This article is rather funny because it misses out on key facts of how doctors practice medicine these days.<p>I listen to my supremely well educated plastic surgeon wife regularly discussing and giving guidance to office staff around patients in their private practice. Their general approach is to get patient statistics, and that is all, without the aggregated vital signs. I asked her once, "Why don't you get the patient vital signs too?"<p>Her response was unexpected, "If we get patient vital signs, we immediately become liable for patient overall health. Our malpractice insurance is specific to the practice of medicine for plastic surgeons, and plastic surgeons only. Our front office staff are normally front office only, or aspiring doctors on a break between their undergrad and entry to medschool. Our practice uses no Nurse Practicioners, Physician's Assistants, or nurses. We're not set up, or staffed appropriately to deliver general medical care."<p>Conclusion 1: Medical care is characterized by liability control; there are logistics/staffing aspects to medicine around specific types of care.<p>Medical Diagnosis we think of as scans, remote tests. You get a CAT scan, you get an MRI, or X-ray, bam, 15 seconds, 5 minutes, or an hour later (after waiting in a hospital for hours) you're done and some radiologist or other specialist is interpreting the results and you have a diagnosis. That is true in some cases, but not others. If you get a positive mammogram, or a suspicious lump what is the next step? Welp, that is regularly one of two things - a needle biopsy, or an investigational biopsy. Needle implies small, thin, fairly painless. Not this needle - instead imagine a needle designed for tissue harvesting, like a horse sized needle. This big giant thing needs to go into your breast to suck up enough of the suspicious lump for a pathologist to examine it. Alternatively, you could have an investigational biopsy where a surgeon takes a small amount of tissue from inside your breast with a scalpel. Investigational biopsies via scalpel can be a big scam too, where a car accident occurs, a cut tendon in the hand, and the surgeon decides to open up the arm past the wrist to visualize all the soft tissue up the arm. Lucrative billing enhancements.. But, when it comes to breasts, we know that certain life changes predispose towards a positive mammogram for a limited time window. Stopping breast feeding being the foremost change that can cause suspicious lumps.<p>Conclusion 2:
Diagnostic tests can be quite painful, and, at the wrong time, quite unneeded. Some of them are damaging. Good medicine is about as much when to intervene, and when to test, just as much as it is about when not to intervene and when not to test.