrust them by default either. Judgment works when it is applied case by case, not when it is replaced with blanket contempt.
> I never heard any doctors claim any of the covid vaccines were completely safe. Do you mind if I ask which doctors, exactly? Not institutions, not vibes, not headlines. Individual doctors. Medicine is not a hive mind, and collapsing disagreement, uncertainty, and bad messaging into “many doctors” is doing rhetorical work that the evidence has to earn.
There’s no data here. Many aspects of life are not covered by science because trials are expensive and we have to go with vibes.
And even on just vibes we often can get accurate judgements. Do you need clinical trials to confirm there’s a ground when you leap off your bed? No. Only vibes unfortunately.
If you ask people (who are not doctors) to remember this time they will likely tell you this is what they remember. I also do have tons of anecdotal accounts of doctors saying the Covid 19 vaccine is safe and you can find many yourself by searching. Here’s one: https://fb.watch/Evzwfkc6Mp/?mibextid=wwXIfr
The pediatrician failed to communicate the risks of the vaccine above and made the claim it was safe.
At the time to my knowledge the actual risks of the vaccine were not fully known and the safety was not fully validated. The overarching intuition was that the risk of detrimental of effects from the vaccine was less than the risk+consequence of dying from Covid. That is still the underlying logic (and best official practice) today even with the knowledge about the heart risk covid vaccines pose.
This doctor above did not communicate this risk at all. And this was just from a random google search. Anecdotal but the fact that I found one just from a casual search is telling. These people are not miracle workers.
> That is simply false. LLMs are trained on human writing, human incentives, and human errors. They can weaken certain authority and social pressures, which is valuable, but they do not escape bias. They average it. Sometimes that helps. Sometimes it produces very confident nonsense.
No it’s not false. Most of the writing on human medical stuff is scientific in nature. Formalized with experimental trials which is the strongest form of truth humanity has both practically and theoretically. This “medical science” is even more accurate than other black box sciences like psychology as clinical trials have ultra high thresholds and even test for causality (in contrast to much of science only covers correlation and assumes causality through probabilistic reasoning)
This combined with anecdotal evidence that the LLM digests in aggregate is a formidable force. We as humans cannot quantify all anecdotal evidence. For example, I heard anecdotal evidence of heart issues with rna vaccines BEFORE the science confirmed it and LLMs were able to aggregate this sentiment through sheer volumetric training on all complaints of the vaccine online and confirm the same thing BEFORE that Stanford confirmation was available.
> You are entitled to that opinion, but I wanted to kiss the surgeon who removed my daughter’s gangrenous appendix. That reaction was not to their supposed prestige, it was recognition that someone applied years of hard won skill correctly at a moment where failure had permanent consequences.
Sure I applaud that. True hero work for that surgeon. I’m talking about the profession in aggregate. In aggregate in the US 800000k patients die or get permanently injured from a misdiagnosis every year. Physicians fuck up and it’s not occasionally. It’s often and all the fucking time. You were safer getting on the 737 max the year before they diagnosed the mcas errors then you are NOT getting a misdiagnosis and dying from a doctor. Those engineers despite widespread criticism did more for your life and safety than doctors in general. That is not only a miracle of engineering but it also speaks volumes of the medical profession itself which DOES not get equivalent criticism for mistakes. That 800000k statistic is swept under the rug like car accidents.
I am entitled to my own opinion just as you are to yours but I’m making a bigger claim here. My opinion is not just an opinion. It’s a ground truth general fact backed up by numbers.
> And if doctors are car mechanics, then patients are machines. That framing strips the humanity from all of us. That is nihilism.
There is nothing wrong with car mechanics. It’s an occupation and it’s needed. And those cars if they fail they can cause accidents that involve our very lives.
But car mechanics are fallible and that fallibility is encoded into the respect they get. Of course there are individual mechanics who are great and on a case by case basis we pay those mechanics more respect.
Doctors need to be treated the same way. It’s not nilhism. It’s a quantitative analysis grounded in reality. The only piece of evidence you provided me in your counter is your daughter’s life being saved. That evidence warrants respect for the single doctor who saved your daughter’s life and not for the profession in general. The numbers agree with me.
And treatment for say the corporation responsible for the mcas failures and the profession responsible for medical misdiagnosis that killed people is disproportionate. Your own sentiment and respect for doctors in general is one piece of evidence for this.
> If you ask people (who are not doctors) to remember this time they will likely tell you this is what they remember. I also do have tons of anecdotal accounts of doctors saying the Covid 19 vaccine is safe and you can find many yourself by searching. Here’s one: https://fb.watch/Evzwfkc6Mp/?mibextid=wwXIfr
> No it’s not false. Most of the writing on human medical stuff is scientific in nature. Formalized with experimental trials which is the strongest form of truth humanity has both practically and theoretically. This “medical science” is even more accurate than other black box sciences like psychology as clinical trials have ultra high thresholds and even test for causality (in contrast to much of science only covers correlation and assumes causality through probabilistic reasoning)
Sorry, but these kinds of remarks wreck your credibility and make it impossible for me to take you seriously.
If you disagree with me then it is better to say you disagree and state your reasoning why. If the reasoning is too foundational than it is better to state it as such and exit.
Saying something like my "credibility is wrecked" and impossible to take me "seriously" crosses a line into deliberate attack and insult. It's like calling me an idiot but staying technically within the HN rules. You didn't need to go there and breaking those rules in spirit is just as bad imo.
Yeah I agree I think the conversation is over. I suggest we don't talk to each other again as I don't really appreciate how you shut down the conversation with deliberate and targeted attacks.
Since someone else asked and you said you didn't remember, do you think he may have had Normal Pressure Hydrocephalus (NPH)? And the surgery which he had may have been a VP shunt (ventricular-peritoneal) -- something to move fluid away from his brain?
Quite a mouthful for the layman and the symptoms you are describing would fit. NPH has one of my favorite mnemonic in medicine for students learning about the condition, describing the hallmark symptoms as: "Wet, Wobbly and Wacky."
Wet referring to urinary incontinence, Wobbly referring to ataxia/balance issues and Wacky referring to encephalopathy (which could mimic dementia symptoms).
Now that you mention it, it may have been NPH. The thing is, I did the chatting with ChatGPT and handed the printout to the doc. Biology was never my strong suit, so my eyes glaze over when I see words like "Hydrocephalus" :-D
That's a tip I recommend people to try when they are using LLMs to solve stuff. Instead of asking "how to..", ask "what alternatives are there to...". A top-k answer is way better, and you get to engage more with whatever you are trying to learn/solve.
Same if you are coding, ask "Is it possible" not "How do I" as the second one will more quickly result in hallucinations when you are asking it for something that isn't possible.
General doctors aren't trained for problem solving, they're trained for memorization. The doctors that are good at problem solving aren't general doctors.
That's a sweeping generalization unsupported by facts.
In reality you'll find the vast majority of GPs are highly intelligent and quite good at problem solving.
In fact, I'd go so far as to say their training is so intensive and expansive that laypeople who make such comments are profoundly lacking in awareness on the topic.
Physicians are still human, so like anything there's of course bad ones, specialists included. There's also healthcare systems with various degrees of dysfunction and incentives that don't necessarily align with the patient.
None of that means GPs are somehow less competent at solving problems; not only is it an insult but it's ridiculous on the face of it.
Even if they are good at problem solving, a series of 10-minute appointments spaced out in 2-3 month intervals while they deal with a case load of hundreds of other patients will not let them do it. That's the environment that most GPs work under in the modern U.S. health care system.
Pay for concierge medicine and a private physician and you get great health care. That's not what ordinary health insurance pays for.
>You followed up a sweeping generalization with a sweeping generalization and a touch of bias.
As opposed to what, proving that GPs are highly trained, not inherently inferior to other types of physicians, and regularly conduct complex problem solving?
Heck, while I'm at it I may as well attempt to prove the sky is blue.
>I imagine the issue with problem solving more lays in the system doctors are stuck in and the complete lack of time they have to spend on patients.
Maybe they are, but for most of my interactions with GP's in recent years, and several with specialists, for anything much beyond the very basics, I've had to educate them, and it didn't require much knowledge to exceeds theirs on specific conditions.
In one case, a specialist made arguments that were trivially logically fallacious and went directly against the evidence from treatment outcomes.
In other cases, sheer stupidity of pattern matching with rational thinking seemingly totally turned off. E.g. hearing I'd had a sinus infection for a long time, and insisting that this meant it was chronic and chronic meant the solution was steroids rather than antibiotic, despite a previous course having done nothing, and despite the fact that an antibiotic course had removed most of the symptoms both indicating the opposite - in the end, after bypassing my GP at the time and explaining and begging an advance nurse practitioner, I got two more courses of antibiotic and the infection finally fully went.
I'm sure all of them could have done better, and that a lot of it is down to dysfunction, such as too little time allotted to actually look at things properly, but some of the interactions (the logical fallacy in particular) have also clearly been down to sheer ignorance.
I also expect they'd eventually get there, but doing your own reading and guiding things in the right direction can often short-circuit a lot of bullshit that might even deliver good outcomes in a cost effective way on a population level (e.g. I'm sure the guidance on chronic sinus issues is right the vast majority of time - most bacterial sinus infections either clear by themselves or are stopped early enough not to "pattern match" as chronic), but might cause you lots of misery in the meantime...
Your personal experience is anecdotal and thus not as reliable as statistical facts. This alone is not a good metric.
However your anecdotal experience is not only inline with my own experience. It is actually inline with the facts as well.
When the person your responding to said that what you wasn’t backed up by facts I’m going to tell you straight up that, that statement was utter bullshit. Everything you’re saying here is true and generally true and something many many patients experience.
>When the person your responding to said that what you wasn’t backed up by facts I’m going to tell you straight up that, that statement was utter bullshit.
The person you just replied to here isn't the same person I replied to.
> In reality you'll find the vast majority of GPs are highly intelligent and quite good at problem solving.
Is this statement supported by facts? If anything this statement is just your internal sentiment. If you claim it’s not supported by facts the proper thing you should do is offer facts to counter his statement. Don’t claim his statement isn’t supported by facts than make a counter claim without facts yourself.
Read that fact. 800,000 deaths from misdiagnosis a year is pretty pathetic. And this is just deaths. I can guarantee you the amount of mistakes unreported that don’t result in deaths dwarfs that number.
Boeing the air plane manufacurwe who was responsible for the crashing Boeing 737 mcas units have BETTER outcomes than this. In the year that those planes crashed you have a 135x better survival rate of getting on a 737 max then you are getting an important diagnosis from a doctor and not dying from a misdiagnosis. Yet doctors are universally respected and Boeing as a corporation was universally reviled that year.
I will say this GPs are in general not very competent. They are about as competent and trust worthy as a car mechanic. There are good ones, bad ones, and also ones that bullshit and lie. Don’t expect anything more than that, and this is supported by facts.
Yeah, the main fact here is called medical school.[0]
>Read that fact. 800,000 deaths from misdiagnosis a year is pretty pathetic. And this is just deaths.
Okay, and if that somehow flows from GPs (but not specialists!) being uniquely poor at problem solving relative to all other types of physicians—irrespective of wider issues inherent in the U.S. healthcare system—then I stand corrected.
>135x better survival rate of getting on a 737 max
The human body isn't a 737.
>I will say this GPs are in general not very competent. They are about as competent and trust worthy as a car mechanic.
How is going to medical school a measurement of problem solving ability? You need to cite a metric involving ACTUAL problem solving. For example, a misdiagnosis is a FAILURE at solving a problem.
Instead you say “medical school” and cite the Harvard handbook as if everyone went to Harvard and that the medical book was a quantitative metric on problem solving success or failure. Come on man. Numbers. Not manuals.
> The human body isn't a 737
Are you joking? You know a 737 is responsible for ensuring the survival of human bodies hurdling through the air at hundreds of miles per hour at altitudes higher than Mount Everest? The fact that your risk of dying is lower going through that then getting a correct diagnosis from a doctor is quite pathetic.
This statement you made here is manipulative. You know what I mean by that comparison. Don’t try to spin it like I'm not talking about human lives.
> Ignorant.
Being a car mechanic is a respectable profession. They get the typical respect of any other occupation and nothing beyond that. I’m saying doctors deserve EXACTLY the same thing. The problem is doctors sometimes get more than that and that is not deserved at all. Respect is earned and the profession itself doesn’t earn enough of that respect.
Are you yourself a doctor? If so your response speaks volumes about the treatment your patients will get.
>This statement you made here is manipulative. You know what I mean by that comparison. Don’t try to spin it like I'm not talking about human lives.
Let me spell it out then: The mechanisms by which a human body and a 737 work are so vastly different that one may as well be alien to the other. It's quite an apples and oranges comparison.
Yeah, you can draw parallels in some areas but I'd say on the whole the analogy isn't exactly apt. That said, I'll indulge:
Imagine if every 737 was a few orders of magnitude more complex, and also so different to the point that no plane even looked or functioned the same. Then, imagine we didn't fully understand how they worked.
Point being: Medicine is fuzzy because the human body is fuzzy and imprecise. Everybody's a little different. Contrast to aviation, which is very much an exact science and engineering discipline at this point.
Medicine isn't engineering. Treating patients isn't the same as the design and manufacture of aircraft.
That of course doesn't excuse shitty healthcare systems that can clearly do better when stats indicate there's preventable adverse outcomes happening. I just don't think laying the blame at the feet of doctors somehow being too stupid to problem solve is helpful when there's a larger system that's preventing them from doing their best work for their patients. If anything that narrative is counterproductive.
>Are you yourself a doctor?
Nope, just a layperson who knows they're a layperson.
>Let me spell it out then: The mechanisms by which a human body and a 737 work are so vastly different that one may as well be alien to the other. It's quite an apples and oranges comparison.
Should've done this in the first place because no one understands what you're saying otherwise.
The problem internals are different but we are comparing the outcome and that is: human lives. You seem to think this is an invalid comparison. It's not.
>Medicine isn't engineering. Treating patients isn't the same as the design and manufacture of aircraft.
I never said that. The whole point was you made the claim doctors are good problem solvers because they went to medical school.
I said that claim is utter bullshit. They aren't that good and they misdiagnose shit all the time. The point still stands and you delivered evidence to validate that. You said Medicine is fuzzy and engineering exact. You said the problem was vastly more complex as well.
All of this proves the point. The problem is harder, the science is fuzzy. Doctors armed with medical science, which is definitively worse, operating on a problem that is definitively harder will be generally WORSE problem solvers then people in other occupations IF we hold everything else the same. So doctors as a group ARE not good problem solvers. That WAS the point. We are referring to doctors as a group and thus the ONLY point of comparison for problem solvers ARE other occupations.
That's just a given and it follows from your OWN logic.
>That of course doesn't excuse shitty healthcare systems that can clearly do better when stats indicate there's preventable adverse outcomes happening. I just don't think laying the blame at the feet of doctors somehow being too stupid to problem solve is helpful when there's a larger system that's preventing them from doing their best work for their patients. If anything that narrative is counterproductive.
Did I lay the blame on doctors? No. I just said they aren't good problem solvers. That's a fact. That's not blame.
But let's be clear, I agree it's counter productive to lay blame OR call doctors stupid and such a thing WAS not done by me. I was simply making the claim that THEY are NOT good problem solvers. You inserted extra negative sentiment into the "narrative" as an hallucination by your own imagination.
Look, point is you're wrong on every count. Doctors are not good at problem solving period. They're pretty bad at it. The comparison with aviation engineers is apt because those guys are GOOD problem solvers.
And again, it's not the doctors fault that they are incompetent. It's the hardness of the problem and the limitations of the science that make them like this.
After undergoing stomach surgery 8 years ago I started experiencing completely debilitating stomach aches. I had many appointments with my GP and a specialist leading to endoscopies, colonoscopies, CAT scans, and MRI scans all to no avail and they just kept prescribing more and more anti-acids and stronger painkillers.
It was after seven years of this that I paid for a private food allergy test to find that I am allergic to Soya protein. Once I stopped eating anything with Soya in it the symptoms almost completely vanished.
At my next GP appointment I asked why no-one had suggested it could be an allergic reaction only to be told that it is not one of the things they check for or even suggest. My faith in the medical community took a bit of a knock that day.
On a related note, I never knew just how many foods contain Soya flour that you wouldn't expect until I started checking.
The one I had as kid, well. He was old, stuck in old ways, but I still think he was decent at it.
But seeing the doctor is a bit more difficult these days, since the assistants are backstopping. They do some heavy lifting / screening.
I think an LLM could help with symptoms and then looking at the most probable cause, but either way I wouldn't take it too serious. And that is the general issue with ML: people take the output too serious, at face value. What matters is: what are the cited sources?
You still need 2 deviations above the average college student to get to med school. As a rough proxy for intelligence. The bottom threshold for doctors is certainly higher than lawyers
In general your comment was false. You're just lying and making things up. There are lower-tier medical schools in California, Massachusetts, and most every other state. The state, whether it's Kansas or somewhere else, is almost totally irrelevant to the quality of physicians produced.
No I'm not. I'm referring to a specific bad school(s) in kansas. I never made a comment about Kansas itself.
I never said the state is correlated with the quality of the doctor, or even if the quality of the school is associated with the quality of the doctor. You made that up. Which makes you the liar.
>If you're referring to a specific school then name the school instead of making lame low-effort comments about a state.
You're fucking right. I should've named the specific school. (And I didn't make a comment about the state I made a comment about school(s) in the state which is not about all schools in the state.)
That's would I should do. What you should do is: Don't accuse me of lying and then lie yourself. Read the comment more carefully. Don't assume shit.
No point in continue this. We both get it and this thread is going nowhere.
Huh? So your complaint is that you keep getting black doctors? That’s dumb, but whatever - why not just… get a white doctor? Or Asian or whatever you think is the smart one?
Black students (among other minorities) with unacceptable MCAT (as in, if another race had them they would be rejected) are accepted, at a rate 6-10x more likely to be admitted with similar scores. The motivation is that doctors should match the demographic they treat, and minority doctors are underrepresented, so should be accepted at higher rates: https://www.uclahealth.org/news/article/clinical-outcomes-pa...
The obvious outcome is that minorities students, being less prepared as measured by MCAT and somewhat setup for failure, have a much higher failure rate, with black students being 85% more likely to leave medical school than white: https://news.yale.edu/2023/07/31/black-md-phd-students-exper...
The system was, as is the stated goal by all, setup to pass minority students that would have previously been rejected, at every step of them becoming a doctor, to provide a net positive for minority populations, since it's accepted that you'll get the best outcome if your doctor is the same race as you.
Thank you, this is it exactly. And my biggest concern isn't the % of unprepared students who leave medical school. It's the % who stay and get passed through.
"You know what they call the most unqualified insert-identity-here person in the med school class of 2025 who squeezed by because it would look bad if they didn't?"
"Dr."
Which is why 99% AI-driven diagnosis can't come fast enough.
I feel like only the last paragraph was relevant here - I don’t particularly care why he wants a doctor of race X instead of Y. My question remains the same: why not just… get a doctor with the skin color you prefer? You’re not exactly assigned one for life at birth.
I think you're bringing up a different (very related) point than him, with both points having truth:
1. You're free to pick the race of your doctor. Matching your race is a data driven positive.
2. 30 years ago, the system made sure a minority doctor was (at least, but probably more so do to discrimination) as competent as a white doctor. These days, the system is intentionally and deliberately set up so to help pass less competent minority students, due to the positives of #1.
They’re not even trained for memorization. They’re trained for mitigation and I don’t really blame them for the crap pay they receive. Over the course of a 40-year career they basically make what a typical junior dev makes. It’s fast becoming a rich man’s hobby career.
It's about the same pay as a (professional) engineer. In the US, both engineers and doctors are very highly paid. In the UK and Japan they are paid about 50-100k if experienced, which is somewhere about 2-4x less than their US counterparts.
"According to the Government of Canada Job Bank, the median annual salary for a General Practitioner (GP) in Canada is $233,726 (CAD) as of January 23, 2024."
That's roughly $170,000 in the US. If you adjust for anything reasonable, such as GDP per capita or median income between the US & Canada, that $170k figure matches up very well with the median US general practitioner figure of around $180k-$250k (sources differ, all tend to fall within that range). The GPs in Canada may in fact be slightly better paid than in the US.
I wouldn't be surprised if AI was better than going to GP or many other specialists in majority of cases.
And the issue is not with the doctors themselves, but the complexity of human body.
Like many digestive issues can cause migraines or a ton of other problems. I am yet to see when someone is referred to gut health professional because of the migraine.
And a lot of similar cases when absolutely random system causes issues in seemingly unrelated system.
A lot of these problems are not life threatening thus just get ignored as they would take too much effort and cost to pinpoint.
AI on the other hand should be pretty good at figuring out those vague issues that you would never figured out otherwise.
> AI on the other hand should be pretty good at figuring out those vague issues that you would never figured out otherwise.
Not least because it almost certainly has orders of magnitude more data to work with than your average GP (who definitely doesn't have the time to keep up with reading all the papers and case studies you'd need to even approach a "full view".)
And speaking of migraines, even neurological causes can apparently be tricky: Around here, cluster headaches would go without proper diagnosis for about 10 years on average. In my case, it also took about 10 years and 3 very confused GPs before one would refer me to a neurologist who in turn would come up with the diagnosis in about 30 seconds.
The first was "dementia" (or something related to it, I don't remember the exact medical term). The second was something to do with fluid in some spinal column (I am sorry once again, I do not remember the medical term; they operated on him to drain it, which is why I remember it). I don't remember the third one, unfortunately.
Perhaps a CSF leak due to a dural sack tear in the spine? Was his symptom only having headaches while standing? Happened to my wife. 6 weeks of absolute hell.
On second thought — the opposite. A bulge/blockage of CSF?
Apparently, as I've recently learned due to a debilitating headache, CSF pressure (both high and low) can cause a whole host of symptoms, ranging from mild headache and blurred vision to coma and death.
It's pretty wild that a doctor wouldn't have that as a hypothesis.
I can give you the exact opposite anecdote for myself. Spent weeks with Dr Google and one or another LLMs (few years ago so not current SOTA) describing myself and getting like 10 wrong possibilities. Took my best guess with me to a doctor who listened to me babble for 5 minutes and immediately gave me a correct diagnosis of a condition I had not remotely considered. Problem was most likely that I was not accurately describing my symptoms because it was difficult to put it into words. But also I was probably priming queries with my own expected (and mistaken) outcomes. Not sure if current models would have done a better job, but in my case at least, a human doctor was far superior.
Thanks for sharing. I struggled with long-term undiagnosed issues for so long. It took me 15 years of trying with doctors until one did a colonoscopy and found an H.Pylori infection in 2018. Prescribed the right kind of antibiotics and changed my life. In hindsight, my symptoms matched many of the infection's. No doctor figured it out.
So many doctors never bothered to conduct any tests. Many said it's in my head. Some told me to just exercise. I tried general doctors, specialists. At some point, I was so desperate that I went to homeopathy route.
15 years wasted. Why did it take 15 years for the current system?
I'd bet that if I had ChatGPT earlier, it could have helped me in figuring out the issue much faster. When you're sick, you don't give a damn who might have your health data. You just want to get better.
Programmers have the benefit of being able to torture and kill our patients at scale (unit and integration testing), doctors less so. The diagnostic skills one hits in any given doctor may be relatively shallow, plus tired, overworked, or annoyed by a patients self expression… the results I’ve seen are commonly abysmal and care providers are never shocked by poor and misdiagnosis from other practitioners.
I have some statistically very common conditions and a family medical history with explicit confirmation of inheritable genetic conditions. Yet, if I explain my problems A to Z I’m a Zebra whose female hysteria has overwhelmed his basic reasoning and relationship to reality. Explained Z to A, well I can’t get past Z because, holy crap is this an obvious Horse and there’s really only one cause of Horse-itis and if your mom was a Horse then you’re Horse enough for Chronic Horse-itis.
They don’t have time to listen, their ears aren’t all that great, and the mind behind them isn’t necessarily used to complex diagnostics with misleading superficial characteristics. Fire that through a 20 min appointment, 10 of which is typing, maybe in a second language or while in pain, 6 plus month referral cycles and… presto: “it took a decade to identify the cause of the hoof prints” is how you spent your 30s and early 40s.
I thought Hy.Pylori was diagnosed from a stool sample which in my experience is the first thing you’re asked for if you have any gastric issues. Was it only possible to find via the colonoscopy in your case or did the doctors never do a stool test?
The sensitivity from stool samples seems to be less than 80%. The gold standard is gastroscopy, which is often performed anyway to rule out ulcers etc. It is the first time I heard about colonoscopy for H Pylori.
You could do a breath test for h pylori. The colonoscopy was done as a general check by a specialist doctor. So the doctor wasn’t sure but a colonoscopy covered h pylori check.
What I see are people returning to the same categorical errors in medicine.
Drawing medical conditions from an urn occasionally yields a true diagnostic, even more so if conditions are weighed in the urn according to their prevalence in society. But disease lottery is no medical practice.
Two essential errors exist in medicine:
1. Delivering a wrong intervention.
2. Failing to deliver an intervention at the right time due to misdiagnosis.
These are the sins of harm and distraction. The metric for judging a system is not whether it gets things right on one occasion, but whether it makes those mistakes on the others.
Doctors err because people and institutions are imperfect, biology is messy, and human variability is immense. But the former can be attenuated by a plurality of opinions and greater resources (including time), while statistical systems are inherently vulnerable to the latter two.
Language models hallucinate and deliver both essential errors - all while speaking in a very confident and convincing manner. What OpenAI is advertising is a system that nudges vulnerable people to abandon, distrust, ignore, or simply avoid seeking true medical practitioners to rely on a statistical system out of an unjustified, naive trust in the machine.
As a reminder to those concerned with healthcare accessibility, picking the wrong solution to a problem for lack of a right one does not solve the problem. That reasoning was the basis of practices such as bloodletting and lobotomy. Time after time again, medical science teaches us the limits of this kind of thinking.
A cause that needs surgery is readily diagnosed with a Brain MRI. If the doctor didn't order one after symptoms of "balance and slurred speech" then it's not a success of AI but a lethal negligence of the doctor. AI is a substitute for bad doctors not (yet) for good ones.
That story says a lot about where the gaps really are. Most doctors aren’t lacking raw intelligence, they’re just crushed for time and constrained by whatever diagnostic playbook their clinic rewards. A chatbot isn’t magic insight, it’s just the only “colleague” people can brainstorm with for as long as they need. In your uncle’s case it nudged the GP out of autopilot and back into actual differential diagnosis. I’d love a world where physicians get protected time and incentives to do that kind of broader reasoning without a patient having to show up with a print‑out from Gemini, but until then these tools are becoming the second opinion patients can actually obtain.
> The proper decorum here is if the doctor made the wrong diagnosis. All fees and causal charges made by the doctor must be fully refunded and paid for. It’s only fair given the premium they were originally given to make a false diagnosis.
Do you think it would be better to live in a world with no doctors? You can already live in that world if you want. Thanks to doctors, millions of people around the world no longer die from treatable illnesses. Everyone in my family has either had their life saved, or saved from ruin, by a doctor at one point or another.
I hate this bs where someone tries to defeat my point by making it one dimensional. Do we want to live in a world with no doctors? Do you think humans are such simpletons that you need to immediately go there in order to break down the argument for me?
I think the world would be better if becoming a doctor wasn’t tied up with financial incentives and prestige. Lower the bar of becoming a doctor so the fees aren’t astronomically high. Also there would be more doctors so we don’t suffer from the glut of supply we currently do. Also more doctors means more competition so that automatically ups quality and accuracy of treatment.
Every doctor needs a rotten tomato score plastered on their lab coat by law. That number needs to be rooted in metrics not vibes. How many misdiagnosis he made how many times he lost a lawsuit for malpractice. All of that would make the world a better place.
> Everyone in my family has either had their life saved, or saved from ruin, by a doctor at one point or another.
There are 800000k patients who die or are seriously injured by a misdiagnosis every year. Show gratitude for the doctors who saved your family… but gratitude for the profession in general? My gratitude is much lower in the general case.
> There are 800000k patients who die or are seriously injured by a misdiagnosis every year.
Yes, I once sat in a recovery room with my Mom after she had been given too much propofol during an endoscopy. Despite the fact that her breathing was labored, the clinic she was at didn't want to do anything so I called 911. I'm not sure what happened, but I can see that side of your point. I did learn to be much more careful about how I saw to my parents medical care after that.
Hey I don't appreciate your comments or your attacks (which happened in a another thread) so I'm ending it. I can't control you but I would appreciate it if you leave and don't talk to me. Thanks.
Isn't there a risk doctors stop giving out a diagnosis for most cases? So you'll pay for their time then have to see 10 different ones before getting any idea what's wrong? Because they're avoiding the risk of a wrong diagnosis in all but the most obvious cases.
The easy way to stop this is to charge less. 50 bucks. And have the patient sign something and have him affirm that his diagnosis is probabilistic and not fully reliable.
They need to charge what they’re actually worth and what they are worth correlates with reliability. They also need to communicate the effective reliability to the patient.
Instead they charge something like a thousand dollars for less than an hour of their time for a false yes or no diagnosis.
> The proper decorum here is if the doctor made the wrong diagnosis. All fees and causal charges made by the doctor must be fully refunded and paid for. It’s only fair given the premium they were originally given to make a false diagnosis.
lol terrible idea. just as great as having so that the service you bought is entirely refunded if the code has a single bug.
Well the issue here is that the bug can cause you to die or can fuck up your entire life. A software bug generally doesn’t do anything to you and you actually don’t pay much money for software.
One false diagnosis from a doctor costs you thousands of dollars and fucks up your life.
Remember mcas? The bug on the 737 max that forced Boeing to pay reparations? That’s the level of bullshit people are dealing with for doctors. Life altering stuff. This isn’t some chrome bug or smart phone bug. Therefore the penalties and repercussions of mistakes should be equivalent.
If the diagnosis only costs 100 dollars or something, and I was told that the diagnosis was only a probability… I could accept a no refund policy in that case.
Legally speaking, why should the rules for important services be different than unimportant services. The price paid for the services is proportional to its value, if there are no consequences for a bug in your code, it was worth less and you should have paid less for it, the refund would be commesurate.
It's worth noting that you framed the discussion in terms of refunds, so any extra human life uncalculable value isn't really within the scope of a refund, you'd have a malpractice case which is entirely different from a breach of contract. This is just about the fees paid for the service.
Malpractice is deliberate harm by not following standard professional practices or doing deliberate harm.
I’m not talking about that. What I’m talking about is fucking simple. A doctor gives you advice and you pay him thousands for it. That advice is completely fucking wrong.
In what universe does that payment make sense? In what universe is giving wrong information deserving of thousands of dollars of payment for services rendered. It’s bloody simple: it’s not deserved and a refund is in order.
You're generally paying for time and materials, not results. This is common practice in many industries, not just healthcare, so your rhetorical question is silly and displays deep ignorance about how the system works. If you want to pay for results only then you're free to negotiate a cash payment contract with your healthcare providers on that basis. No one is stopping you from doing that so let's not have any lame responses claiming that the system is conspiring against you or something.
You have got to be kidding me. No one on the face of the earth wants to pay a doctor for time. They want to pay for results.
Nobody is going to pay thousands of dollars for shitty advice or treatments that can potentially kill you... are you kidding me? What human will happily dish out thousands of dollars just to give "time" to the doctor for wrong advice. That has got to be a joke.
>If you want to pay for results only then you're free to negotiate a cash payment contract with your healthcare providers on that basis.
It needs to be law to make it on this basis. Every patient would demand this. The only person who wouldn't demand this is a doctor who's "time" doesn't provide results.
What's going on here is the patient has nowhere else to turn. If every doctor negotiates on "time" and the legal system is set up this way, what other choice does the patient have then to gamble thousands on something that won't work?
Let me explain it to you plainly. The system is set up this way so patients are indoctrinated to accept unfair treatment. They can even be aware of flaws in the system but they still have to accept it because the behavior is so wide spread.
It's similar to North Korea. If everyone in north korea stood up to Kim Jong Un, the sheer number of people getting screwed over vs. people in power is so overwhelming the government would topple immediately. But the system is pervasive. And that is the medical system in the US: Pervasive and systemic. And it goes deeper than just the unreliability of doctors here.
I WANT to negotiate based on results... but thanks to the cartel-like policies of the medical system all together, I can't. Ask any patient... EVERY patient wants this, but none of them can do it. Same as your average north korean... they don't want to starve under an unreasonable regime, but they have no choice.
You may not have realized it but your last sentence was a slip up... Your initial sentences was an attempt to justify time based payment by comparing and contrasting to other occupations like lawyers... but in your last sentence you were essentially (and likely accidentally) telling me to suck it up because I have no choice. That was not something any patient wants to hear.
You seem to be unclear on the basics of how this works. There's no need for any new laws. If you want to negotiate a value-based care agreement with a healthcare provider instead of paying on a fee-for-service basis then you're free to do so. Existing laws allow for that.
As for your absurd assertions about what every patient wants, you're just lying and making things up. Many patients (like me) don't want that or have no strong preference at all. Your comparison to North Korea is just deranged and bears no relationship to objective reality.
The fact nobody negotiates for results based treatment is similar to how everyone really needs insurance to afford medical treatments. It's not law to have medical insurance but basically everyone needs it regardless. The problem is systemic. It's not purely related to law. Side effects and incentives stemming both from law and outside of law force things to be this way.
Stop manipulating the conversation this way. You know what I mean. Any sane person pays for results, not for time and garbage results.
>As for your absurd assertions about what every patient wants, you're just lying and making things up. Many patients (like me) don't want that or have no strong preference at all. Your comparison to North Korea is just deranged and bears no relationship to objective reality.
No it's not a lie. It's obvious to anyone reading. I'm so confident about it that I'll even say you're lying about what you want.
You don't want to pay a doctor thousands of dollars for his time and wrong advice that can potentially kill you. No patient wants this. 800,000 patients per year die or are seriously injured from misdiagnosis. Every single one of those patients wants there money back. That is objectively reality. You're not stupid. You're not delusional. So you know this. At this point you're just arguing and lying.
>Your comparison to North Korea is just deranged and bears no relationship to objective reality.
800,000 patients injured/dead from misdiagnosis. 300,000k of that is deaths. That's equivalent to mass slaughter. One of these persons is my brother, imagine if it was yours.
It's not deranged. You're deranged for thinking it's NOT. The comparison is not only relevant as an analogy but relevant in degree of severity.
You seem to be assuming that a different payment model would reduce diagnostic errors. There is no evidence for that. Anything related to biology is necessarily probabilistic and highly error prone. Some care quality improvements are certainly possible but those aren't necessarily tied to payment models. It's more important to focus on evidence-based clinical practice guidelines.
>You seem to be assuming that a different payment model would reduce diagnostic errors.
No. The payment model should change to be fair, I never said the payment reduces diagnostic errors. The patient should be informed about the probabilistic nature of the diagnosis. A contract (not in fine print) to protect the doctor from lawsuits from misdiagnosis should be signed by the patient to reflect this. Then the payment should be Heavily reduced to reflect the unreliability of the diagnosis. By heavily I mean becoming a doctor should not be a profession that is associated with extreme wealth because the unreliability of their diagnosis/treatment does not convey that level of value.
>Some care quality improvements are certainly possible but those aren't necessarily tied to payment models.
I don't think it's "some" quality improvements. The US has some of the worst outcomes in the 1st world in terms of quality of care. There are massive improvements that can be made here.
>It's more important to focus on evidence-based clinical practice guidelines.
Agreed, and until the evidence, clinical practice guidelines and effectiveness of doctors rises to the level of significant reliability, both payment and respect should be adjusted to reflect the current level of low reliability.
Why not run an experiment like this post: take a probiotic capsule, put its contents in a growing medium; after a day or two, sample from the medium and send it in for testing, and see which strains actually grew?
When I was an instructor for courses like "Intro to Programming", this was definitely the case. The students ranged from "have never programmed before" to "I've been writing games in my spare time", but because it was a prerequisite for other courses, they all had to do it.
Teaching the class was a pain in the ass! What seemed to work was to do the intro stuff, and periodically throw a bone to the smartasses. Once I had them on my side, it became smooth sailing.
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