Wordpress now offers me free images of whatever I'm talking about. This is presumably an illustration of how the world doesn't necessarily become a better place if you tell everyone they urgently need to seek medical help for something you won't tell them anything more about. Image by uncultured via Flickr

I had a couple of bad looking medical test results in a row, so I was sent to a specialist, with advice along the lines of ‘well, we can’t say it’s not cancer… probably get checked out as soon as possible’. When I eventually got to the specialist he immediately told me a bunch of relevant conditional probabilities: of any problem at all given such test results, of it being a bad problem given it’s some kind of problem, the probability per year of cancer given each kind of problem. These were not scary numbers at all. Given that it can take months to extract your data from one doctor and get an appointment with a specialist, it would have been very nice to have been told these numbers by the original doctor, instead of just knowing for a few months that such results are some unknown degree of evidence in favor of cancer. Is this just an oversight by a particular useless doctor?

It seems not. I’ve noticed another two examples of the same problem in medicine recently. If you look up symptoms online, you will often be told to seek emergency medical assistance immediately. It often doesn’t even tell you what the potential problem is, and certainly not what the odds are of it occurring, so it’s pretty hard to evaluate the suggestion. If you actually go to a doctor about one of these symptoms, the doctor often tells you not to worry about it without more than knowledge of your age.  Often the website also knows your age, or at least asked it, and it would be simple for them to mention that said symptom is only a concern if you are over fifty, or even just the basic information about how common such a thing is given that symptom. Similarly my region has a free health phone line where you can ask a nurse whether symptoms are worth bothering to go to a doctor about. That seems like a decent idea, since apparently people overestimate when its worth going to the doctor. However in my small amount of experimentation it seems that anything I say prompts the suggestion that I see a doctor ‘within four hours’. I mean, I have tried telling them my bottom hurts at 2am and they tell me to get to a doctor within four hours.  I would be very surprised if an emergency room  was willing to treat sore bottoms in the middle of the night, so why not just tell the caller that at the start? Sending someone to a doctor can’t possibly help if the doctor is guaranteed to send them home.

In all these cases medical advice errs so much in the direction of caution that the doctor finally responsible for treating you will often hardly have to look at you before sending you home. The advice givers also refuse to offer relevant information such as conditional probabilities, so you can’t judge for yourself how far you want to cycle in freezing night to avoid a one in a million chance of arthritis or whatever. The costs of these behaviors in the short term are needless anxiety for patients, and doctors’ visits that informed patients would not want. In the long term patients will learn to distrust such advice givers and will miss out on useful advice when they really should go to an emergency room, while probably still harboring a slight fear that they have done wrong and will prematurely die for their sins. Is this medical advice format as common as it seems to me? Why is it done? I can understand an uninformed relative who is super-concerned about your wellbeing and believes you to be biased telling you you must seek medical advice for everything and refusing you any information. Or a doctor being in favor of it. But why do these presumably informed third parties and other doctors do it?

Added 1 Sept 10: I’m fine, sorry I wasn’t clear enough about that.