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tx21

Flashy article title clickbait.

Doctors are not fools. If a tool truly made their job easier, it would not be rejected out of hand.

Job security for physicians is rarely the issue, there are plenty of sick people.

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Surgical safety checklists were shown to lower 30-day post-operative mortality by 22%:

https://www.cardiovascularbusiness.com/topics/coronary-inter...

You'd imagine something as basic as checklists would be implemented as standard procedure in modern medicine -- yet this study was in 2013, not 1963. Most likely the majority of surgeons are still dragging their feet on this. It's a very conservative field with lots of big egos.

Checklists make patient outcomes better; they don't make surgeons' work easier.

I guess killing the patients as soon as the cut them open would be easier for the doctor :), but their job us to heal patients. Anything that improves on outcomes is good. The OP might have suggested that instead of new tools, just use the old checklist system.

There's also trust issue. Doctors, who like everyone can be opinionated, had to be convinced one-by-one that checklists actually work and are worth messing up their work habits - unlike the many other things people are trying to sell hospitals.

I don't completely agree. Medicine has a reputation for being extremely conservative with technology.

It's understandable, because you don't want to mess around with people's health, but I also see doctors largely acknowledge that their field is more conservative than it should be.

It's apparently also different based on specialization. Opthalmologists apparently have a reputation for being early adopters.

And early thermometers weren't as practical as they are today, someone going to the doctor for a cold probably doesn't want to be sent to the hospital across town to wait in line for a 25 minute temperature rating when the doctor's hand is usually "good enough":

The original thermometers were a foot long, available only in academic hospitals, and took twenty minutes to get a reading.

And it's probably the same with CT scans -- I have a stomach ache, I don't want to come back tomorrow to be scheduled for a $2000 CT scan just in case it's appendicitis. Now if I take the medicine and it's not better in a day or two, maybe then I will want that CT scan.

>> Now if I take the medicine and it's not better in a day or two, maybe then I will want that CT scan.

That's what most doctors in my country would do. Are you saying that US doctors will send you to CT right away, just to be sure?

That seems to be what the article is implying should happen, just like doctors of the past should have embraced expensive and inconvenient thermometers sooner, it seems that the article is implying that modern doctors should embrace modern diagnostic tools:

Modern CT scans, for example, perform better than even the best surgeons’ palpation of a painful abdomen in detecting appendicitis. As CT scans become cheaper, faster, and dose less radiation, they will become even more accurate.

Though Defensive Medicine is definitely happens in the USA and probably other countries as well:

https://en.wikipedia.org/wiki/Defensive_medicine

I went to the ER complaining of stomach pains. They heard my description and immediately put me into a room. A few hours later, I had a CT scan confirming that I had appendicitis. I had surgery that same that and was out of the hospital 2 days later.

Had they sent me home, medicine or no, things could have gone a lot worse.

I'm glad they do the CT scan here and not just send people away until they get worse.

I had a similar experience. I show up at the ER and they do their thing. Doctor says, "the symptoms indicate appendicitis, but the tests (which are mostly just poking you in the side and seeing how bad it hurts) are inconclusive. Normal procedure is to send you home and see how it goes, but I'd really feel more comfortable if we took a CT scan to be sure". At this point I'm in so much pain if he said he wanted to do a voodoo ceremony, I'd have been all in. CT scan reveals I had a weirdly shaped appendix, hidden behind a couple of folds of intestine, in a slightly different area than they are usually in. So the poking test didn't work cause they were poking around in the wrong area. If they'd sent me home I'd have come back with a burst appendix, which is potentially fatal. Ironically, just as they were wheeling me into the operating room, a woman came into the ER with an actual burst appendix so they wheeled me out and took her first.

I had a dog who started having a runny bloody nose all the time. 4 xrays, 2 nasal endooscope procedures and several thousand dollars and still can't figure out what's wrong. In desperation took him to a really good emergency/surgery vet clinic, they did a CT scan and it reveals a large tumor growing on the nasal cavity side of the soft palate. Confirmed with an endoscope going into the mouth and back up into the sinuses, couldn't see it from the front. Super frustrating because it was too late to do anything at this point.

I think using CT scans in the context of a checkup, to look for problems, is bad, because as discussed elsewhere on this thread, if you go looking for something, you'll find something. But if you already know there is a problem, they're the best tool we have for looking inside the body without cutting.

That's exactly what should happen -- you came in with symptoms that seemed more serious than just a stomachache, so you were scheduled for a CT.

It's not like you came in with gas pains and the doctor had to send you for a CT just in case it turned out to be something more serious.

>...Job security for physicians is rarely the issue, there are plenty of sick people.

Yea you would think so... Unfortunately, in medicine, just because a computer program is better then a Dr at diagnosing a patient is no guarantee it will be used. The classic example here was the MYCIN expert system developed in the 1970s. MYCIN was shown to outperform infectious disease experts by 1979 in a blind testing:

>... Eight independent evaluators with special expertise in the management of meningitis compared MYCIN's choice of antimicrobials with the choices of nine human prescribers for ten test cases of meningitis. MYCIN received an acceptability rating of 65% by the evaluators; the corresponding ratings for acceptability of the regimen prescribed by the five faculty specialists ranged from 42.5% to 62.5%. The system never failed to cover a treatable pathogen while demonstrating efficiency in minimizing the number of antimicrobials prescribed.

https://jamanetwork.com/journals/jama/article-abstract/36660...

https://en.wikipedia.org/wiki/Mycin

There are good reasons why MYCIN and similar systems were never accepted, mainly the fact that diagnosing an infectious disease is pretty useless on it's own. If the doctor has already narrowed it down to an infectious disease, telling which one it is is trivial. The hard part is getting there.

>... diagnosing an infectious disease is pretty useless on it's own.

I don't think that was what was being measured.

The evaluation was a comparison of:

>...MYCIN's choice of antimicrobials with the choices of nine human prescribers for ten test cases of meningitis.

In that evaluation:

>...MYCIN received an acceptability rating of 65% by the evaluators; the corresponding ratings for acceptability of the regimen prescribed by the five faculty specialists ranged from 42.5% to 62.5%.

The fact that the acceptability ratings of the five faculty specialists ranged from 42.5% to 62.5% implies that this isn't a trivial problem.

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