Your take on the generally unscientific practice of medical diagnosis.

Discussion in 'General Science & Technology' started by squishysponge, Mar 4, 2006.

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  1. Billy T Use Sugar Cane Alcohol car Fuel Valued Senior Member

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    Again you are either not in touch with reality or not able to correctly read my post. I agree that doctors are rarely, if ever, sued because of the test they DO perform.

    The typical large judgement against a doctor that is "test related" (Not because he left a sponge inside, etc) concern the test he did NOT do. I clearly stated this. - That doctors do many tests than normally are NOT medically necessary in most cases to protect them selves against mal practice suits in the rare cases where the testing for highly unlikely diseases is infact desirable.

    I.e. a patient who is suffering from a rare disease, may not get the correct diagnosis promptly as they did not get the test that could indicate it promptly. The doctor initially falsely assumed they were not the 1 in 400,000 who gets disease X, which has the same symptoms as common diseases A, B, C, & D, which he did initially test for and found they were not the cause of the illness. Only later, and at some damage to the patient, which gives grounds for the suit, did the doctor order the testing for disease X. His ass is probably cooked, if patient get a half-competent lawyer.

    This has become so bad that many doctors now do tests, interiews, etc. to see if they even want to accept a new patient. - If you are a woman with history of child delivery problems and once again pregnate, or a previously operated on heart patient with new chest pains, etc. - God help you. Many doctors can no longer afford to take the risk. Thank your lawyer for that .

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    Last edited by a moderator: Mar 11, 2006
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  3. invert_nexus Ze do caixao Valued Senior Member

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    Ah. This would appear to be the old MD/PhD divide, eh?

    Scientists and researchers have long been the underdog in the divide. Poorly paid. Poorly appreciated. Scientists doing all the hard work while physicians get all the accolades.

    Here's one doctor whose diagnosis is never wrong.

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    Jocce,

    Yeah. Not very science-like, is it? Anecdotal or anything?




    Leeda,

    Sure about that? What do doctors really do...? Other than stick a finger up your ass every now and again...

    Doctors are on top in this schism for a simple reason. People are stupid and selfish and they see the doctor there with his finger up their ass but don't see the researcher tucked away in a lab somewhere researching colon cancer or what have you.

    People are short-sighted little bunnies, in other words.
    Hippity hoppity. Easter's on its way!

    Only when I'm the one suffering.



    Sponge,

    Well. Isn't that convenient?

    I find it difficult to believe, however.


    Anyway.
    Your point. Is simply that physicians should follow up initial diagnosis with testing to confirm said diagnosis. Correct?
    Nothing wrong with that. Except, of course, when the patient doesn't want or doesn't have the ability to pay for additional tests. Some tests are cheap and easy. Some tests aren't.
    But, your basic premise is sound, although you're rather aggressive about it. Especially for someone who proffessed a humble opinion in the opening post.


    A question. Should the physician wait until test results come back before prescribing treatment to the patient? What then would be the case if the patient should die or suffer harm in that waiting period?
     
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  5. squishysponge Registered Senior Member

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    You clearly dont even know anything about diagnostic tests and the nature of its implication on medicine.
     
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  7. squishysponge Registered Senior Member

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    Considering that english is very likely not your first language, I actually do find it hard to comprehend what you were/are saying.

    You are also sidetracking the argument with medical/social issues regarding medical treatment which was never the point of the debate. What you mentioned would be a medical malpractice case, whereby the patient will sue their health care provider for negligence, which has nothing to do with the diagnostic test, or its discussion this topic is about.
     
  8. squishysponge Registered Senior Member

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    Its only a logical and statistically theoretical fact that theres going to be more malpractice cases than are documented. There simply wont be 'proof' of the other cases because they will go unnoticed, etc.

    You are simply mixing social reasons into the point of my discussion. Of course there are going to be economic reasons, political reasons etc that will affect whether or not such a test will/can end up being implimented to backup the diagnosis. That is still besides the point I was asserting, that diagnosis is not valid enough without these tests performed, regardless of the realistic reality to the situation. However I did mention that through economic and innovative methods and initiatives, that diagnostic tests can be made much more readily available/cheaper/etc.

    The example you are refering to seems suitable only for emergency medicine/surgery, whereby prompt diagnosis and treatment is vital to patient survival. Chronic conditions have more time and will not qualify as your example. My answer is, that there are many pharmaceuticals and medical devices available to emergency doctors that provides them with many options to keep their patient alive. However these treatments are no cure but they are sometimes good enough to keep their patient alive until a better diagnosis can be made (assuming their illness and prognosis is not bad, no brain damage, etc). Antihistamines, anticoagulants, receptor antagonists, reactive enzymes, etc have very direct and immediate physiolgoical effects that can be used to try to keep the patient alive depending on their immediate vitals. Heart lung machines etc can also be employed.

    I mean they have many methods to try to keep their patient alive. All of this thogh is regardless of the point of post.
     
  9. madanthonywayne Morning in America Staff Member

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    This coming from the guy who goes on and on about doctors not ordering enough tests and then you complain that they order too many tests. Sounds like the doctor is damned if he does and damned if he doesn't in your book.

    BTW, I'm quite familiar with the use of diagnostic tests.
     
  10. squishysponge Registered Senior Member

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    71
    I guess apart from not knowing anything about medicine you also seem to lack the ability to comprehend and grasp the point on what has been discussed. Do tell me, where I asserted, instead of blindly accusing, that less tests are better.

    Also you were just a waste of time to even reply. i.e.

    --"Did you ever hear of false positives? If you give a test to a population with a low incidence of a condition, false positives will so far outnumber true diagnoses as to render the test practically useless."-you

    That is simply just totally wrong understanding of not only statistical theories, but yes, also the nature of diagnostic tests.

    --"Furthermore, as I mentioned previously, most acute problems will be resolved before any of your expensive and SLOW lab tests are even completed.

    If a patient has a chronic condition, of course lab work can be helpful and is ordered. Also, if a patient is suspected of having a life threatening condition, pertinent lab tests are ordered on an emergent basis." - you

    Again, lack understanding and insight.
     
  11. LeeDa Danger! Read with caution. Registered Senior Member

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    Invert Nexus

    I thought a scientist in a lab researching colon cancer is part of the "medical profession". "Medical profession" refers to the whole shibang doesn't it. If it doesn't then "get more (everyone) people involved in the whole shibang". Give average people (everyone) work to do. Im sure the work exists. Theres not enough being done, not enough people involved. Medicine is perverted in alot of ways (Michael Jackson?) but I guess I shouldn't expect anything less. Maybe in 10000 years. The flesh is weak but there is no spirit. Were ugly.
     
  12. madanthonywayne Morning in America Staff Member

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    I said:
    --"Did you ever hear of false positives? If you give a test to a population with a low incidence of a condition, false positives will so far outnumber true diagnoses as to render the test practically useless."
    You said:
    The concept I'm speaking of here is positive predictive value. Using a shotgun approach and ordering tests willy nilly is not only a waste of money, but not helpful.
    For a more specific reinforcement that it is I, not you, who knows what he is talking about:
    Sound familiar? Perhaps the author of this paper also has:
    Or maybe he, like me, has actual training in this area and is not just talking out of his ass?
    Clearly, since you aren't interested in facts, but in bashing the medical profession.
     
  13. squishysponge Registered Senior Member

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    71
    You are so ignorant its unbelievable.

    Every type of diagnostic test have their own confidence levels, but commercially available blood tests are deemed very accurate. You also plain lack perception. Diagnostic tests arnt just limited to blood tests. There are physical examinations, mris, xrays, etc - are all diagnostic tests.

    Also for the quote you are refering to is for lupus patients. It is like so common sense for anyone in the field to know that patients with systematic lupus have highly increased chances of error for serum antibody blood tests such as elisa. Lupus is an autoimmune disease with a hyperactive immune system. It is very likely that patients would have developed antibodies for many things, that increases the likelihood for those antibodies to react with the test enzymes in elisa, to show up as false positives. There have been numerous cases of false positives for lupus patients for HIV antibody tests because of this for example. However, given a normal patient, such tests are deemed highly accurate. Not to mention different diagnostic tests have different criterions to meet before conclusion is drawn. HIV tests for example go through both elisa and western blot. If the patient suffers from systematic lupus and they have a positive result, they will go through cd4+ cell count (without taking antivirals) and also go through viral load (PCR) tests to confirm diagnosis.

    You dont even know what you are tlaking about and pulling random things off the internet. Dont just pull one specialized case and thinks it applied to all diagnostic blood tests. It doesnt. Wise up please.
     
  14. madanthonywayne Morning in America Staff Member

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    The point of the example cited was to illustrate the limitations of testing. This was in response to your earlier statement:
    So we should test for everything without regard for the cost or the chance that the patient might actually have a particular condition. You went even further:
    So you're saying it's wrong that doctors only order tests when there is evidence to make the docor believe tests should be done

    PS Cut back on the ad homs. They do little to bolster your arguments.
     
  15. squishysponge Registered Senior Member

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    71
    That example you point out in hopes of backing up whatever your agenda was, shows how blindsighted you are.

    Those types of cases are outliers and are not within norms of the population. The attempt to use outlier statistics to try to reject the common hypothesis is just laughable. Even still, other tests could be ultilized to draw up the diagnosis through other means.

    So anyways you are still missing the whole point here. Thsi topic isnt even about diagnostic tests, but rather the fact that a doctor's diagnosis is not backed up by actually testing their patient, hense its an opinion rather than fact. You simply failed to follow through what is going on. For that reason you will be ignored until you really do have something tangible to say.
     
  16. invert_nexus Ze do caixao Valued Senior Member

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    Sponge,

    I don't understand how this is possible. Malpractice suits are a matter of record.
    Or are you saying that there are cases of negligence or whatever on the part of the physician that doesn't get prosecuted as malpractice? This is true enough. But, I wonder if it is counterbalanced by frivolous lawsuits?

    Yes. Social and economic. But, how can either of these facets be avoided?

    Consider the physician's plight. He must deal with the public. This is his function. Therefore he is held hostage by the social. And, the economic is a bottleneck in medical treatment. With all the malpractice lawsuits forcing physician's to pay such high insurance (and also drive their porsches) a common man is unable to pay for medical care. Health insurance is mandatory and gets paid out of both ends of the system. Leeches.

    Anyway. You can discuss the issue divorced from the social and economic, but to do so would be to break it down to an abstract that doesn't effectively represent reality.


    Not only have I discussed social and economic issues, but I've also discussed temporal issues as well. Do you think that we should look at diagnosis in a freeze-frame sort of way that removes the issue of urgency of treatment as well?


    And what is to be removed from the situation next?


    What exactly do you want to discuss here?

    Perhaps. Perhaps. But, then again. Didn't you just make a quick diagnosis?
    Heh.

    Emergency room visits have a greater sense of urgency involved, but I have little doubt that regular visits have their share.

    Also, one must consider the patient. To the patient, there is a sense of urgency no matter what the condition. The patient wants to be cured as quickly as possible. With the least amount of fuss. With the least amount of hassle.

    Also, bringing the issue back to the economic. Every visit to the doctor raises the rates. If you go in for a quick diagnosis followed by tests but must wait for the test results to come in before going back for treatment, then this immediately doubles the amount of money you're paying for your visit. And where does this cycle end? If the treatment isn't effective and further tests are required, there's another doubling. A visit. Then another visit for treatment. Etc...

    Yes. But they still require diagnosis without the benefit of test results. The situations are somewhat different, I agree. (One of the main differences, to the patient, is cost, by the way. The emergency room charges an arm and two legs while a regular visit is only an arm and a leg.)



    Leeda,

    Not at all. The researcher may be working on medical research, but the functions are quite different. The researcher works in a lab and works to advance the state of knowledge and etc... The physician works with the public and reaps the harvest of the researcher's work.

    It's true that the two areas intermingle at times, but there has been and will always be a divide between the phd and the md. Both sides look down on each other. Md's think Phd's couldn't afford med school. Phd's think Md's just want nice cars or want to play god. That sort of thing.


    They are not a single group.
    This is born out by the difference in their educations.
    Phd. Md.

    There was a recent article in Science about this. I thought it was funny how the story was told of a physician who thought to go to the lab to do some research and write a paper and become famous or win a nobel prize or something. Physician's have huge egos and he thought he'd just be able to waltz in and everything would go his way and wham bam fame and riches. Turns out he was wrong.

    Another story told in the article was how a researcher had spent several hours explaining to a physician the basics of pcr and how he could use it in his work. The researcher ended up staying late and missing some appointment or something. But, what pissed him off was that later he overheard the same doctor asking the same questions of some other researcher. The doctor didn't want to understand the pcr. He just wanted to be able to use it as a tool. Quick and easy.

    I think that last story really illustrates the differences between the two professions well.

    Of course, I'm neither a researcher nor a physician so I'm full of shit. But, that's my two cents.
     
  17. Lensman Registered Senior Member

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    Doctors are human. Humans make mistakes. The problem is our society has put doctors up on a pedestal and when they turn out to have "feet of clay" we feel betrayed.

    Doctors' diagnoses are checked regularly. Every time someone has a body part cut out by surgery, that part is sent to the Pathology department where it's examined to see if it really was pathological. If not, believe me the attending physicians will hear about it!

    Doctors are subject to peer review, and can have their license to practice medicine revoked. Surely everyone here is aware that this does happen. How many *other* professions are subject to having their legal ability to practice revoked by peer review? Doctors aren't subject to lesser standards than are other types of scientists-- they are subject to *greater* standards.

    I'm not in the medical profession, but I don't see anything going on in this thread but a bunch of doctor bashing by people who probably have had a bad experience either personally or by someone close to them.

    Yeah, and if wishes were fishes we'd all be rich. One of the reasons medical costs are spiraling out of control in the U.S. is that doctors are forced to make many unneeded tests in order to reduce the number of frivolous malpractice suits. Independant studies have shown that *most* tests performed are unneeded.
     
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