The same idea applies to most tests in medicine. That is why tests are mostly done conditionally.
Mostly it is just how the medical industry works. A previous co-worker of mine had a wife that ran a small family practice. He was always griping about the money they spent on insurance for the place ($20k a year or quarterly, can't remember). I asked why it was so much, and case in point, he told of a story just in the prior year of a woman that came in for a knot on her breast. She was informed to come back in a month as sometimes hormones can cause them to come and go. Well they never saw her again but a year later they got a malpractice lawsuit from her since she now had breast cancer...
Even if you (or anyone, for that matter) might be comfortable with that, I think you'd find that a lot of patients wouldn't be.
$ many of these MRIs require contrast material.
(2) Malpractice for a missed cancer in most states has an enormous lookback period and an automatic “doctor loses.” It doesn’t matter if the doc made a statistically appropriate call. So docs follow-up on anything but the most unambiguously benign lesions.
but factually incorrect call is apparently OK, because they are treating "median person", and not the actual patient.
This has to do with money - and nothing else.
And of course we make statistical calls! When you’re deciding -prospectively- whether a course of testing or treatment is in a patient’s best interest, you have to look at the stats on likely benefits and harms of various courses of action. I’d love to know what my patients have before hand, so I could avoid dealing with probabilities, but I haven’t been blessed with that particular power. I’d love for the data to exist to tell me how to interpret a result in my precise patient rather than a larger population she belongs to, but “solitary pulmonary nodules in 33-year old men who smoked twice in college and live half a mile from a freeway with two episodes of bronchitis in their teens” is a study that hasn’t been conducted yet. One day perhaps it will be, and if so, I’ll be grateful for it. But right now that data doesn’t exist, so we use what we have, and use our judgment to tailor it to the patient in front of us - imperfectly.
I recommend reading “overdiagnosed” by Gilbert Welch.
> make statistical calls!
Really? Your fuzzy feels are not statistics.
Do you even at least try to know how large is the type 2 error in your guesswork? Is it better than flipping a coin?
I think Doctors (I am one) definitely err on the side of overtreating in those uncertain situations. Just like politicians, it feels more caring to act than to not act.
If you MRI 1000 people and leave the vague results in the hands of a bunch of physicians, they will tend to be interventional. This will lead to a spate of overtreatment.
Ways around this would be to consent patients for watchful waiting in the case of uncertain lesions. Even so, telling people they have weird looking lumps that you're not going to treat will cause serious anxiety.
Why can't a doctor see an anomaly and decide not to chase it down based on the same reasoning that they use to not scan for it?