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Strangeattractor comments on Open Thread, Jun. 22 - Jun. 28, 2015 - Less Wrong Discussion
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I went to the dermatologist and today and I have some sort of cyst on my ear. He said it was nothing. He said the options are to remove it surgically, to use some sort of cream to remove it over time, or to do nothing.
I asked about the benefits of removing it. He said that they'd be able to biopsy it and be 100% sure that it's nothing. I asked "as opposed to... how confident are you now?" He said 99.5 or 99.95% sure.
It seems clear to me that the costs of money, time and pain are easily worth the 5/1000(0) chance that I detect something dangerous earlier and correspondingly reduce the chances that I die. Like, really really really really really clear to me. Death is really bad. I'm horrified that doctors (and others) don't see this. He was very ready to just send me home with his diagnosis of "it's nothing". I'm trying to argue against myself and account for biases and all that, but given the badness of death, I still feel extremely strongly that the surgery+biopsy is the clear choice. Is there something I'm missing?
Also, the idea of Prediction Book for Doctors occurred to me. There could be a nice UI with graphs and stuff to help doctors keep track of the predictions they've made. Maybe it could evolve into a resource that helps doctors make predictions by providing medical info and perhaps sprinkling in a little bit of AI or something. I don't really know though, the idea is extremely raw at this point. Thoughts?
My advice would be:
1) See another doctor to get a second opinion. (And possibly a third opinion, if you don't like the second doctor.) Keep looking for a doctor until you find one that explains things to you in enough detail so that you understand thoroughly. Write down the questions you want answered ahead of time, and take notes during your appointment. "I am confident" is a bullshit answer unless you understand what possibilities the doctor considered, why the doctor thinks this one is the most likely, what the possible approaches to dealing with it if it turns out to be "not fine" are, and their advantages and disadvantages, what warning signs to look for that might indicate it is not fine, and the mechanism by which the cream option would work.
Unfortunately, the state of medical knowledge is such that there may not be good answers to all of the questions. The best the doctor may be able to do is "I don't know" for some of them. But you can get a better understanding of the situation than you have now, and a better understanding of where there are gaps in the medical knowledge.
2) Read a bunch of scientific papers about cysts and biopsies and tests so that you understand the possibilities and the risks better.
3) Also read about medical errors and risks of surgeries. People following doctor's instructions is one of the leading causes of death in the USA. I read an article about it in JAMA a few years ago. There might be more up-to-date papers about it by now. Having a medical procedure done is not a neutral option when it comes to affecting your chances to continue living.
For example, here's a paper that indicates that prostate biopsies could increase the mortality rate in men. This is just one study, not enough information to make an informed decision.
Boniol M, Boyle P, Autier P, Perrin P. Mortality at 120 days following prostatic biopsy: analysis of data in the PLCO study. Program and abstracts of the 2013 American Society of Clinical Oncology Annual Meeting and Exposition; May 31-June 4, 2013; Chicago, Illinois. Abstract 5022. http://onlinelibrary.wiley.com/doi/10.1002/ijc.23559/full