Hacker News Reader

Comment by dan000892 | Hacker News Reader

Something isn’t right when you’re considering lawsuit potential when making patient care decisions.

I stand by my argument that a GP prescribing an anticoagulant based solely on an iWatch having detected a-fib is grossly negligent (just as—in keeping with my earlier comparison—he would be if he prescribed an anti-hypertensive to a patient who stated they had a BP of 180/120 at home one time).

I’m not entirely sure why you docsplained that 12-leads cannot bend spacetime and that a Holter monitor would be likely be ordered to detect intermittent arrhythmias over a longer period of time, but thanks. Can I claim CE hours for this?

View on HN

The argument against more monitoring is one of false positives. Suppose the Apple Watch has a 5% false positive rate, and detects problems with 1% of 100 million users.* That's 50k extra patients going to their doctors, thinking there might be something wrong with them. The next test may have a 1% false positive rate. That would put 500 extra patients on anti-coagulants.

That may not materially change the public health calculation, or it may. But that's the calculus -- not that a GP would blindly prescribe, just that increasing the top of the funnel is not necessarily a good thing. (Plus, extra cost.)

Positives and negative impact of additional testing must be measured for optimal decisions.

* numbers to make the math easy

As opposed to the “but I might get sued” argument, I find this argument totally reasonable. Thank you for stating it so clearly.

I’m cautiously optimistic but recognize that we need more data because evidence-based medicine is all about testing hypotheses. The hypothesis here is that continuous 1-lead monitoring will provide a net benefit to the population employing it. Maybe it will and maybe it won’t; Either way I think it’s pretty cool that we’re about to amass a ton of relevant data from which we’ll be able to derive an answer.

Reply on news.ycombinator.com