2 ms·

> The problem of treating too aggressively is a treatment problem, not a measurement problem. One of the most important questions you can ask your doctor is "w

by DanBC 6y ago

> The problem of treating too aggressively is a treatment problem, not a measurement problem. One of the most important questions you can ask your doctor is "what happens if I don't have this test?" and "What happens if I don't have this treatment?" But most people don't ask these questions. And so it really is a measurement problem. Over-testing, over-diagnosis, and over-treatment are well understood mechanisms of harm. https://ebm.bmj.com/content/23/1/1 https://ebm.bmj.com/content/23/1/1 https://www.bmj.com/content/362/bmj.k2820 https://www.bmj.com/content/362/bmj.k2820 The harm caused by inappropriate screening is so severe that we (UK) have a committee to weigh up the harm vs benefit of different screening programmes. https://www.gov.uk/government/groups/uk-national-screening-committee-uk-nsc https://www.gov.uk/government/groups/uk-national-screening-c...

ebg13 6y ago
> But most people don't ask these questions. And so it really is a measurement problem Putting the burden of asking these questions on the patient is wrong because patients don't go through a decade of training to become patients. And expecting the doctors to always ask these questions is wrong because I guess now we're not supposed to trust our doctors. But that doesn't mean we should suddenly live in a world without patient advocacy. It means you need to put it in the right place, in the hands of neither the patient nor the doctor directly. But if you never measure, and you need to be clear that, modulo epsilon, nobody ever measures heart rhythms despite heart disease being the #1 cause of death, then you definitely have no chance for anyone to ask those questions. > over-diagnosis and over-treatment are well understood mechanisms of harm. So are under-diagnosis and under-treatment. Both can only ultimately be solved by more information, not less.

by DanBC 6y ago

ebg13 6y ago

> But most people don't ask these questions. And so it really is a measurement problem Putting the burden of asking these questions on the patient is wrong because patients don't go through a decade of training to become patients. And expecting the doctors to always ask these questions is wrong because I guess now we're not supposed to trust our doctors. But that doesn't mean we should suddenly live in a world without patient advocacy. It means you need to put it in the right place, in the hands of neither the patient nor the doctor directly. But if you never measure, and you need to be clear that, modulo epsilon, nobody ever measures heart rhythms despite heart disease being the #1 cause of death, then you definitely have no chance for anyone to ask those questions. > over-diagnosis and over-treatment are well understood mechanisms of harm. So are under-diagnosis and under-treatment. Both can only ultimately be solved by more information, not less.