5 ms·

You can make the right call but still be wrong sometimes. There's a cost to tests of rare diseases.

by acover 3y ago

corethree 3y ago
Then let the person who is wrong foot the cost. The cost isn't just the cost of the test. It's the cost of what occurred because the doctor decided to block a test.
- evgen 3y ago
  No one is preventing you from going to a private clinic and paying for the test yourself. The doctor is not 'blocking' the test or preventing you from getting it, they are just not authorising it. Sounds like you have a problem with either your insurance provider or your wallet.
  - amluto 3y ago
    Or the jurisdiction in which you live in which labs are not permitted to test without a doctor’s order? This is very common.
  - corethree 3y ago
    https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%20Library/AuthorizationOrderTests.pdf https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%... This is a cartel based law. Basically patients can't order tests or even look at results from tests by law. The "made up" reasoning for why this law exists is because the law makers acquiesced into agreeing with doctors that all patients are fucking idiots. That's the bullshit reason. But really it's business reasons. Same reason why the doctor supply is made artificially low, all these things are legislated by the AmA to lower the supply of doctors and give them more control. >Sounds like you have a problem with either your insurance provider or your wallet. If you're a doctor. My problem is you. How does a doctor even have the gall to say this? It's flat out wrong. So if you're a doctor there's only two logical possibilities for why you said what you said. 1. You're a liar and are therefore untrustworthy. 2. You don't know what you're talking about and are therefore incompetent. Which is it?
    - rscho 3y ago
      I am a doctor, and I encourage you to learn about how diagnostic test performance is modelled, and the consequences linked to overtesting and testing without contextual knowledge. It may change your perspective and lead you towards less extreme opinions.
      - corethree 3y ago
        Are you a US doctor? I urge you to explain why you charge so much and have the poorest performance out of all 1st world countries? It may change your perspective on treating patients like idiots when really the US doctor is the epitome of fraudulent incompetence. Over testing is a problem. The way to lessen over testing is to not be an incompetent doctor so that patients don't take things into their own hands. Barring that you have no choice but to let the patient test himself. It's the moral thing to do. I guess here's an interim solution. Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it. The reason is the patient is more intimately familiar with his own symptoms and your just pattern matching based off of a high level probability. If you've never seen a patient with a certain condition you often bias towards the conditions you've seen. Yes patients can be biased but so can you. And there's no denying that patients can do more detailed research and they have a perspective with a resolution you will never achieve. The good doctor needs to listen to them.
        rscho 3y ago
        I have worked in both the US and Europe. I am back in Europe now, as I vastly prefer it over the US. > Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it. Precisely not. That's exactly how you get unusable results with super expensive healthcare, because the follow up that a positive test dictates is often worse than the initial problem, and can impact the population at large (e.g. antibiotics use). All that in a context where the post test probability is very low. There are situations where this does not apply, because we have good exploratory AND confirmatory tests, but that's far from being the norm. Regarding your other points, sure we should always listen to what the patient has to say. There even is a saying about it: "90% of diagnoses are made on personal history". That's because diagnostic tests often are far less useful than you'd expect. Again, I encourage you to learn about how medical testing works. You say you root for AI to replace docs, but apart from not being human anymore, I doubt you'll find your robot doc to be so different regarding your particular situation. All that aside, I'm not rich. I chose to stay in Europe where I earn less because both US doctors and patients are so toxic. You are a prime example of this. In Europe, we test much less and overall both docs and patients are far less aggressive. Yet healthcare here is cheaper, universal and IMO better overall. Everybody profits from more relaxed doc-patient relationships. US Healthcare is first and foremost a cultural issue, and US patients are part of the problem as much as docs are.

You can make the right call but still be wrong sometimes. There's a cost to tests of rare diseases.

by acover 3y ago

You can make the right call but still be wrong sometimes. There's a cost to tests of rare diseases.

Then let the person who is wrong foot the cost. The cost isn't just the cost of the test. It's the cost of what occurred because the doctor decided to block a test.

evgen 3y ago
No one is preventing you from going to a private clinic and paying for the test yourself. The doctor is not 'blocking' the test or preventing you from getting it, they are just not authorising it. Sounds like you have a problem with either your insurance provider or your wallet.
- amluto 3y ago
  Or the jurisdiction in which you live in which labs are not permitted to test without a doctor’s order? This is very common.
- corethree 3y ago
  https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%20Library/AuthorizationOrderTests.pdf https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%... This is a cartel based law. Basically patients can't order tests or even look at results from tests by law. The "made up" reasoning for why this law exists is because the law makers acquiesced into agreeing with doctors that all patients are fucking idiots. That's the bullshit reason. But really it's business reasons. Same reason why the doctor supply is made artificially low, all these things are legislated by the AmA to lower the supply of doctors and give them more control. >Sounds like you have a problem with either your insurance provider or your wallet. If you're a doctor. My problem is you. How does a doctor even have the gall to say this? It's flat out wrong. So if you're a doctor there's only two logical possibilities for why you said what you said. 1. You're a liar and are therefore untrustworthy. 2. You don't know what you're talking about and are therefore incompetent. Which is it?
  - rscho 3y ago
    I am a doctor, and I encourage you to learn about how diagnostic test performance is modelled, and the consequences linked to overtesting and testing without contextual knowledge. It may change your perspective and lead you towards less extreme opinions.
    - corethree 3y ago
      Are you a US doctor? I urge you to explain why you charge so much and have the poorest performance out of all 1st world countries? It may change your perspective on treating patients like idiots when really the US doctor is the epitome of fraudulent incompetence. Over testing is a problem. The way to lessen over testing is to not be an incompetent doctor so that patients don't take things into their own hands. Barring that you have no choice but to let the patient test himself. It's the moral thing to do. I guess here's an interim solution. Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it. The reason is the patient is more intimately familiar with his own symptoms and your just pattern matching based off of a high level probability. If you've never seen a patient with a certain condition you often bias towards the conditions you've seen. Yes patients can be biased but so can you. And there's no denying that patients can do more detailed research and they have a perspective with a resolution you will never achieve. The good doctor needs to listen to them.
      - rscho 3y ago
        I have worked in both the US and Europe. I am back in Europe now, as I vastly prefer it over the US. > Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it. Precisely not. That's exactly how you get unusable results with super expensive healthcare, because the follow up that a positive test dictates is often worse than the initial problem, and can impact the population at large (e.g. antibiotics use). All that in a context where the post test probability is very low. There are situations where this does not apply, because we have good exploratory AND confirmatory tests, but that's far from being the norm. Regarding your other points, sure we should always listen to what the patient has to say. There even is a saying about it: "90% of diagnoses are made on personal history". That's because diagnostic tests often are far less useful than you'd expect. Again, I encourage you to learn about how medical testing works. You say you root for AI to replace docs, but apart from not being human anymore, I doubt you'll find your robot doc to be so different regarding your particular situation. All that aside, I'm not rich. I chose to stay in Europe where I earn less because both US doctors and patients are so toxic. You are a prime example of this. In Europe, we test much less and overall both docs and patients are far less aggressive. Yet healthcare here is cheaper, universal and IMO better overall. Everybody profits from more relaxed doc-patient relationships. US Healthcare is first and foremost a cultural issue, and US patients are part of the problem as much as docs are.