Caught our exam grader pasting every essay into ChatGPT

[u/relaqz]

Not a single word was read per grade.

[u/RancherFactoryHunter]

While that can and does happen in some obvious or unfortunate circumstances, the other side of that is as a diagnostician you are often faced with a constellation of nonspecific symptoms. For many patients, these are ultimately inconsequential without any need for intervention. In weighing what to do, it's about running up the bill on large number of patients running tests for less likely illnesses vs. potentially missing a serious illness.

AI could certainly have potential to catch missed conditions in its differential, but there's a distinct possibility it may also recommend every test known to man in the process, leaving one with a hefty bill unless it is also trained in cost-benefit scenarios. And at that point, who knows if it also won't make the same mistakes based on probabilities in evidence-based medicine.

[u/ElectronFax → u/RancherFactoryHunter]

Even if you completely remove the money and logistical aspect of testing everyone, there’s also the important balancing act that ordering some tests can cause more harm than good in some people. For example, ordering a PSA in a very elderly gentleman. If it’s high you’re going to subject him to a prostate biopsy when he’s unlikely to die from the cancer itself anyway.

[u/Recent_Prompt1175 → u/RancherFactoryHunter]

I mean, it shouldn't take over 12 years for a woman to be diagnosed with endometriosis when she has ridiculous amounts of pain that leave her unable to function when menstruating. Especially when that woman saw at least 5 different OB/GYNs over those 12 years. Physicians make mistakes all the time and discount women's pain. A woman shouldn't have to suffer for 12 years before getting a diagnosis.

[u/bark-beetle → u/RancherFactoryHunter]

I suspect you're a real doctor and not AI. Did it ever occur to you that a cost-benefit analysis shouldn't be a factor in treating your patients?

[u/RancherFactoryHunter → u/bark-beetle]

Is this some sort of gotcha? There's reasonable diagnostics to order based on the patient presentation and then there's overkill. Of course costs are not the primary concern in the course of treating someone, but I don't order tests that I consider unnecessary costs and risks to the patient. An AI unable to discern that you don't need a liver biopsy just because of ALT elevation in a diabetic on statin therapy is the concern I was expressing.

[u/bark-beetle → u/RancherFactoryHunter]

"Overkill" is weird term for a doctor to use, but OK. I know the costs of all diagnostic tests. "Unnecessary costs", get fucking real bro. Real life isn't a TV show.

My differential diagnosis of you:

• Not a good doctor

• A very tired doctor, insufferable to work with

• A mediocre dentist

[u/RancherFactoryHunter → u/bark-beetle]

Thanks for the laugh 😄

[u/bark-beetle → u/RancherFactoryHunter]

Is this some sort of gotcha? There's reasonable diagnostics to order based on the patient presentation and then there's overkill. Of course costs are not the primary concern in the course of treating someone, but I don't order tests that I consider unnecessary costs and risks to the patient. An AI unable to discern that you don't need a liver biopsy just because of ALT elevation in a diabetic on statin therapy is the concern I was expressing.

Some doctors are like this.

[u/Rahnna4 → u/bark-beetle]

And you’re clearly not a doctor, economist or public health professional. It sucks but in all systems healthcare resources have limits. In single payer/public funded systems there’s a budget and spending on one with will mean something else can’t be funded and they’re awful decisions to make. Even when the budget is increased there are essentially endless tests and experimental tests and treatments that could potentially be funded and a line will have to be drawn somewhere. In patient pays system you have an obligation to be mindful of the cost burdens you’re putting on the patient and consider if the test is really likely to help them or will just cause financial distress for little gain. There’s also then an issue of overdiagnosis, where you find things that don’t matter and aren’t causing symptoms but once detected on an MRI or whatever will set off a cascade of investigations and potentially even surgeries and we’re seeing that in terms of quality of life and health outcomes are actually worse than if it was never found. Not to mention tests themselves can be harmful with radiation, infection risks, pain and increased patient anxiety. Even if someone had all the money in the world it would still be bad medicine to just give them all the tests.

[u/bark-beetle → u/Rahnna4]

And you’re clearly not a doctor, economist or public health professional. It sucks but in all systems healthcare resources have limits.

I'm lucky enough to not give a shit what you think about my medical background.

a line will have to be drawn somewhere

brown paper bag test to decide who is black or white? the line has to be drawn? get fucked.

if the test is really likely to help them or will just cause financial distress for little gain

get fucked.

Not to mention tests themselves can be harmful with radiation, infection risks, pain and increased patient anxiety.

MRI risks? GET FUCKED

you find things that don’t matter and aren’t causing symptoms but once detected on an MRI or whatever will set off a cascade of investigations and potentially even surgeries and we’re seeing that in terms of quality of life and health outcomes are actually worse than if it was never found

GET FUCKED

it would still be bad medicine to just give them all the tests.

How would it be bad medicine to order a test? Fuck you.

[u/Rahnna4 → u/bark-beetle]

Not that you’re discussing in good faith, but for anyone curious about a case study that illustrates a lot of these issues look at what happened when Australia rolled out routine PSA screening for men. More cases of prostate cancer were identified, lots of men got chemo, lots of men and their families went through all the emotional turmoil of a cancer diagnosis. Lives were upended. The mortality rate of testicular cancer didn’t change at all. Lots of men had their quality of life shattered for the same outcome had they been tested when symptoms emerged, and for a good chunk of them they’d have never known they had it and died with it not from it. The screening program was ended because it was going more harm than good.

[u/bark-beetle → u/Rahnna4]

You think you're discussing this in good faith?

My partner literally has prostate cancer and he's not being treated by chemo or any drugs. They test him, which REQUIRES A DOCTOR, and he's decided to NOT TREAT IT WITH CHEMO, which also r quires a doctor, so why don't you FUCK OFF.

Also,

The screening program was ended because it was going more harm than good

GET FUCKED

[u/Apprehensive_Ear9187 → u/bark-beetle]

Even if you take out the money and the potential inherent complications of some tests as other have already mentioned, false positives and false negatives exist.

No test has 100% specificity and 100% sensitivity. In a world where we test everything for every patient (hyperbole, obviously) the outcomes would be worse, that’s why the science behind what, when and where to test is used to dictate it.

[u/bark-beetle → u/Apprehensive_Ear9187]

You seem like AI or a high school student, which is fine.

[u/Apprehensive_Ear9187 → u/bark-beetle]

English is not my first language.

[u/bark-beetle → u/Apprehensive_Ear9187]

Mine neither, AI.

GET FUCKED.

[u/Apprehensive_Ear9187 → u/bark-beetle]

Lmao, gj

[u/caffpanda → u/bark-beetle]

It absolutely should, because the patient and the broader system still have to pay for it. Do you want a $3000 bill for a CT scan for something that could've been caught with an ultrasound for a fraction of the price? Do you want a $1200 diagnostic for a rare condition that occurs 1/150,000 people or a $60 diagnostic for a far more likely condition first?

[u/bark-beetle → u/caffpanda]

because the patient and the broader system still have to pay for it

why am I the only person in this conversation that understands the public cost of medical care?

I never said that you shouldn't have an ultrasound. i had multiple ultrasounds on by balls which is clearly cheaper than an MRI.

a fraction of the price?

It would have been cheaper to cut my balls off, but I'm glad i have better doctors than you.

[u/caffpanda → u/bark-beetle]

Ask any of your doctors if they consider cost vs benefits in their treatment and diagnostics, you'll get a very similar answer to what's been said here.

[u/Funexamination → u/bark-beetle]

It is. We are concerned about patient life and quality of life. Financial burden affects quality of life quite a bit.

Death, Disease, Distress, Disability, Dissatisfaction and Destitution are the clinically relevant end points. Last one relates to money

[u/bark-beetle → u/Funexamination]

You'd have to be the dumbest dipshit doctor in the world to not know that four out of five relates to money.