# Medical decision making

Lesswrong Sydney runs a local dojo once a month to talk about rationality topics.  This month our topic was "medical decision making".  This is our notes for considerations on how to make decisions.  Please feel free to contribute your own small pieces of advice to this repository of considerations about making decisions in the medical world.

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Expect to encounter the medical system sometime between now and when you die; for serious and life altering treatment. You should be prepared to work with limited information and under stress. 

How do you make medical decisions? 
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*   Medical decisions are often made under stress/duress - during a medical issue or threat of death from condition.
    *   Have a patient advocate especially when under influential conditions because you may not be able to make good decisions.  Have a friend in the room to be able to say “this person is not usually like this”.  The medical system doesn’t really care as much as you care about yourself
        *   The person should be pushy against an authoritarian system.
*   Expertise, information
    *   Get a second medical opinion 
    *   Consider alternative medicine treatments 
    *   Use information from AI (now available)
        *   Always double check an LLM's suggestions (like you would have done with Wikipedia)
    *   Medical experts usually don’t have statistical skills (get statistics questions wrong)
    *   The median doctor reads the result section of the abstract of a paper, not even a whole paper or a whole abstract.
    *   Cookbook approach: medical system has very rigid rules, it’s harder and harder to be making personalised care.  
    *   Counterpoint: You can’t just read a few websites and think you know more than a doctor.
*   Conflict of interest 
    *   Medical professionals - that endorse themselves to do procedures like surgery and convince patients to pay them to do it.
    *   Pharmaceutical industry - solutions that make money if people keep taking the drugs.  Curing someone will make a pharma company bankrupt.
    *   Medical system - downplays the side effects of the treatment.  Blind to the side effects, after all - they don’t feel the side effects.
*   Making decisions around the body as a whole system, where specialists don’t necessarily notice the whole body.
*   Medical orthodoxy can be wrong
    *   Vit D from the sun is more beneficial than BCC skin cancers are bad for you.  People live longer with the cancers because of the health benefits of the Vit D
    *   Orthodoxy does change very slowly ~15 years from discovery to usage in the field
*   Different countries have different recommendations (Australia, America, etc)
*   Anecdotal evidence of medical solutions
    *   Can feel very strong if you are close to the decisions and outcomes.
*   Responsibility
    *   No one is more responsible to you than you are.  It would be nice if they cared as much as you, but they simply cannot.  (in rare cases they may temporarily care strongly but it won’t last, so you want to take over responsibility for yourself again asap)
*   The insiders in the medical system know who’s who.
    *   Which doctors are good and which are bad.  This can save your life.
*   5 year rule on new drugs
    *   Don’t take anything under 5 years old.  Wait for it to be field tested if you have the luxury of time.
    *   E.g. amphetamines for weight loss, Thalidamide.
    *   Exception example: insulin - was life saving when it came to market.
*   Watch the news for any drugs you are taking for any new information.
    *   Drug recalls, new side effects, dangerous co-factors
*   Genetic wisdom
    *   You may know family relevant conditions and you may know them better than the medical system.
*   Optimise for quality of life
    *   Balance for quality of life worth living.
*   If trying an intervention you should be able to tell if it’s working
    *   Feedback mechanisms can be blood tests, feeling better, specific changes but you need feedback somehow.
*   Advance care directives
    *   Have a plan before you need it.

Some Rules
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*   Every medical intervention has side effects 
*   Surgery is dangerous 
*   Some medicines are poisons
*   Get and keep a copy of every test that is ever done to you
*   The best medical experience is not having a medical experience - be healthy instead.
    
    *   Get sleep
    *   Be fit/exercise
    *   Nutritious diet
    
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Thanks for reading.  Hope this was helpful for your decision making.