How Long Have I Got Left? • Hacker News Board

Re: How Long Have I Got Left?

#181

Post by thomasz » Sun, Jan 26, 2014, 8:58 AM UTC

MarkMc wrote: post #176

thomasz wrote: post #63

> We never cite detailed statistics, and usually advise against Googling survival numbers, assuming the average patient doesn’t possess a nuanced understanding of statistics When I was at the receiving end of that talk, this attitude made me incredibly angry. They know exactly that we will look up those numbers, they are just too afraid to have a honest discussion with us. People make very bad decisions because those…

I too was on the receiving end of that talk. Are statistics so really so difficult that doctors cannot give them to patients? Here's a Kaplan-Meier curve for patients with Leukaemia: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202035/figure/F... Would it really be so difficult to say, "We estimate you have a 50% chance of being alive in 18 months, and a 25% chance of being alive in 10 years. But don't give up hope b…

The problem with the Kaplan-Meier curve is that most of the time, they represents figures about the whole patient population, but depending on the disease, there are extreme differences between stages and possibly dozens of cytogenetic factors. AML 5 year survival can be as low as ~15% and as high as ~70%. For Melanoma patients, it ranges between 100% (in situ) and 10% (stage IV).

Re: How Long Have I Got Left?

#182

Post by Someone » Sun, Jan 26, 2014, 10:38 AM UTC

rayiner wrote: post #170

larrys wrote: post #165

Earlier quoted context omitted.

Perhaps it's not as important as the other things they need to learn. While I don't know the answer I wouldn't assume that having a basic understanding of statistics is better than other things they are memorizing and understanding. (It could be but you can't assume that. Similar to feature creep with products or software.)

A basic understanding of statistics is crucial to being a doctor. When my wife was pregnant, we were faced with decisions like whether to get genetic testing and whether to breastfeed, but were frustrated to deal with statistical incompetence from doctors and nurses who couldn't explain the consequences of courses of action except in child-like "do this" and "don't do this" ways. One nurse, when discussing IUDs, quot…

I disagree, especially about the nurses. The medical system is a huge machine. Nurses and doctors are but cogs in that machine. The system produces guidelines such as "after looking at tens of studies, for patients above X years old, procedure X doesn't make sense"; it's way more important for doctors to be able to assess symptoms and to have a feeling for how to tweak those guidelines (yes, this guy is over 60, but he ran a marathon last week without problems, has never smoked, and his parents, both in their nineties, do not need care yet) than to know the ins and outs of statistics.

After all, all those statistics are kind of meaningless. They rarely are split by sex, age, smoking behaviour, and familial history ("Where was the study of nonsmoking 36-year-old neurosurgeons?") It's a doctor's job to, somehow, find the best approach using incomplete data.

More importantly, all guidelines likely are about approaches that have changed since the data was collected. That new anesthetic procedure may have shifted things by a percent, that slightly adjusted monitoring protocol another, the improved CT scanner another, etc.

Medicine just isn't that much of an exact science as many of us think it is. In many cases, we haven't managed to make it a science (yet). For example, in IVF, even after years of working together to copy each other's best practices, one hospital might have a 30% success rate, another a 40% one, even after normalizing for every difference in patient population or treatment we can think of.

Re: How Long Have I Got Left?

#183

Post by belluchan » Sun, Jan 26, 2014, 12:14 PM UTC

algopats wrote: post #173

belluchan wrote: post #160

Earlier quoted context omitted.

I'm not trying to do anything malicious but intentions are irrelevant when it comes to truth. It's either right or wrong. If someone really had a good reason for believing in God I'd like to know about it. I am also interested in atheists who later turn to God because I don't comprehend how such a thing is possible unless they were never rigorous in their scepticism or had some kind of terrible psychological trauma.…

wrong questions you two banging heads for. Before you go for the ultimate, first, pin down a thing (anything) thats not changing (what, why, how, ...until all questions satisfy you/logically-subside). Atleast you will have a REAL thing to anchor/pivot from. As they say, reality(atheist's synonym for god) is real. God is reality. Real reality is not changing; get your mind established on it, the wisdom unfolds.

I think the conversation went fine.

Re: How Long Have I Got Left?

#184

Post by davedx » Sun, Jan 26, 2014, 2:00 PM UTC

saboot wrote: post #175

ifktaotc wrote: post #29

A few years ago I got testicular cancer. The information about the disease came in pieces: first all I knew was that there was a lump; then came the ultrasound, the CT scan, then biopsy of the testicle, then a second surgery to sample lymph nodes to which the cancer might have spread. At every step I would obsessively query my doctors for conditional probabilities: given what we'd just found out, what were the chance…

> Given HN user demographics, there are almost certainly some of you reading this who've gotten it already, or who will. Just checked myself .. I may (hopefully not) have proven your statement. Will see doctor on Monday. Thanks for the PSA

Good luck! I have had recurring epididymitis for the last 15 years or so, starting when I was around 19, and every time I wonder if it could be cancer, but it proves to be an infection that is treatable with antibiotics.

Well done booking the doctor visit straightaway. It took me weeks, and I was massively stressed the whole time.

Re: How Long Have I Got Left?

#185

Post by JoeAltmaier » Sun, Jan 26, 2014, 2:38 PM UTC

TeMPOraL wrote: post #140

thomasz wrote: post #73

Earlier quoted context omitted.

Two to three extra hours is vastly exaggerated, and not that much time for someone who needs to know the chances of dying a horrible death. I might add that this is an objection based on economic argumentation, which, while not invalid, is not the one given by doctors. They argue like the author of the article did: That they know better than you how you will react to this kind of information, and that they can manage…

I had some university classes with a doctor few years ago; he brought up the WHO definition of health: "A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." (emphasis mine) He then told that questions like "should we tell the patient that he has two years left, and watch him and his family live the life of constant worry and sadness (and probably of a therap…

Sounds controlling. Who is the doctor to 'let him live his life' at all? The doctor is there to work on the disease. The life part belongs to the patient.

Maybe the issue discussed here is with the doctor entirely - what they think of themselves when seeing a patient respond to their expert opinion. So the patient cries, or panicks, or leaves their family? That is nothing to the doctor; not their business nor responsibility.

Its not irresponsible for the doctor to tell the facts, no matter how they lead. Because the impact on the patient is not their responsibility at all. Trying to make it so is wrong and selfish and manipulative.

Re: How Long Have I Got Left?

#186

Post by kirse » Sun, Jan 26, 2014, 6:51 PM UTC

300bps wrote: post #166

kirse wrote: post #135

Earlier quoted context omitted.

What else do you expect? You're not supposed to find most of it acceptable. Why are you surprised when a book that records the fall of man into sin and depravity is both shocking and FULL of stories of man pushing the bounds of depravity? It is brutally authentic and you should be reeling at the accounts of the depths of what mankind has done to himself. The Bible doesn't "advocate" anything by those verses. Surely y…

It's so obvious you haven't read the full bible, or even any of the links I gave. The very first link is where "The angel of the LORD" said to go back into slavery. So you blame that on men. This is why it is pointless to discuss anything with zealots. Your brains turn off for this topic.

The very first link is where "The angel of the LORD" said to go back into slavery. So you blame that on men.

Hmm, what does Genesis 16:10 say, the verse that immediately follows that command? Do you read all your books in such a way that each sentence cannot be linked to the previous or following sentences?

Attempting to restrain or set boundaries (i.e. laws and rules) around man's sinful habits does not mean God was advocating for sin -- in the same way that a parent attempting to set some ground rules around their child's drug habit does not mean they are advocating the drug habit.

Re: How Long Have I Got Left?

#187

Post by sireat » Mon, Jan 27, 2014, 11:16 AM UTC

obituary_latte wrote: post #14

taylodl wrote: post #4

"I began to realize that coming face to face with my own mortality, in a sense, had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when." Within this passage lies the meaning of life.

For you, maybe. And even then, probably not. It's so easy to try and attempt to break it down. And every-time we work towards that, we are neglecting the true nature of the chaos from which we were sewn. You don't know when you will die. I don't know when either of us will die. OMFG it can't make sense. Should it? Do I prepare? If so, how? WTF will my dog do? The truth is: you can't know the truth until the moment co…

Assuming one is not religious, why should the last moment in life be more important than your experiences the previous 10 years?

That is if you are Ivan Ilyich, is the last moment really that important?

Re: How Long Have I Got Left?

#188

Post by obituary_latte » Mon, Jan 27, 2014, 4:34 PM UTC

sireat wrote: post #187

obituary_latte wrote: post #14

Earlier quoted context omitted.

For you, maybe. And even then, probably not. It's so easy to try and attempt to break it down. And every-time we work towards that, we are neglecting the true nature of the chaos from which we were sewn. You don't know when you will die. I don't know when either of us will die. OMFG it can't make sense. Should it? Do I prepare? If so, how? WTF will my dog do? The truth is: you can't know the truth until the moment co…

Assuming one is not religious, why should the last moment in life be more important than your experiences the previous 10 years? That is if you are Ivan Ilyich, is the last moment really that important?

It's not that the last moment is more important -- it is that the last moment is, by definition, the last moment you will be able to reflect on the sum of your experiences. That moment is the culmination of your life. Being aware of it allows you to influence that moment today.

I'd not read or heard of Tolstoy's Ilyich. A read of the Wikipedia[1] page, though, suggests that his last moment was incredibly important: in it he came to realize he had not lived fully and was in fact living only for himself. His impending death, up until then viewed selfishly by him, became release for those around him. Once he saw his death as an escape for his loved ones, his pain subsided.

[1]http://en.wikipedia.org/wiki/The_Death_of_Ivan_Ilyich

Re: How Long Have I Got Left?

#189

Post by TeMPOraL » Mon, Jan 27, 2014, 9:35 PM UTC

JoeAltmaier wrote: post #185

TeMPOraL wrote: post #140

Earlier quoted context omitted.

I had some university classes with a doctor few years ago; he brought up the WHO definition of health: "A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." (emphasis mine) He then told that questions like "should we tell the patient that he has two years left, and watch him and his family live the life of constant worry and sadness (and probably of a therap…

Sounds controlling. Who is the doctor to 'let him live his life' at all? The doctor is there to work on the disease. The life part belongs to the patient. Maybe the issue discussed here is with the doctor entirely - what they think of themselves when seeing a patient respond to their expert opinion. So the patient cries, or panicks, or leaves their family? That is nothing to the doctor; not their business nor respons…

> Because the impact on the patient is not their responsibility at all.

That directly conflicts with the WHO definition of health. Which is exactly my point. Doctors nowdays are responsible for more than just the physical well-being, and they try to figure out how to handle these additional responsibilities in an optimal way.

Re: How Long Have I Got Left?

#190

Post by saboot » Wed, Jan 29, 2014, 2:38 AM UTC

davedx wrote: post #184

saboot wrote: post #175

Earlier quoted context omitted.

> Given HN user demographics, there are almost certainly some of you reading this who've gotten it already, or who will. Just checked myself .. I may (hopefully not) have proven your statement. Will see doctor on Monday. Thanks for the PSA

Good luck! I have had recurring epididymitis for the last 15 years or so, starting when I was around 19, and every time I wonder if it could be cancer, but it proves to be an infection that is treatable with antibiotics. Well done booking the doctor visit straightaway. It took me weeks, and I was massively stressed the whole time.

How did you know it was epididymitis instead of a tumor?

The mass I have is right on top of the gland, but after an ultrasound it appears to be a tumor.