这篇笔记汇集了Lesswrong Sydney每月理性主义讨论会关于“医学决策”的思考。文章强调在信息有限和压力下做出医疗决定的重要性，建议寻求患者代理人，并对医疗系统保持审慎态度。内容涵盖了获取第二医疗意见、考虑替代疗法、审慎使用AI信息、警惕医疗专业人员及制药业的潜在利益冲突，以及认识到医学正统观念可能过时。同时，文章鼓励个人承担健康责任，利用家族病史信息，权衡生活质量，并遵循“五年规则”来评估新药物的安全性。最后，提醒读者所有医疗干预都有副作用，并强调预防性健康措施的重要性。

💡 **理性应对医疗挑战：** 在面对医疗问题或潜在生命威胁时，信息往往有限且压力巨大。文章建议在这些情况下，应积极寻求患者代理人的帮助，以确保在非正常状态下也能做出明智的决定。同时，对医疗系统保持审慎，认识到个人健康应由自己承担首要责任，并适时展现“ pushy”（坚持己见）的态度，以争取最佳的医疗服务。

🔬 **多源信息与审慎求证：** 获取第二医疗意见是明智之举，同时也可以考虑替代医学疗法。对于AI提供的医学信息，应如同对待维基百科一样，进行双重核查。文章指出，医学专家可能缺乏统计学技能，并且对研究论文的阅读深度有限，医疗系统也倾向于采用“食谱式”的僵化规则，可能难以提供个性化护理。因此，患者需要主动整合多方信息，并保持批判性思维。

⚖️ **警惕利益冲突与医学局限：** 文章揭示了医疗领域潜在的利益冲突，包括医生可能为了经济利益而推荐不必要的治疗，以及制药行业可能倾向于提供持续性用药而非根治性方案。医疗系统本身也可能存在对治疗副作用的低估。此外，医学正统观念并非一成不变，可能存在滞后性，且不同国家和地区的医疗建议可能存在差异。因此，患者应警惕这些因素，并认识到医学并非完美，有时也存在局限性。

🛡️ **个人责任与长远考量：** 强调没有人比你自己更关心你的健康。应主动了解家族病史，并根据自身情况做出决策。对于新药物，文章提出“五年规则”，建议在药物上市五年后，经过充分的临床验证再考虑使用，除非是像胰岛素这样具有生命救助作用的例外情况。同时，要密切关注正在服用的药物的最新信息，包括药物召回或新发现的副作用。最终目标是优化生活质量，并建立有效的反馈机制来评估治疗效果。

✅ **健康生活与预案规划：** 任何医疗干预都伴随副作用，手术具有风险，部分药物如同毒药。因此，保持健康的生活方式，如充足睡眠、规律运动和均衡饮食，是预防医疗经历的最佳方式。此外，提前制定预立医疗指示（Advance Care Directives），并妥善保管所有个人医疗记录，是为未来可能发生的医疗状况做好充分准备的关键步骤。

Published on September 7, 2025 8:13 AM GMT

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? 

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 DOrthodoxy 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

Every medical intervention has side effects Surgery is dangerous Some medicines are poisonsGet 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 sleepBe fit/exerciseNutritious diet

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Thanks for reading.  Hope this was helpful for your decision making.

Discuss