G McC typed:
> 55 year old female smoker asks for a screening CXR as her younger sister
> (heavier smoker) has just been diagnosed lung ca.
This, you would normally think, is good enough reason to give
up the dreaded weed. Younger sister diagnosed withy ca. Gotta
make her give up. Thinking about it. Maybe just needs that one
little push. But she wants an XR, which, if normal, will allay
her fears and allow her to continue to smoke, to help her cope
with her sister's premature death. If the XR shows something,
her fears will be confirmed, and she can continue to smoke because
it won't make any difference.
So, what's she's asking for is validation. She wants you to say
to her: "Shit, love, you're gonna get it anyway, just like your
sister, so you may as well keep smoking. I'll prescribe antibiotics,
expensive inhlaers, oral medicine, nebuliser solution, home oxygen.
You keep smoking. It's the only pleasure you have, you sad, sad,
sad, misguided, self-deluded, nicotine addict."
Which is what I say to them in an alternate reality.
> Should I order a CXR in an otherwise healthy person?
Why not? They've paid for a health service with all their
fag taxes. May as well give 'em something afore they die young.
> What is the reliability, validity, predictive value etc. of the test?
> How often should it be repeated?
Can't think it matters all that much.
Medicine is an art.
And I'm grafitti on the urinal wall.
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