4 ms·

I'm so fucking tired of this perspective. Yes, it's technically correct. Many of us have done the canonical "cancer screening false positive / false negative" e

by ohazi 7y ago

I'm so fucking tired of this perspective. Yes, it's technically correct. Many of us have done the canonical "cancer screening false positive / false negative" example demonstrating the problem in a statistics class. But at the end of the day, I'm paying a doctor to care for me, not the general public. I may be a member of the general public, but the public interest and my interests are not identical. If I'm willing and able, I should be able to pay to have a test done (anonymously), and be left alone to deal with the statistics of what the results actually mean for myself. The fact that I have to fight my doctor to do this is condescending bullshit.

jcims 7y ago
PREACH! It's a bunch of gatekeeping bullshit and drives me crazy. My wife went through two years of misery and the number of times I had to argue over getting labs done that ultimately influenced her treatment left me with a rather deep mistrust and skepticism over the medical community that is going to take a lot of time to repair.
KptMarchewa 7y ago
This attitude is another example of why private healthcare is a very bad idea.
- logicchains 7y ago
  You might change your mind if you'd ever met an arrogant doctor whose biggest concern was their own ego and you didn't have a second option. I'm met a few doctors who are so rude and arrogant they wouldn't even pass the HR screen at anywhere I've worked. Depriving people of choice just gives assholes even more of a chance to be assholes, because people have no other alternatives than to go to the assholes.
  - dashwav 7y ago
    You're right - depriving people of choice can cause bad doctors to stick around longer because patients are forced to go to them. This is why we need something like single-payer - no one should be forced to go to a bad doctor because their private insurance decided to only have one or two options in-network locally.
yellow_lead 7y ago
I'm not saying you shouldnt be allowed to pay and pick your own tests or your loved ones tests. You have a good point, population statistics can't be extrapolated back down to an individual on a case by case basis. I had to deal with doctors recently, so I understand where this frustration comes from. I only mean to say that there could be some negative effects from people doing this in aggregate.
pedrosorio 7y ago
The reason you don’t want to do “all of the tests” and “deal with the results” is not about the probability of a false positive, but the consequences of getting one: “In the United States, estimated deaths per year include: [26][27][28][29] 12,000 due to unnecessary surgery 7,000 due to medication errors in hospitals 20,000 due to other errors in hospitals 80,000 due to nosocomial infections in hospitals 106,000 due to non-error, negative effects of drugs Based on these figures, iatrogenesis may cause as many as 225,000 deaths per year in the United States” https://en.m.wikipedia.org/wiki/Iatrogenesis https://en.m.wikipedia.org/wiki/Iatrogenesis
- ohazi 7y ago
  This is exactly what the doctor parrots back at me. Again, these are outcome statistics for the general population. I'm well aware of these numbers, but I am not an average patient. I'm not going to look at the outcome of a single test and blindly decide to take a strong medication or to get surgery. If I want a test done, it's because I'm doing research to try and figure out a complicated issue that doctors have not been able to help me with, usually due to their own time and resource constraints. I have all the time in the world, and if a condition is affecting me, I'm going to care more about addressing it correctly than any doctor. I'm completely aware that a test is just one data point, that tests have error rates, and that interventions have risks. I was one of the first ~1000 to get whooping cough (pertussis) during the 2008 outbreak, before they knew that the vaccine cocktail that my generation was given needed more frequent adult boosters. I figured it out after a few days of digging. Do you want to know how many doctors I had to yell at to finally convince one of them just to run the test? And this is a test with zero intervention risk -- they can't do anything if it comes back positive, they just tell the NIH. Doctors have gone off the deep end here. Yes, testing has risks, but they should focus on the intervention risks. You should be allowed to run as many tests as you want for informational purposes if you're just trying to figure out what might be going on, especially if you're aware that errors can happen and are capable of acting responsibly with the resulting (single, noisy) data point.
  - evandijk70 7y ago
    You might have a case if you were paying for the test out of pocket, but I presume you have health insurance. In that case, it is also the doctor's duty to prevent unnecessary spending. Combined with the fact that most patients are not well informed and will demand pointless or even counterproductive, it is better to leave treatment and testing decisions to doctors, not patients. Even if doctors sometimes get it wrong it is still better than the alternative.
deleted 7y ago
[deleted]

by ohazi 7y ago

jcims 7y ago

PREACH! It's a bunch of gatekeeping bullshit and drives me crazy. My wife went through two years of misery and the number of times I had to argue over getting labs done that ultimately influenced her treatment left me with a rather deep mistrust and skepticism over the medical community that is going to take a lot of time to repair.

KptMarchewa 7y ago

This attitude is another example of why private healthcare is a very bad idea.

logicchains 7y ago
You might change your mind if you'd ever met an arrogant doctor whose biggest concern was their own ego and you didn't have a second option. I'm met a few doctors who are so rude and arrogant they wouldn't even pass the HR screen at anywhere I've worked. Depriving people of choice just gives assholes even more of a chance to be assholes, because people have no other alternatives than to go to the assholes.
- dashwav 7y ago
  You're right - depriving people of choice can cause bad doctors to stick around longer because patients are forced to go to them. This is why we need something like single-payer - no one should be forced to go to a bad doctor because their private insurance decided to only have one or two options in-network locally.

yellow_lead 7y ago

I'm not saying you shouldnt be allowed to pay and pick your own tests or your loved ones tests. You have a good point, population statistics can't be extrapolated back down to an individual on a case by case basis. I had to deal with doctors recently, so I understand where this frustration comes from. I only mean to say that there could be some negative effects from people doing this in aggregate.

pedrosorio 7y ago

The reason you don’t want to do “all of the tests” and “deal with the results” is not about the probability of a false positive, but the consequences of getting one: “In the United States, estimated deaths per year include: [26][27][28][29] 12,000 due to unnecessary surgery 7,000 due to medication errors in hospitals 20,000 due to other errors in hospitals 80,000 due to nosocomial infections in hospitals 106,000 due to non-error, negative effects of drugs Based on these figures, iatrogenesis may cause as many as 225,000 deaths per year in the United States” https://en.m.wikipedia.org/wiki/Iatrogenesis https://en.m.wikipedia.org/wiki/Iatrogenesis

ohazi 7y ago
This is exactly what the doctor parrots back at me. Again, these are outcome statistics for the general population. I'm well aware of these numbers, but I am not an average patient. I'm not going to look at the outcome of a single test and blindly decide to take a strong medication or to get surgery. If I want a test done, it's because I'm doing research to try and figure out a complicated issue that doctors have not been able to help me with, usually due to their own time and resource constraints. I have all the time in the world, and if a condition is affecting me, I'm going to care more about addressing it correctly than any doctor. I'm completely aware that a test is just one data point, that tests have error rates, and that interventions have risks. I was one of the first ~1000 to get whooping cough (pertussis) during the 2008 outbreak, before they knew that the vaccine cocktail that my generation was given needed more frequent adult boosters. I figured it out after a few days of digging. Do you want to know how many doctors I had to yell at to finally convince one of them just to run the test? And this is a test with zero intervention risk -- they can't do anything if it comes back positive, they just tell the NIH. Doctors have gone off the deep end here. Yes, testing has risks, but they should focus on the intervention risks. You should be allowed to run as many tests as you want for informational purposes if you're just trying to figure out what might be going on, especially if you're aware that errors can happen and are capable of acting responsibly with the resulting (single, noisy) data point.
- evandijk70 7y ago
  You might have a case if you were paying for the test out of pocket, but I presume you have health insurance. In that case, it is also the doctor's duty to prevent unnecessary spending. Combined with the fact that most patients are not well informed and will demand pointless or even counterproductive, it is better to leave treatment and testing decisions to doctors, not patients. Even if doctors sometimes get it wrong it is still better than the alternative.

deleted 7y ago

[deleted]