4 ms·

As a physician, please, get more tests. My wife wants some new shoes!

by killjoywashere 7y ago

tathougies 7y ago
Well there are lot of rich health conscious people in this country that would love to do that for your wife.
- phaemon 7y ago
  Now there's a comment you don't want taken out of context.
ijidak 7y ago
I'm absolutely fine with that. :-) After all, businesses exist to provide a service, and when I pay for that service if the owner gets to buy his wife shoes, that doesn't bother me. What does bother me is that I can't walk into a clinic, let's call it "EasyLabs", and ask for an EKG right now, for $100, $200, $300. It's the immediacy and tranparency of pricing, that's lacking and eliminating the doctor as middle man for tests and diagnostics that aren't harmful. Money is not my concern. The inefficiency is what is shocking to me. To put the inefficiency of medical diagnostics in perspective, it is likely faster and easier for me to go out right now and buy a new $50,000 car, than it is for me to order my own MRI. To me that just seems crazy. But, as I said, maybe I'm missing something about the danger of getting tests like an EKG or an MRI needlessly. For example, we know accumulated radiation from unnecessary x-rays would be harmful. So clearly not every medical diagnostic is safe to self-request.
- DanBC 7y ago
  MRIs are harmful for patients without symptoms. https://www.amjmed.com/article/S0002-9343(13)00967-4/pdf https://www.amjmed.com/article/S0002-9343(13)00967-4/pdf http://www.lessismoremedicine.com/blog/video-do-more-screening-tests-lead-to-better-health-docmikeevans http://www.lessismoremedicine.com/blog/video-do-more-screeni... (There are lots of posts about over testing on the Less is More site: http://www.lessismoremedicine.com/blog/tag/overtesting http://www.lessismoremedicine.com/blog/tag/overtesting ) Take a patient who has smokes about five cigarettes every day. Should we MRI their lungs to see if they have lung cancer? The patient has the MRI, and doctors see some small spots in the lungs. Is this cancer? Or is it something that is completely harmless, such as scarring from childhood disease? To find out a needle biopsy is used. This is low risk, but it isn't no risk. The biopsy comes back clear. Does that mean that these spots are harmless, or does it mean that the person doing the biopsy missed them? At each stage we're perhaps causing fear and alarm and distress, and not really getting any useful information. But we do know that this person smokes, and we do know that their health would be improved if we could help them stop smoking, and we know that nicotine replacement and support is an effective way to stop smoking for many people. It's probably a better way to spend the money.
  - nybble41 7y ago
    Your example does not show that MRIs are harmful. It only shows that overreacting to the result of an MRI may be harmful. If you can just avoid overreacting then having more information can only help, never hurt. The results may seem useless now, but combined with other test results, advances in our medical knowledge, and tools like Machine Learning we may be able to draw useful inferences from that information later.
    - DanBC 7y ago
      The discussion is about testing now, today. It's not about testing in 10 years time. > can only help, never hurt This is simply untrue. Assuming for a moment that people can avoid overreacting you're still ignoring the stress caused by getting a partial dx. And if you're not going to do anything with the information it's pointless doing it: you've exposed people to risk (hospitals are low risk, not no risk, environments) for no purpose. I've linked to doctors and statisticians and healthcare researchers all saying the same thing. Here's a UK Cancer charity which repeats the point: https://scienceblog.cancerresearchuk.org/2018/03/06/overdiagnosis-when-finding-cancer-can-do-more-harm-than-good/ https://scienceblog.cancerresearchuk.org/2018/03/06/overdiag... What you chose to do with your body is, of course, totally up to you. But you should stop spreading the FUD that imaging is harmless or that more information is always better.
      - nybble41 7y ago
        > The discussion is about testing now, today. It's not about testing in 10 years time. Indeed, and the results of tests done today may be relevant in ten years, even if we don't have the ability to draw useful information from them right now. If nothing else it may at least provide a baseline for comparison. > Assuming for a moment that people can avoid overreacting you're still ignoring the stress caused by getting a partial dx. Stressing out over an inconclusive test result would be overreaction. It's not as if stress is automatically a bad thing anyway, in moderation, or as if not knowing (or worse, being prevented from investigating) doesn't cause stress of its own. > And if you're not going to do anything with the information it's pointless doing it... I agree, so it's a good thing I never suggested that the results should be completely ignored. Just don't overreact. > ...hospitals are low risk, not no risk, environments... There is no such thing as a no-risk environment; moreover, imaging doesn't need to be performed at a hospital. A clinic is sufficient. Not doing the tests conveys its own share of risk; many conditions are much easier to treat when detected early, but you won't detect them early if you don't start looking until after symptoms manifest. > ...FUD that imaging is harmless... You have yet to provide any evidence that imaging is harmful, which hasn't stopped you from attempting to spread Fear, Uncertainty, and Doubt on the subject. The only FUD here is your own.

As a physician, please, get more tests. My wife wants some new shoes!

tathougies 7y ago

Well there are lot of rich health conscious people in this country that would love to do that for your wife.

phaemon 7y ago
Now there's a comment you don't want taken out of context.

ijidak 7y ago

I'm absolutely fine with that. :-) After all, businesses exist to provide a service, and when I pay for that service if the owner gets to buy his wife shoes, that doesn't bother me. What does bother me is that I can't walk into a clinic, let's call it "EasyLabs", and ask for an EKG right now, for $100, $200, $300. It's the immediacy and tranparency of pricing, that's lacking and eliminating the doctor as middle man for tests and diagnostics that aren't harmful. Money is not my concern. The inefficiency is what is shocking to me. To put the inefficiency of medical diagnostics in perspective, it is likely faster and easier for me to go out right now and buy a new $50,000 car, than it is for me to order my own MRI. To me that just seems crazy. But, as I said, maybe I'm missing something about the danger of getting tests like an EKG or an MRI needlessly. For example, we know accumulated radiation from unnecessary x-rays would be harmful. So clearly not every medical diagnostic is safe to self-request.

DanBC 7y ago
MRIs are harmful for patients without symptoms. https://www.amjmed.com/article/S0002-9343(13)00967-4/pdf https://www.amjmed.com/article/S0002-9343(13)00967-4/pdf http://www.lessismoremedicine.com/blog/video-do-more-screening-tests-lead-to-better-health-docmikeevans http://www.lessismoremedicine.com/blog/video-do-more-screeni... (There are lots of posts about over testing on the Less is More site: http://www.lessismoremedicine.com/blog/tag/overtesting http://www.lessismoremedicine.com/blog/tag/overtesting ) Take a patient who has smokes about five cigarettes every day. Should we MRI their lungs to see if they have lung cancer? The patient has the MRI, and doctors see some small spots in the lungs. Is this cancer? Or is it something that is completely harmless, such as scarring from childhood disease? To find out a needle biopsy is used. This is low risk, but it isn't no risk. The biopsy comes back clear. Does that mean that these spots are harmless, or does it mean that the person doing the biopsy missed them? At each stage we're perhaps causing fear and alarm and distress, and not really getting any useful information. But we do know that this person smokes, and we do know that their health would be improved if we could help them stop smoking, and we know that nicotine replacement and support is an effective way to stop smoking for many people. It's probably a better way to spend the money.
- nybble41 7y ago
  Your example does not show that MRIs are harmful. It only shows that overreacting to the result of an MRI may be harmful. If you can just avoid overreacting then having more information can only help, never hurt. The results may seem useless now, but combined with other test results, advances in our medical knowledge, and tools like Machine Learning we may be able to draw useful inferences from that information later.
  - DanBC 7y ago
    The discussion is about testing now, today. It's not about testing in 10 years time. > can only help, never hurt This is simply untrue. Assuming for a moment that people can avoid overreacting you're still ignoring the stress caused by getting a partial dx. And if you're not going to do anything with the information it's pointless doing it: you've exposed people to risk (hospitals are low risk, not no risk, environments) for no purpose. I've linked to doctors and statisticians and healthcare researchers all saying the same thing. Here's a UK Cancer charity which repeats the point: https://scienceblog.cancerresearchuk.org/2018/03/06/overdiagnosis-when-finding-cancer-can-do-more-harm-than-good/ https://scienceblog.cancerresearchuk.org/2018/03/06/overdiag... What you chose to do with your body is, of course, totally up to you. But you should stop spreading the FUD that imaging is harmless or that more information is always better.
    - nybble41 7y ago
      > The discussion is about testing now, today. It's not about testing in 10 years time. Indeed, and the results of tests done today may be relevant in ten years, even if we don't have the ability to draw useful information from them right now. If nothing else it may at least provide a baseline for comparison. > Assuming for a moment that people can avoid overreacting you're still ignoring the stress caused by getting a partial dx. Stressing out over an inconclusive test result would be overreaction. It's not as if stress is automatically a bad thing anyway, in moderation, or as if not knowing (or worse, being prevented from investigating) doesn't cause stress of its own. > And if you're not going to do anything with the information it's pointless doing it... I agree, so it's a good thing I never suggested that the results should be completely ignored. Just don't overreact. > ...hospitals are low risk, not no risk, environments... There is no such thing as a no-risk environment; moreover, imaging doesn't need to be performed at a hospital. A clinic is sufficient. Not doing the tests conveys its own share of risk; many conditions are much easier to treat when detected early, but you won't detect them early if you don't start looking until after symptoms manifest. > ...FUD that imaging is harmless... You have yet to provide any evidence that imaging is harmful, which hasn't stopped you from attempting to spread Fear, Uncertainty, and Doubt on the subject. The only FUD here is your own.