Medpundit comments on the recent study suggesting that mammograms expose many to unnecessary treatment. The trouble with screening tests is that the problem of a false positive is a tough sell:
Most people want everything done just to make sure they’re OK and that nothing gets missed. The problem is that those unnecessary procedures cost money. Most of the time, it’s the government’s or the insurance company’s money, so no one cares.
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{ 7 comments }
I think that this mentality is, sadly, very widespread. It’s evidenced in the very terminology that’s used to describe various types of health care systems. How many times have you heard someone on the left refer to socialized medicine as “free”? It’s not just misleading, it’s blatantly false, but that doesn’t stop many people from framing it that way. You can’t make people look at the whole picture when they only want to see part of it.
I disagree. I just had a baby and I complained (and laughed a lot) that I was having way too many tests – they told me my chances of having a baby with Down’s Syndrome based on stats like age were 1 in 5,000, which was plenty comforting to me, and then they had me do a blood test so they could tell me the odds were really 1 in 50,000 or was in 1 in 500,000? The numbers stopped meaning anything to me and the time it took get a bunch of negative results to rare problems was a pain and caused a lot of unnecessary worry.
“I just had a baby and I complained (and laughed a lot) that I was having way too many tests – “
But would you have sued the OB-GYN if you had not been offered the test and had a Baby with Downs? I mean you could have aborted in that case. A wrongful Birth suit?
Anon at 4:15 – you cannot blame everything on litigation. There is no fear of litigation in having a website or being a doctor on TV or answering questions on some ask-the-doctor websites. Yet, quite a lot of them promote tests. Very few mention overdiagnosis among risks; yet fewer explain how it affects incidence.
Don’t blame patients for the lack of information. And some patients really don’t want tests. But they are “convinced” and “persuaded” and labelled irresponsible.
Stormy, you realize that you have a right to say “I don’t want it” if you feel you don’t want a test to rule out 1 in 5000 chance of something bad? You just need to be really sure this is really what you want.
Sorry Diora you don’t practice medicine. I do and I work with OB’s (thank god I am not one). The frequency of trisomy 21 is around 1:600 (not 1:5000) for all comers and increases substantially with “older” mothers (we don’t know her age). Is that really all that rare? Nobody is labeling her irresponsible (despite your insinuation) but a frank conversation must be held with the patient as to reasons for doing/not doing tests and the risks involved either way. Unfortunately if this discussion is not held and the baby has a problem….well you know how John Edwards made his millions now don’t you.
I agree with anon 923. Look at it this way: What else negative do doctors have to worry about other then being sued? TYhey make a comfortable living, they generally get respect (unless they work in an ER), and they can, if they want, work less hours then the general public. So most docs obsess about beig sued, and tailor their practice by practicing defensive medicine to avoid lawsuits. I’m an ER DOc, all I ever think about at work is avoiding lawsuits. This will probably be rebuked by several physicians, but are you in a raped specialty?
Anon at 9:23 -you completely misunderstood my post. I am not the one who said what the chances are for a particular test – stormy was told that (could it be by her doctors?). In fact, I didn’t mention what the test was for in my post at all because it was irrelevant to the point I was trying to make.
I simply said that if someone feels that the chance of benefit is not good enough one can always refuse, but she should be sure this is really what she wants. Do you disagree with this statement?
The other thing I mentioned was that litigation cannot explain everything, that for example it cannot explain lack of accurate information on chance of benefit and risk of some tests on doctor’s websites and doctors’ interviews in the media. I specifically mentioned overdiagnosis, which I thought was enough of a clue that I had different tests in mind.
But if this wasn’t clear from my post I apologize. I know next to nothing about prenatal testing – never having children I had no reason to research it. I do have some strong feelings about screening and personal choice, which is what I was commenting on.
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