Debugging the Doctor Brain: Who's teaching doctors how to think?

Quality and Experience of Doctors

• Several commenters perceive newer doctors, especially in Canada, as better trained and more up to date than older ones.
• Others note research suggesting older physicians can have worse outcomes in some specialties, but emphasize that experience and stable “standard of care” for common problems still matter.
• Concern that 30–40 years of experience using outdated techniques may not translate into better care, especially in fields that have advanced rapidly.

Feedback Loops and Evidence in Practice

• Surgeons and GPs often get delayed, noisy feedback on outcomes; linking a specific decision to a death years later is hard.
• Some systems notify primary doctors of hospitalizations and deaths and hold morbidity and mortality conferences, but how deeply this informs practice varies.
• Commenters stress reliance on large trials and evidence-based medicine because individual-case feedback is unreliable.

Long COVID and Patient-Driven Ideas

• One patient describes years of pushback before their doctor took viral persistence seriously; sees patients as helping drive physician thinking, but very slowly.
• Disagreement over how much evidence existed in 2020–2021. Links to early long-COVID and viral-persistence work are provided.
• Some mention self-sourcing antivirals abroad; others question specific choices (e.g., Paxlovid for long COVID) but note emerging trial rationales.

Training, Weed-Out Culture, and How Doctors Learn

• Debate over “weed-out” courses like organic chemistry: some see them as necessary filters for a prestigious, capacity-limited profession; others argue they wrongly equate fast initial understanding with long-term mastery.
• Critique of medical curricula: heavy early basic science divorced from clinical relevance, then later disease/treatment blocks. Proposals for “vertical slice” teaching that integrates basic science with a small set of core diagnoses early.
• Observations that residency evaluation can be biased: residents get labeled “good” or “bad” early, confidence is mistaken for competence, and introverts are penalized.

Hospital Economics, Residency Funding, and Work Conditions

• Anger at large per-resident funding versus relatively low resident salaries; some call it “fraud,” others point to legitimate overhead, supervision, and malpractice costs.
• Nonprofit hospitals are criticized for high executive pay, seen as a de facto profit extraction mechanism.
• Widespread reports of burnout among nurses and residents, with hospitals treating staff as fungible and relying on overwork rather than hiring more.

Insurance, MBAs, and System Design

• In the US, insurance and malpractice risk heavily shape testing and treatment: some patients see under-testing “because of costs,” others see aggressive testing when coverage is good.
• Some argue this is just supply-and-demand equilibrium for labor; others blame MBAs and fee-for-service incentives for turning hospitals into “for-profit assembly lines,” even when nominally nonprofit.
• Similar overwork and per-patient incentives are reported in Canada and elsewhere, not just in the US.

Continuing Education and Staying Current

• In the US, doctors must earn continuing medical education credits, often via conferences and board recertification exams.
• Commenters question the rigor and independence of CME, view some recertification as a money grab, and note that a few short courses cannot fully retrain older clinicians on new paradigms.

AI, “Vibes,” and the Future Role of Doctors

• Some predict that well-designed systems will eventually replace most non-research doctors, highlighting machines’ potential for always-updated knowledge and lack of fatigue.
• Practicing clinicians push back, emphasizing tacit pattern recognition (“vibes”), real-time observation, and complex, weakly data-driven judgment, especially in acute settings like anesthesia.
• Consensus leans toward AI as a powerful assistive tool rather than a near-term replacement.

Teaching “How to Think”

• Several comments argue that medicine (and education generally) rarely teaches thinking directly; instead, it teaches tasks and assumes thinking will emerge.
• Suggested ingredients for “thinking training”: problem decomposition, hypothesis testing, comfort with uncertainty, awareness of cognitive biases, and metacognitive skills (e.g., spaced repetition and semantic encoding).
• Humanities and certain psychology-of-learning courses are cited as traditional or effective venues for this, but seen as underused in current medical training.

Systemic Issues and Rare Conditions

• Overwork and hazing culture in training are criticized as harmful to performance but persistent.
• A patient with a rare disease describes long delays in diagnosis due to rigid adherence to “common things are common,” illustrating how system pressures and heuristics can fail outliers.