I don’t think it’s antithetical to Western medicine. It’s antithetical to mass produced, industrialized medicine. Those aren’t the same thing. I only want them to use the scientific method on each individual patient. That’s all. They don’t seem interested in it though. They don’t seem to be able to think for themselves and reason on their own. They like acute diseases and disorders. Here’s a virus, and we kill it with this medicine. Here's a bacteria and we kill it with this medicine. Here’s a tumor and we cut it out. Anything more complex and they don’t have any interest in it. If they want to treat the patients they actually have, they need to learn how to do this other work.

The other option is we just accept that they don’t have any interest in this type of complexity, and say OK, that’s fine, but they no longer have a monopoly on medicine. We find other ways of certifying other branches of science to treat people with these things. There are a lot of people who are already treating these things well. I go to a nutritionist who is amazing and has helped me more than any other doctor. She’s not anti-science or using crackpot theories. She’s still scientific. But my insurance won’t cover the because the MDs have a monopoly on that.

As you've said, the human body is complex. We don't always know what's wrong - of course we do our best with the tests we have, but often we're ruling things out and are left without a clear answer. When I try to tell patients that "I don't know", they're frustrated with me. And frequently, it's the patients that are mad that I don't have a pill or procedure that can fix it immediately.

You say that doctors like diseases that we can treat...well, of course we do. I want to help people! Why would I enjoy having to tell someone they're feeling badly but I can't figure out why with my current available tests and data? It doesn't mean that the symptoms aren't real, I just don't know what's causing them.

People think modern medicine means we have all the answers, but that's not the case by a long shot and the vast majority of human experience and condition is still unknown, and I do wish people understood that more.

(And, side note, insurances put up a fight with a ton of doctor-prescribed orders as well, it's a huge problem in the system. I'm sure all healthcare workers would love universal dietitian coverage.)

> When I try to tell patients that "I don't know", they're frustrated with me. And frequently, it's the patients that are mad that I don't have a pill or procedure that can fix it immediately.

One of my best experiences with a doctor was when he told me he believed my symptoms were real, but he didn’t know what caused them. After being told I was healthy repeatedly even though I had very real symptoms, just being believed was a relief.

Different patients want different things. Some want a quick fix. I don’t. I want to get to the bottom of it. Maybe try to ask some questions up front to gauge which type of person they are, so you can know how to give them bad news?

The other problem I was referring to was not that doctors like diseases that they can treat. That’s a misrepresentation of what I said. I was talking about how they seem to only like diseases with a VERY clear-cut diagnosis and standard treatment, where they can run one test, then write a prescription and solve the problem. Boom. Next! But anything that’s slightly more complex than that or has any grey area, and they don’t have the patience or mindset to troubleshoot the problem.

As a software engineer, I find doctors’ lack of curiosity very difficult to deal with. You get the strong sense that they’re just looking up a flow chart, but when things don’t fit the flow chart they have no method for dealing with that uncertainty, so they give up. I guess part of the problem is that easy fixes are the only thing that can fit into a twenty minute visit. Seems like there’s no time to be curious.

I don’t expect miracles. I know that modern medicine still doesn’t have anything close to all the answers. I suppose I just want doctors to get more comfortable with uncertainty and learn how to manage that uncertainty better. Don’t act certain about things they can’t be certain about, and be more curious when the patient in front of them doesn’t fit the diagnostic flow chart.

I understand that you’re all in a difficult situation though. Dealing with insurance B.S., difficult patients, legal risks, hundreds of thousands of dollars in school loans… I don’t envy you at all. But I can’t act like the current situation is working. It’s not.

What would it mean to use the scientific method on each individual patient? You can't run a valid RCT or even an observational study with an n=1 sample size.

You can form hypotheses and test them though. That is what they do when they run the "standard" tests, but once those tests are done most doctors don't seem to be good at and/or interested in coming up with further hypotheses.

You're mixing up unrelated issues. Anyone can call themselves a "nutritionist"; it's essentially a meaningless term.

MDs don't have a monopoly on receiving medical insurance payments. Insurers will pay for many non-medical allied health services including registered dieticians (RD) in cases where those meet coverage rules based on scientific evidence.

> Insurers will pay for many non-medical allied health services including registered dieticians (RD) in cases where those meet coverage rules based on scientific evidence.

Saying they will pay out in their brochure and actually paying out are two very different things. Anyone who has spent any time trying to get reimbursed for medical expenses knows the maze of dark patterns that insurance companies will use to avoid paying out. They wear you down with broken websites and “lost” form submissions until you give up. Medical insurance companies don’t make money by providing healthcare. They make money by collecting premiums and not providing healthcare. And actual scientific evidence has very little effect on what’s covered easily and what gets the runaround.