Hacker News Reader

Comment by ceejayoz | Hacker News Reader

That might be the right call.

https://www.health.harvard.edu/blog/a-checkup-for-the-checku...

> Careful reviews of several large studies have shown that these annual visits don't make any difference in health outcomes. In other words, being seen by your doctor once a year won't necessarily keep you from getting sick, or even help you live longer. And some of the components of an annual visit may actually cause harm. For example, lab tests and exams that are ordered for healthy patients (as opposed to people with symptoms or known illnesses) are statistically more likely to be "false positives" — that is, when test results suggest a problem that doesn't exist. Even if these inaccurate findings affect only a tiny percentage of the more than 200 million adults who would undergo such exams, the monetary, practical, and emotional costs are huge.

View on HN

That sounds less like the exams are the problem, and more like the incorrect handling of false positives is the problem.

>and more like the incorrect handling of false positives is the problem.

And what would be the "correct" way of handling it? Remember, you don't know that the test returned positive, not that it's a false positive or not. Are you going to tell the patient, "your breast cancer test returned positive, but given your age and other risk factors the probability that you actually have breast cancer is pretty low, so we won't do anything about it"? Even if that's the right thing to do from a statistical perspective, can you imagine the public outrage directed at the bureaucrat/politician that implemented this policy, if it turned out the patient did have breast cancer and died 2 years later?

Definitely not "we won't do anything about it". The medical industry (and frankly many other things but especially the medical industry) needs to find an effective way to present the common result "this test returned positive, but given the base rate in the population and the accuracy of this test, this is not necessarily enough information and your probability of having X is still only Y%, so we're going to run another non-invasive test to see if there's even enough information to warrant doing a more detailed check; ZZ% of people get a negative on the second test".

Perhaps find a nice graphical presentation of the simplest version of Bayes Rule: "the base rate in the population is this, here's what the test means for the part of the population that doesn't have it, here's what the test means for the part that does, here's how your probability went up but that it's still vastly more likely you don't have it than that you do."

Japan is famous for doing an extensive annual health check …

Perhaps they shouldn’t.

That is [an] incorrect conclusion to make.

In other developed (or even developing) countries, going to a doctor if you feel anything is not a financial question. You just go. Also annual bloodwork -- without needing to even do a doctor visit -- is sometimes a thing.

You can go to the specialist you think you need. Got a heart/chest issue: you go to the specialist and do not worry if it is covered or how to pay them.

Disclaimer: lived/live for years in both Europe and U.S. I also have a glimpse of how the japanese system works and South America a bit too. These things are not comparable. You would think North Americas are a different "world far far away."

tl;dr: I find the average in the U.S. surprising. Then I look at the median life expectancy.

I agree it’s better when folks don’t have to worry about affording healthcare. I’d like a single-payer universal system here.

That doesn’t mean an annual physical is good for you.

Annual physical in the U.S. is one's chance to get a "relatively free" doctor visit for an issue they have.

The conclusion that if you are healthy there is a higher chance to have a false positive is misleading.

a) that is true by definition: they have asserted the patients are healthy already; b) statement assumes that in the U.S. people go to the doctor at the same rate as they go in other countries; and thus have a chance to test themselves / do checkups necessary to their particular family/individual risk profile;

So drawing the directive that annual physicals are to be discarded is hypocritical. And to be substituted with "questionnaires" is .. [well I don't really have words.] They are stretching for a conclusion to remove the ~free annual requirement.

(cc from your linked blog study/recommendation): > Second, they acknowledge that if the annual visit is to be discarded, primary care doctors will need to find a more proactive way to monitor their patients' attention to preventive care. They suggest that waiting for patients to keep their annual visits to review this is too "passive" an approach, and encourage practices to shift to "active engagement" of their patients. Ways to do this might include: online risk assessments, waiting-room questionnaires, and a review of preventive care at any visit to the doctor.

> Annual physical in the U.S. is one's chance to get a "relatively free" doctor visit for an issue they have.

Again, fixing that absurdity would be great. Not by giving more annual physicals, but by removing the payment aspect of things like much of the developed world has.

Reply on news.ycombinator.com