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> The doctor rings true. I had 3 separate doctors on 3 separate occasions diagnose my 21 month old son with an ear infection, instead of the plum-sized malignan

> The doctor rings true. I had 3 separate doctors on 3 separate occasions diagnose my 21 month old son with an ear infection, instead of the plum-sized malignant brain tumour that it was. This one is difficult. The first doctor with the first diagnosis was likely doing the right thing. Although tragic, it's exceedingly rare for someone that young to present with a brain tumour. If a doctor was ordering CT scans every time someone arrived with ear infection symptoms, they statistically be causing more harm than good. CT scans raise an individuals risk of cancer ever so slightly. Not a big deal for individuals, but scaled up to an entire population it's actually a real creator of cancer risk. Now obviously if you have some serious symptoms then the incremental risk of a CT scan is less than the risk of missing a serious diagnosis. However, jumping straight to the CT scan without good reason would be a mistake. So now doctors are in a position where they must integrate diagnostic history into the equation. Showing up to multiple doctors with an "ear infection" that isn't responding to any treatments warrants deeper investigation. If the issue isn't resolved, proceeding to imaging makes sense. This is why it's important to begin return visits with a summary of what's been done so far. If you get a doctor who wants to re-start the diagnostic process without accounting for previous work done so far, unfortunately the only real solution is to move on to someone else.

kirrent 5y ago
Exactly, the post is a Scott Alexander post so he'd never object to the concept of priors. There's nothing wrong with having a strong prior that the volcano's not going to blow up this year, that it's just the wind not a break-in, or that it's most likely an ear infection with a tumour so unlikely as to not be worth the radiation risk and cost of a CT. Really, the article is about people who don't bother to monitor the likelihood that updates their prior because the prior is so damn explanatory anyway. But, a doctor treating an ear infection isn't doing this because the act of treatment is also a test. It's not the 'did the volcano erupt' or 'did we get burgled' test with huge downsides because even if there's a serious underlying issue a week or two is unlikely to change too much. If the purported infection doesn't clear up then it's time for the doctor to update their prior and reconsider what investigations or treatment options are now appropriate. Even better than taking your history to your next doctor, keep seeing the same doctor.

kirrent 5y ago

Exactly, the post is a Scott Alexander post so he'd never object to the concept of priors. There's nothing wrong with having a strong prior that the volcano's not going to blow up this year, that it's just the wind not a break-in, or that it's most likely an ear infection with a tumour so unlikely as to not be worth the radiation risk and cost of a CT. Really, the article is about people who don't bother to monitor the likelihood that updates their prior because the prior is so damn explanatory anyway. But, a doctor treating an ear infection isn't doing this because the act of treatment is also a test. It's not the 'did the volcano erupt' or 'did we get burgled' test with huge downsides because even if there's a serious underlying issue a week or two is unlikely to change too much. If the purported infection doesn't clear up then it's time for the doctor to update their prior and reconsider what investigations or treatment options are now appropriate. Even better than taking your history to your next doctor, keep seeing the same doctor.