I'm sure future humans will be horrified to learn that we walked around with barely no meaningful monitoring on our body stats for our whole lives... Only seeking out help when problems got big enough to be visible to the naked eye or bad enough to impair us.
My TLDR: There may be unknown unknowns in the medical system.
It doesn't say how many, it doesn't say the consequences, it just says "most". And since people die, there's probably something we don't know.
That said, I'm not sure this problem as described is one that is even conceivably fixable at this scale. As in, I'm literally not sure that a machine that perfectly diagnoses all the health conditions of a person going forward is logically consistent.
How do we fix the current system? We could make a global centralized review system for doctors then start maintaing records of performance, mistakes due to just being a "bad doctor," mistakes due to just bad timing (patient complained too late to fix), mistakes due to being overworked ("seeing" 100 patients a day), etc.
Even with a global system of reviews and oversight, we'd need a way to evict the failing doctors or reduce their responsibilities.
It's a lot like the rampant police violence/corruption problems coming to light now because everybody has mobile video recorders. When everything is hidden, nobody notices and it's difficult getting anybody to believe you about widespread systemic failures.
What's the equivalent of a cell phone video for medical malpractice?
A few years ago, I was fresh out of college and working at large university with a very good teaching hospital. I was making $30k/year, but had amazing Cadillac health insurance. I started developing asthma (unbeknownst to me. It was caused by a very gradual onset allergy, and I had never had asthma before), wasn't able to walk up a short flight of stairs on my way to work one day, and, instead of turning right to go to the office, I decided to turn left to go to the urgent care center attached to the school.
I wasn't waiting more than 5 minutes (for a walk in!), was seen by two doctors and at least one nurse, including a pulmonary specialist, got a chest x-ray, a breathing test, lots of stethoscope exams, and diagnosed (correctly!) with asthma. I don't remember how long I was seen for, but it was a very long time, for what most doctors would probably consider to be a fairly straightforward diagnosis. (Oh! And it was all free -- they didn't even bother to mail me a statement afterwards. I gave them a $20 bill for the co-pay, $5 for the prescription and that was the end of it)
Around the same time, a friend of mine, in a different school, going to a not great school clinic with his school's official insurance plan, was in a similar situation to yours, where a collapsed lung was misdiagnosed as "you're just tired, get more sleep," without an exam. (Granted, as an engineering major, he did need to get more sleep, but still!) As you might imagine, there were some pretty hefty hospital bills later on when his condition deteriorated...
Anyway, your situation sounds terrible, and I wouldn't be surprised if the collapsed lung misdiagnosis was fairly common. "Collapsed lung" just seems like one of those things that's really easy to misdiagnose (in some presentations, at least) as a number of other things, unless you're good with a stethoscope, and/or have access to medical imaging equipment (and the will to use it!). Ugh.
It's so absurd to me how fantastic and thorough my treatment was at one school (I was on the same insurance plan the students were), and how badly the screwed up a similar situation at a school just 10 miles away -- both with nearly equal tuition rates and health insurance plan costs.
It all turned out ok, because I could tell there was something wrong, went and got x-rays and eventually got operated on. This was all 20 years ago. Apparently, tall-ish, skinny guys in their early 20ies are one of the highest risk groups for collapsed lungs - the other being older smokers, which sounds more like what you'd expect.
Ha! Yup, my friend with the collapsed lung was very tall, very skinny, and 21 at the time.
This college clinic also misdiagnosed a pregnancy as "you stopped menstruating because of your low weight" in a friend of mine who came in, literally saying "I think I'm pregnant." (You'd think that would be the first test a college clinic would do!)
In both situations, they figured something was wrong a little while later, and surgery did the trick!
Wonder if that's the genius from IHS (Indian Health Service) that insisted my co-worker had AIDS when he went in for flu symptoms. The doctor had "seen it" and since my co-worker took the normal path to be a drug and alcohol counselor he fit the doctor's criteria. He had to go home and tell his wife. The negative blood test came back a week later. They shuffled said doctor to somewhere else instead of canning the idiot.
As someone currently dealing with two completely seperate but overlapping medical conditions that have somewhat similar symptoms I'm in a four way battle between what I think, what my GP thinks and what specialist #1 and specialist #2 think.
Specialist #1 sent me to Specialist #2 who pretty much dismissed out of hand that the problems where related to his specialism but said he'd do the tests anyway, turns out I do have something that is under his specialism.
It's a bit frustrating tbh, the only doctor who's been awesome was the A&E consultant who basically said "this is not normal, march into your GP's and demand the following tests" had he not done that and I not followed his advice I'd still not know what was causing a significant part of the problems I was having nor that certain daily routine tasks could make things horrifically worse.
When you see how little time physicians spend with patients, this is not a surprise. Additionally, new research is continually coming out, and the doctors are often not up-to-date on it. This is a huge problem called Translational Research. For this reason, it is important that you do your own research.
Just today I went to the doctor and had a bad experience, as it is usual since I came to the US.
I basically love everything about living in America. I love this country. But one thing that I don't love here is primary medical care. It is so damn shitty compared to what is was in my home country of Brazil.
I don't understand what goes on here. I have to basically convince doctors to examine me. They treat me like they're doing me a favor. I'll usually leave the office with a recommendation to take ibuprofen or a prescription for antibiotics, and most of the times that doesn't address my concerns. Also, doctors here have this huge attitude that I don't recall ever seeing on a Brazilian doctor.
I can't fathom how the country with the most advance medicine in the world does so bad on primary care.
This is an artifact of the medical insurance system in the US, which focuses upon low-cost, high-volume processing of patients and gouging the delivery staff on payments. Subscribe to an expensive concierge physician service (the kind that is cash/check/bank-transfer only, no insurance allowed, some don't even take credit cards), and the difference is night and day; impeccable bedside manners, no rushed visits, 24x7 phone access to your personally-assigned doctor (with only light screening by the RN on duty, if any screening at all), some even perform house calls.
It is no secret that if you are well-to-do or wealthier in the US, then it offers you some of the best medical services and quality delivery you can buy anywhere in the world; the steady stream of medical tourism by the very wealthy non-US patients year-in and year-out attests to that. And if you are not so well-off in the US, then any complex medical complications requiring sophisticated treatment to survive can be a horrifically terrifying experience, depending upon your individual roll of the dice in our byzantine insurance maze.
While many US citizens decry "socialism" when single-payer systems are discussed, I personally believe Coase's Nature of the Firm might offer one possible solution set out of many possible such sets, in terms of a solution along the lines of co-ops.
I have never heard of a concierge physician service. where can I learn more about the issues surrounding medical insurance and its impact on patient care? as someone who lives in the US and relies on the healthcare system, I'm very interested.
Right you are, I should have been more specific for the US readers of my comment. General Practitioner's are not nearly as well-compensated by insurance as specialists, and GP's are the primary care main point of contact for most Americans. Thanks for pointing out the need for the clarification.
Finding a doctor is like finding a good mechanic or a hair stylist - it's kind of on you. There is no shortage of terrific doctors in this country who really care about doing their best for you, but it does take some shopping around and online research to find them; try reading doctor review sites, check their credentials, think about what their support staff sounded like when you call to make an appointment - if the receptionist sounds cross or grumpy, you can bet the Doctor's going to be worse.
When doctors "practice" medicine they aren't saying "We're amateurs just like band practice." They're just using the traditional wording. You also here this with other older professions like law.
Bodies are pretty complex systems to diagnose. We ask programmers to work in pairs to reduce mistakes and then trust our lives to a single opinion. Buyer beware if you're not getting second opinions.
This. There is also a pretty wide variation in skill levels between different doctors. With only one arbitrarily selected opinion the chances of getting advice from the wrong end of the spectrum is higher.
What is frustrating is cases where doctors insist they are right, and how dare you the patient question their expertise based on your internet research.
I mean, look, I totally get their side--you are paying them for their knowledge which they accumulated from years of practicing and years of specialized training. You SHOULD largely trust them. But doctors are also often overworked, and may not always specialize in your particular area. You also obviously have a much more vested interest in the outcome as a patient, so there's a decent chance you'll spend much more time researching it than your doctor.
All of this to ask..."how can we strike a balance?" If one has doubts about what their doctor is telling them, they can always get another opinion. I just wish there was a better way to vet any research one might do on their own without the doctor getting upset that you continued to look into the matter instead of just taking their word on it when things don't improve.
Personally, I have an awesome doctor, but when I have these concerns I preface them by saying "I recognize this is internet research, and I trust your opinions on these things, but I had X, Y and Z questions." They have always been perfectly happy to answer my questions and address my concerns (as I would hope given what they bill my insurance for a 15 minute visit...)
Well, not in Canada. So instead of paying through the nose for a second opinion you have the guilt of possibly squandering taxpayer money by having more doctors spend more time on you.
Getting it done right with a bunch of tests to rule out 1 in a million chances is a lot more expensive than getting it right without tests (and wrong 1 in a million times.)
I feel it's the other way around. I am a sample size of one; the doctor's experience, and the experience of the people who trained that doctor, is a far larger and more reliable sample, and so the doctor's diagnosis is more likely to be correct (absent any other information) than mine.
My go-to example here is a few years ago I had unbelievable abdominal pain for a day or two and saw a doctor about it. And the first thing the doctor thought it was -- gallstones, which I ended up having a mildly-complicated and expensive test for -- turned out to be completely wrong. But I don't fault the doctor for that: it was, given what I was experiencing and my family's medical history (multiple people who had to have their gallbladders out due to gallstones), the most likely cause, to such an extent that focusing on anything else until it had been ruled out would have been a bad idea.
(it turned out to be inflamed cartilage in my ribs, which was the second thing investigated, once the abdominal ultrasound ruled out gallstones)
Except medical knowledge is not like pushing up a code commit. A new break through comes out, but it takes time for it to filter its way through the medical community, get doctors educated, convince them to change their ways, etc. Doctors are often required to get a certain number of CME credits every year, but there's no guarantee they'll be 100% current on the cutting edge of your issue.
So if a doctor can lag behind from an education standpoint, is that an opportunity for a patient to help fill in gaps if they are willing to invest time?
Please make no mistake, I largely agree that doctors are much better at considering the options and diagnosing accordingly. My point is that they are not omniscient, and new developments in medicine happen all the time. While a specialist might be expected to be more current in their specialty, a general practitioner might not be.
We should be free to push a doctor on things and have them answer as to why we're wrong. I can only imagine that must be very annoying to doctors. After working even with technical clients that manage to misunderstand and come up with all sorts of troublesome reports of non-issues, it's easy to get complacent.
While it's not a good use of resources to run all sorts of tests for everyone, the tradeoff changes for you individually. Sorta like how the fox is only running for its lunch while the rabbit is running for its life. The limiting factor is probably the reliability of tests: get enough done and you'll find _something_ that looks wrong but isn't.
Wikipedia lists hospital error as the leading preventable cause of death[1]. The source used notes "Serious harm seems to be 10- to 20-fold more common than lethal harm.".
I'm a bit biased due to repeated experience. I lost one child due to being overly deferential to doctors instead of pushing a harder (trivially preventable issue). I saved another after flat-out rejecting the analysis of a nurse that appeared to be having trouble with simple math (after insisting on being re-evaluated, the child was rushed to emergency care; issue avoided - even got an apology).
It reminds me of patio11's advice on salary negotiation. A bit of discomfort while discussing the subject vs a large payoff. I'd prefer to feel a little uncomfortable and annoy a doctor with a few additional questions, piss of a nurse for double-checking their work, given the stakes.
You should not feel guilty getting second or third opinions for any serious diagnosis. It also discourages the moral hazard of diagnosing what is not there for personal profit.
The pain and cost of treating a disease that is not there costs society a lot more than doing a cheap verification.
The flipside of that is that patients might bias doctor's decision away from what was a good decision in the first place. I've had many American doctors be somewhat apologetic when they recommended no treatment, or a less invasive treatment. My response was that if they didn't recommend a treatment then I didn't want it either. There are real risks from any treatment.
The only time I ignored advice was when I went to a doctor for a cough, and because I mentioned chest pain (from coughing), they decided to get an EKG, which showed some abnormality. Apparently this abnormality is not uncommon in healthy people. They recommended more tests with a specialist, but I figured that a not uncommon result on a test, when doing that test wasn't justified by my original symptoms, didn't amount to enough evidence to go any further.
I will never fully forgive the nurse who informed me in 1998 that I had AIDS and that I needed set up a living will and get my affairs in order before I began experiencing "cognitive decline." It turned out I didn't have AIDS but a highly treatable parasitic infection from time spent working in the Amazon.
> The probability that one of these women [asymptomatic, aged 40 to 50, from a particular region, participating in mammography screening] has breast cancer is 0.8 percent. If a woman has breast cancer, the probability is 90 percent that she will have a positive mammogram. If a woman does not have breast cancer, the probability is 7 percent that she will still have a positive mammogram. Imagine a woman who has a positive mammogram. What is the probability that she actually has breast cancer?
That can be reworded to something much easier:
> Eight out of every 1,000 women have breast cancer. Of these 8 women with breast cancer, 7 will have a positive mammogram. Of the remaining 992 women who don't have breast cancer, some 70 will still have a positive mammogram. Imagine a sample of women who have positive mammograms in screening. How many of these women actually have breast cancer?
It's a good book and covers cases of misdiagnosed HIV.
If you find this article interesting you might consider the book "How Doctors Think". It's basically an entire book dedicated to the subject of misdiagnosis and how our modern medical system has some systematic flaws that contribute to it. If I think about just how often I'm incorrect in trying to diagnose an electronics or software problem, and how little time an average doctor spends on a problem, it's not surprising to me that anything that is remotely outside the norm could be easily misdiagnosed. For me the takeaway is to just accept that for common problems doctors can do a great job, but if you have a condition that is not making progress despite seeing a doctor be open to the fact their diagnosis could be incorrect. I had a minor problem with my ears a few months ago, went to a doctor, was given a diagnosis and treatment which temporarily improved the condition but did not seem to eliminate it. Went to another doctor a few weeks ago, given a different diagnosis and treatment. There you go.
Doctors know they are wrong all the time, but they must keep the cost of testing to a minimum while considering the more life-threatening possibilites first.
This story is a textbook example of bad reporting.
The headline and opening paragraph combine two completely different categories of error--"wrong" and "late"--so that it is possible to say "most Americans".
The story then goes on to talk exclusively about "wrong" as if that was the dominant category. "Late" is never mentioned.
The abstract of the ($60) report talks about errors only, but reading between the lines "late" is subsumed under the author's notion of "error".
So this story tells us nothing about the actual rate of misdiagnosis, but it leaves unwary readers with the probably false impression that "most Americans will experience misdiagnosis".
This is not to say that misdiagnosis is not a serious problem. But then, so is really bad reporting.
In my totally unauthoritative opinion the diagnostic process has been optimized to find the most likely cause as quickly as possible. This isn't a terrible strategy on the aggregate. It increase the overall likelihood that the most people will get the right diagnosis. But the trade-off is that some people will get the wrong diagnosis. The alternative would be for doctors to spend more time really digging into symptoms and tests to ensure they get it right the first time, every time, but then fewer people would get diagnosed.
This would be okay if doctors would accept the limitations of the system and admit when they don't know the correct diagnosis or are not sure. In that case they would say something like "This is the most likely diagnosis, but it doesn't meet your symptoms, you should seek a specialist" or something to that effect. I think what happens too often is that doctors confuse the most likely diagnosis with the correct diagnosis, possibly because they're unwilling to admit their fallibility.
This is an area, that currently available IT technologies could be of great help - if they were seriously deployed:
First, automated medical questionnaires before the visit can gather much more detailed information that a doctor in such a short visit, and display it to the doc in an efficient manner, while letting the doctor verify or ask more. There's a company doing this via tablets at clinics, forgot the name.
Second, medical expert systems(like Isabel healthcare) that could manage the extreme complexity of Healthcare, request missing data, offer an accurate list of possible diagnoses with probabilities without forgetting rare diseases. Basically Dr. House in a box.
But, I fully expect doctors to resist those systems, like in the past, because it takes away from their skill and makes their work boring.
But maybe we as consumers should demand this, both through the political process and through our consumer power?
False positives and false negatives are no fun. I presented with rather obvious signs of colon cancer, but due to my age and lack of family history, my GP misdiagnosed it as irritated hemorrhoids. A year later, I went back to him and he decided he better refer me to a specialist who diagnosed me with a 6cm tumor. Luckily that thoracic surgeon was pretty damn good at his job, and I'm here 10 years later to write this post.
Sometimes medicine is an easy diagnosis, sometimes outliers bite you in the ass...
How many of the people here react positively when members of their family share their "internet computer experience" when trying to fix a computer? Yeah, thought so.
Now, let's move on to the fact that the patient is saying "fix me" while the doctor is operating on "First, do no harm."
Now, translate that to some individual who is actively having a health problem that may be dangerous. But who doesn't want to hear things like "stop smoking", "stop drinking" and "get exercise" and wants a pill.
Now, add in people actively trying to scam you to get prescription medication.
Now, some people simply want to be told completely what to do because they don't have the capacity to make the decisions for themselves (cancer diagnoses in particular bring this out).
Finally, doctors are human and are sometimes having a bad day.
etc.
Dealing with people sucks and is an art rather than a science.
My experience with doctors has been this: if the doctor won't explain his reasoning or it isn't logical, I'm getting another doctor. This cleans out the idiots and the assholes.
The flips side is that if the doctor IS explaining something to you: shut the fuck up and listen. The quickest way to leap up the communication scale is to be so informed about what's happening that you can ask intelligent questions about the situation after an explanation.
Just remember, doctors are running with the probabilities.
A well-informed, logical patient is almost as improbable as an Ebola diagnosis.
>How many of the people here react positively when members of their family share their "internet computer experience" when trying to fix a computer? Yeah, thought so.
The difference is that people actually respect doctors and usually do what doctors tell them to--baring lack of money, time, or willpower, or some other quack like Andrew Wakefield telling them not to. Technology professionals by contrast aren't respected, and our advice (like "keep your software up to date") is often simply ignored regardless of how much we repeat it.
>Now, let's move on to the fact that the patient is saying "fix me" while the doctor is operating on "First, do no harm."
They're operating on "first, make as much money as we can." If they weren't, then medical bills wouldn't be the #1 cause of bankruptcy in the US.
>Now, add in people actively trying to scam you to get prescription medication.
Many countries (particularly in Latin America) don't allow doctors to act as gatekeepers to medicines and allow you to legally purchase almost any drug, with or without a prescription. To require otherwise is simply rent-seeking under the guise of protecting people from themselves.
>Just remember, doctors are running with the probabilities.
Its Occams Razor. There's never any point in a diagnosis other than the most common problem that shares your symptoms. Nobody is doing much to weigh the risks of false positive/negative vs each diagnosis' life-threatening properties. Even if they did, they'd have to measure life in dollars (the cost of tests etc) which is a losing game no matter how you play.
52 comments
[ 28.0 ms ] story [ 2064 ms ] threadI'm sure future humans will be horrified to learn that we walked around with barely no meaningful monitoring on our body stats for our whole lives... Only seeking out help when problems got big enough to be visible to the naked eye or bad enough to impair us.
It doesn't say how many, it doesn't say the consequences, it just says "most". And since people die, there's probably something we don't know.
That said, I'm not sure this problem as described is one that is even conceivably fixable at this scale. As in, I'm literally not sure that a machine that perfectly diagnoses all the health conditions of a person going forward is logically consistent.
How do we fix the current system? We could make a global centralized review system for doctors then start maintaing records of performance, mistakes due to just being a "bad doctor," mistakes due to just bad timing (patient complained too late to fix), mistakes due to being overworked ("seeing" 100 patients a day), etc.
Even with a global system of reviews and oversight, we'd need a way to evict the failing doctors or reduce their responsibilities.
It's a lot like the rampant police violence/corruption problems coming to light now because everybody has mobile video recorders. When everything is hidden, nobody notices and it's difficult getting anybody to believe you about widespread systemic failures.
What's the equivalent of a cell phone video for medical malpractice?
I wasn't waiting more than 5 minutes (for a walk in!), was seen by two doctors and at least one nurse, including a pulmonary specialist, got a chest x-ray, a breathing test, lots of stethoscope exams, and diagnosed (correctly!) with asthma. I don't remember how long I was seen for, but it was a very long time, for what most doctors would probably consider to be a fairly straightforward diagnosis. (Oh! And it was all free -- they didn't even bother to mail me a statement afterwards. I gave them a $20 bill for the co-pay, $5 for the prescription and that was the end of it)
Around the same time, a friend of mine, in a different school, going to a not great school clinic with his school's official insurance plan, was in a similar situation to yours, where a collapsed lung was misdiagnosed as "you're just tired, get more sleep," without an exam. (Granted, as an engineering major, he did need to get more sleep, but still!) As you might imagine, there were some pretty hefty hospital bills later on when his condition deteriorated...
Anyway, your situation sounds terrible, and I wouldn't be surprised if the collapsed lung misdiagnosis was fairly common. "Collapsed lung" just seems like one of those things that's really easy to misdiagnose (in some presentations, at least) as a number of other things, unless you're good with a stethoscope, and/or have access to medical imaging equipment (and the will to use it!). Ugh.
It's so absurd to me how fantastic and thorough my treatment was at one school (I was on the same insurance plan the students were), and how badly the screwed up a similar situation at a school just 10 miles away -- both with nearly equal tuition rates and health insurance plan costs.
This college clinic also misdiagnosed a pregnancy as "you stopped menstruating because of your low weight" in a friend of mine who came in, literally saying "I think I'm pregnant." (You'd think that would be the first test a college clinic would do!)
In both situations, they figured something was wrong a little while later, and surgery did the trick!
Glad it turned out well for you too!
Something tells me this wouldn't be a headline if you replaced "Americans" with "Mexicans" or "Norwegians".
Specialist #1 sent me to Specialist #2 who pretty much dismissed out of hand that the problems where related to his specialism but said he'd do the tests anyway, turns out I do have something that is under his specialism.
It's a bit frustrating tbh, the only doctor who's been awesome was the A&E consultant who basically said "this is not normal, march into your GP's and demand the following tests" had he not done that and I not followed his advice I'd still not know what was causing a significant part of the problems I was having nor that certain daily routine tasks could make things horrifically worse.
I basically love everything about living in America. I love this country. But one thing that I don't love here is primary medical care. It is so damn shitty compared to what is was in my home country of Brazil.
I don't understand what goes on here. I have to basically convince doctors to examine me. They treat me like they're doing me a favor. I'll usually leave the office with a recommendation to take ibuprofen or a prescription for antibiotics, and most of the times that doesn't address my concerns. Also, doctors here have this huge attitude that I don't recall ever seeing on a Brazilian doctor.
I can't fathom how the country with the most advance medicine in the world does so bad on primary care.
It is no secret that if you are well-to-do or wealthier in the US, then it offers you some of the best medical services and quality delivery you can buy anywhere in the world; the steady stream of medical tourism by the very wealthy non-US patients year-in and year-out attests to that. And if you are not so well-off in the US, then any complex medical complications requiring sophisticated treatment to survive can be a horrifically terrifying experience, depending upon your individual roll of the dice in our byzantine insurance maze.
While many US citizens decry "socialism" when single-payer systems are discussed, I personally believe Coase's Nature of the Firm might offer one possible solution set out of many possible such sets, in terms of a solution along the lines of co-ops.
http://www.slate.com/articles/business/moneybox/2013/02/amer...
Remember that next time you get a diagnosis. "Doctors practice medicine."
http://www.etymonline.com/index.php?term=practice
I mean, look, I totally get their side--you are paying them for their knowledge which they accumulated from years of practicing and years of specialized training. You SHOULD largely trust them. But doctors are also often overworked, and may not always specialize in your particular area. You also obviously have a much more vested interest in the outcome as a patient, so there's a decent chance you'll spend much more time researching it than your doctor.
All of this to ask..."how can we strike a balance?" If one has doubts about what their doctor is telling them, they can always get another opinion. I just wish there was a better way to vet any research one might do on their own without the doctor getting upset that you continued to look into the matter instead of just taking their word on it when things don't improve.
Personally, I have an awesome doctor, but when I have these concerns I preface them by saying "I recognize this is internet research, and I trust your opinions on these things, but I had X, Y and Z questions." They have always been perfectly happy to answer my questions and address my concerns (as I would hope given what they bill my insurance for a 15 minute visit...)
My go-to example here is a few years ago I had unbelievable abdominal pain for a day or two and saw a doctor about it. And the first thing the doctor thought it was -- gallstones, which I ended up having a mildly-complicated and expensive test for -- turned out to be completely wrong. But I don't fault the doctor for that: it was, given what I was experiencing and my family's medical history (multiple people who had to have their gallbladders out due to gallstones), the most likely cause, to such an extent that focusing on anything else until it had been ruled out would have been a bad idea.
(it turned out to be inflamed cartilage in my ribs, which was the second thing investigated, once the abdominal ultrasound ruled out gallstones)
So if a doctor can lag behind from an education standpoint, is that an opportunity for a patient to help fill in gaps if they are willing to invest time?
Please make no mistake, I largely agree that doctors are much better at considering the options and diagnosing accordingly. My point is that they are not omniscient, and new developments in medicine happen all the time. While a specialist might be expected to be more current in their specialty, a general practitioner might not be.
While it's not a good use of resources to run all sorts of tests for everyone, the tradeoff changes for you individually. Sorta like how the fox is only running for its lunch while the rabbit is running for its life. The limiting factor is probably the reliability of tests: get enough done and you'll find _something_ that looks wrong but isn't.
Wikipedia lists hospital error as the leading preventable cause of death[1]. The source used notes "Serious harm seems to be 10- to 20-fold more common than lethal harm.".
I'm a bit biased due to repeated experience. I lost one child due to being overly deferential to doctors instead of pushing a harder (trivially preventable issue). I saved another after flat-out rejecting the analysis of a nurse that appeared to be having trouble with simple math (after insisting on being re-evaluated, the child was rushed to emergency care; issue avoided - even got an apology).
It reminds me of patio11's advice on salary negotiation. A bit of discomfort while discussing the subject vs a large payoff. I'd prefer to feel a little uncomfortable and annoy a doctor with a few additional questions, piss of a nurse for double-checking their work, given the stakes.
https://en.wikipedia.org/wiki/Preventable_causes_of_death
The pain and cost of treating a disease that is not there costs society a lot more than doing a cheap verification.
The only time I ignored advice was when I went to a doctor for a cough, and because I mentioned chest pain (from coughing), they decided to get an EKG, which showed some abnormality. Apparently this abnormality is not uncommon in healthy people. They recommended more tests with a specialist, but I figured that a not uncommon result on a test, when doing that test wasn't justified by my original symptoms, didn't amount to enough evidence to go any further.
https://plus.maths.org/content/reckoning-risk
This is what most people struggle with:
> The probability that one of these women [asymptomatic, aged 40 to 50, from a particular region, participating in mammography screening] has breast cancer is 0.8 percent. If a woman has breast cancer, the probability is 90 percent that she will have a positive mammogram. If a woman does not have breast cancer, the probability is 7 percent that she will still have a positive mammogram. Imagine a woman who has a positive mammogram. What is the probability that she actually has breast cancer?
That can be reworded to something much easier:
> Eight out of every 1,000 women have breast cancer. Of these 8 women with breast cancer, 7 will have a positive mammogram. Of the remaining 992 women who don't have breast cancer, some 70 will still have a positive mammogram. Imagine a sample of women who have positive mammograms in screening. How many of these women actually have breast cancer?
It's a good book and covers cases of misdiagnosed HIV.
http://www.amazon.co.uk/gp/aw/d/0140297863
http://www.amazon.com/gp/aw/d/0140297863
https://en.wikipedia.org/wiki/How_Doctors_Think
https://en.wikipedia.org/wiki/Differential_diagnosis
Doctors know they are wrong all the time, but they must keep the cost of testing to a minimum while considering the more life-threatening possibilites first.
The headline and opening paragraph combine two completely different categories of error--"wrong" and "late"--so that it is possible to say "most Americans".
The story then goes on to talk exclusively about "wrong" as if that was the dominant category. "Late" is never mentioned.
The abstract of the ($60) report talks about errors only, but reading between the lines "late" is subsumed under the author's notion of "error".
So this story tells us nothing about the actual rate of misdiagnosis, but it leaves unwary readers with the probably false impression that "most Americans will experience misdiagnosis".
This is not to say that misdiagnosis is not a serious problem. But then, so is really bad reporting.
This would be okay if doctors would accept the limitations of the system and admit when they don't know the correct diagnosis or are not sure. In that case they would say something like "This is the most likely diagnosis, but it doesn't meet your symptoms, you should seek a specialist" or something to that effect. I think what happens too often is that doctors confuse the most likely diagnosis with the correct diagnosis, possibly because they're unwilling to admit their fallibility.
First, automated medical questionnaires before the visit can gather much more detailed information that a doctor in such a short visit, and display it to the doc in an efficient manner, while letting the doctor verify or ask more. There's a company doing this via tablets at clinics, forgot the name.
Second, medical expert systems(like Isabel healthcare) that could manage the extreme complexity of Healthcare, request missing data, offer an accurate list of possible diagnoses with probabilities without forgetting rare diseases. Basically Dr. House in a box.
But, I fully expect doctors to resist those systems, like in the past, because it takes away from their skill and makes their work boring.
But maybe we as consumers should demand this, both through the political process and through our consumer power?
Sometimes medicine is an easy diagnosis, sometimes outliers bite you in the ass...
Now, let's move on to the fact that the patient is saying "fix me" while the doctor is operating on "First, do no harm."
Now, translate that to some individual who is actively having a health problem that may be dangerous. But who doesn't want to hear things like "stop smoking", "stop drinking" and "get exercise" and wants a pill.
Now, add in people actively trying to scam you to get prescription medication.
Now, some people simply want to be told completely what to do because they don't have the capacity to make the decisions for themselves (cancer diagnoses in particular bring this out).
Finally, doctors are human and are sometimes having a bad day.
etc.
Dealing with people sucks and is an art rather than a science.
My experience with doctors has been this: if the doctor won't explain his reasoning or it isn't logical, I'm getting another doctor. This cleans out the idiots and the assholes.
The flips side is that if the doctor IS explaining something to you: shut the fuck up and listen. The quickest way to leap up the communication scale is to be so informed about what's happening that you can ask intelligent questions about the situation after an explanation.
Just remember, doctors are running with the probabilities.
A well-informed, logical patient is almost as improbable as an Ebola diagnosis.
The difference is that people actually respect doctors and usually do what doctors tell them to--baring lack of money, time, or willpower, or some other quack like Andrew Wakefield telling them not to. Technology professionals by contrast aren't respected, and our advice (like "keep your software up to date") is often simply ignored regardless of how much we repeat it.
>Now, let's move on to the fact that the patient is saying "fix me" while the doctor is operating on "First, do no harm."
They're operating on "first, make as much money as we can." If they weren't, then medical bills wouldn't be the #1 cause of bankruptcy in the US.
>Now, add in people actively trying to scam you to get prescription medication.
Many countries (particularly in Latin America) don't allow doctors to act as gatekeepers to medicines and allow you to legally purchase almost any drug, with or without a prescription. To require otherwise is simply rent-seeking under the guise of protecting people from themselves.
>Just remember, doctors are running with the probabilities.
and running with scissors in the dark, apparently: http://slatestarcodex.com/2013/12/17/statistical-literacy-am...
http://www.paulgraham.com/ambitious.html