[timewizard]

> The hospital gets about 7,000 urgent skin cancer referrals each year, but only 5% turn out to be cancer.

It seems to be that you could be doing a _much_ better job of filtering this pipeline before it gets to this point. How can so many _urgent_ cases end up being negative?

They're using AI to solve a problem that probably shouldn't exist.

[RobinL]

The referral is just because a non expert can't be sure. The cost of the referral is relatively small, but the cost of getting it wrong is large.

Someone I know recently had a referral - it's pretty light touch, you just get a prompt appointment, and they do a minor op to remove the mole, and send it to the lab for testing. Luckily in their case, it wasn't cancer. But nothing in the process seemed weird, it was just the way of the GP escalating it because they couldn't be sure. Hypothetically, if the AI had been able to diagnose with higher certainty than the GP, all of this could have been avoided, so definitely room for improvement.

[alistairSH]

Do all cases in the UK start with a GP? No ability to go straight to a dermatologist? And are all dermatologists based out of hospitals?

In the US, we'd just go straight to a dermatologist, who would either remove it on the spot, or for a location that's liable to scar badly, refer to a specialist surgeon. For somebody fair skinned with lots of sun damage like myself, it's an annual "ritual".

[mattlondon]

Most UK health stuff starts with a GP appointment.

Even for private health care, you usually see a GP first (could be a private GP or NHS, in-person or video) and they then refer you to the next thing whatever that may be. ( N.B. that a NHS GP can give you a referral that you use for private treatment)

There are some things you can just straight up book an appointment for yourself without a referral from a GP, but 95% of the time you start with a GP.

No idea specifically about dermatologists, but my expectation would be that would be the sort of thing that would need a referral for. Perhaps for some "non-medical" procedures and 100% for cosmetic procedures you don't need a referral, but anything even tangentially close to The C Word would almost certainly be sending you down the normal channels.

[alistairSH]

I wonder what % of GP skin consults result in a referral? If it’s even remotely close to a majority, seems like it would be better just going straight to the dermatologist.

Sample of one, but every spot (5+ over the past decade) I’ve asked my dermatologist about has resulted in a biopsy and of those several were cancer.

[fn-mote]

> every spot (5+ over the past decade) I’ve asked my dermatologist about has resulted in a biopsy

Not to be too cynical but... is there a financial incentive for them to do a biopsy?

Of course it might be best practice as well.

[alistairSH]

I’m sure there is an incentive, but at least in my case the rate of biopsy to confirm cancers is greater than 50% so it certainly seems to me like the biopsies are in fact warranted.

[fn-mote]

> In the US, we'd just go straight to a dermatologist

In the US, you would go straight to a dermatologist, because your health insurance plan (or high paying job) allows you to do that.

People with an HMO would begin with the GP, because that's what the plan requires.

[ClumsyPilot]

> Do all cases in the UK start with a GP?

yes, and in the entire GP practice they do not have a single device invented in the 21st century. All the tools they have are a stethoscope, oxymeter, otoscope, blood pressure monitor, basically stuff you might have at home

They can't, for example, do a rapid antigen test or a lateral flow test, ultrasound or anything else you may consider a sign of modern medicine and diagnostics. Stuff countries in Eastern Europe and East Asia have already adopted.

Their diagnostic conclusion is heavily influenced by a spreadsheet that lists statistic probability of illness for different demographics, as advised Mckinsey.

If you happen to have a serious condition but fall into a group that is 'suppose to be' healthy (young man with Pneumonia) you will be bounced and told to go home until your condition deteriorates.

They will gatekeep you from getting an X-ray. When your condition deteriorates and is incontrovertible you will be taken seriously, but now you need serious treatment instead of a quick round of antibiotics.

Popular opinion in Britain is that the NHS is great, but it's overburdened. But it's fallen behind - management practices are archaic, diagnostics is poor, and there is lack of accountability and first reaction to medical errors is to brush off the patients / victims.

Over the past few decades, the first reaction of NHS management is to cover up their mistakes.

Just read the Wiki page about Great Ormond Street Hospitalk, the hospital that treats the country's most severely ill children:

> Great Ormond Street Hospital was involved in a scandal regarding the removal of live tissue and organs from children during surgery and onward sale to pharmaceutical companies without the knowledge of parents in 2001

Or the case with bone surgeon Yaser Jabbar, at the same hospital, who caused severe harm to 22 children and the hospital fought the parents and brushed issues under the carpet. Issues like removing wrong organ and getting length of a foot wrong by 20 centimeters. He operated on 700 children before someone put a stop to it

[alistairSH]

And why are skin cancers being referred to a hospital at all?

Personal experience in the US... treatment can be done on the spot at the primary dermatologist's office (curettage usually) or referred either to a Mohs specialist or a plastic surgeon (both of whom usually treat at their office). Short of a melanoma that's progressed/metastasized, I don't think I've ever heard of a skin cancer being treated at a hospital (not saying it doesn't happen, only that that would be an exception, based on personal/family/friend experiences).

[pixl97]

I don't really know anything about the UK medical system, but my guess is comparing it with how the US works isn't a good fit.

Just doing a quick google search on dermatologists in the UK mostly pointed at hospitals that offered the service, so may have something to do with that.

[jgerrish]

> And why are skin cancers being referred to a hospital at all?

I'm working on deciphering the Google Mock API right now. It's just one of those fucking things you do, you know? Figuring out how to set expectations on parameters, etc. Hundreds of thousands of SDEs and students went through it before it became second nature.

I dream of playing around with some future testing language where I can build mock blocks in a Scratch-like manner. Awesome, eh?

Fuck yeah, Alan Kay.

Maybe I could work on the team that builds it.

But who am I kidding? I get to be pushed into other work while I waste time to filling out unnecessary tax paperwork.

Because to get more medical lab work done, I need to have authentic IRS transcripts.

A written 1040 isn't enough.

Otherwise I have to go to the hospital to get imaging.

It wasn't necessary. Signed fully electronic non-forgible IRS forms for health purposes could have been done with minimal citizen pushback.

With, and this is key, an educated public who understood the economics.

So I'll work on wasting my time educating loved ones on the economics of paper-less forms and all forms of monopolies while I say no to future shows in Chicago or Canada or wherever.