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Experts warn yearly checkups carry risks and do not reduce mortality

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Re: Experts warn yearly checkups carry risks and do not reduce mortality

#101

Post by debacle »

qgin wrote: post #99
debacle wrote: post #55

Most primaries are useless. Having someone who works in healthcare in your family is of incredible value, and the general advice is to always see a specialist. We could likely do away with primary doctors in the US. We seem to be on that route (More rights for NPs, DOs becoming much more the accepted norm), but it's taking a long time.

It can be hard to know what specialist to see.

For someone who doesn't know, it's impossible. But being a patient advocate has a moral hazard that insurance companies (who provide them now) aren't equipped to deal with.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#102

Post by jcims »

belter wrote: post #8
ultim8k wrote: post #5

That’s BS if I may. How would I know I have higher cholesterol if I didn’t do blood tests?

Interestingly, the scenario is somewhat discussed in the article: "...Rivero used as an example a request he receives frequently: to check the cholesterol of young people with no risk factors. “Checking a 32-year-old man with no history of sudden death or hypercholesterolemia in the family is pointless,” and can result in prescriptions for medication of questionable usefulness and that is not without risk in the even…

I had my family test their blood sugar because we had a test kit sitting around. That's how we found out my youngest was at the beginning states of type 1 diabetes. If we hadn't checked her sugars, she would have undoubtedly been admitted to the hospital under DKA and had a traumatic introduction to her condition.

As it was, nobody, not the local doctors nor the children's hospital in the local metro center, had any idea of what to do with her. We had to repeat our story numerous times and she was admitted for no reason for three days because that was their protocol.

So i think the whole idea is bullshit. Test early, test often and let the practices catch up to the new amount of information.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#103

Post by epylar »

nradov wrote: post #100
polalavik wrote: post #94

Earlier quoted context omitted.

With all due respect, I think it’s unreasonable to call my expectations unreasonable. That mindset is the mindset of an old company - “we just do things around here like that because that’s the way they’ve always been done.” The field should move forward with technology we shouldn’t settle for something because that’s the way it is.

Your expectations are unreasonable. This is not a problem that technology can solve. Large scale, long term human trials will always be expensive no matter how much technology we throw at the problem. If you have a suggestion for improvement then be specific. Vague complaints aren't helpful.

High-fidelity simulations to reduce the number of failed trials.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#104

Post by jxramos »

m3047 wrote: post #79
ghostpepper wrote: post #9

There's a similar phenomenon when you look at fetal heart monitoring for otherwise healthy pregnant women going into labour. The two options are continuous monitoring, where the monitor is left in place for the entire hospital stay, and periodic monitoring, where a nurse installs it, takes a reading, and removes it about once an hour. Common sense would dictate that negative outcomes are reduced with continuous monit…

A lot of negative comments on this and there are no references provided, however some human traits are well-understood: * people irrationally tend to add rather than remove complexity to solve problems * experts' decision accuracy improves faster with more information than their personal evaluation of / comfort with those decisions * people asked to evaluate the contents of a picture repeatedly while being shown incr…

I think we have too much cultural habits, marketing suggestions, etc etc around the whole notion of "more is better". So more complexity, more gadgets, more yada yada without ever going back and checking the premises and accuracy of these things and their claims along the way. We get stuck in these "dwell points of the ideal" where we assume because something is deployed that it's in some ideal operating state and take a bunch of stuff for granted at that point.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#105

Post by PuppyTailWags »

imwithstoopid wrote: post #23

95% of yearly US medical exams: doctor tells patient to lose weight. patient does not comply, and is even heavier next year

Something has to be happening in the environment that's making people fatter. The only process that is statistically successful on a population level in getting people to lose significant amount of weight is a hormone regulating drug, and it has to be kept up for the rest of the life of the fat person or they'll gain it all back. Even the extreme surgical intervention of cutting the stomach seems somewhat temporary. WTF is happening?

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#106

Post by remexre »

armitron wrote: post #22
masfuerte wrote: post #14

Earlier quoted context omitted.

There's no contradiction. Ignoring symptoms is foolish. Yearly checkups may do more harm than good. Both of these things can be true.

A lot of cancers have no symptoms at the beginning, but they can be flagged in blood tests performed as part of general health checkups.

Do annual checkups involve blood tests where you are? I've only had blood taken as part of one once, and that was in direct response to a new diagnosis of a health condition in a grandparent.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#107

Post by albertgoeswoof »

waterhouse wrote: post #82
tetromino_ wrote: post #29

Earlier quoted context omitted.

I think the idea is this: even accurate tests have false positives. For patients in a low-risk group, virtually all positive results in the checkup will be false positives. When the low-risk group is large (the entirety of a nation's healthy 20-30 year olds), the number of such false positives will also be large. The positive results, regardless of whether they are true or false, will have some sort of follow-up. May…

> whether it is ethical or worthwhile to expose patients to the risk of harming their health through the follow up So you seem to be saying that, in certain cases, if you have a positive test result, then the expected value of taking certain follow-up actions is negative. It follows that a rational actor, knowing this, would not take those actions in that situation. Then isn't the solution for doctors to update their…

On an individual case you’re right. But in aggregate is where the nuance lies.

E.g. If 99 out of 100 cases are false positives, and those 99 people are harmed by taking action, but the one true positive was helped, which is the better policy to pursue? Blanket screening or none at all?

This gets more complicated when there are limited resources available, eg treating the 100 people means someone else misses out.

And then there are diseases like cancer, which pretty much every human will get, if they live long enough. So screening for some types of cancer can have negative health implications on some target populations.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#108

Post by jxramos »

nradov wrote: post #70
sklargh wrote: post #18

I have a personal example of this. My father died largely because of his annual physical. He hated doctors, became nervous around them and thus expressed hypertension in-office. He did not have material hypertension but did defer to his physician. Over the long term, despite my best efforts, this killed him. His blood pressure medication regime was poorly managed and severely impacted his quality of life. He eventual…

This is commonly known as "white coat syndrome". Some patients get nervous in medical offices, and some healthcare providers don't follow the recommended measurement protocol of allowing the patient to sit quietly for 5 minutes first. So this leads to some false positive hypertension diagnoses and iatrogenic harm. Hypertension is common, dangerous, and generally under diagnosed. So primary care doctors have been trai…

that's it right there, iatrogenic harm. Good term to know about.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#109

Post by walkhour »

polalavik wrote: post #44

You would think doctors would be able to collect data and then come up with statistical tables of “hey you may have xyz. The risk to look into this further has these possible complications with these success/failure rates. The risk of no intervention has these other set of outcomes with these likelihoods” All you get at a doctor is someone typically saying “eh you’re young don’t worry about it” until it’s too late. I…

AI is going to very early optimize this use case. I fear for the Dr's job because I can't see what many of them will be needed for.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#110

Post by georgeburdell »

sklargh wrote: post #18

I have a personal example of this. My father died largely because of his annual physical. He hated doctors, became nervous around them and thus expressed hypertension in-office. He did not have material hypertension but did defer to his physician. Over the long term, despite my best efforts, this killed him. His blood pressure medication regime was poorly managed and severely impacted his quality of life. He eventual…

My doctor calls this doctor’s office hypertension. If the reading is high, he always makes a point to circle around and do it again at the end of the appointment. For me, there’s usually a 10-20 (units, I forget which ones) difference. I do not have hypertension
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