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Whenever we run a test in medicine, we ask, "How would the result affect management?" If the result, one way or another, would not change management, the test i

Whenever we run a test in medicine, we ask, "How would the result affect management?" If the result, one way or another, would not change management, the test is not worth running. The site is down so I have to go from the headline, but I'd ask the same question: how would this service affect clinical management? Can you offer an example?

Udo 14y ago
> Whenever we run a test in medicine, we ask, "How would the result affect management?" Yet, a lot of unnecessary tests are run daily at every hospital I've seen. But what's worse is that often times doctors are reluctant to find out more about a patient's illness simply because they believe "it wouldn't affect treatment and it's not worth it anyway". It doesn't take a scientist to figure out why this approach can be disastrous. At the same time, high-paying private patients are often considered to be worth finding out the specifics. The whole system of clinical knowledge and action is broken from this point on. Doctors often do not keep current with advances in medical research, and I encountered a few who are actively opposed to it, asserting that medicine should not go any further than it does today because it's considered "unnatural". Medicine is in danger of becoming scientifically bankrupt. This startup, while I think it's a great concept, is a symptom of this disease. Practitioners, even in the odd case they're interested in advanced knowledge that is not being passed down from whoever the resident rockstar surgeon is, generally do not have proper access to current knowledge and statistics. It seems to me this system, where a life is more often than not considered ephemeral and expendable (except if you're a small child or a pregnant woman), this system is broken and cannot in its current form provide the services we will need as our civilization advances. As it is, this system plays into the hands of religion and pseudo science (a trend which doctors are generally comfortable with), and it is one of the dehumanizing factors that make our hospitals places of desperation instead of regeneration.
- apsec112 14y ago
  Hello. I agree with your criticisms of the medical system, and MetaMed was started specifically to help fix these problems - to bring science back into medicine. It's impossible for any one person to keep current with all research, so we provide a service where a team of scientists can keep up on the latest research for individual physicians and patients. We're all about giving access to statistics and scientific knowledge - it's what we do.
  - Udo 14y ago
    As I said: I think it's a great idea and I wish you all the success in the world. If only this wasn't necessary... I also hope that you don't encounter too much resistance from practitioners.
- carbocation 14y ago
  > But what's worse is that often times doctors are reluctant to find out more about a patient's illness simply because they believe "it wouldn't affect treatment and it's not worth it anyway". It doesn't take a scientist to figure out why this approach can be disastrous. Some tests will not change management (just get a chest ct? no chest x-ray needed); other tests could change management but are unlikely to have an unusual result (have appendicitis? skin biopsy is probably not indicated). So without context it's possible to both agree and disagree with you equally emphatically. > At the same time, high-paying private patients are often considered to be worth finding out the specifics. More often, it seems that people who can pay push for and get unnecessary services, finding out specifics in a way that does not affect management. I am still very curious to hear from the creators of this company how they think it will affect management, and whether they have an example. Medicine needs a huge amount of change. Whether or not this affects management basically determines whether this has utility or is simply high-end entertainment.
  - Udo 14y ago
    It's not just the perspective of a patient or a relative of a patient, though I can offer that too. This is the profession as I encountered it in medical school and clinical phases of my university career. Granted, it's in Germany not the US, but I'm guessing it can't be that different on the other side of the Atlantic.
    - carbocation 14y ago
      Sorry, I completely changed 100% of the text that you replied to. I should have deleted the original and written a new one, but at the time I saw no reply.
zmmmmm 14y ago
> If the result, one way or another, would not change management, the test is not worth running That's got some rationality to it, but how do you value the impact to the patient of simply having an answer? I know people who've broken down and cried with relief when they finally knew what was wrong and the search was over, even though it just meant a lifetime of living with the disease for them.
- carbocation 14y ago
  A test that means the difference between knowing a diagnosis and not knowing a diagnosis is often management-changing. If this test gives you the diagnosis, even if there is no therapeutic option for that disorder, then it means that your search for an answer is through (ending the need for continued testing, anxious uncertainty, etc). In other posts I offer examples of tests that would not change management, and surely experienced clinicians could offer myriad other examples. (A lot of it depends on the clinical context.) But thank you for bringing this up; I agree that a diagnosis is, in itself, valuable for patients (and care providers).

Udo 14y ago

> Whenever we run a test in medicine, we ask, "How would the result affect management?" Yet, a lot of unnecessary tests are run daily at every hospital I've seen. But what's worse is that often times doctors are reluctant to find out more about a patient's illness simply because they believe "it wouldn't affect treatment and it's not worth it anyway". It doesn't take a scientist to figure out why this approach can be disastrous. At the same time, high-paying private patients are often considered to be worth finding out the specifics. The whole system of clinical knowledge and action is broken from this point on. Doctors often do not keep current with advances in medical research, and I encountered a few who are actively opposed to it, asserting that medicine should not go any further than it does today because it's considered "unnatural". Medicine is in danger of becoming scientifically bankrupt. This startup, while I think it's a great concept, is a symptom of this disease. Practitioners, even in the odd case they're interested in advanced knowledge that is not being passed down from whoever the resident rockstar surgeon is, generally do not have proper access to current knowledge and statistics. It seems to me this system, where a life is more often than not considered ephemeral and expendable (except if you're a small child or a pregnant woman), this system is broken and cannot in its current form provide the services we will need as our civilization advances. As it is, this system plays into the hands of religion and pseudo science (a trend which doctors are generally comfortable with), and it is one of the dehumanizing factors that make our hospitals places of desperation instead of regeneration.

apsec112 14y ago
Hello. I agree with your criticisms of the medical system, and MetaMed was started specifically to help fix these problems - to bring science back into medicine. It's impossible for any one person to keep current with all research, so we provide a service where a team of scientists can keep up on the latest research for individual physicians and patients. We're all about giving access to statistics and scientific knowledge - it's what we do.
- Udo 14y ago
  As I said: I think it's a great idea and I wish you all the success in the world. If only this wasn't necessary... I also hope that you don't encounter too much resistance from practitioners.
carbocation 14y ago
> But what's worse is that often times doctors are reluctant to find out more about a patient's illness simply because they believe "it wouldn't affect treatment and it's not worth it anyway". It doesn't take a scientist to figure out why this approach can be disastrous. Some tests will not change management (just get a chest ct? no chest x-ray needed); other tests could change management but are unlikely to have an unusual result (have appendicitis? skin biopsy is probably not indicated). So without context it's possible to both agree and disagree with you equally emphatically. > At the same time, high-paying private patients are often considered to be worth finding out the specifics. More often, it seems that people who can pay push for and get unnecessary services, finding out specifics in a way that does not affect management. I am still very curious to hear from the creators of this company how they think it will affect management, and whether they have an example. Medicine needs a huge amount of change. Whether or not this affects management basically determines whether this has utility or is simply high-end entertainment.
- Udo 14y ago
  It's not just the perspective of a patient or a relative of a patient, though I can offer that too. This is the profession as I encountered it in medical school and clinical phases of my university career. Granted, it's in Germany not the US, but I'm guessing it can't be that different on the other side of the Atlantic.
  - carbocation 14y ago
    Sorry, I completely changed 100% of the text that you replied to. I should have deleted the original and written a new one, but at the time I saw no reply.

zmmmmm 14y ago

> If the result, one way or another, would not change management, the test is not worth running That's got some rationality to it, but how do you value the impact to the patient of simply having an answer? I know people who've broken down and cried with relief when they finally knew what was wrong and the search was over, even though it just meant a lifetime of living with the disease for them.

carbocation 14y ago
A test that means the difference between knowing a diagnosis and not knowing a diagnosis is often management-changing. If this test gives you the diagnosis, even if there is no therapeutic option for that disorder, then it means that your search for an answer is through (ending the need for continued testing, anxious uncertainty, etc). In other posts I offer examples of tests that would not change management, and surely experienced clinicians could offer myriad other examples. (A lot of it depends on the clinical context.) But thank you for bringing this up; I agree that a diagnosis is, in itself, valuable for patients (and care providers).