entropydude

12 lat temudiscuss

Well...we would probably need to factor in the long term costs. Hepatitis C is the leading cause of liver transplantation. The pre-transplant work, surgery, and medical follow up costs on the order of $500,000 each. Not including complications. Obviously everyone with Hepatitis C does not reach cirrhosis to the point of tranplant, but it's still a sizeable number.

entropydude

12 lat temudiscuss

Agreed, carelessness can cause serious issues. I see it sometimes but overall I would say most doctors (I in a tertiary care academic facility so obviously there is a bias) take their job quite seriously and understand the gravity of decisions they make.

It's proabably a waste of resources and time to have a 2-check method as protocol (doctors are already overworked). Often times it is present informally (radiologists/pathologists will often have their colleagus review problematic cases for agreement and neurologists and surgeons will frequently review the films)

What everyone should do is realize you can always get a second opinion and have another expert review the material.

entropydude

12 lat temudiscuss

I'm a doctor and former software programmer, so let me offer a counterpoint:

I would disagree with your statement that medical people have a fatalistic passive attitude. In this case the decision is between 1) watching and waiting to see if the tumor grows and 2) acting immediately to take it out. The tumor in question is a meningioma, a relatively common tumor of the skull (meninges, to be precise) whose natural behavior is unpredictable (some are essentially benign, others are highly malignant). Sometimes high-risk features can be identified on MRI imaging (brain invasion, areas of tissue necrosis, rapid growth) and these will always be treated with intervention. I work at UCSF, one of the top neurosurgery programs in the world, and I can guarantee you the radiologists don't make the mistake on sizing tumors mentioned here (well maybe they do, but it is out of carelessness rather than a problem with there software. it is not hard to find anatomic landmarks to ensure you are measuring at the same level). I would argue that a small meningioma without worrisome features should definitely not be operated on because the risks of surgery are not negligible! These surgeries are no joke, they are extraordinarily complex and they are mucking around next to structures which can cause significant morbidity, neurologic deficits, and even death sometimes if they nick the wrong artery.

It is well accepted practice and backed by evidence (see the WHO:tumors of the CNS publication) that the best way to decrease overall morbidity is by watching and waiting with these types of meningiomas. This is because MOST meningiomas are low-risk/benign (they are often found incidentally during autopsies for other reasons) and the risk of adverse surgical outcomes would be high if you subjected each of these people to invasive procedures when the incidence of high grade meningiomas is low. It is a population based strategy and unfortunately on an individual level you can't predict the outcome, but that is unfortunately a problem with this data. Fortunately lots of new technologies are emerging that can tease out individual differences (the so-called personalized medicine technologies)

That being said the new techniques to map out anatomy to aid surgeons is very cool! And to be fair, it sounds like the patient in this article did not get great care and that some of the doctors were not following the standard of care (1 year between imaging is definitely too long).

comments