On Thu, 8 Nov 2001, Andrew Jull wrote:
> Recently in NZ we have had a commission of inquiry into the misreading of
> cervical smear slides by a provinicial sole practice pathologist over a 10
> year period. I had hoped as a consequence that the public and media may have
> gained insight into the fact that diagnosis is probabilistic.
> More recently aggresive media response to misread prostate samples in an
> audit of histology slides at a metropolitan laboratory leads me to believe
> that no such learning took place. At recent dinner party were we got to
> discussing this, it was news indeed to the lay imbibers who all thought a
> diagnosis once given was a certainty.
I think the idea that a great deal of medicine consists in intelligently
handling uncertainty is one that the public by-and-large does not get at
all, and is a huge problem.
In the US I'm sure a lot of this is driven by the advertising function
of getting people to do (profitable) medical things, which wants to make
benefit (of screening tests, drugs, etc.) sound nearly certain.
By and large I think unless you can somehow -- and I don't know how --
make this a matter of public discussion and understanding, it is going to
be hard-to-impossible to get across in the limited atmosphere of the
consulting room. You just can't communicate it to most people -- not all
-- in that context if they don't have some sort of preparation for it.
I think it leads to false expectations that can be a source of
disappointment, litigation, misunderstanding, and unwarranted
dissatisfaction all right.
The trouble is, if you are honest about the degree of uncertainty, will
some patients blow off the whole endeavor or prefer alternative medicine?
(I vote for honesty ok, I'm just bringing up the point.)
(member of the public myself)