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Comment by ircshotty | Hacker News Reader

Anecdotally, when I had a potential skin cancer checked at a London hospital they were completely ill-prepared.

When I came back to Australia, it was checked and immediately removed as an obvious melanoma.

Perhaps the idea of Comparative Advantage also applies to healthcare between countries with natural variances to types of disease?

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Australia, Queensland, Brisbane has the highest incidence of skin cancer in World. So Drs and dermatologists would have more experience detecting it here. UV is probably much less intense in England . This link graph shows skin cancer is over 2x in Australia https://www.statista.com/statistics/1032114/countries-with-t...

Queenslander here. There’s also a fairly well equipped imaging centre that’s being testing this form of diagnosis for 5 years: https://acemid.centre.uq.edu.au/research/cre-skin-imaging-an...

> Australia, Queensland, Brisbane

OT but what an odd way to address a place. I know it's called down under but not everything there is back to front.

Sadly, a friend of mine died from this type of problem. He traveled from Ghana to Jordan and fell ill in Jordan, the Jordanian doctors didn't diagnose it as malaria in time to save him because Jordan doesn't have malaria. I'm sure it would have been obvious to a Ghanaian doctor.

Friend did a lot of work in Africa. Got back to the US and starts getting symptomatic and says to himself “I think I got malaria”.

Goes to the biggest university hospital nearby he can find.

Was initially dismissed but waited it out for the infectious diseases specialist and they quickly agreed with his self-diagnosis.

They kept them in hospital for a few days so a parade of clinical students/residents could come by for the specialist to say: “this man has malaria”

I came back from Bali and shortly after came down with a really high fever when I was on vacation in Maine. When I got home week later called my primary as I was still running a bit of a fever and got blood work which was pretty bad. Went to ER and my primary care figured it was something tick related. The infectious disease guy on call immediately identified as Dengue Fever. At the end, including sending blood to the Louis Pasteur Institute in Paris I spent something south of $1K to get told I’d recover on my own—the Paris tests came back like weeks later—and there really wasn’t much they could do.

Weird. Pretty much every time I've gone to a doctor (in the Midwest US, no less) for an illness, the second question they ask is always "have you been out of the country recently?" just to rule out anything caught from abroad.

Then again, my one experience with a university hospital was pretty shitty, so maybe that's it?

This was decades ago, so maybe getting asked regularly nowadays was because of that previous education.

I had a weird cardiac issue, for which they kept me in the hospital for a few days and brought in more and more doctors to hear my story. Added tens of thousands to my bill. Eventually checked myself out "against doctor's advice".

When I first heard the clinical idiom "When you hear hoof-beats, think horses not zebras" I thought it was a precautionary saying about the bias toward assuming the familiar. But it's meant to be instructive!

No, that’s backwards. It means what it says. When you see a symptom first look for the common things it could be, not the one in a million chance.

We have a formal description of this, it's called bayes theorem.

The Jordanian doctors just had poor priors.

In this particular case, "when you see stripes with hoofbeats, think zebra, not horse with a paintjob"

A good family friend caught abdominal TB while abroad, came back to Canada, and was terribly misdiagnosed. TB is very rare here; abdominal TB even more so, and early symptoms look like a lot of other diseases. It took several hospital visits before the doctors realized the actual problem. He very nearly died, and spent nearly a year in the hospital recovering from a parade of complications.

Being a pasty Brit, going to Australia was a real eye opener in how much more on the ball they were about skin cancer, not just in medical terms but culturally. We're getting better here (I was there more than a decade ago) but it's still seen as quite amusing when people get sunburnt here.

Awareness started in the 1980s in Australia with Sid the Seagull:

https://www.youtube.com/watch?v=tGgn5nwYtj0

https://www.abc.net.au/btn/classroom/sun-safety-campaign/103...

Speaking with some 70 year olds, their opinion on the "best doctor in town for skincare" was basically a doctor who'd simply cut out whatever you like and send it for a biopsy.

At most you had to deal with a stitch or two but often only a bandaid. Nowadays the hydrocolloid bandages seem magic.

It's even more granular than that.

My neighbour who is a doctor moved to another city because that's where he managed to get a spot to train for his field.

It appears that he's learning much more there than he would back home because in this country some procedures are rare outside of his current location.

Reminds me of that South Korean trauma surgeon who trained in the states and has pushed for Korea to get US-style trauma centers.

Dude got plenty of experience dealing with gunshot wounds, which probably helped him when that one North Korean defector came over the border, riddled with bullets (you may have heard this story, it was big news at the time). The especially weird coincidence was that the surgeon's mentor from the states was in Korea at the time this happened, what are the odds.

https://abcnews.go.com/International/doctor-north-korean-def...

Similar vein: during The Troubles, physicians in Belfast got particularly good at dealing with managing cranial pressure and making skull plates from bar bombings, and dealing with bone repair from kneecap punishment shootings

https://www.nytimes.com/1987/08/18/world/ulster-doctors-lear...

My experience - Having had at least 10 skin cancers cut out over the last 30 ish years, is the only way that it can definitely be determined ( skin cancer or not ) is a biopsy.

Australia has high skin cancer so it's not suprised that doctors there are best in this area.

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