Comment by tedggh

so, poor healthcare workforce quality is not just an "issue of an economically poor country", as I thought!?

like, I tried to treat the bloating in one municipal clinic in Ternopil, Ukraine (got "just use Espumisan or anything else that has symeticone" and when it did not work out permanently, "we don't know what to do, just keep eating symeticone") and then with Gemini 3 (Pro or Flash depending on Google AI Studio rate limits and mood), which immediately suspected a poor diet and suggested logging it, alongside activity level, every day.

Gemini's suggestions were nothing extreme - just cut sugar and ban bread and pastry. I was guilty of loving bread, croissants, and cinnabons (is this how they are translated?) too much.

the result is no more bloating on the third week, -10cm in waistline in 33 days, gradually improving sleep quality, and even ability to sleep on a belly, which was extremely uncomfortable to me due to that goddamned bloating!

Just my observation as a sixty-something year old, and my attempt to understand the changes I’ve seen… It seems like these days doctors advice and hospital emergency procedures are mostly (and increasingly so) based on statistical likelihoods of outcomes (from where exactly I’m not sure; and who vetted them??) and a set of options that insurance companies will pay for, probably determined similarly. Probably will get worse until AI gets inserted into the loop. I also wonder if perhaps this is occurring to accommodate a reduction of the typical skill set of the “wellness” oriented practitioners most of us see for check-ups and emergencies. I have received good care from specialists by and large.

Yeah it's bad. That doesn't mean it's necessarily uniformly bad. But if it's bad where you are, yeah it's bad.

You can see multiple doctors (among the ones you're allowed to see by your insurance). The doctors are all in an echo chamber which reinforces their thinking. Their cognitive load and goal seeking is burdened by what they can determine they can bill insurance for (there is still no price transparency). You don't have a "regular" / primary care physician because they rotate through the provider network constantly.

Symptoms which don't fit the diagnosis are ignored / dealt with by deflecting that you should "see your regular physician". "Stare decisis" rules the second opinion. In their minds they believe they have no place to write down e.g. drug interactions with things which they didn't prescribe and don't believe in (the one time I got a call from quality control working for the umbrella organization I utilized this as an example of why I was looking for a different doctor and the QA person, who was, they said, a licensed nurse, said "they can add that to the record, I'll do it right now").

You might get fired as a patient for passing out or having a seizure during a blood draw, hard to say whether that's because they failed to follow SOP and call the meatwagon or because you upset staff by acting unusually. You might get into a conversation with a physician which goes strange and they end up telling you that their clinic gets health inspections like a restaurant... they don't. There's a "wet work" inspection (just like a butcher shop) before occupancy is allowed, but there's no posted inspection report because... there is no inspection! But there's more. There are relatively "safe" and common procedures which still have ooopsies and people end up in the hospital or die. The hospitalization rate might be 1:5000 and the death rate 1:100000 but if you do a million of these there are going to be a few. If the procedure took place in a clinic it's supposed to be reported, and the reports are public record; but surprise surprise, the reported rates for serious complications are far far below what the actuarial tables show.

If you're seeing constellations of incidents similar to these, you need to get a second opinion from somewhere / somebody who is not caught up in that particular bubble. It can be very hard to see what's happening, and also to find a measurable proxy for "in / not in the bubble".