4 ms·

I'm a physician. This is the thing most people don't get about tests. It's tiring to see these startups with their flawed agenda.

petra 10y ago
But what if we could redesign the healthcare systems, in a way that doesn't expose people to all their test results , only critical ones, but gives the doctor/system that data in order to enable to better watch their patient ? Would that be useful?
- bobowzki 10y ago
  Well, it's a good point but how do you decide what's critical? To answer my own question; I believe the future lies in machine learning algorithms processing symptoms and tests (I guess a symptom is also a test in the sense that it's the answer to a question). Most of the times there's also not a simple answer to be found . The right answer depends on many factors including the capabilities of your hospital/country/economy and the state of science.
  - petra 10y ago
    >> I believe the future lies in machine learning algorithms processing symptoms and tests At the core you're still left with the question - tell your patient directly results of a statistical analysis of a few possibilities and options - and often see him take the wrong one, or guide him through trust(in you or the machine) while not showing him full details. Right ?
  - paviva 10y ago
    > The right answer depends on many factors including the capabilities of your hospital [...] Absolutely ! I'll add that the physician himself is a kind of test, in the sense that his own sensitivity/specificity to diagnosing a disease can be calculated. It is well known -- and I'a argue it's a feature, not a bug --, that the exact same patients with the exact same symptoms will have a different work-up whether he's seen a GP, an emergency physician, or, say a heart surgeon. The reason is pretty simple: because disease prevalence is different in those three practices, the doctor has to order more or less tests to get the same predictive power. E.g., when every patient has heart disease, every ECG change is probably sign of disease, whereas when almost nobody has any heart problems, ECGs are pretty meaningless.
- paviva 10y ago
  No, as I explained, when disease prevalence is low, most tests -- even when clearly "positive" -- don't shift probabilities in any appreciable way, and just add to the noise, and render decision making even harder. Of all patients, nurses and doctors are the ones who are the less likely to asks for "more tests", precisely because they understand that they are essentially meaningless when pre-test probability is very low. Suggested readings : 1. Bayes' Theorem: https://en.wikipedia.org/wiki/Bayes%27_theorem https://en.wikipedia.org/wiki/Bayes%27_theorem 2. Base rate fallacy: https://en.wikipedia.org/wiki/Base_rate_fallacy https://en.wikipedia.org/wiki/Base_rate_fallacy

petra 10y ago

But what if we could redesign the healthcare systems, in a way that doesn't expose people to all their test results , only critical ones, but gives the doctor/system that data in order to enable to better watch their patient ? Would that be useful?

bobowzki 10y ago
Well, it's a good point but how do you decide what's critical? To answer my own question; I believe the future lies in machine learning algorithms processing symptoms and tests (I guess a symptom is also a test in the sense that it's the answer to a question). Most of the times there's also not a simple answer to be found . The right answer depends on many factors including the capabilities of your hospital/country/economy and the state of science.
- petra 10y ago
  >> I believe the future lies in machine learning algorithms processing symptoms and tests At the core you're still left with the question - tell your patient directly results of a statistical analysis of a few possibilities and options - and often see him take the wrong one, or guide him through trust(in you or the machine) while not showing him full details. Right ?
- paviva 10y ago
  > The right answer depends on many factors including the capabilities of your hospital [...] Absolutely ! I'll add that the physician himself is a kind of test, in the sense that his own sensitivity/specificity to diagnosing a disease can be calculated. It is well known -- and I'a argue it's a feature, not a bug --, that the exact same patients with the exact same symptoms will have a different work-up whether he's seen a GP, an emergency physician, or, say a heart surgeon. The reason is pretty simple: because disease prevalence is different in those three practices, the doctor has to order more or less tests to get the same predictive power. E.g., when every patient has heart disease, every ECG change is probably sign of disease, whereas when almost nobody has any heart problems, ECGs are pretty meaningless.
paviva 10y ago
No, as I explained, when disease prevalence is low, most tests -- even when clearly "positive" -- don't shift probabilities in any appreciable way, and just add to the noise, and render decision making even harder. Of all patients, nurses and doctors are the ones who are the less likely to asks for "more tests", precisely because they understand that they are essentially meaningless when pre-test probability is very low. Suggested readings : 1. Bayes' Theorem: https://en.wikipedia.org/wiki/Bayes%27_theorem https://en.wikipedia.org/wiki/Bayes%27_theorem 2. Base rate fallacy: https://en.wikipedia.org/wiki/Base_rate_fallacy https://en.wikipedia.org/wiki/Base_rate_fallacy