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Good! hopefully the cost comes down too Its pretty baffling to me why we don't do ultrasounds a lot more than we currently do them. Recently went down the rabb

Good! hopefully the cost comes down too Its pretty baffling to me why we don't do ultrasounds a lot more than we currently do them. Recently went down the rabbit hole of childhood cancers and there are so many that can be detected and treated earlier if ultrasounds were a standard practice at every check up. The rationale for not doing it seems to be just cost , and its likely you dont have cancer. But if you do , I would sure like to know early!

HWR_14 4y ago
I thought there was a high number of false positives from ultrasounds.
Buttons840 4y ago
My dad recently learned he had a heart valve defect that many first learn about when it kills them; surgery fixed it. Doctor suggested his children should be checked for the same. The check involved doing an ultrasound of the heart. One ultrasound per person could save lives. I'm not sure why every baby (fetus) gets an ultra sound but once born they usually get none.
- haldujai 4y ago
  Findings on imaging have value in specific clinical contexts. There are a lot of things you can see that will take you down a rabbit hole of further investigations and turn out to be nothing. We perform fetal ultrasonography which excludes most of the relevant deadly cardiac conditions. It is well established in medicine that improved/early detection does not equal improved patient outcomes and can actually result in patient harm.
  - ttGpN5Nde3pK 4y ago
    > It is well established in medicine that improved/early detection does not equal improved patient outcomes and can actually result in patient harm. Is there a specific time of detection that is well established as improving patient outcomes?
- ant6n 4y ago
  Babies should get hip ultra sounds, so there’s that.
TaupeRanger 4y ago
The rationale for not doing so is that it has never been investigated in a controlled study. The benefit would have to be proven to make patients live longer or better lives overall, and the risk of iatrogenic harms from doing ultrasounds at every checkup would be astronomical. Not to mention the additional cost.
vkou 4y ago
> Its pretty baffling to me why we don't do ultrasounds a lot more than we currently do them Because just like undertesting kills people, overtesting kills people. And because medical dollars are limited, and even in a perfect world, they should be spent towards the highest ROI.
- mhb 4y ago
  This sort of reasoning makes sense at population scale, but not particularly for individual decision making if someone is spending their own money.
  - vkou 4y ago
    Almost nobody either in the US or out of it is spending their own money for healthcare, it's usually them spending the money of their health insurance plan, be it private or public. Also, as mentioned above, the ROI of overtesting can well be negative.
    - mhb 4y ago
      There are plenty of people who can spend their own money for healthcare. Anyway, as mentioned explicitly above, the ROI for that cohort can be different for the groups that don't spend their own money. Probably the societal ROI is better for spending more of its healthcare money on something else anyway. More relevantly, people who are paying for their own care can choose how to address any issues discovered by testing. If you're on a trip deciding where to go and someone tells you not to look at part of the map because it is a dangerous area, does it make sense to blindly believe them or to look at it, do further investigation and then decide whether to travel there?
- rapjr9 4y ago
  If overtesting kills people then I'd argue the testing is flawed or the followup procedures are flawed.
refurb 4y ago
The rationale is that is you end up with more false-positives, which need to be ruled out with more invasive testing (biopsy) which not only costs more, but also has risks of it's own. So testing more can actually result in worse health outcomes than limited testing.

HWR_14 4y ago

I thought there was a high number of false positives from ultrasounds.

Buttons840 4y ago

My dad recently learned he had a heart valve defect that many first learn about when it kills them; surgery fixed it. Doctor suggested his children should be checked for the same. The check involved doing an ultrasound of the heart. One ultrasound per person could save lives. I'm not sure why every baby (fetus) gets an ultra sound but once born they usually get none.

haldujai 4y ago
Findings on imaging have value in specific clinical contexts. There are a lot of things you can see that will take you down a rabbit hole of further investigations and turn out to be nothing. We perform fetal ultrasonography which excludes most of the relevant deadly cardiac conditions. It is well established in medicine that improved/early detection does not equal improved patient outcomes and can actually result in patient harm.
- ttGpN5Nde3pK 4y ago
  > It is well established in medicine that improved/early detection does not equal improved patient outcomes and can actually result in patient harm. Is there a specific time of detection that is well established as improving patient outcomes?
ant6n 4y ago
Babies should get hip ultra sounds, so there’s that.

TaupeRanger 4y ago

The rationale for not doing so is that it has never been investigated in a controlled study. The benefit would have to be proven to make patients live longer or better lives overall, and the risk of iatrogenic harms from doing ultrasounds at every checkup would be astronomical. Not to mention the additional cost.

vkou 4y ago

> Its pretty baffling to me why we don't do ultrasounds a lot more than we currently do them Because just like undertesting kills people, overtesting kills people. And because medical dollars are limited, and even in a perfect world, they should be spent towards the highest ROI.

mhb 4y ago
This sort of reasoning makes sense at population scale, but not particularly for individual decision making if someone is spending their own money.
- vkou 4y ago
  Almost nobody either in the US or out of it is spending their own money for healthcare, it's usually them spending the money of their health insurance plan, be it private or public. Also, as mentioned above, the ROI of overtesting can well be negative.
  - mhb 4y ago
    There are plenty of people who can spend their own money for healthcare. Anyway, as mentioned explicitly above, the ROI for that cohort can be different for the groups that don't spend their own money. Probably the societal ROI is better for spending more of its healthcare money on something else anyway. More relevantly, people who are paying for their own care can choose how to address any issues discovered by testing. If you're on a trip deciding where to go and someone tells you not to look at part of the map because it is a dangerous area, does it make sense to blindly believe them or to look at it, do further investigation and then decide whether to travel there?
rapjr9 4y ago
If overtesting kills people then I'd argue the testing is flawed or the followup procedures are flawed.

refurb 4y ago

The rationale is that is you end up with more false-positives, which need to be ruled out with more invasive testing (biopsy) which not only costs more, but also has risks of it's own. So testing more can actually result in worse health outcomes than limited testing.