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This really isn't a big deal. Doctors know that these pulse ox meters aren't very accurate and use them accordingly. Nobody's changing their plan because you
by treis 6y ago
This really isn't a big deal. Doctors know that these pulse ox meters aren't very accurate and use them accordingly. Nobody's changing their plan because you have a pulse ox of 93 instead of 95. They're there to quickly measure big changes that indicate a problem. In other words, they're looking for patients going from 98 to 75, not 98 to 95.
- jrajav 6y agoWhat's the point of casually dismissing this article's premise? Whether the conclusions are fully sound or not isn't the goal of this article, this is journalistic not academic. The goal is to raise awareness of a potential bias, and I think it achieves that (assuming the facts all check out). For one, according to the article the discrepancy was found to be up to 8 points in some cases, not 3. And it seems reasonable that quick, practical decisions in hospitals are made based on point thresholds, not purely huge point leaps as you suggest. I haven't dug any further than the article and your comment to verify these facts. But rather than find a way to prove why this doesn't matter, why don't we assume it does? Then the knowledge and awareness might spread a little bit more through us, and if it is an issue, it might be that much more likely to be solved. There's no penalty for being wrong with a weakly held but well-meaning assumption. At the very least, we can be more aware of another possible dimension of bias in technology.
- x86_64Ubuntu 6y agoThis thread because it has race as a secondary theme will be rife with such statements dismissing the premise.
- spoopyskelly 6y agoBullshit should be dismissed, regardless of race.
- treis 6y ago>What's the point of casually dismissing this article's premise? Because it should be casually dismissed. This person doesn't know what they're talking about, refused to listen to the people who told them they didn't know what they are talking about, and wrote an article full of nonsense.
- rednerrus 6y ago"Journalists" in 2020 summarized.
- prvc 6y ago>why don't we assume it does? Then the knowledge and awareness might spread a little bit more If the assumption is incorrect, then it would be misinformation that we would be spreading.
- jennyyang 6y agoMedicine is very rarely about absolutes, it's mostly about how things get better or worse. When I was in the hospital, no one looked at the absolute values of my blood work, they cared to see if it dropped based on the treatment they saw. Also, doctors are already aware about how oximeters may be inaccurate. It doesn't mean that they still can't be useful.
- skwb 6y agoYeah, if we had such cut and dry "rules" about medicine, then we could automate a lot of what doctors do. Medicine is as much about the art as it is the science. You come to understand the limitations of different measuring techniques, and learn to know when you need to rely on each for more accurate representations.
- btach 6y agoMany quick, practical decisions are made on patient assessment and clinical judgement, not just numbers. None of us that I know of has ever come across a perfect pulse ox. "Treat the patient, not the numbers" as the saying goes. When they don't match up, I like to do things like use a different finger/hand (or ear lobe or forehead).
- diydsp 6y agoFTA: "At a reading of 88 or 89, Medicare will reimburse for oxygen at home, but at 90 it won’t"
- tssva 6y agoGetting oxygen at home reimbursed by Medicare also requires diagnoses with certain conditions and specific testing. If oxygen at home is required the testing to satisfy Medicare requirements won't be conducted using the common finger tip pulse ox meter.
- openasocket 6y agoThere might actually be room for a lawsuit there, if that regulation has a demonstrable impact on people with darker skin
- in_cahoots 6y agoThat hasn’t been true at all in my experience. When my son got pneumonia, we were told he would be hospitalized at 92 when he was reading 94. He’s dark-skinned so who knows what the actual reading should have been.
- tashi 6y agoMy insurance company didn't authorize a full sleep study because my overnight pulse oximeter results were normal, so it took me an extra couple of years to find out I needed a CPAP machine. It might have helped to know that my skin color could cause inaccurate results.
- dragonwriter 6y ago> Nobody's changing their plan because you have a pulse ox of 93 instead of 95. Threshold values are used to.make decisions, dark skin people do read higher (meaning decisions not informed by knowledge of the difference are likely to delay intervention for darker skinned people) and also have worse outcome with otherwise similar presentation for many of the conditions where pulse oximetry would be a factor in decision-making. It's quite possible that the outcome difference is in part because of the measurement difference, even if the likely impact in each individual case is minor.
- rscho 6y agoWe are looking for people to make 90+, 92+ if reasonably healthy. 75 is super low, and apart from exceptions is a _very_ concerning value. See the dissociation curve of hemoglobin/O2 to know why. However yes, in my experience I never had enough difference in dark-skinned individuals to be clinically meaningful.
- zamfi 6y agoFrustratingly, this kind of dismissal perpetuates injustices. First, let's be clear: > Doctors know that these pulse ox meters aren't very accurate and use them accordingly Some doctors know... > Nobody's changing their plan because you have a pulse ox of 93 instead of 95. They're there to quickly measure big changes that indicate a problem. Sometimes, perhaps even often, they're used for this. It's one use case of pulse oximetry, and it's an important one. I read your post as extrapolating general claims from common cases, and erasing the real experiences of people that fall outside of these common cases. Bias often happens at the margins. That doesn't make it less real for the people who suffer from it, even if most people don't suffer, even if the common cases work well. It can be hard to see those margins when you aren't in them, but that doesn't mean they don't exist -- they are still worth writing about and trying to fix.
- deleted 6y ago[deleted]
- CositaS 6y agoAlso, while they might not change plan because of a reading of 93 instead of 95 - the article describes a bias of up to 8%, which does seem enough to be significant.
- slowmovintarget 6y agoThis IS NOT BIAS! This is physics! As someone else pointed out, this isn't only about melanin in the skin. Darkened skin for any reason will cause this (burns, smoking, dirt, etc...). Medical personnel are trained to account for this partial accuracy. The other fact is that there are newer techniques being worked on to improve the technology.
- throwanem 6y ago> This IS NOT BIAS! This is physics! Bias doesn't happen in physics. Bias happens where humans and physics interact. > Medical personnel are trained to account for this Medical personnel aren't the only people who use pulse oximeters and need them to read reliably. Beyond that, this thread and the article it discusses are full of examples of why "medical personnel are trained" isn't enough of an answer here.
- sangnoir 6y ago> In other words, they're looking for patients going from 98 to 75, not 98 to 95 The problem is that that '95' might really be a '90' - surely a drop from 98 to 90 is a cause for concern. If that information is being hidden, it needs to be fixed, regardless of other, more subjective fallback methods.
- JamesBarney 6y agoThe difference of 5% is only common in the 60-70% on some clips. In the 90%-100% level the different is up to 2%-3% on the worst pulse ox's, and usually around 1%. For reference I have two pulse oximeters at home and they routinely give me results that differ by 2-3%. Seems like an issue we should fix, but I don't know what impact this would have in a clinical setting given that they use multiple criteria and the devices are known to be inaccurate.