[hgomersall]

It's more complicated than that. Misdiagnosis comes with a high cost. What we emphatically do not have is a way to reliably confirm or stage without additional risky interventions, and that's before we even start discussing the mental health implications of misdiagnosis. So as a doctor, it's not about withholding information for the benefit of the patient, it's being aware that for many cancers, in aggregate, they may very well end up doing more harm than good if they screen for it.

[mathieutd]

I don't understand this logic at all. How can more information be bad? If you see a mass that looks very likely to not be cancer, for which the cost of further investigation is higher than the likely benefit, then the rational patient will agree not to investigate further. I don't see how more information can be bad unless you assume that the patient is an idiot or irrational.

[fidotron]

Exactly. You could even have the option of contributing your MRI scans to academic research so that future identification of cancer improves, and set up a happy feedback loop.

The scary truth is modern western medicine is primarily optimized to extract revenue while reducing spending and improving patient outcomes is merely a side effect of that process. Even in places such as the UK NHS it's all about not finding out things we don't want to know so we don't have to spend money dealing with it.

This is why I look forward to when we can replace doctors (not nurses) with AI.

[magicalist]

> The scary truth is modern western medicine is primarily optimized to extract revenue

MRI scans are a fantastic source of revenue, as are treatments for things that don't actually need to get treated. Reducing those things are actually doing the opposite of the motivation you're claiming.

[fidotron]

Those raise revenue. Actual spending involves effort which cannot be easily industrialized, and is only done to maintain the prestige of the industry.

This is why getting tested for something which results in endless prescriptions is done enthusiastically while a test for something which might find something which requires them doing actual work provokes the sort of self serving concerns expressed elsewhere.

[magicalist]

> This is why getting tested for something which results in endless prescriptions is done enthusiastically while a test for something which might find something which requires them doing actual work provokes the sort of self serving concerns expressed elsewhere.

You'll have to be more specific because right now this is just handwaving. What kind of "actual work" are you referring to?

It's generally actual medical researchers, who will neither get revenue or have to do actual work, who are objecting to excessive testing without patient outcome benefits.

[fidotron]

> You'll have to be more specific because right now this is just handwaving. What kind of "actual work" are you referring to?

Anything that isn't completely reduced to an industrial process. i.e. we want to have a simple no-effort repeatable billable outcome for this or we won't do it and will claim doing so is counter productive or dangerous.

> It's generally actual medical researchers, who will neither get revenue or have to do actual work, who are objecting to excessive testing without patient outcome benefits.

And they're doing the establishment's dirty work by doing so.

To provide a concrete example, I'm in Canada, and my other half had to pay for private MRI and ultrasound scans to identify a lump that she was laughed out of the room by three successive doctors for claiming she had. The MRI got her finally referred to a surgeon that announced he'd never seen anything like it, removes it, end of story.

That's far from an isolated case. I know people in the UK that literally died from these antics.

At one point I was invited to the opening of some medical simulation centre, and the speeches were enlightening. Two things stay with me: tests in India demonstrated that qualified doctors were no better than unqualified doctors except when the qualified doctors were told some of the patients were faking as part of an experiment and they are being observed, but mainly "I read a study that showed ~5-10% of people in US hospital are there because of a medical mistake from a previous visit, so I laughed and commissioned an equivalent study to show how much better we are in Canada, except for us it was >15%". The person telling that story was rightly disgusted. Those are not numbers for a profession that respects patients in the slightest.

You will forgive people with actual experience on the receiving end of this nonsense for thinking that maybe it's not actually setup to provide the assistance it claims to provide, and is primarily for the aggrandizement of those engaged in the rituals.

[steveBK123]

Yes. This to me is the same line of thinking as "in a meta study, wearing a helmet makes bikers more reckless and prone to injury so it's actually safer to be helmetless". No, actually it's safest to wear a helmet AND not become reckless.

So similar approach here - its safer to get the imaging AND remain rational in evaluating results & next steps.

[hgomersall]

Because further investigation is dangerous. So you see a mass which has an a posteriori probability of being cancer of 1%, but the investigation causes serious complications in 2% of cases, then the decision to investigate is not clear cut. The additional information has not only not helped but has led to additional stress.

[steveBK123]

Not all further investigation needs to be surgical. A mass that is found can be observed in decreasingly frequent ultrasounds or some other imaging and surgically investigated/removed only if found to be growing or passed a concerning size threshold.

A doctor jumping straight to invasive procedures seems to be a mix of poor risk management and rarity of this type of medical imaging.

My doctor for example, pointed out that actually in some East Asian countries, there are routine annual imaging tests done that pick up some of the types of cancer we do no screening for.

To me the reason we don't in US is simply how medical care is paid for - employer provided insurance, and some actuarial calculation that on the insured pool they'd spend more money on imaging than they'd save on high cost stage 4 cancer care. Personally I'm happy to advocate more for myself, even if it costs money.

[hgomersall]

Do you have any experience of cancer staging or medical imaging? It certainly sounds like you don't.

[bell-cot]

Both human nature and the legal system can be very hostile to "we didn't investigate anomaly A, B, C, D, E, ... in the patient's scans and test results, because none of them seemed likely to be worth the costs of doing so".