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Comment by roflchoppa | Hacker News Reader

My sister had an experience where she went to the doctor multiple times because she had felt something “off” about her health, fatigue, small aches in her chest.

Multiple times she was turned down for breast cancer screenings, she was told that she was too young (33 at the time). It was not until she had requested that the doctor write a note of their denial, along with reasoning, that they finally gave her some screenings.

It was stage 2(3?), it had affected several lymph-nodes, but she was lucky that she persisted and did not just say “oh ya it’s fatigue”. When I ask her about how she knew, it’s always the same response, that it was just a feeling, that she knew something was not normal.

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Yeah it's definitely possible. And it's terrible if you or someone you love is in that situation. But for the vast majority of people feeling off, tired, and some small aches is going to be nothing.

There are costs to testing, financial and otherwise. For example you take someones family history, and other risk factors into account. There is a 1/100,000 chance that they have cancer. Then you add in the symptoms, fatigue, and minor aches and pains. That brings it to a 1/50,00 chance.

We don't have the money, technicians, or machines to run an MRI on everyone who shows up to the doctor with a problem that has a 1/50,000 chance of being cancer.

Then for many tests, with such a low prior probability, a positive test has a higher chance of being a false positive. So now you patients with massive anxiety out over a positive that has high chance of being a false positive. And you need to send them or further more invasive anymore expensive tests, that have real risks of harm.

> We don't have the money, technicians, or machines to run an MRI on everyone who shows up to the doctor with a problem that has a 1/50,000 chance of being cancer.

A guy launched a car into space; I think we have all this stuff but we — as a society — just don’t find the business case for “poor people being alive” very compelling.

There was a period where doctors would run every test on the list.. They stopped this because even if everything were free, each test has a false positive rate with a psychological cost to the patient. If anything the US has a problem with not accepting that everyone is going to die and asking them to go on to a road makes this more likely, (thus costing more than the value of the appointment.)

Being told that a doctor won’t do a test because it’s not worth it has a psychological cost that is higher than being told that the screening test came back positive and they need to run some more tests.

You are incorrectly calculating the “value of the appointment” from precisely the wrong viewpoint. Remember that healthcare is about the patient’s health, not the bill.

No, you're missing the point. Over treatment is a serious problem in healthcare. There is always some risk of iatrogenic harm, and for many tests the risks outweigh the benefits. Many tests don't even have a simple positive or negative result: often the outcome is inconclusive.

https://www.bloomsbury.com/us/price-we-pay-9781635575910/

This is such a wild non-sequitur! A single person doing a single wildly expensive thing is not comparable to hundreds of thousands or millions of people doing a far less expensive thing. The orders of magnitude don't cancel out; the 5-6 orders of magnitude in number of "people doing expensive thing" outweighs the 3-4 orders of magnitude difference between the costs of the things you are comparing.

It's also just so wildly irrelevant to the topic at hand

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