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Framing it as a choice between "have a cookbook decision tree that's been validated by RCTs in exactly this context" and "do a lot of costly (in resources and s
by abecedarius 7y ago
Framing it as a choice between "have a cookbook decision tree that's been validated by RCTs in exactly this context" and "do a lot of costly (in resources and side effects) followup tests to show we're doing everything we can" is an example of the irrationality that needs fixing. People are capable of actually reasoning with uncertainty when they care about outcomes. When it's you, personally, facing a decision in your life, you don't throw up your hands and say "It's too complicated to decide! There are no actuarial tables about exactly this situation!" Having to decide means having to make a bet. You can be a better or a worse gambler, but we're all gamblers. Medicine as a profession seems to want to pretend they're not, rather like "investors" pretend to be qualitatively different from "speculators".
- arkades 7y agoIt’s not “cookbook decision tree”, it’s “data from which to make meaningful inferences about this finding.” It would be nice if we always have that; with incidental findings, we often don’t.
- abecedarius 7y agoPut it this way: my doctor ordered a test for me, got the results, and made a recommendation. I was ignorant of both the costs (of all sorts) beforehand and of the product of probability and utility on which he (implicitly and unavoidably unless irrationally) based the decision. He did make a meaningful inference from this data, as anyone must to make a decision; he just refused to help me, as a consultant instead of a master, to make my own.