Advice to new Doctors starting practice

Hi all,

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

Generalists(general medicine):

  1. Get extremely unbeatable at 20 Questions(rationality link). It’ll help you make your initial diagnoses(ones based on questions about symptoms) faster and more accurate.
  2. Understand probability, bayes theorem and how to apply it** This will help you interpret the test results, you ordered based on the 20 questions.
  3.  Understand base rate fallacy, and how to avoid  being over confident.
  4. Practice enough of systems thinking in your diagnoses and prognoses thought-experiments. May be even try it in other domains to check your skill level. And for extra credits learn some of the basics of dynamical sytems***, as the human body is one.
  5. Understand the upsides and downsides of the drugs you prescribe. Know the probabilities of fatal and adverse side-effects and update them with evidence(Bayes’ theorem mentioned above) as you try out different brands and combinations.
  6. Know the costs and benefits of any treatment and help the patient make a good decision based on the cost-benefit analysis of treatment combined with the probabilities of outcome.
  7. Ask and Keep a history of medical records and allergies of the patient and till their grand parents.*
  8. Be willing and able to judge, when a patient is better off with a specialist. Try to keep in touch with Doctors nearby and hopeful all types of specialists.
  9. Explain the treatment options and pros and cons in easy language to the patients. It’ll reduce misunderstandings and eventually dis-satisfaction with the treatment.
  10. Resist the urge to treat patients as NPCs. Involve them in the treatment process.
  11. Meditate
  12. Find a hobby, that you can keep improving on till the end of life.
  13. Be aware of the conflict of interest between the patient and the pharmaceutical companies.
  14. Have enough research skills to form opinions on base rates/probabilities in different diseases and treatment methods as needed.
  15. If you’re in a big hospital setup, make sure you’ve the best hospital administration, if not find ways to improve or find better big hospital.
  16. Medical expertise is only relevant once you see the patient. Your ability to judge the evidence requires getting access to it; this means you need to be able to correctly send requests, get the data back, and keep all this attached to the correct patient.Scheduling, filing and communication. Lacking these, medical expertise is meaningless.
  17. Be aware of cognitive biases humans are liable to make.

Specialists:

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

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

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

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

Disclaimers:

  1. Most of what follows is based on my experiences(either as a patient myself or a concerned relative) with Indian Doctors. Some of it may be trivial, to others, but most of it is skills a doc will need and ignored in school.
  2.  I’ve split it in two (specialists and generalists) but there’s a fair amount of overlap.
  3. These are fairly high standards, but worth shooting for and I’ve kept the focus on smart rather than hard work.
  4. I’ve stayed from a few topics like: bedside manners/social skills, specific medical treatments and conditions(obviously, I’m not a Doctor after all) and a few others, you can add/delete(also specify/pick levels) as you see fit.
  5. Pick the skill-levels as demanded by your client population and adjust.
  6. I’m assuming generalists, don’t have to deal with emergency cases, but in some parts, that’s not likely then pick common emergency categories and follow specialist advice.
  7. My qualifications are basic mechanical engineering plus a master’s in cognitive science. By their nature, I’ve a very shallow knowledge/overview of the topics involved, but too little certainty for me to give any specific advice.
  8. I wrote this based on my experiences and with humans in mind, but veterinary Doctors may find some useful too.
  • — I understand this is difficult in Indian circumstances, but I’ve seen it being done manually(simply leaves of prescriptions organized alphabetically, link to dr.rathinavel) , so it’s possible and worth the effort unless, you practice in area of highly migratory population.(for example rural vs urban areas).

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

*** — Please don’t take this literally. Though I’m optimistic that dynamical system tools may be enough to describe the human body, it might turn out human body is more dynamic than them. In other words, use your judgement, and make sure you can apply the dynamical systems theory to say “three-body problem

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