3 ms·

The emphasis there is on "further treatment". The test itself is broadly benign (except the general risks associated with phlebotomy and any risk of psychologic

The emphasis there is on "further treatment". The test itself is broadly benign (except the general risks associated with phlebotomy and any risk of psychological harm). The issue is that doctors often over-react to adverse results due to the risk of being sued if it did turn out to be a true positive. I have two examples of this. One was during a routine blood test I had a liver enzyme flag up, which was then further investigated non-invasively with ultrasound and it was determined that I might either have moderately developed NAFLD (non-alcoholic fatty liver disease, I'm obese) or very early stage NASH (non-alcoholic steatohepatitis) associated fibrosis. The doctor wanted to perform a liver biopsy to confirm which is obviously an invasive procedure with a 1%-ish risk of complications. My response was to ask how the treatment would differ between diagnoses, and he said in either case the treatment would be the same: lifestyle change. He agreed that from a risk perspective the biopsy was just inviting additional risk for no benefit, but that policy is to recommend the test and if I refuse it I'll need to sign an indemnification document saying I was refusing further diagnostics against medical advice. A few years go by, I've made efforts to improve my lifestyle, lost weight, and now my liver tests are all normal proving it was just NAFLD after all. In another case, I had a suspicious finding in an eye test which (long story short) led to me getting two head CT scans which showed no problems. In hindsight, I think a double dose of brain radiation over a common minor finding with no other symptoms was a crazy over-reaction and I would have refused if I had all the facts, but it could have been a life threatening situation in some ridiculously tiny percentage of cases so it was all rush rush and I didn't have time to weigh it up. Often the correct thing to do may be a combination of further non-invasive testing, repeating the test (possibly after a period of time), and "watchful waiting". Doctors often don't feel comfortable with the level of personal risk that could expose them to, and for good reason. That is the issue, not the test.

smt88 2y ago
> The issue is that doctors often over-react to adverse results due to the risk of being sued if it did turn out to be a true positive. Do you think a patient is going to receive a false positive and accept a response from a doctor of, "Oh, might be a false positive. Let's ignore it and not do any more risky testing."? That scenario makes no sense from either perspective. If you get a positive, you do more testing (or skip to treatment). Your examples are well-taken and I understand them, but they don't apply to cancer. When you detect cancer with any test, you immediately do something risky: either a further test that involves risk, or treatment that involves a lot of risk.
- toast0 2y ago
  > Do you think a patient is going to receive a false positive and accept a response from a doctor of, "Oh, might be a false positive. Let's ignore it and not do any more risky testing."? I mean, it depends on the test; a reasonable answer could be this is likely a false positive and confirmation tests have risks, here are some symptoms to look out for, and we'll test on a regular basis and see if anything changes. That's not appropriate for all positive results from screenings, but it is for some.
- cameronh90 2y ago
  I didn’t say we do nothing, it’s just the next step doesn’t have to be invasive testing. Obviously the particulars are going to come down to the specific test, but you could be looking at a set of MRIs, repeated a few weeks apart to determine, firstly if it is a false positive, and secondly, how aggressive it seems to be. In other cases it might be just repeating the test periodically and watching out for other symptoms. We do this with cervical screenings for example, since it’s quite a slow moving disease, where a low grade result will just result in you being put on a more frequent testing pathway. It has been suggested that we should move to a similar protocol with prostate testing too, where a high PSA shouldn’t result in any immediate action unless there are other symptoms, but rather the test should be repeated periodically to monitor how the numbers are changing. Now, that’s not to say you should do all tests. The test could still be pointless (i.e. there are no actions one can take in response to the result either way) or ,more commonly, simply not cost effective. However I fundamentally do not agree that more information itself is harmful, it’s just our response to it that’s lacking and that should be improved.

smt88 2y ago

> The issue is that doctors often over-react to adverse results due to the risk of being sued if it did turn out to be a true positive. Do you think a patient is going to receive a false positive and accept a response from a doctor of, "Oh, might be a false positive. Let's ignore it and not do any more risky testing."? That scenario makes no sense from either perspective. If you get a positive, you do more testing (or skip to treatment). Your examples are well-taken and I understand them, but they don't apply to cancer. When you detect cancer with any test, you immediately do something risky: either a further test that involves risk, or treatment that involves a lot of risk.

toast0 2y ago
> Do you think a patient is going to receive a false positive and accept a response from a doctor of, "Oh, might be a false positive. Let's ignore it and not do any more risky testing."? I mean, it depends on the test; a reasonable answer could be this is likely a false positive and confirmation tests have risks, here are some symptoms to look out for, and we'll test on a regular basis and see if anything changes. That's not appropriate for all positive results from screenings, but it is for some.
cameronh90 2y ago
I didn’t say we do nothing, it’s just the next step doesn’t have to be invasive testing. Obviously the particulars are going to come down to the specific test, but you could be looking at a set of MRIs, repeated a few weeks apart to determine, firstly if it is a false positive, and secondly, how aggressive it seems to be. In other cases it might be just repeating the test periodically and watching out for other symptoms. We do this with cervical screenings for example, since it’s quite a slow moving disease, where a low grade result will just result in you being put on a more frequent testing pathway. It has been suggested that we should move to a similar protocol with prostate testing too, where a high PSA shouldn’t result in any immediate action unless there are other symptoms, but rather the test should be repeated periodically to monitor how the numbers are changing. Now, that’s not to say you should do all tests. The test could still be pointless (i.e. there are no actions one can take in response to the result either way) or ,more commonly, simply not cost effective. However I fundamentally do not agree that more information itself is harmful, it’s just our response to it that’s lacking and that should be improved.