"Donal" wrote in message

You all have an inflated view of your knowledge. Most of you seem to think
that it is acceptable to take a guess. I'd like to give you a wake-up
call.
If you are not 100% certain, then you should admit that you don't know.
Your confidence is somebody's bereavement.

I really didn't care to get into this discussion, but it's obvious you have
absolutely no concept of how medicine is practiced. 100% certainty is
exceedingly rare in medicine, as in virtually anything where the human body
and mind are concerned.

Example: A patient comes to me with a painful, red eye. I can generally
determine from signs and symptoms whether it is an infection, or from some
other cause. Say, for example, that it's an infection. Once again via
signs and symptoms I can usually determine if the causative organism is
viral, bacterial, or parasitic. If viral, I'll prescribe an antibiotic
prophylactically (viruses tear up tissue like a rototiller through a garden)
and advise palliative measures. If a bacterial or parasitic infection, I
may culture it, if it is severely acute, and prescribe a broad-spectrum
antibiotic. If subacute, I'll simply prescribe an appropriate antibiotic
regimen and have the patient return in a day or so. The reason is
simple--if one waits until the results from a culture and sensitivity return
from the lab, one of three possible outcomes will have occurred: 1) the eye
will have gotten worse, 2) the infection will be unchanged, and 3) the eye
will have gotten better on its own. The first two are unacceptable, so an
antibiotic is prescribed as a matter of routine. And 95% of the time, the
antibiotic will clear up the infection. I can't recall the last time I had
a patient return with an infection that failed to respond to what I
prescribed. Yes, it has happened, but rarely. The point is, most medicine
is practiced in a similar manner, i.e.--without knowing 100% of the facts.
But that professional knowledge you seem to have no respect for actually
allows us to make a very educated guess, and far more often than not, it is
the correct one.

Another example: A patient presents with abdominal pain. The differential
diagnosis points to, say, two possibilities: a simple irritation to the
bowel from some unknown causative agent (toxin, hypersensitivity to
something ingested, etc.) or perhaps, say, an infectious agent of some sort,
like an enteric virus. So the doctor prescribes something to make the
patient feel better along with something to neutralize the irritant or kill
the infective agent. 90% or better of patient will be treated successfully
by this method. But say, for the sake of discussion, that the patient has a
bowel obstruction, a potentially fatal condition, and that the physician
missed the diagnosis. When 8 hours or less pass and the patient is still
suffering, he will call the doctor who will then order further testing, such
as lower-GI X-rays and/or and of a number of scans, bloodwork, and further
physical examination. So why, you'll no doubt ask, did he NOT order them in
the first place? Because of cost, plain and simple. To order such tests on
every patient that walks through the door with a belly ache would bankrupt
the third party carriers overnight, or at least end medical insurance
coverage as we know it. Such tests aren't generally needed by competent
clinicians with good differential diagnostic skills for routine belly aches.
And in most cases the patient won't expire before the necessary tests are
done. Occasionally doctors misread the symptoms and signs and miss the keys
that might have saved a patient's life. That is medicine in a nutshell--it
isn't perfect. As I said before, it's an inexact art. A physician's
confidence in his knowledge is his #1 tool in the diagnosis and management
of illness. Many tout technology as the savior of the human race, w/r/t
medicine, but without doctors with good diagnostic skills, technology is
useless.

Another aspect to this is that if tort reform or some sort judicial review
of medical malpractice cases does not become reality, the day might arrive
when a physician must order up every possible test for every sniffle and
belly ache that comes through his door in order to keep his ass out of
court. In that event, health care will reach astronomical cost points,
possibly hundreds of times what it costs today. And it will NOT be any more
effective in saving lives than it is now, only more expensive.

It's really your choice. Do you want reasonable health care costs, or do
you want 100% assurance that nothing is ever missed? You can't have both.

Do you have 100% assurance that every time you board an airliner you will
reach your destination alive? Do you have 100% assurance that your next
trip to the park with the kiddies won't result in a random, drive-by
shooting, killing your or your child? Do you have 100% assurance that when
you buy a bottle of Tylenol that one of the capsules won't be filled with
cyanide? Of course you don't. But the odds are overwhelmingly in your
favor for a favorable outcome. The same is true with medicine, despite what
the yellow journalistic anti-medicine press and websites wrongly profess.

Max