Context: I’m a second year medical student and currently residing in the deepest pit in the valley of the Dunning-Kruger graph, but am still constantly frustrated and infuriated with the push for introducing AI for quasi-self-diagnosis and loosening restrictions on inadequately educated providers like NP’s from the for-profit “schools”.
So, anyone else in a similar spot where you think you’re kinda dumb, but you know you’re still smarter than robots and people at the peak of the Dunning-Kruger graph in your field?
I’m a software engineer, and this is my life. I know I don’t know a whole hell of a lot of shit, but I can sure as fuck tell that a LOT of people I come into professional contact with are largely faking it - and more importantly, don’t admit when they reach the bounds of their actual knowledge.
Yep. My work is dependent on outside contractors who claim big knowledge to get the contract, but then deliver broken code and no documentation. Faking knowledge is more lucrative than having knowledge. And negativity is so structurally frowned upon (you can get fired for not being positive enough) that these grifters rarely get called out.
you can get fired for not being positive enough
This is a sign of a broken organization
A broken industry more like. Or a broken economy. You pick.
And negativity is so structurally frowned upon (you can get fired for not being positive enough) that these grifters rarely get called out.
And this is what enables it to be grifting all the way down.
The only losers are people who are actually competent and don’t lie about their competencies to get ahead.
This is how the Dr. Death guy was able to keep getting jobs. He would basically mess up and kill/maim someone, then he’d get pushed out of one hospital, and go right into another. The same phenomenon occurs in many fields
Same. The only time I realize how much shit I know is when I have to do knowledge transfer to someone else. Other than that, most of the time I feel like I don’t know dick all.
I think you answered your own question by bringing up Dunning Krueger. It’s perfectly coherent to at the same time recognize one’s own flaws and also recognize that other people may be too dumb to do the same. That being said, it probably isn’t healthy. A better way to look at it might be to recognize that the level of expertise you are expecting of yourself isn’t necessarily what others are expecting of you. At least not at all times.
I would agree with this. Interesting way of looking at it.
But just an fyi, dunning Krueger effect has been disproven as a theory because the correlation the studies purported to find were only the same variables correlated with themselves.
Dunning Krueger is a flawed theory and the effect is not real. But i hear you, it definitely feels true a lot of times.
In my field, over confident people are unsafe.
If someone uses confidence to show their competency, I have a tendency to back off and question their actual abilities until I see it in action. If someone I am working with is unaware of their own experience someone on my team could die.
Edit: obviously in the medical field if y’all don’t know what you’re doing a patient could have a bad outcome or even die as well.
I call this, self loathing. But, in all seriousness, if you are a critically minded person, it stands to reason that you’d see flaws in others but even more so in yourself, whom you know more intimately.
“You can’t hate me like I do. I know me better.” – Pitchshifter
IMHO, the best folks always have some sense of impostor syndrome. It compels them to think critically through their work, and they tend to be the folks that ask others for their opinions.
Overly confident people often don’t do that shit, but they also often mesmerize people with their confidence and fail up. Despite their poor performance, they climb the ladder.
That’s not to say that people shouldn’t be confident about your abilities. They should. That said, I try to judge people on what they’ve done, not how charming they are.
Hearing a doctor say “I don’t know” is actually a great sign of competence and humility IMO
Honestly, I would have WAY rather had some doctors tell me “I don’t know, let me get another opinion from someone,” instead of misdiagnosing me because they felt they needed to confidently give me a bad answer.
That shit would’ve saved me a lot of pain, suffering, and surgical procedures.
It’s not quite a catchphrase yet, but when discussing cases or whatever, I frequently use the sentence: “I’m not sure, lemme go look that up.”
For competent people, I’m not even sure Impostor Syndrome is a real thing as much as it is just intimate knowledge of your own limitations, and making judgment calls based on knowledge of your own limitations. Does it mean you’re not capable of those things? No, it just means you’re aware that you lack knowledge in that arena. It’s not as though you can’t gain new knowledge. The most educated seem to be really aware of the things they don’t know, and look to other experts for the things they don’t know.
I’d say knowledge of your own limitations and and unwillingness to sell yourself as being more competent than you are in general are positives overall, indeed.
I try to remind myself that I’ve only gotten as far as I have because of hard work. I don’t have any special talent, I’m not some kind of genius, I just know how to work hard for the things that matter.
I have graduated to the stage of my career where I believe “I have to teach these kids how to do things correctly before my coworkers corrupt them, or they learn bad behaviors on their own.” I was thrown in the fire early in my career and am trying to be the mentor I wish I had. I know where my knowledge gaps are, but generally know who to rely on. I definitely generate the most value when I stick to my expertise, but I still try to learn more whenever possible.
I should remember this crap for my next self-evaluation (I hate that crap).
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OP I was recently in hospital (cancer ward) and heard the guy in the next bed argue with the doctors about his treatment by saying, “I disagree.”
Not “I found some info on the web that said something slightly different,” but “I disagree,” as if his opinions had equal weight to the doctor’s.
His source? A single online article about a hospital in a poor, developing country.
The arrogance was astounding.
At least once a day I heard him tell someone that “I’m an engineer” and that he has “a couple of hundred people” working under him. His wife seemed pretty invested in the idea of his brilliance, too.
I really don’t know how actual doctors put up with Dr Google.
I worked professionally in medicine for a few years before starting medical school, and thus far my approach has been to entirely disregard anything they said on the subject and continue as normal unless the nonsense they’re spouting has the potential to cause serious harm. Our patient care professor is training us to listen attentively, then dismantle the nonsense as politely as possible while guiding the patient’s viewpoint back to something approaching reality.
So, anyone else in a similar spot where you think you’re kinda dumb, but you know you’re still smarter than robots and people at the peak of the Dunning-Kruger graph in your field?
That’s not just a work related issue mate, it’s life. All I can say is give it five years, you might even end up finding some of the mongoloids rather endearing!
Were I in any other field, I might agree with you, but given that I am in the medical field, stupidity and incompetence cost real human lives and I cannot tolerate that if it can be at all avoided.
Yes, all the time. I try not to let it bother me and mostly laugh it off, unless there’s safety concerns. I think most people are doing their best and everyone is dumb sometimes so I try not to judge or jump to conclusions.
I think a lot of people in grad school go through something similar. Sometimes you get the imposter syndrome, and sometimes you get the sense that a lot of other people are imposters.
I cringe every time I hear someone in a professional setting say something like “we all have no clue what we are doing”. Speak for yourself, lol, some of us know exactly what we are doing, and can tell you don’t.
I guess the biggest piece of advice I can give is to just try your best to have a level confidence that matches your actual knowledge on a topic. Don’t rely on your own expertise too much at this stage; if you think AI self-diagnosis is bad, find some research on it, and let that do any talking. Your biggest asset at this stage is scientific literacy, so use that.
MD’s have all gone through the same experience, so they know what it’s like. The thing that makes it a little harder in your field is that the very nature of being a medical doctor requires you to show confidence to your patients, and whether or not you are sure about something, you still have to make a decision to act (or not act). If a microbiologist doesn’t have data to support their hypothesis, they can just say they dont have an answer and leave it at that.
and sometimes you get the sense that a lot of other people are imposters.
Because a lot of people are. Especially people who end up in charge of things.
I mean, it’s not like there hasn’t been an entire cottage industry for churning out real, new research papers for rich fucks who don’t actually know how to write a research paper for over twenty years. I had a friend who survived grad school in the early 2000’s being paid to write research papers for idiot rich kids at more prestigious schools. They get to slap their name on original research and say “not plaigiarism, I’m a smart kid, I promise!” Add in a little Nepotism and you’ve got the fixings for some idiot in charge of something they shouldn’t be.
You get the sense a lot of people are imposters because literally a lot of them actually are and their class of people has been growing and been being given the controls to society and they literally don’t know what the fuck they are doing but they are in charge.
Yup. I agree 100%. For everyone person getting a hard degree (define that how you will) to actually learn skills, there’s someone who has family connections who just needs the degree to check a box, or someone who has been privileged enough that they think they can “fake it till they make it” (and they end up being able to).
My job would be so much easier if everyone I work with had the skills their degrees would lead you to believe they have.
I once met a guy who was like 28, but he had a super impressive sounding resume with like 6 different jobs. I don’t remember where, but think prestigious universities, big tech companies, federal agencies, etc. Everyone acted like he was a genius, but if you think about it, that’s like 1 year per job. If he was that good, one of those places would have tried to keep him around longer. Depending on the field, 1 year isn’t really enough time to have much impact, anyway. He basically just chained together buzzwords.
infuriated with the push for introducing AI for quasi-self-diagnosis and loosening restrictions on inadequately educated providers like NP’s from the for-profit “schools”.
That’s because these decisions are not being made with data, considerations for patient safety, and so on.
It has everything to do with bloated hospital administrations who eat up all the money and spend pennies on actually helping patients. It’s usually not fucking doctors who are like “you know what would be cool, if I could replace half my nurses with an AI in my phone. I would save so much money!”
It’s just one more pot to piss money away into while saying it improves something.
CEO’s and other business leaders regularly ignore data and evidence they don’t like. Look at the Return to Office fight, they don’t care about the data, they don’t care about employee satisfaction or retention, or savings in real estate. They are miserable and they want you to be miserable, too. They have more than enough money for them to weather all the bad decisions they make, because the worst parts of their bad decisions fall on the weakest and poorest in society, as usual. So they could give a damn what anyone thinks of their shitty ideas: their shitty ideas are going to happen, because they’ve got the purse-strings.
These ideas don’t come from regular people. They come from an entire class of people who is completely disconnected from what any of these decisions do. They are only making decisions for a number on a spreadsheet, and sometimes they don’t actually give a shit if the number goes down as long as they get to continue feeling in control of other people. They literally don’t care that their decisions are dumb and will hurt people, they’re going to do them anyway.
IMHO, this has fuck-nothing to do with Dunning-Krueger and everything to do with decisions made by rich out of touch twats.
If inaction were deemed socially acceptable as a management strategy, the world would be an incredibly better place.
So much of the bullshit ideas come from managers who think they have to always seen to be doing something, whereas sufficiently complex systems are often self-balancing and require little to no direct action.
But to act on this they’d have to admit that managerial jobs are largely bullshit and unnecessary.
Sir, this is a Wendy’s. Sorry your fries took so long.
At least I can rest assured of the fact that AI will be next to useless in my intended field. Emergency medicine is an environment where you get a random constellation of symptoms and complaints with very little direction on which are related to the current illness, and which ones are not currently relevant. Also, in the time it would take to get all the info into the AI for a trauma/cardiac/code situation, the patient might be dead or rapidly heading in that direction.
Can’t AI aggregate the data on triage outcomes to prioritize larger scale emergencies… it has to be useful somehow I would think
It wouldn’t need to be AI, just sone statistics and “Crdiac arrest? Piority 9. Broken arm? piority 1” decision-making.
I’m a tech wizard not a healer, there probably are factors that define one cardiac arrest even more critical than the other i just do not know them.
There’s some things you look for that are difficult to describe to someone who hasn’t seen it before. That’s part of why experience is so valuable in Emergency Medicine, and it’s not uncommon to put your best nurses out in triage. People will do this kinda twitchy/wilting/loss of focus/change in pallor/change in posture right before they go down. I don’t have a good way to describe it, and it might be easier to draw even, because it really is a body language thing and the general appearance of the patient that can inform your decision making.
I have thought about trying to plan out a learning algorithm that could spit out suggestions for triage level and preliminary tests based on input data like vital signs, symptoms, and complaints… but I would never implement something like that as anything beyond a tool for the nurses at triage to use. There would have to always be an option to override the algorithm because there’s some aspects of patient presentation that are not easily quantifiable. I’d never be able to explain it in a way that one could input it into a computer, but even with my limited experience, I can tell which patients are going to crump on me.
We use our NPs like project managers; or, in a way that is progressive and not a death panel, a health manager. Get tests, pass results and ideas back to the GP who signs off on them, go get more tests, book a surgery, line up everything for a referral, suggest drug mods and swaps, etc. My mom just got one and she’s finally sorting her shit out. It’s so great to have like a tiger parent running your medical life.
NPs working under a physician with actual oversight is fine. The ones I have problems with are the ones that have a physician sign the hundreds of notes a month while maybe reviewing a handful, and worse, the ones pushing for independent practice without even that sham of oversight involved.
I am a person whose parents were medical-professionals, whose dad was a medical-researcher & doctor.
I have been gaslit by doctors all my life.
IF diagnosis IS evidence-based decision-tree,
THEN an expert-system can do it, without the bias of human-doctors.
However…
IF diagnosis ISN’T evidence-based decision-tree,
THEN authority-based-medicine is the only valid medicine, as doctors hold to be true, while claiming that their authority-based medicine is “evidence based” medicine.
I’m not the only person to have noted that doctors don’t allow evidence-based medicine to threaten authority-based medicine:
https://www.edge.org/response-detail/25433
That article got turned into a chapter in the book, edited by John Brockman, “This Idea Must Die”.
( I do not agree with all the articles in that book, but that particular one is both right & too-soft )
EITHER Davidson’s & Harrison’s Medicine textbooks are valid basis for diagnosis, in which case an expert-system MUST be capable of doing objectively-valid diagnosis,
https://www.amazon.com/Davidsons-Principles-Practice-Medicine-Penman/dp/070208347X/
https://www.amazon.com/Harrisons-Principles-Internal-Medicine-Twenty-First/dp/1264268505/
XOR doctor-authority has some “special non-deterministic magic/sorcery” that an expert-system cannot replicate.
There IS no escape from logic & fact.
PS: you can read the Residency subreddit to see an ocean of evidence for medical-residency being a year-long identity-forming hazing-ritual, as it objectively damages doctor-learning, doctor-performance, doctor-health, doctor-empathy ( iirc there are several PubMed items on that one ), etc, yet it is still being enforced, in spite of how it measurably produces opposite-to-claimed changes.
You can also read how the researchers Logan, King, & Fischer-Wright discovered that doctor-culture is the exemplar of narcissitic-culture, and gave the simple test that there was only 1 hospital ( when they wrote their simplified-language-for-business-people book “Tribal Leadership”, to cause change ) in the US which didn’t have narcissistic-culture ruling it:
https://www.amazon.com/Tribal-Leadership-Leveraging-Thriving-Organization/dp/0061251321/
Walk into any hospital, & see if human-validity/human-dignity has been sooo eradicated from the lower staff, that they consistently won’t meet your gaze, as a professional entering the hospital.
I forget the name of the hospital which had demonstrated that human-validity CAN live below doctors, but their research earned much from that particular one.
Of course, for anyone to accept the points I raise, would require that they hold-to evidence-based knowing, instead of authority-based-“knowing”, wouldn’t it?
Feel free to downvote me to oblivion, for my testable-facts.
PPS: I’m not attacking you, I am attacking an ideology-addiction/prejudice-addicion in the culture you are being indoctrinated into embodying.
There is a book “Doctored” on the disillusionment of an American physician, and there are many, many, many, books out now, on different aspects of the ideology/prejudice that Western Medicine has become, including perhaps “Money-Driven Medicine”, “In Shock”, and others whose names I don’t happen to remember this moment.
I wish I somehow had the leverage to make Western Medicine become evidence-based medicine, but that would require supernatural-powers, at this point.
It would certainly be healthier for the people in Western Medicine.
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The problem with AI and poorly educated professionals is not the ability to diagnose and treat based on evidence-based medicine. The problem is that you have to know enough about medicine, and enough about real human people to know what kinds of questions to ask in the first place. If nothing else, there is a massive amount of information gained from a patient’s body language, mannerisms, behavior, and the physical exam itself that would be extremely hard to quantify in a meaningful way for someone without the background education and experience to come to any useful conclusions.
Yes. Sent out our “professional” team to get measurements for a cabinet install. They sent back a hand-drawn thing which would have been fine except they missed a number of key dimensions that I can’t design this kitchen without. Pisses me off.
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