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There's a saying in medicine, "when you hear hoofbeats, think horses, not zebras". The idea is that medical students' imaginations get captured by rare exotic diseases, which they spuriously diagnose their patients with on the flimsiest of evidence. It's far more likely that the patient is suffering from an extremely common illness (even an unusual presentation of a common illness) than that they're suffering from a rare, exotic illness. I'm currently rewatching the medical drama House, whose working title was Chasing Zebras, the idea being that House and his team are the ones who chase down the zebras only after the less talented and specialised medics have confirmed that it isn't a horse. Almost every episode begins with House being presented with an unsolved case whose etiology he dismisses as something banal and uninteresting: it's only after the patient's symptoms worsen that he realises it really is a zebra.
The admonition to think of horses rather than zebras is not just an amusing observation about the availability heuristic, about the funny fact that we fixate on statistically rare events at the expense of common ones. Rather, it is an important lesson for doctors to internalise, not just to improve their skill as diagnosticians, but for the sake of their patients' welfare and for the efficiency of the medical system as a whole. Ordering tests for a statistically rare illness your patient almost certainly doesn't have wastes their time and unnecessarily immiserates them: rather than doing so, you should have started treatment for the common illness they probably do have. Ordering unnecessary tests is wasteful, a major contributor to Baumol's cost disease, and means that other doctors will get the results of tests they ordered much later (which in turn delays treatment for their patients). Doctors, sadly, are notoriously bad at statistics, which is a shame when statistics are such a huge part of their job.
A huge proportion of complaints about the deficiencies of a given country's medical system ultimately boil down to people failing to understand the "think horses, not zebras" insight. You'll have an obese person who'll claim that a whole series of doctors erroneously assumed their health problems were caused by their obesity and their advice boiled down to "lose weight", only to discover that they actually had a tumour. We're meant to interpret this as evidence of entrenched fatphobia among medics or whatever, but whenever I hear one of these stories, I can only help but think that this is the medical system working exactly as intended. When an obese person complains of health problems consistent with those caused by obesity, nine times out of ten they are caused by obesity, and would be resolved with lifestyle changes. Running a cancer test on every obese patient who complains about trouble sleeping and shortness of breath would bankrupt the health service overnight. I feel the same when photogenic young women appear on television to complain that their doctors missed the symptoms of their breast cancer and they're trying to "raise awareness" thereof. Despite what ad and awareness campaigns would have us believe, breast cancer is a disease that overwhelmingly affects older women. Preemptively screening every woman in her twenties for breast cancer is not a remotely sensible use of scarce medical resources. But everyone loves a sob story, especially when the victim is young and attractive. Older women might as well not exist for how much attention people pay to them.
Likewise here. When a teenaged girl goes missing, and the police tell the family not to worry because she's only run away from home and she'll surely show up in a day or two – well, I don't have hard stats on this, but it wouldn't surprise me if they were correct nine times out of ten. Having the police drop everything and initiate a full-scale manhunt every time a teenage girl yells "I never asked to be born!" is not a remotely sensible allocation of scarce police resources. (Indeed, if it became common knowledge that this is how police departments react whenever a teenage girl goes missing, it would be something that organised criminals could exploit: pay a junkie a hundred quid to report her non-existent daughter missing, then rob a bank while they're preoccupied looking for her.)
On the margin, this approach inevitably means that doctors will occasionally miss a disease independent from an obese person's BMI, a young woman's breast cancer, or a teenager who actually has been abducted. This is regrettable, and yet I defy you to think of an alternative which is better on net. When you hear missing teenager, think runaway, not serial killer.
I know last month I devoted a whole post to criticising people who think the government should dictate who journalists are allowed to report on, how, and in what timeframe, pointing out the perverse incentives and side effects this would inevitably create. And yet I maintain the world would be a much better place if no one was allowed to report the news unless they could provide accurate definitions of "mean", "median" and "mode".
Your docs suck at stats link is broken.
Thanks, fixed.
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