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‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

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Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#31

Post by AnIdiotOnTheNet »

taneq wrote: post #12
walrus01 wrote: post #4

As a non medical professional, I can't even imagine the difficulty in trying to diagnose a severely sick child that is too young to speak or articular symptoms/where it hurts... Scary.

Also, 'fever and a bit of a rash' are the symptoms of just about every childhood illness ever, and perfectly harmless 99% of the time and fatal within 24 hours 0.1% of the time (or something). Every few years you get some indignant news story banging on about how some awful hospital sent a poor sick child (presenting with fever and a rash) home with some Panadol instead of ordering a full battery of tests, and then t…

I feel like if you want to call yourself a doctor you should be able to tell the difference. If you're only good for diagnosing simple and common maladies then you're likely to be replaced by an algorithm soon.

I may be biased. In my own experience, doctors largely just seem to exist to get you out of their office and billed as quickly as possible, dismissing anything you say that doesn't align with whatever theory they've latched on to.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#32

Post by [deleted] »

roenxi wrote: post #28

Let us reflect that medical practice is one of the textbook examples for people making bad decisions due to Simpson's paradox. That the sheer number of highly opinionated people who are confident and wrong is staggering (take nutritional information, for example). That the risk of being embroiled in a good game of political or legal football is high. On top of that, this is a field that historically has had poor expo…

[deleted]

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#33

Post by arbuge »

taneq wrote: post #13
Fomite wrote: post #9

Earlier quoted context omitted.

One of the things my veterinarian colleagues talk about a lot is how do you make a diagnosis with "My chicken is acting funny" as the only information you have.

"My car's making a funny noise." "My computer's acting weird."

"My chicken is fried."

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#34

Post by kashprime »

Emergency doctor here, I have to say that diagnosing a sick child is one of the hardest things you can do in medicine (aside from figuring out why someone is feeling 'dizzy'). The limiting step here is that we can't do blood tests and x-ray/CT on everyone that walks in the door (which itself can lead to harm: https://emergencymedicinecases.com/overinvestigation-emergen...)

I work in one of the busiest ER's in Canada, and maybe one child out of hundreds will have something hidden... Many illnesses, particularly meningitis, are so rapid in killing the patient that you may miss the early symptoms (which are often mild).

What many posters have eluded to about 'gut feeling' is well described in medical education literature, where 'system 1' is well thought out, algorithmic reasoning, and 'system 2' is pattern recognition and based on experience. Many cognitive biases can affect both meeting (described will in this paper: https://www.ncbi.nlm.nih.gov/m/pubmed/12915363/).

Your gut feeling can be affected from anything from unusual vital signs, to the way a patient talks, to beads of sweat on their forehead, and a million other things that take years and years of training to catch.

Anyone who can build an ML model to catch these clues is going to make billions.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#35

Post by philipodonnell »

kashprime wrote: post #34

Emergency doctor here, I have to say that diagnosing a sick child is one of the hardest things you can do in medicine (aside from figuring out why someone is feeling 'dizzy'). The limiting step here is that we can't do blood tests and x-ray/CT on everyone that walks in the door (which itself can lead to harm: https://emergencymedicinecases.com/overinvestigation-emergen... ) I work in one of the busiest ER's in Canada…

> Anyone who can build an ML model to catch these clues is going to make billions.

You'd be surprised. IBM poured billions into Watson and appears to have been pretty successful in nearly reaching parity with a certified oncologist, but the results were dismissed because it didn't outperform them.

> At first, Manipal used Watson to recommend treatment options for all cancer patients, said oncologist S.P. Somashekhar. It found the software agreed with doctors most of the time, so Manipal stopped using Watson on every patient, he said.

https://www.wsj.com/articles/ibm-bet-billions-that-watson-co...

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#36

Post by j16sdiz »

philipodonnell wrote: post #35
kashprime wrote: post #34

Emergency doctor here, I have to say that diagnosing a sick child is one of the hardest things you can do in medicine (aside from figuring out why someone is feeling 'dizzy'). The limiting step here is that we can't do blood tests and x-ray/CT on everyone that walks in the door (which itself can lead to harm: https://emergencymedicinecases.com/overinvestigation-emergen... ) I work in one of the busiest ER's in Canada…

> Anyone who can build an ML model to catch these clues is going to make billions. You'd be surprised. IBM poured billions into Watson and appears to have been pretty successful in nearly reaching parity with a certified oncologist, but the results were dismissed because it didn't outperform them. > At first, Manipal used Watson to recommend treatment options for all cancer patients, said oncologist S.P. Somashekhar.…

It is used to recommend treatment options, not diagnosis

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#37

Post by freeone3000 »

philipodonnell wrote: post #35
kashprime wrote: post #34

Emergency doctor here, I have to say that diagnosing a sick child is one of the hardest things you can do in medicine (aside from figuring out why someone is feeling 'dizzy'). The limiting step here is that we can't do blood tests and x-ray/CT on everyone that walks in the door (which itself can lead to harm: https://emergencymedicinecases.com/overinvestigation-emergen... ) I work in one of the busiest ER's in Canada…

> Anyone who can build an ML model to catch these clues is going to make billions. You'd be surprised. IBM poured billions into Watson and appears to have been pretty successful in nearly reaching parity with a certified oncologist, but the results were dismissed because it didn't outperform them. > At first, Manipal used Watson to recommend treatment options for all cancer patients, said oncologist S.P. Somashekhar.…

That's not a great definition of parity. We'd want accuracy and specificity numbers linked to outcomes, not concurrence. The times when Watson agrees with doctors is effectively irrelevant - results would be the same whether or not he was added. We need to highlight whether, given a disagreement, Watson was better or worse for outcomes.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#38

Post by kashprime »

philipodonnell wrote: post #35
kashprime wrote: post #34

Emergency doctor here, I have to say that diagnosing a sick child is one of the hardest things you can do in medicine (aside from figuring out why someone is feeling 'dizzy'). The limiting step here is that we can't do blood tests and x-ray/CT on everyone that walks in the door (which itself can lead to harm: https://emergencymedicinecases.com/overinvestigation-emergen... ) I work in one of the busiest ER's in Canada…

> Anyone who can build an ML model to catch these clues is going to make billions. You'd be surprised. IBM poured billions into Watson and appears to have been pretty successful in nearly reaching parity with a certified oncologist, but the results were dismissed because it didn't outperform them. > At first, Manipal used Watson to recommend treatment options for all cancer patients, said oncologist S.P. Somashekhar.…

I think better diagnostic testing is one way to solve this. Oncology in some ways is easy since the data input is usually a set of biomarkers particular to that tumour (i.e. estrogen receptor, her2/neu, etc). It's probably the most rapidly advancing field in medicine. Same with radiology and dermatology where the input can be images which can be standardized. Dealing with analog humans is another challenge entirely!

Better biomarkers for acute illnesses with fewer false positives would help you better test 'accuracy' versus an ML model.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#39

Post by groby_b »

Cthulhu_ wrote: post #24
rendaw wrote: post #10

Earlier quoted context omitted.

Not pediatrics, but I had hand issues and went to a handful of doctors over the couse of two years who dismissed me after poking or prodding my hands a couple times. AFAICT there's no way to _know_ a doctor has experience and wisdom, but it's crazy that doctors won't even order relevant tests done. It's not a matter of costs - all they need to do is ask first. In the end I went to the Mayo clinic in Minnesota where t…

My GF's gone through the same windmill, over the span of seven (or more) years before finally getting a diagnosis. Multiple ones actually. Her abdominal pain issues and discomfort were blamed on period pains first, then IBS (because her mother has that too), until finally, after she herself asked for it, she was diagnosed with endometriosis (and an ultrasound revealed a 10cm cyst). Likewise, she's struggled with bein…

Your girlfriend also made the "mistake" of being a woman, and I wish I were kidding about that.

The fact that "borderline histrionic" is diagnosed much more often in women echoes back to the Victorian diagnosis of "hysteria", and pain reported by women is often discounted.

And unfortunately for her, ADHD also falls into the category of doctors ignoring women. It's slowly getting better, but essentially, all diagnostic tools were tailored to boys, and the first studies for girls' symptoms were beginning to come out in the early 2000s.[1] If you read that article, you'll also find that her way to discover ADHD is common for women - you find out because your child is diagnosed.

It's not only that ailments are hard to diagnose, it's that most medical research is tailored towards white males. (And most experiments are geared towards the college age group, due to ready availability).

The further you're outside of that group, the more work you'll have to do on your own.

[1] http://www.apa.org/monitor/feb03/adhd.aspx

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#40

Post by lmkg »

tialaramex wrote: post #23
nerdponx wrote: post #16

Earlier quoted context omitted.

But you can't take apart or reboot the chicken.

And this is why I write software for a living. Because "Take the chicken to pieces to find out why it's broken" makes sense to me, so I'd be a rubbish chicken doctor.

From what I understand, that actually is common for chickens because they're usually livestock rather than pets. If one chicken might be sick, you care more about whether it's contagious than the outcome to the one chicken, so you do the most thorough diagnostics you can even if that requires an autopsy.

Now dogs on the other hand...

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