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Comment by goda90 | Hacker News Reader

>brow-beat a doctor into running the absurdly simple blood test

I feel like I see this story all the time: "a simple test found the issue that they denied I had".

What we should be examining are the incentives for the doctor to resist running tests. Are they too invasive? Some can be, but blood tests certainly aren't. Are they too expensive? Ah, there's the ticket. The doctors are either losing money on tests that find nothing, or they are getting berated by the managers for wasting money on tests that find nothing, or the insurance company is saying no when they ask to run tests.

We have the technology to have proactive medicine. We could be catching cancers in early stages all the time with some standard sets of annual tests. But the economic incentives are all out of whack, and we're waiting until the last minute to do these tests.

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Many tests are simply not that good. It's not that simple, like pay $1 for a test that with absolute certainty tells you if you have disease X or not. It would be good if that was the case because then it WOULD have been just a question of money.

But if you have a test that is wrong 20% of the time, and you take this on all your patients every year, you will end up with a huge amount of mental suffering or possibly physical side-effects (unnecessary biopsies, or even surgery). You might end up giving people long runs of unnecessary meds. OTOH, you might end up missing some diagnoses if you don't do some tests. Balancing all of this is difficult.

Of course this is not news to the medical profession, this is a big input to the standard flowcharts. And you can always find anecdotal edge-cases that think their particular case was crystal clear and should have immediately been diagnosed. But don't assume that medical diagnosis and treatment is as trivial as doing a blood test and some googling.

> Many tests are simply not that good. It's not that simple, like pay $1 for a test that with absolute certainty tells you if you have disease X or not.

I will note that in my case the test is routine and reliable and has been since before I was born.

Sure you can't take every test at face value. How you approach the results of something that isn't 100% accurate is important. A potential false positive should mean a follow-up test, not a full diagnosis. Or even just holding onto the information until it can be part of a bigger picture with presenting symptoms. You don't even need to tell the patient what the results MIGHT point to, so you don't encourage hypochondria.

> We have the technology to have proactive medicine. We could be catching cancers in early stages all the time with some standard sets of annual tests.

I often wonder why such an expensive device as an MRI machine isn't utilized 24/7. I'd gladly go in for a scan at 3am if it meant paying even as little as 20% less.

The really strange thing about tests is even if you pay out of pocket you still have to get a doctor to sign off on it, which dramatically increases the friction and price for testing.

It's just information about your body. You shouldn't need a doctor's approval for that.

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