DanielLC comments on Open thread, February 15-28, 2013 - Less Wrong Discussion
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As somebody who's had to deal with doctors because of a plethora of diseases, I must say you're absolutely right. (I also shadowed a few and am considering applying to med school.)
I don't remember what this concept is called, but basically it posits that "one should look for horses, not zebras" and is part of medical education. That is, a doctor should assume that the symptoms a patient has are caused by a common disease rather than by a rare one. So most doctors, thanks to their confirmation bias, dismiss any symptoms that don't fit the common disease diagnosis. (A girl from my town went to her physician because she complained of headaches. The good doctor said that she's got nothing to worry about and recommended more rest and relaxation. It turned out that the girl had a brain tumor which was discovered when she was autopsied. The good doctor is still practicing. Would this gross example of irrationality be tolerated in other professions? I think not.)
Most doctors are not so rational because of the way their education is structured: becoming a doctor isn't so much about reasoning but memorizing heaps of information ad verbatim. It appears that they are prone to spew curiosity-stoppers when confronted with diseases.
What gross example of irrationality? The vast majority of people with headaches don't have anything to worry about.
The question is whether "people with headaches" is the right reference class. If the headache is unusually severe or persistent, it makes sense to look deeper. Also, a doctor can ask for details about the headache before prescribing the expensive tests.
More precisely, the question is whether or not the right reference class is one in which cancer tests are worth while. The headaches would have to be very unusually severe to get enough evidence.
It was never mentioned whether or not the doctor asked for details. It's also possible that none of those reference classes are worth looking into, and she'd need headaches and something else.
Cancer isn't the only solvable problem which could get ignored if headaches are handled as a minor problem which will go away on their own.
Yeah, but the other ones also get ignored if you assume it's cancer. To my knowledge, they have to be individually tested for. If none is worth testing for individually, it's best to ignore the headaches.
“The vast majority” != “All”. What's wrong with “you most likely have nothing to worry about, but I suggest doing this exam the off-chance that you do”? You've got to multiply the probability by the disutility, and the result can be large enough to worry about even if the probability is small. (Yes, down that way Pascal's mugging lies, but still.)
EDIT: Okay, given the replies to this comment I'm going to Aumann my estimate of the cost of tests for rare diseases upwards by a couple of orders of magnitude. Retracted.
I'm pretty sure that, in this case, the probability is smaller than the disutility is large. Getting tested for cancer doesn't come cheap.
Doctors get taught to practice evidence-based medicine. There's a lack of clinical trials that show that you can increase life span by routinically giving people who suffer from headaches brain scans.
If I understand the argument right, then doctors are basically irrational because the favor empirical results from trials over trying to think through the problem on a intellectual level?
MONNAY.
The question is, whose utility?
There's also the problem of false positives. Treatments for rare diseases are often expensive and/or carry serious side effects.
I was thinking of diagnostics, not treatment, though from DanielLC's reply I guess I had underestimated the cost of that, too.
If you start diagnosing and find false positives than you are usually going to treat them.