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Comment by cm2012 | Hacker News Reader

cm2012

Too much caution makes doctor advice useless. If they tell you to go waste time and money at the hospital every time there's a 1% chance of an issue, you won't actually go when it matters. That's one reason I try to ask doctors to estimate % risk.

On this note: WebMD is not a doctor but has the same issue. There's no differentiating between a real emergency issue and a CYA liability one.

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That's why I'm asking for more non invasive diagnostics and not experience based "you're fine [and it would cost too much to check further]". I won't die because or someone's habits.

That's not a resolution to the disagreement, though; that's just one side of it. The disagreement is about how to balance the cost of false negatives against the cost of additional testing.

As an aside, an EKG is not remotely the most important part of diagnosis for myocardial infarction; that's the job of the person taking the history. (Myocardial infarction cannot be diagnosed purely from ECG.)

Cost is fallacious. Medical world is stuck in pre advanced electronics era where any device would cost a ton and they rely on companies to make new devices but it's a lucrative market with twisted incentives.

We need a musk like character to shake the medical diagnosis status quo.

ps: I don't want to spend my life obsessing about monitoring my vitals but I'd still prefer to have the option rather than relying on blind faith.

>> We need a musk like character to shake the medical diagnosis status quo.

You first to trust your life and your loved ones to the SpaceX or Tesla of the medical world.

But - disruption! Fake it till you make it!

Tesla used to be very safety focused. Not that much since autopilot. SpaceX is still extremely impressive in terms of progress/accident ratio.

By cost, I don't mean money.

"Cost" is not purely monetary. The cost of additional testing includes patient's time spent traveling too and from additional appointments, additional patient stress waiting for results, additional infections or other side effects from the tests themselves. There are very few things that have zero risk. If you run something on a large enough population someone will have an adverse reaction.

The cost benefit trade off for additional testing isn't just about dollars spent performing the tests. Its about how many thousands of hours of people's lives will be spent in pointless worry and how many additional people will be made sick or killed by testing Vs the additional people that could be saved by additional testing.

Do doctors have any training that would equip them to give a remotely accurate risk probability estimate?

In my experience doctors are terrible at this, although it's supposed to be basically their entire job. I really think they should get more training in it, or some type of Bayes-esque tool to make what they're thinking explicit.

But the reality is the patients don't understand the numbers, and in the OPs case a % risk doesn't mean much if it happens to you.

> really think they should get more training in it, or some type of Bayes-esque tool

They have those online. If you're in your 30s and have a reasonably healthy lifestyle and don't smoke, then your risk of dying from a cardiac event over a ten year period is likely somewhere between 0.25% and 0.5%, depending on how much you exercise and genetic factors.

If anything, Bayesian logic is what leads doctors to ignore signs of heart attacks in young people in the first place.

My wife's current psychiatrist is awesome at this - he quotes the scientific literature for relative risk levels when talking about medicine changes or interactions.

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