Cool, so your serum zorblaxian levels are 300 ng/L. The finding was incidental, so it’s jot tied to existing symptoms / clinical suspicion. It’s a molecule involved in the inflammatory cascade. We don’t know what diseases it’s associated with or not, nor what the change in probability of having the diseases it could be associated with are, not change in prognosis. But, you have a number which your local lab pegs at 1 standard deviation above the mean for the sample they calibrated their measurement technique on.
So, should we now do a work-up for every disease known to man with an inflammatory component? If you have one, if, every test - with their attendant complications and costs - for every disease you don’t have will have net negative effect on your health. You baseline have no symptoms or clinical suspicion for any of these (again, tautology or incidental finding), so the baseline probability is you actually have no disease at all, and this is a spurious value. So, what’s the advantage of this incidental finding?
Framing it as a choice between "have a cookbook decision tree that's been validated by RCTs in exactly this context" and "do a lot of costly (in resources and side effects) followup tests to show we're doing everything we can" is an example of the irrationality that needs fixing. People are capable of actually reasoning with uncertainty when they care about outcomes. When it's you, personally, facing a decision in your life, you don't throw up your hands and say "It's too complicated to decide! There are no actuarial tables about exactly this situation!" Having to decide means having to make a bet. You can be a better or a worse gambler, but we're all gamblers. Medicine as a profession seems to want to pretend they're not, rather like "investors" pretend to be qualitatively different from "speculators".
It’s not “cookbook decision tree”, it’s “data from which to make meaningful inferences about this finding.” It would be nice if we always have that; with incidental findings, we often don’t.
Put it this way: my doctor ordered a test for me, got the results, and made a recommendation. I was ignorant of both the costs (of all sorts) beforehand and of the product of probability and utility on which he (implicitly and unavoidably unless irrationally) based the decision. He did make a meaningful inference from this data, as anyone must to make a decision; he just refused to help me, as a consultant instead of a master, to make my own.
> Cool, so your serum zorblaxian levels are 300 ng/L. The finding was incidental, so it’s jot tied to existing symptoms / clinical suspicion. It’s a molecule involved in the inflammatory cascade.
This isn't that hard. You look at it again in 6 months. And you ask "Did it go up? Did it go down? Is this just your baseline?" And you keep your eyes open a little more strongly for issues that might correlate.
And, you know what, I, the patient, am FAR more invested in keeping tabs on whether things are going right or wrong in my own body than any doctor.
> And, you know what, I, the patient, am FAR more invested in keeping tabs on whether things are going right or wrong in my own body than any doctor.
As someone who has had to figure out his health on his own after multiple doctors have failed or many never even attempted to help, I cannot agree with this more.
So, should we now do a work-up for every disease known to man with an inflammatory component? If you have one, if, every test - with their attendant complications and costs - for every disease you don’t have will have net negative effect on your health. You baseline have no symptoms or clinical suspicion for any of these (again, tautology or incidental finding), so the baseline probability is you actually have no disease at all, and this is a spurious value. So, what’s the advantage of this incidental finding?