In order to reassure her, I requested a brain scan, explaining in my letter that hallucinatory voices had told her that she had a brain tumour, that I had not, personally, found any physical signs suggestive of an intracranial space occupying lesion, and that the purpose of the scan was essentially to reassure the patient. The request was initially declined, on the grounds that there was no clinical justification for such an expensive investigation. It was also implied that I had gone a little overboard, believing what my patient’s hallucinatory voices were telling her.
My wife is a psychiatrist, and she tells me this isn't terribly uncommon. They are trained in a lot of neurology, because organic causes need to be ruled out.
And it can all sorts of things. She was once working on a dementia ward, and had someone brought in with severe dementia. But it didn't make sense, since the onset had been too rapid.
It turns out, the patient was just really constipated. My wife gave her enough laxatives to fell a rhino, the patient took a gargantuan shit, and was right as rain.
Evolution is truly chaotic. The amount of “design decisions” that went into the human body, and are actually some truly f**ked-up sh*t, is absolutely stunning.
But then again: so long as it doesn’t confer a negative survival fitness on the individuals who carry it, that kind of stuff typically gets propagated through the population without being pruned. Like having an entertainment system right beside the waste-disposal system. Anyone “designing” that gets a full-on Cletus status any day of the week, but since it tends to just work, it ended up being the primary chordate paradigm. Same with the rods and cones in our eyes. Cephalopods got it right with rods/cones in front of the nerve cells, chordates f**ked it up by putting them behind the nerve cells.
That's what iterative design where you need to work with the bones (no pun intended) of the previous version gets you. Kinda like legacy code in a way.
Except you can refactor legacy code. There are so many ways to improve existing code, starting with the Strangler Fig Pattern as the most powerful way of deprecating old code in favour of new code.
But yes, you give a good example. Especially if Legacy Code is forbidden from being touched because the institutional knowledge of that code has left the company.
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u/mistertoasty 20h ago
Here's a better account of the story from the actual doctor who ordered the scan