5 ms·

I don't disgree with the viewpoint of this article. However, having served on a hospital credentials committee, and bearing witness to what type of lawsuits me

by dr_ 13y ago

I don't disgree with the viewpoint of this article. However, having served on a hospital credentials committee, and bearing witness to what type of lawsuits medical providers have been subject to, I can assure you that if a physician advises against a screening mammogram to a woman in her early 40's despite the fact that there are "organizations" that encourage it, and she ends up with breast cancer and possibly dies, that physician will get sued and will in all likelihood lose, or have to settle. Task forces can make all kinds of recommendations, but unless there are changes to the legal system to back them up , don't expect major changes. Somewhere in this discussion it was suggested that doctors are ignorant. It is, in fact, the exact opposite.

thisone 13y ago
There was a similar story in a This American Life episode about the PSA test for prostate cancer. There's a short interview in Act One with a doctor who was sued for malpractice for allowing a patient to choose to not have the test. http://www.thisamericanlife.org/radio-archives/episode/391/more-is-less http://www.thisamericanlife.org/radio-archives/episode/391/m...
comrade_ogilvy 13y ago
I am the guilty party, and I think your counterargument is a good one. It is not the actual screenings that I particularly care about -- that is just data. The elephant in the room is the implied massive amount of overtreatment that are justified on the basis of the screenings -- overtreatment that inflicts a tremendous physical, emotional, financial, and health toll on the patient. What are the long term health costs of unnecessary chemotherapy? Is it ethically okay for a doctor to inflict torturous poisoning (chemotherapy) on a patient for fear of potential lawsuits, when it could easily be true that 75% of those patients gain zero medical benefit?
- sliverstorm 13y ago
  Is it ethically okay I'd think in the general case, yes. The patient is going to want it, even if it is only 25% effective. I'm not an expert on medical ethics, but in my mind if the patient has complete information and still wants the treatment, the doctor is not morally bankrupt in providing it. The doctor can certainly advise otherwise if they choose, of course.
  - fr0sty 13y ago
    Even in the face of "complete information" from a doctor there is a log of "awareness" being raised elsewhere which is almost uniformly in the battle/fight/beat/win direction. In such a case it is very easy to see how it would be possible for the patient to choose treatment which is in fact against their best interest. Also, as mentioned elsewhere in the thread the current regulatory/legal climate leaves a vanishingly small upside and massive downside to the doctor who would advise against treatment.
  - comrade_ogilvy 13y ago
    You are assuming the patient has complete information. If actually true, I would agree. What is "complete information"? Do the doctors offer the statistics that the treatment is not 25% effective, that by American medical treatment norms chemo is 75% worse than useless and of the remaining 25% many will still die? The patients are scared. Doctors are playing on those fears, acting on the assumption that fast and aggressive treatment is the wisest course all the time. The patients are reacting out of fear, not getting second opinions, and are hurried into the operating table to be cut open. That is the norm. I have seen it happen. It is my personal opinion that, no, most doctors are not offering complete information. So your argument, while reasonable, simply does not apply.
- tsotha 13y ago
  >What are the long term health costs of unnecessary chemotherapy? How could you possibly know it whether or not it's necessary?
  - comrade_ogilvy 13y ago
    There are other rich nations that treat breast cancers with chemo/radiation ~25% as often as American doctors, and get the same overall breast cancer mortality rate. That is extremely strong evidence that American doctors are applying a painful & damaging treatment far more often than can be rationally justified.
    - tsotha 13y ago
      Still, there's no way you can know in a particular case if the cancer will respond to chemotherapy or not. And how are you measuring mortality?
      - comrade_ogilvy 13y ago
        In some cases, no; in some cases, yes. By the number of women who actually die of breast cancer. Suppose, normalized for population size, 1000 women of a certain age die of breast cancer in both country A and country B. In country A, 5000 women are treated with chemo. In country B, 20000 women are treated with chemo. Which country has the more competent doctors? I think the answer is obvious. Hint: The USA is not country A.
        tsotha 13y ago
        The answer isn't obvious at all. What if in country B the average woman with breast cancer lives an additional five years? What if breast cancer is simply more prevalent in country B? You're trying to oversimplify something that isn't simple. By the way, exactly what country are you talking about here?

by dr_ 13y ago

thisone 13y ago

There was a similar story in a This American Life episode about the PSA test for prostate cancer. There's a short interview in Act One with a doctor who was sued for malpractice for allowing a patient to choose to not have the test. http://www.thisamericanlife.org/radio-archives/episode/391/more-is-less http://www.thisamericanlife.org/radio-archives/episode/391/m...

comrade_ogilvy 13y ago

I am the guilty party, and I think your counterargument is a good one. It is not the actual screenings that I particularly care about -- that is just data. The elephant in the room is the implied massive amount of overtreatment that are justified on the basis of the screenings -- overtreatment that inflicts a tremendous physical, emotional, financial, and health toll on the patient. What are the long term health costs of unnecessary chemotherapy? Is it ethically okay for a doctor to inflict torturous poisoning (chemotherapy) on a patient for fear of potential lawsuits, when it could easily be true that 75% of those patients gain zero medical benefit?

sliverstorm 13y ago
Is it ethically okay I'd think in the general case, yes. The patient is going to want it, even if it is only 25% effective. I'm not an expert on medical ethics, but in my mind if the patient has complete information and still wants the treatment, the doctor is not morally bankrupt in providing it. The doctor can certainly advise otherwise if they choose, of course.
- fr0sty 13y ago
  Even in the face of "complete information" from a doctor there is a log of "awareness" being raised elsewhere which is almost uniformly in the battle/fight/beat/win direction. In such a case it is very easy to see how it would be possible for the patient to choose treatment which is in fact against their best interest. Also, as mentioned elsewhere in the thread the current regulatory/legal climate leaves a vanishingly small upside and massive downside to the doctor who would advise against treatment.
- comrade_ogilvy 13y ago
  You are assuming the patient has complete information. If actually true, I would agree. What is "complete information"? Do the doctors offer the statistics that the treatment is not 25% effective, that by American medical treatment norms chemo is 75% worse than useless and of the remaining 25% many will still die? The patients are scared. Doctors are playing on those fears, acting on the assumption that fast and aggressive treatment is the wisest course all the time. The patients are reacting out of fear, not getting second opinions, and are hurried into the operating table to be cut open. That is the norm. I have seen it happen. It is my personal opinion that, no, most doctors are not offering complete information. So your argument, while reasonable, simply does not apply.
tsotha 13y ago
>What are the long term health costs of unnecessary chemotherapy? How could you possibly know it whether or not it's necessary?
- comrade_ogilvy 13y ago
  There are other rich nations that treat breast cancers with chemo/radiation ~25% as often as American doctors, and get the same overall breast cancer mortality rate. That is extremely strong evidence that American doctors are applying a painful & damaging treatment far more often than can be rationally justified.
  - tsotha 13y ago
    Still, there's no way you can know in a particular case if the cancer will respond to chemotherapy or not. And how are you measuring mortality?
    - comrade_ogilvy 13y ago
      In some cases, no; in some cases, yes. By the number of women who actually die of breast cancer. Suppose, normalized for population size, 1000 women of a certain age die of breast cancer in both country A and country B. In country A, 5000 women are treated with chemo. In country B, 20000 women are treated with chemo. Which country has the more competent doctors? I think the answer is obvious. Hint: The USA is not country A.
      - tsotha 13y ago
        The answer isn't obvious at all. What if in country B the average woman with breast cancer lives an additional five years? What if breast cancer is simply more prevalent in country B? You're trying to oversimplify something that isn't simple. By the way, exactly what country are you talking about here?