Your take on the generally unscientific practice of medical diagnosis.

[squishysponge]

Of course, if you life in fantasy land where such mundane things as time and cost doesn't matter.

Except, this is a discussion. And you were one of those that dont believe in testing.

Also, a lot of things we have now, we didnt have in the past because they were unavailable or due to cost issues. That didnt stop us eventually having them today. Its purely economics and innovation. Problems with costs can easily be overcome given the right amount of effort put into solving the problem. Testing can be made cheap. There just needs to be a strucural change of the health industry.

 

[Mr Anonymous]

Em.... forgive me here, but isn't somewhat rather all of the above really the equivalent of saying: "And one day we'll all have heli-cars and some of us will fly to work of a morning using our personal jet packs and really it will all be simply, incredibly marvellous!"

The one day, in the future, all it takes... etc, scenario. Sure, works great on paper and if it was any way like as easy as you seem convinced to implement, why do things the hard way as they are done if not for the reason, though haphazard and not in the slightest 100% efficient - in the main primary diagnosis works and its the only means available?

Given the last time I actually saw my previous GP was over 10 years ago on an edition of Panorama investigating prescription fraud, I'm seriously no great fan at all of either GP's nor the GP system and getting adequate treatment I've always found a matter of sheer pot luck rather than service guaranteed - but given the incredible scale of things it's simply possible for the average human being to undergo, healthwise, how exactly does one provide a reliable test for everything without some means of narrowing down the search criteria?

Basically, via making diagnosis as is done.

 

[mountainhare]

squishy:

However the practice of medical diagnosis is very often, in my very humble and frankly honest opinion, to be one that is highly speculative, very unsciencelike and plagued by a lot of speculation, guesswork, mistakes and ignorance.

Gross exaggeration.

You complain about a lack of testing, yet doctors often have solid reasons for with-holding certain tests. It's all about probability. If the probability of a particular individual having a disease is incredibly low, then doctors will not waste the time or taxpayer money on a test. It's quite easy for you to squeal for testing, but tests such as a CAT scan, an MRI or an ultrasound can cost thousands of dollars. Endscopys and gastrocopys can cost hundreds of dollars. Expecting to be given an MRI every time you have a stomach ache is unfeasible.

For example, if a four year old child comes into the surgery with diarrhea and a bit of vomiting, and a fever, then the doctor will give a diagnosis of 'probable mild gastro infection'.
Guesswork? Not really. It's called making inferences, and accepting the most reasonable explaination which fits the evidence. Children get gastro infections all of the time.

If the child comes back a week later with even worse vomiting and diarrhea, the doctor will take samples and send them off to the lab. If a bacteria is found, the doctor will state 'food poisoning', and give a strong round of antibiotics.

If no such things are found, then the doctor will then test for lactose intolerance, Celiac disease, etc. All of these tests are done WHEN and IF required, not on some whim.

Quite simply, a doctor is in a better position to know what tests to give a patient than you are. So shut your yap and quit bitching. Unless you are willing to pay for an MRI every time you feel a bit ill, stop complaining.

 

[squishysponge]

Em.... forgive me here, but isn't somewhat rather all of the above really the equivalent of saying: "And one day we'll all have heli-cars and some of us will fly to work of a morning using our personal jet packs and really it will all be simply, incredibly marvellous!"

The one day, in the future, all it takes... etc, scenario. Sure, works great on paper and if it was any way like as easy as you seem convinced to implement, why do things the hard way as they are done if not for the reason, though haphazard and not in the slightest 100% efficient - in the main primary diagnosis works and its the only means available?

Given the last time I actually saw my previous GP was over 10 years ago on an edition of Panorama investigating prescription fraud, I'm seriously no great fan at all of either GP's nor the GP system and getting adequate treatment I've always found a matter of sheer pot luck rather than service guaranteed - but given the incredible scale of things it's simply possible for the average human being to undergo, healthwise, how exactly does one provide a reliable test for everything without some means of narrowing down the search criteria?

Basically, via making diagnosis as is done.

Yes it would be great if the present holds what we can only dream of in the future. Sure. Doesnt dismiss the fact that the current system isnt good. And plus, the point of the post is a discussion of the nature of diagnostic medicine not about improving health care.

 

[squishysponge]

squishy:

Gross exaggeration.

You complain about a lack of testing, yet doctors often have solid reasons for with-holding certain tests. It's all about probability. If the probability of a particular individual having a disease is incredibly low, then doctors will not waste the time or taxpayer money on a test. It's quite easy for you to squeal for testing, but tests such as a CAT scan, an MRI or an ultrasound can cost thousands of dollars. Endscopys and gastrocopys can cost hundreds of dollars. Expecting to be given an MRI every time you have a stomach ache is unfeasible.

For example, if a four year old child comes into the surgery with diarrhea and a bit of vomiting, and a fever, then the doctor will give a diagnosis of 'probable mild gastro infection'.
Guesswork? Not really. It's called making inferences, and accepting the most reasonable explaination which fits the evidence. Children get gastro infections all of the time.

If the child comes back a week later with even worse vomiting and diarrhea, the doctor will take samples and send them off to the lab. If a bacteria is found, the doctor will state 'food poisoning', and give a strong round of antibiotics.

If no such things are found, then the doctor will then test for lactose intolerance, Celiac disease, etc. All of these tests are done WHEN and IF required, not on some whim.

Quite simply, a doctor is in a better position to know what tests to give a patient than you are. So shut your yap and quit bitching. Unless you are willing to pay for an MRI every time you feel a bit ill, stop complaining.

Health care used to be about draining patients 'tainted' blood because they believed draining out the bad blood could make them feel better. Far from the truth. Gloves weren't worn during surgery before. Widely used today. Today, latex is becomming weeded out of the health care system due to allergic hypersensitivity so even the gloves that surgeons were used to are changing. In the future robots will be used for surgery.

All these changes were implimented and helped improve the health care structure and medical practice we know today. Regardless of the fact that all of those changes before them were also unfeasable and deemed unneccessary, these changes still took place for all the things you people simply take for granted today. All of your arguments right now for the current state of diagnostic practices shows me that you are just naive because the current system we have is anything but solid. For me and as Im sure with a major majority of scientists and doctors who understand the flaws of this system, will unlike you - not be contempt with the system naturally want to find ways to improve this system for a better future.

First off, you dont go to surgery right off the bat for diarrhea and vomitting. The correct term is also called 'gastointestinal'. Secondly, anyone who has GI problems for over a week means there is something wrong with them and requires immediate care; also at the same time proving that your doctors first diagnosis was flawed or he was incompetatnt to help his patient - which goes to show the flaw of the diagnostic system.

Also, testing for lactose intollerance isnt even expensive. Dont just go around searching for these things and posting them on here and think its going to help your argument. It can only help your argument if you know what you are talking about and obviously it appears to me you are just searching random facts from the internet and using it here. To test for lactose intollerace is as simple as taking a small shot of lactose, and simply waiting around 2-3 hours to see if there is immediate bowel movement.

 

[mountainhare]

Squishy:

The correct term is also called 'gastointestinal'.

Lollerskates! Talk about semantics and nitpicking, as well as a dash of arrogance! Since you're a fan of nitpicks, may I point out that it is 'gastrointestinal'.

First off, you dont go to surgery right off the bat for diarrhea and vomitting.

It really depends what other symptoms there are, and on the person's age. However, my point was that merely because one is ill, does not mean that that individual should be subjected to every diagnostic test under the sun.

Also, testing for lactose intollerance isnt even expensive. Dont just go around searching for these things and posting them on here and think its going to help your argument. To test for lactose intollerace is as simple as taking a small shot of lactose, and simply waiting around 2-3 hours to see if there is immediate bowel movement.

LOL. That's not how it works at all, dumbass. The patient is given some lactose, and then the amount of hydrogen in their breath is measured. However, this isn't a surefire test, and there is a lot of uncertainty. So quite often, individuals with suspected lactose intolerance undergo an endoscopy to determine whether they can digest lactose. And may I point out that even lactose tests can be expensive. They take about 30+ minutes, and seeing a doctor is quite expensive in many parts of the world.

Oh, and as to your claim that I'm pulling 'random facts' off the internet. I'm a student of Biomedical Science, and all of what I am stating here comes from my coursework. Oops, you look rather stupid now, don't you? I'm guessing that you're a 1st year med student who's feeling rather cocky after attending a lecture regarding medicine in society.

Thus, it doesn't surprise me that you frown on independent research. What's wrong with an individual researching a topic via the internet, and then using this knowledge in a discussion? Do you think that the only 'credible' knowledge is the stuff heard in lecture halls? Are you so arrogant as to think that your little lectures are the only way to learn? Perhaps word of mouth was the only way to pass knowledge on in the stone age, but we live in the age of technology now. All you have to do is crack open a book, or Google a term, and you have an answer.

For me and as Im sure with a major majority of scientists and doctors who understand the flaws of this system, will unlike you - not be contempt with the system naturally want to find ways to improve this system for a better future.

Who denied that the system can be improved? You've just erected a massive strawman, and I'm starting to question why I'm even dignifying your drivel with a response.

You initially claimed that medical diagnosis is "highly speculative, very unsciencelike and plagued by a lot of speculation, guesswork, mistakes and ignorance."

I'm objecting to your above claim, because it's bullshit. Whether the system is 'perfect' is not relevant.

 

[Jocce]

squishysponge: I think everyone would like to see better medical care but the way you desribe the current state of it doesn't fit with my own observations so I beg to differ.

It would also be very nice if you quit trying to belittle people who have different experiences than you're having. You say doctors suck, I don't think they do. Does that prove I don't know enough? You come across as slightly immature in those kinds of responses.

 

[gsys]

I can attest to the occasional fallibility of the diagnostic method as practiced in the US. As a child I was told for weeks that my abdominal pains were the "flu" before my parents convinced them to do some real testing, which revealed that I had Crohn's Disease.

 

[Mr Anonymous]

Yes it would be great if the present holds what we can only dream of in the future. Sure. Doesnt dismiss the fact that the current system isnt good. And plus, the point of the post is a discussion of the nature of diagnostic medicine not about improving health care.

I gather you mean there, "diagnostic treatment" rather than medicine - with respect to which my initial statement still stands. There remain a myriad of aliments and conditions which both can and do effect the human body - far too many than can be in anyway determined by one specific set of generalised tests.

The process of making a diagnosis is one of determine specific search criteria only - without applying that, how else can one reduce the search for a probable cause of aliment?

 

[squishysponge]

Squishy:

Lollerskates! Talk about semantics and nitpicking, as well as a dash of arrogance! Since you're a fan of nitpicks, may I point out that it is 'gastrointestinal'.


It really depends what other symptoms there are, and on the person's age. However, my point was that merely because one is ill, does not mean that that individual should be subjected to every diagnostic test under the sun.


LOL. That's not how it works at all, dumbass. The patient is given some lactose, and then the amount of hydrogen in their breath is measured. However, this isn't a surefire test, and there is a lot of uncertainty. So quite often, individuals with suspected lactose intolerance undergo an endoscopy to determine whether they can digest lactose. And may I point out that even lactose tests can be expensive. They take about 30+ minutes, and seeing a doctor is quite expensive in many parts of the world.

Oh, and as to your claim that I'm pulling 'random facts' off the internet. I'm a student of Biomedical Science, and all of what I am stating here comes from my coursework. Oops, you look rather stupid now, don't you? I'm guessing that you're a 1st year med student who's feeling rather cocky after attending a lecture regarding medicine in society.

Thus, it doesn't surprise me that you frown on independent research. What's wrong with an individual researching a topic via the internet, and then using this knowledge in a discussion? Do you think that the only 'credible' knowledge is the stuff heard in lecture halls? Are you so arrogant as to think that your little lectures are the only way to learn? Perhaps word of mouth was the only way to pass knowledge on in the stone age, but we live in the age of technology now. All you have to do is crack open a book, or Google a term, and you have an answer.


Who denied that the system can be improved? You've just erected a massive strawman, and I'm starting to question why I'm even dignifying your drivel with a response.

You initially claimed that medical diagnosis is "highly speculative, very unsciencelike and plagued by a lot of speculation, guesswork, mistakes and ignorance."

I'm objecting to your above claim, because it's bullshit. Whether the system is 'perfect' is not relevant.

Mine was a spelling mistake. Yours was an incorrect terminology. Huge difference.

No, it is not dependent on age and symptoms. You make belief diagnosis and treatment isnt even right. You subscribe the patient to lactose intollerance test for vomitting and fever? And you suggest surgery.

Look. I am a firm believer of merit based arguments/debates instead of having to pull ranks and put qualifications on the board to overshadow people's comments/ideas. Therefore I will not bring out my qualification for that matter and you should be ashamed to have to attempt to out rank me by doing so, in order to get your point across.

Also it is now extremely obvious to me you just dont know what you are talking about and just searching online for facts. Dont just search sites on yahoo and wikipedia and expect those to be the absolute truth. Its probably better to learn from real textbooks biosci major.

There are many types of tests for lactose intollerance. Hydrogen level in breath is one of them. The other is the one I mentioned, which is basically bowel movement within the next 2-3 hours (guarenteed, that given a correct high dose of lactose to a lactose intollerant patient, and they will have bowel movement within 2-3 hours guarenteed). Another test which obviously you would have never guessed is blood test. However due to limitations of apparatus of methods available to some physicians, it really depends which method the doctor wants to use to test the lactose intollerance on their patients.

 

[squishysponge]

Oh I just saw your other points. No, lactose intollerance tests are not expensive at all. With the bowel movement test I mentioned, you can even do this at home technically by drinking a lot of milk. Except @ a physicians office, they give you a shot of pure lactose.

Plus the test is patient based. Physiologically everybody is lactose intollerent to some extent. Its how much lactose intollerant you are that matter and how much dairy product you consume relative to how much it affects you which counts. The most definitive test in my opinion is the bowel movement test as it is cheapest, reliable and a definate indicator. Also I would never suggest a intestinal biopsy to have to prove lactose intollerance because that is simply overkill. The negative impact of such a test completely overshadows the advantage of a diagnosis (which can easily be done by other non invasive methods, costs less).

 

[squishysponge]

I gather you mean there, "diagnostic treatment" rather than medicine - with respect to which my initial statement still stands. There remain a myriad of aliments and conditions which both can and do effect the human body - far too many than can be in anyway determined by one specific set of generalised tests.

The process of making a diagnosis is one of determine specific search criteria only - without applying that, how else can one reduce the search for a probable cause of aliment?

The point is it doesnt matter. Im not here to try to find a new way in which 1 test can be taken to diagnose all symptoms. That in fact is impossible at the moment given available testing methods (blood, urine, xray mri, etc because no 1 way can find all diseases).

Of course there has to be a diagnosis first. As long as human doctors are still around, thats what has to be done. Except presently, after such diagnosis (assuming a capable doctor), then theres another hurdle and that it gathering real proof using testing methods. Thats what is lacking right now. Tests are not generally assigned to backup the diagnosis..

Therefore my point is, your point is irrelavent because you are talking about making 1 test for everything, when Im pointint out we make diagnosis without tests to prove the diagnosis.

 

[squishysponge]

I can attest to the occasional fallibility of the diagnostic method as practiced in the US. As a child I was told for weeks that my abdominal pains were the "flu" before my parents convinced them to do some real testing, which revealed that I had Crohn's Disease.

I feel sorry for you. Your case is the exact type of problem Im talking about that can arise from the flawed system in diagnosis.

The problem with some physicians also, are their general attitude towards a lot of their patients. They tend to force/convince you that it is not a serious problem and that you are wasting your/and their time, such that you become hesitant to go see them again given the same symptoms unless it is really bad. Its the negative social effect of the system; but thats regardless of the point of the post.

 

[Jocce]

Its the negative social effect of the system.

What system?

 

[GeoffP]

Just a little side-sniping from me to dear old mountainhare. He bitched on and on in another thread about my "appeal to credentials" and yet here I find him taking the same road.

My, my. Perhaps he confused "Hippocratic" with "hypocritical"?

Oh, and as to your claim that I'm pulling 'random facts' off the internet. I'm a student of Biomedical Science, and all of what I am stating here comes from my coursework. Oops, you look rather stupid now, don't you? I'm guessing that you're a 1st year med student who's feeling rather cocky after attending a lecture regarding medicine in society.

Here, too, he goes off about how the system doesn't need to be perfect to be valid, yet had no idea about how probability works, and tried to dismiss standard probability reporting as being uncertain in his argument with me:

I'm objecting to your above claim, because it's bullshit. Whether the system is 'perfect' is not relevant.

Hypocrisy, thy handle is "mountainhare".

Geoff

 

[Hercules Rockefeller]

However the practice of medical diagnosis is very often, in my very humble and frankly honest opinion, to be one that is highly speculative, very unsciencelike and plagued by a lot of speculation, guesswork, mistakes and ignorance.

What do you think about the general practice of diagnosis by doctors?

I accept that your opinion is humble and honest, but I disagree with it. Doctors are human just like you and me. They make mistakes. They sometimes succumb to self-interest. But to suggest that doctors as a whole are ignorant and un-science-like is ludicrous. Modern medicine is grounded in science and this is the standpoint from which doctors are taught and the standpoint from which they practice and diagnose. I know, I’ve taught basic biochemistry and genetics to many undergrad doctors. You will always be able to find some counter-examples, and you cannot always get away from some logical guesswork in diagnosis, but the over-whelming majority of medical diagnosis is most definitely scientific and logical.<P>

 

[squishysponge]

I accept that your opinion is humble and honest, but I disagree with it. Doctors are human just like you and me. They make mistakes. They sometimes succumb to self-interest. But to suggest that doctors as a whole are ignorant and un-science-like is ludicrous. Modern medicine is grounded in science and this is the standpoint from which doctors are taught and the standpoint from which they practice and diagnose. I know, I’ve taught basic biochemistry and genetics to many undergrad doctors. You will always be able to find some counter-examples, and you cannot always get away from some logical guesswork in diagnosis, but the over-whelming majority of medical diagnosis is most definitely scientific and logical.<P>

I never claimed the practice of medicine is unscientific. I mentioned diagnostic practices are unsciencelike because diagnosis is rarely backed up by scientific proof based on tests.

Just because their knowledge base, is based on scientific studies and knowledge, does not mean their actual practice of diagnosis on their patient is concrete and science-like because a lot of times diagnosis is guessing the most probable cause of symptoms, based on their knowledge of medicine. You may want to argue that is the logical approach; but I will rather say it is unsciencelike. Diagnostic practices now still have too much opinionizing, socializing and communication factors in it to be, for me, considered one that is truely scientific. A scientific diagnosis will be based purely on facts and results regardless of what anyone's opinion is.


But even still, the practice of medicine itself is not concrete either. If you were aware, then you'd know that alot of times medication is prescribed to patients in hopes it is theraputic to them; hoping at the same time no complications arise such as allergic reactions, liver damage, kidney damage, etc. All the while just hoping that it works, and if it doesnt, or if the diagnosis is incorrect, another medicine will be prescribed and hope this other one works. Even though, modern pharmaceuticals have fairly specific physiological/biomechanical/neurological effects and properties that can be prescribed to achieve desired theraputic effects, all of this is still patient based and how they react to them. Until the day we can surely say that one method will definately work, but untill then the practice of medicine is still not concrete.

 

[Billy T]

....Just because their knowledge base, is based on scientific studies and knowledge, does not mean their actual practice of diagnosis on their patient is concrete and science-like because a lot of times diagnosis is guessing the most probable cause of symptoms, based on their knowledge of medicine. You may want to argue that is the logical approach; but I will rather say it is unsciencelike. Diagnostic practices now still have too much opinionizing, socializing and communication factors in it to be, for me, considered one that is truely scientific. A scientific diagnosis will be based purely on facts and results regardless of what anyone's opinion is.

Not at all in touch with reality, but I do not want to jump to any conclusion about your mental health without more scientific tests.

Each humans is unique biochemical systems. Think what the implies.

Yes, typical symptoms are used to select which quantative tests to apply, but often (and at considerable extra expense) many more tests are applied that normal medical expectations could at least delay, if not avoid entirely, if the most probable diagnose is definitly confirmed. These unneeded tests may have some risks for the patient, but the doctor can not run too great a risk (from legal attack - in unusual case situations) from the lawyers etc.

 

[squishysponge]

Not at all in touch with reality, but I do not want to jump to any conclusion about your mental health without more scientific tests.

Each humans is unique biochemical systems. Think what the implies.

Yes, typical symptoms are used to select which quantative tests to apply, but often (and at considerable extra expense) many more tests are applied that normal medical expectations could at least delay, if not avoid entirely, if the most probable diagnose is definitly confirmed. These unneeded tests may have some risks for the patient, but the doctor can not run too great a risk (from legal attack - in unusual case situations) from the lawyers etc.

You are at lost on the whole situation here. My arguments were never to presume the idea that every patient should get tested for every single possible known disease and condition, everytime they check themselves in to seek medical help. The point has always been, that the practice of medical diagnosis is frankly not good enough because diagnosis are generally made without proof from tests (which will be specific to the possible causes based on symptoms).

Apart from that you also seem to lack insight. Medical malpractice is certainly a risk that every health provider should be wary of. However, it is generally unlikely that patients will press charges against their health provider due to diagnostic tests unless there is clearly some sort of misconduct or negligence (such as unintended harm caused to patient due to negligence, etc). Apart from that, the law in north america as I know it, gives patients no legal grounds on which to sue their health provider for giving them their test results, or for performing diagnostic tests, in which the patient has agreed on and has been informed of all related risks.

 

[madanthonywayne]

Of course, if you life in fantasy land where such mundane things as time and cost doesn't matter.

And that's not the only reason testing isn't always better. 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.

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.

Medicine is an ART. We are dealing with people, not test tubes. Doctors are not gods and are not always right. They gather as much data as they can and treat the patient to the best of their ability based on their experience, their scientific knowledge, and their intuitive understanding of each individual case.