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851 points swyx | 1 comments | | HN request time: 0.233s | source
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nickjj ◴[] No.25826835[source]
That was a fun read. I wish the author mentioned how much he was trying to sell the service for. It could have been $59 a month or $599 a month and with doctors you could potentially expect the same answer.

I'm not a psychologist but some of the author's quoted text came off extremely demeaning in written form. If the author happens to read this, did you really say those things directly to them?

For example, Susan (psychologist) was quoted as saying:

> "Oh sure! I mean, I think in many cases I'll just prescribe what I normally do, since I'm comfortable with it. But you know it's possible that sometimes I'll prescribe something different, based on your metastudies."

To which you replied:

> "And that isn't worth something? Prescribing better treatments?"

Imagine walking into the office of someone who spent the last ~10 years at school and then potentially 20 years practicing their craft as a successful psychologist and then you waltz in and tell them what they prescribe is wrong and your automated treatment plan is better.

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james1071 ◴[] No.25827783[source]
He had not the slightest idea of how doctors prescribe drugs.

The typical doctor has minimal training in evaluating medicines - that is not their job.

They defer to so-called opinion-leaders, who are the experts on particular diseases.

These people are the targets of drug companies' marketing - think scientific conferences in 5 star hotels in exotic locations.

The cost of influencing them would be millions.

So,the author was barking up the wrong tree.

That's not to say that he didn't have something, but had no idea how to market it.

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intricatedetail ◴[] No.25828188[source]
Some doctors use expert systems. They select symptoms and computer spits out possible list of treatments and then doctor picks one. If it doesn't work asks to come back and tries the next one. It's kind of like a human in today's self driving cars. Especially when it comes to mental health and anti-depressants. Essentially tests on production.
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sxg ◴[] No.25828359[source]
This isn't even close to how doctors prescribe medications. You don't prescribe meds without having a working diagnosis. Once you have that, you use the knowledge gained in med school and residency to pick the first line drug. If there are contraindications due to comorbidities (which there often are), you have to figure out what other meds you can use. You can consult online resources (e.g. UpToDate) to look up second, third, fourth line meds as well as advice on specific complicated scenarios.

Trial and error with prescription drugs without a diagnosis as you suggest is malpractice. Maybe you're specifically referring to psychiatry? That specialty is uniquely difficult since our understanding of psychiatric diseases is still murky. But even within psychiatry there are best practice guidelines on how to manage and treat different diseases.

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1. ineiti ◴[] No.25831854[source]
You might be right for single-casual illnesses like a broken leg, CoVid-19, Tuberculosis, and others. But it's a whole other thing when it comes to more complex illnesses.

Having been for 18 months through different types of psychiatrists and clinics, I came out quite surprised in how "trial and error" this whole system is.

I'm writing this from Switzerland, where we have an (arguably) high quality health care system. But the amount of "OK, that didn't work, lets try this other drug". Or, now, 18 months later, "Oh well, we did the list once through. But who tells me that the MD prescribing the first drug did a correct analysis? Lets start the list from top again." Or, for a friend of mine, his girlfriend found a working cure like that: "Oh, this brochure describes your symptoms so clearly, and it's completely different from what you've been treated for these last 20 years. Let's try it!"

Spoiler alert for my case with the list: the top of the list was not better the second time around.

If you think this is cynical, well, I would like at least _one_ of these drugs to work. If you think the MDs are all useless: well, at some times I was glad they were there.

So, well, I think having a little less than random system might be helping. Let the MDs watch if it makes sense, enter the correct diagnosis, and catch the stupid errors data entry people can make. But i'd give it a try...