[GTP]

I understand your point, and I might even agree to some extent. However, the issue is that this isn't presented as an opportunity to do research, but as commoditizing a clinical test that, when it isn't done for medical reasons (i.e., investigating some existing symptoms), can lead to a lot of false positives.

[mapkkk]

This is exactly why it's a bad idea. I agree that if this technology comes to fruition, it should be in every clinical and research setting as a tool for us to further our understanding.

It shouldn't be a commodified test anyone can do at any time they feel like it. There are so many examples this leading to over or misdiagnosing already. I've seen patients who thought they had diabetes because they got a CGM over the counter and it showed a blood sugar spike during exercise (as in, their body doing exactly what it was supposed to do). He also now avoids oatmeal because "it spikes my blood sugar". Surprise: reddit and tiktok are awash with such stories as well.

I've seen a patient who on a whim decided to get 24hr blood pressure monitoring done, and thought they have severe hypertension because their systolic reached 170 when they were climbing stairs and during a football match because they were cheering and shouting.

In a similar vein, there are shady practicians who offer full body MRI scans, and fMRI brain scans to the well-to-do as a way of diagnosing things, when in fact neither are specific enough to actually diagnose something on their own.

23andme tests sending patients into clinics because they found a specific SNP that may be associated with worse outcomes for a disease.

We have neither the resources nor a specific enough technology (scan shows something: not specific enough to tell us what it is, but it sure is something) to unleash these for the general population to use.

[evrydayhustling]

Understood; these are the failure modes of cheap, weak tests in a system designed for expensive, high signal tests. I get that it is causing a real pain when these are introduced willy-nilly -- so is there a way for the medical system to evolve into making productive use of such signals?

Because the status quo is not working for a lot of folks in managing their own health, and just saying "it has to be this way" --while every other aspect of their life takes advantage of a wider range of options -- leaves them careening into MAHA style crazyness .

[mapkkk]

This is a tough problem for sure, and I resonate with your sentiment that something has to be done with it.

In my personal (fully anecdotal) view, I think clinicians desperately need to get better at communication, as well as meta-communication. Right now the rift between the patient and practitioner is enormous, because Drs do not take the time to dutifully explain things and processes, and what pitfalls there may be, and like you said, just boil it down to "it has to be this way" and shrug.

Some of this is down to systems design, i.e. not enough time per patient;insufficient support staff (simple example is no nurse being present to take down history concurrently as you spend time with the patient, or no dictation facilities available so you have to manually type everything down during the consult, eating away what precious time you have w/ the patient); a specialist getting bombarded with things a generalist should have treated w/ no referral needed; jurisdictions where violence towards healthcare workers is prevalent and so on..

But I would wager that compassionate listening and communication is the lion's share in why there's this huge rift. We currently do not teach effective communication in medical school, students just see how their attending treats a patient, and they copy their style. Which is funny, because the first thing we were taught in preliminary internal medicine was that 80% of making a diagnosis (any diagnosis) is down to history taking and communication.

As for how exactly we would get institutions to take communication seriously, I have no idea.