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Comment by tylerrobinson | Hacker News Reader

> And I’ll wearily pretend to accept that people are emotional and couldn’t understand Bayesian reasoning or false positives and so we need to worry about stressing them out (#2).

> Why are we taking as given that a net-negative decision to do a biopsy will be made

The author should stop wearily pretending that anxiety isn’t a common result of a positive test, and recognize that the average person is not comforted by a Bayesian analysis when their health could be at risk.

If continuing to a biopsy is as common as the author says (I don’t have any data on it), that suggests anxiety IS a common response and we can’t simply wish it weren’t the case. Mental health is health.

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Could having doctors refuse to run diagnostics also lead to anxiety? It has for me personally but I may not be the typical patient. Some people want zero information about medical issues. They just want to leave all of it to the doctors, no desire to research their condition or understand the details; just trust the doc. I am the sort of person if my mechanic tells me I need an expensive repair, I want to know why. Once I had a dr tell me that I was wrong to feel less anxiety after getting an abnormal brain scan, than I would have felt had I not had the scan at all. It was an absurd conversation and very clear to me that the dr was more invested in his opinion on the matter than he was in listening to my reasons why the scan was reassuring to me. It was an mri, so no radiation. But he insisted that my anxiety would be worse having had the scan than if I hadn’t. A bizarre moment. Anyway, maybe doctors sometimes get too stuck on their own opinions and don’t fully appreciate that there are more than one type of patient? Some people like to change their own oil, some do not. Doctors may also underrate the anxiety of having no clear diagnosis when life changing problems occur. One size fits all mentality is probably wrong.

Did you offer to pay for the MRI cash (roughly $5k I would bet)?

Because to me this sounds more like "your insurance won't pay for it because it is not an indicated study by ACR criteria."

I hear that spending hours on the phone trying to justify a test to an insurance company is no fun, and I bet the task is not made any easier if you don't actually believe that the study will help the patient.

For anyone looking at self pay for an MRI in the US, there's an organization that offers that and other imaging services for the uninsured at $325 or less. https://radiologyassist.com/MRI.html

HMO so yes, costs are a factor. But it was a small cost relative to repeated doctor visits, hospital costs, etc… MRI for massive HMO are not $5000 due to economies of scale. The dr in this case was angry because the MRI revealed brain tumors which needed to be monitored.

$5k would be the estimated outside-of-insurance cost to you, to avoid spending hours of the MD trying to justify the study with the insurance.

Meningiomas by chance?

Has the monitoring improved your health? I'm not sure whether I would be more or less troubled if I had symptoms with an unclear cause vs a possible cause but unclear management plan. I suppose this will be highly variable.

This. I don’t want to know there’s a nodule and then hear “but it could be nothing. Don’t worry about it.”

Because then suddenly, I’ll become hyper aware of every potentially significant symptom and have to resist the urge to constantly google and check if there’s a chance it might indicate something. Is that pimple a pimple? Hey, I don’t remember my neck feeling this lumpy. Boy, I sure do seem to have sinus issues a lot. Are these joint aches normal? Etc, etc, etc.

As a kid, I felt absolutely invulnerable to worrying about my health. The first time I experienced true health anxiety is when my doctor pointed out a mole on my back and said “do you want to check this mole for cancer?” to which I replied, “oh, I guess so?”… only he didn’t. Because he checked with insurance, and insurance came back negative on it.

I am still in my 20s. I’m not in the best health, but my everyday life is pretty uninhibited by health issues. I don’t wake up with coldsweats. So yeah, it could happen to me, but frankly it’s worth being skeptical at my age.

But when the doctor pointed out that mole, they shattered the mental barrier I had between myself and cancer patients. I knew mentally that of course it could happen to me, but I had absolutely no idea that the signs of it could literally be hiding on my back, and I would be none the wiser. I googled and I learned a whole lot, and my intuitions were very wrong. In fact, I had many symptoms that can indicate various cancers. I heard stories about pimples that were not pimples, back pain that was not back pain, etc. people living normal lives who just went in for a checkup and suddenly faced certain death.

I’ve mostly snapped out of the hypochondria mindset, but still today I wonder about some symptoms in a way I never would’ve before. My life is altered by this one thing a doctor said off hand.

And for what it’s worth, I’m not saying he should not have done that. Insurance should’ve covered the biopsy just in case. I’ve outright noticed that sometimes, doctors will slightly edit your responses to things to get insurance to OK a diagnostic, and I think it’s in some part because they know that if you don’t get that peace of mind it could be damaging. Being hyper aware of your heart beat or super concerned about sleep apnea is not as bad as suffering from actual disease, but it’s certainly it’s own kind of hell.

It’s weird to me because much like cancer patients, I viewed myself as separate from hypochondriacs and immune to it as a whole. A lesson learned the hard way, and now I feel a twinge every time I see a new headline about cancer or hypochondria.

But even if you avoid doctors, you can get hypochondria from news article and Google searches too.

Thanks for saying this. There was an article the other day here on HN about someone totally obsessed with “fulfilling“ his iphone app’s health “objectives”.

Anxiety is one of the worst outcomes of over-diagnostics.

But the best way to proceed is still to make the CT and let the patient decide.

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