Algorithms?

[ThrowAwayStepDO]

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[ndafife]

Psych

 

[libertyyne]

hello everyone. as i go through second year it has dawned upon me that i absolutely hate, and i meant hate, learning algorithms. its so robotic and uninteresting to me.

so, i was wondering which fields are heavy in such? hopefully people with experiences in certain fields can chime in. im currently interested in critical care and cardiology, but whenever anything critical care related comes up from clinicians in my courses it seems that there is an algorithm on what to do in xyz on the next slide, which saps all enjoyment out of the learning for me.

thanks a bunch for those willing to help me avoid this possibly horrendous life blunder.

Radiology

 

[Crayola227]

um not sure CC and cardiology are great for people who hate algorithms.....

 

[Anti-PD1]

I hate, no, I abhor algorithms.

Welcome to surgery. Pick an organ.

 

[libertyyne]

I hate, no, I abhor algorithms.

Welcome to surgery. Pick an organ.

What about them selection criteria and post op management tho?

 

[Crayola227]

What about them selection criteria and post op management tho?

isn't that what medicine is for?

j/k

 

[CherryRedDracul]

Radiology

Radiology still has algorithms, e.g., 2017 Fleischer Society guidelines for lung nodule follow-up

OP, every specialty has algorithms and guidelines to standardize practice. But remember that they're "guidelines" and not set in stone. As a physician, you can make different decisions based on your own expertise.

 

[libertyyne]

Radiology still has algorithms, e.g., 2017 Fleischer Society guidelines for lung nodule follow-up

i did think of those when I was making the statement. I am unsure if there are any others besides lung nodule protocols.

 

[CherryRedDracul]

i did think of those when I was making the statement. I am unsure if there are any others besides lung nodule protocols.

I just came off nuclear medicine so we also have the PIOPED-II criteria for evaluating probability of pulmonary embolism on V/Q scan

 

[libertyyne]

I just came off nuclear medicine so we also have the PIOPED-II criteria for evaluating probability of pulmonary embolism on V/Q scan

Very cool, didnt know these existed, are these read with TC99? I know nothing about diagnosing a P/E besides the fact that ddimers are useless.

 

[Stagg737]

Psych

Are you saying psych is heavy on algorithms? If so, strongly disagree.

 

[libertyyne]

Are you saying psych is heavy on algorithms? If so, strongly disagree.

OP said s/he didnt want an algorithimic specialty.

 

[Stagg737]

OP said s/he didnt want an algorithimic specialty.

Right, but the actual question asked was "which fields are heavy in algorithms?", so the one word "psych" answer is a little vague...

 

[libertyyne]

Right, but the actual question asked was "which fields are heavy in algorithms?", so the one word "psych" answer is a little vague...

anyone with any experience with pysch knows that thats not the case. In fact psych is criticized for lack of standardized care for many common conditions.

 

[Crayola227]

there are algorithms in all of medicine

maybe it was a bad career choice

 

[ndafife]

Are you saying psych is heavy on algorithms? If so, strongly disagree.

I thought he was asking about low in algorithms. Which is why I mentioned it

 

[libertyyne]

there are algorithms in all of medicine

maybe it was a bad career choice

 

[Brahnold Bloodaxe]

And people say medicine will be the last field to succumb to automation! Which other professional field already operates largely under the direction of algorithmic processes that define decision making
and
has an ever expanding army of lesser paid workers (midlevels) who are explicitly trained to gather data for the decision making algorithms and execute the outputs of same? The trends in machine learning, EMR aggregation of big data, and rapid expansion in both the number and scope of midlevels will converge to put doctors in a very unhappy place long before the same thing happens to engineers, financiers, and management.

As for actionable advice, definitely do surgery. Automation of proprioceptive planning and execution lags decades behind automation in information processing, and the same thing can be said of midlevel incursion into the surgical fields compared to their infiltration into non-surgical specialties.

 

[CherryRedDracul]

Very cool, didnt know these existed, are these read with TC99? I know nothing about diagnosing a P/E besides the fact that ddimers are useless.

Yeah, we use Tc-99m DTPA in aerosolized form for the ventilation scan and then Tc-99m MAA for the perfusion scan. I've heard of Xenon-133 being used instead of aerosolized Tc-99m DTPA, but Xenon-133 has its own disadvantages that make getting multiple projection images of the patient impossible.

D-dimer is useful if the pretest probability is already low. <4% of patients with a D-dimer < 1000 ng/mL have venous thromboembolism according to some cohort study.

 

[libertyyne]

Hmm. disagree but thank you for the fruitful input

i want to think and help my future patients with their issues not just do something because it's step 4 in this stepwise cookie cutter medicine someone created. that was what i was getting at in my original post.

You still havent told us what your thoughts are on Rads, Pysch, PM&r.

 

[libertyyne]

im open to anything really. just want to be a good doc, make a good living, and help people with their lives.

i was just curious which fields were less algorithm driven (perhaps i didn't describe that clearly in my op, which i totally own- my fault).

If you haven't been following Everyone just assumed you wanted less algo and started listing them, Thats why Rads, Pysch came up. So yes the are comparitively less algo unless the physicians in the thread can chime in to say otherwise.

Cards from my understanding is very algo and so is CC. However like stated above these are just guidelines, suggestions, ultimately it will be your professional judgement that will decide the treatment plan.

 

[Crayola227]

If you think algorithms make most docs feel like a robot in most fields....

I'm not sure you've really caught on to what clinical practice is all about

there's not a field of medicine without algorithms, not even psych

that's why I'm saying that this thing about algorithms seems silly to me

I have a post somewhere that gives ideas about what to do, but I would take some tests, do some soul searching, and consider what fields are like without considering algorithms. What you like and don't like that isn't looking at that.

it's like saying you hate being a doctor because of mneumonics you're learning in med school

algorithms exist because they make clinical decision making easier, and that's not a problem because much of the time it's hard

you have to know things and make decisions and mneumonics and algorithms are tools

there are things we all hate in every job we have, tools we'd rather not use the job demands

that's what makes it a job

 

[Crayola227]

my unfruitful comment was sorta meant to help you see how unfruitful yours was

I get that you likely don't know how to formulate your problem (the first step) and then its solution

I suggest you do more research on both (what you and the fields are like)

Keep in mind, that what you enjoy/detest might not be what you're actually good at. I assumed I had a good sense of direction when I was a kid until I got lost horribly in the woods, and times since then. Like the rejects that audition on American Idol.

I used to think I hated math/science, but I took some in college, and I was

 

[Crayola227]

show me where i said a field without algorithms... you keep talking about something i never said dude

**** posting my in depth reply that might actually help you if you could open your ears and stop insisting on your view of this

your view of this is why you are confused and don't know what to do about this

I'm not the one coming in here making conflicting statements about the practice of medicine

 

[Crayola227]

If other students are interested and reading, they can SDN search function the topics of "specialty choice" and my username and likely find a step by step guide on what to consider when picking a specialty

this guy has it figured out

 

[Crayola227]

um....k lol

You're a second year. But yes, tell me what you need to know to pick a specialty.

 

[libertyyne]

If you think algorithms make most docs feel like a robot in most fields....

I'm not sure you've really caught on to what clinical practice is all about

there's not a field of medicine without algorithms, not even psych

that's why I'm saying that this thing about algorithms seems silly to me

I have a post somewhere that gives ideas about what to do, but I would take some tests, do some soul searching, and consider what fields are like without considering algorithms. What you like and don't like that isn't looking at that.

it's like saying you hate being a doctor because of mneumonics you're learning in med school

algorithms exist because they make clinical decision making easier, and that's not a problem because much of the time it's hard

you have to know things and make decisions and mneumonics and algorithms are tools

there are things we all hate in every job we have, tools we'd rather not use the job demands

that's what makes it a job

when I read OP's initial comment I felt like OP was disdainful of evidence based medicine. Which is a weird thing to be disdainful of , but who am I to judge. Thus commenced the conversation to find the least evidence based field of medicine that a DO could match into.

On a seperate note not giving Op's desire legitimacy but maybe a person would like to go into such a field as these fields may be fertile ground for discovery and creativity. But I am unsure if OP even thought along these lines.

 

[CherryRedDracul]

Every medical specialty's clinical functions can be broken down into algorithms. I bet money that you operate under some sort of internalized algorithms based on what you've learned thus far and not necessarily based on some flowchart you memorized. It's difficult to say which fields have the least number of algorithms to be honest.

If you don't want to follow published guidelines and algorithms, then your next best bet is to do the literature search yourself and make the informed decisions to practice the way you see fit.

 

[libertyyne]

Every medical specialty's clinical functions can be broken down into algorithms. I bet money that you operate under some sort of internalized algorithms based on what you've learned thus far and not necessarily based on some flowchart you memorized. It's difficult to say which fields have the least number of algorithms to be honest.

If you don't want to follow published guidelines and algorithms, then your next best bet is to do the literature search yourself and make the informed decisions to practice the way you see fit.

As an aside, do you think doctors practicing in this manner are meeting the standard of care or are providing the best possible care? I meet some very vocal doctors who flat out reject certain guidelines or evidence based protocols and stick to what ever they fancy.

 

[CherryRedDracul]

As an aside, do you think doctors practicing in this manner are meeting the standard of care or are providing the best possible care? I meet some very vocal doctors who flat out reject certain guidelines or evidence based protocols and stick to what ever they fancy.

Some docs like Paul Marik do not believe that the Surviving Sepsis campaign is built on any robust evidence, but he does augment his practice based on the literature out there so far and on his understanding of the basic sciences. His hydrocortisone-vitamin C-thiamine cocktail for sepsis is based on what he's derived from his sources.

On the other hand, there are other doctors who give vitamin B12 shots for everything (fatigue, inducing weight loss, etc.) or are more liberal with handing out antibiotics.

Medicine is still quite an art form and there are many gray areas in it. In many instances, the guidelines that are out there may not be applicable for a unique clinical scenario. Or the guidelines may be slightly out of date given recent advancements in our medical knowledge. Given these arising discrepancies, some doctors will push the envelope and try new things. Others will shy away and stick to what they believe to be proven and true thus far.

In many instances, there are no right and wrong answers, per se. But there will be doctors who stray away from science-based medicine for $$$.

 

[dpmd]

The algorithms only seem robotic because you lack the knowledge that allows you to consider the steps in the algorithm as anything more than cookbook steps. Should you actually get more training in those fields (well for critical care at least, I don't have enough cards experience to say for sure) you would see how very unrobotic it is and the algorithms are just explicit versions of the interior decision making process you go through for each patient. At times a deviation from the steps is warranted and the educated provider will be able to recognize and adjust as needed. The algorithms help the uneducated learn how to care for those patients. You might not want to dismiss those fields that you were initially interested in until you get a little more experience in them and gain more knowledge in general

 

[Donald Juan]

OP, now that you know you can't get away from algorithms, it seems like your core problem is not knowing what specialty to choose. Here's an algorithm to help you out.

 

[Stagg737]

As an aside, do you think doctors practicing in this manner are meeting the standard of care or are providing the best possible care? I meet some very vocal doctors who flat out reject certain guidelines or evidence based protocols and stick to what ever they fancy.

Cherry already gave a great answer, but I also think there are nuances to EBM that EBM purists always seem to either overlook or just flat out reject. One of the big ones is what to do when there isn't evidence to support a treatment or protocol but the patient is still having problems. We discussed this in another thread, but look at low back pain. If we only utilized EBM when treating those patients, huge numbers of them would have inadequate or no pain control. So do we just throw our hands up and say "Well, everything with evidence has failed, good luck!" or do you start looking into other methods? One of my PMR attendings was extremely evidence-based 95% of the time. However, he did say for some patients that if alternative treatments (acupuncture, chiropractic/omm/massage, etc) was relieving their pain and allowing them to function without needing surgery with little EBM behind it or meds like opioids, that they should just keep doing what they were doing (assuming it was legal).

The other issue with strict EBM is that, like statistics, they're meant as guidelines to predict trends and allow us to identify what will likely work best for the majority of patients. They are often NOT meant to be applied as the definitive and only possible course for an individual. Yes, there are protocols and procedures that are followed exactly, but there are also many areas of medicine where deviation from the studies and protocol is both warranted and necessary to provide the best care to the patient.

Something that has been emphasized throughout my education from both MDs and DOs is that you treat the individual patient. That doesn't mean providing a lower standard of care or not following EBM, it just means doing what's best for that individual patient, which sometimes means deviating from what the guidelines suggest.

thank you! i appreciate the your response. i am happy that my cursory view is just that and more experience would possibly provide a much different viewpoint. i was hoping this was the case!!!

Something I've heard a few times now that I think is relevant to your situation and may help with your view of medicine and algorithms:

Study the rules and follow them as much as possible until you know them inside and out. Once you've mastered the rules, you'll know when it is appropriate to break them.

 

[BorntobeDO?]

I am shocked no one suggested OMM here, if any field isn't algorithm based its OMT. Professor literally make up stuff all the time hoping it will stick and they can be added to Savarese.

 

[You shall know the Truth]

What is meant by algorithm as mentioned in OP?

 

[BorntobeDO?]

if that's what you think i mean as far as my hate for algorithms then i really don't know what to tell you. you and some people here are conflating hate for algorithms with hate for ebm. while parts are related, they are not the same. thanks for the VERY helpful omm suggestion--

Ah your disdain for OMM is keeping you from your algorithm free medical dream! You could be on the other side spewing out nonsense contradicting other professors all while raking in cash and going to vacations.. I mean conferences.

 

[BorntobeDO?]

lol, i would take the most algorithm-y algorithmical field of them all over omm.

You need to get that SBS dysfunction fixed! Your brain isn't getting proper lymphatic or venous flow and is causing you to act irrationality. I would treat you over the internet, but I don't have those powers yet like some of my esteemed professors. You must see a OMT professional immediately.