"Of course it can be less than the cost of the test." includes non-monetary costs. I thought this was clear since the benefit we're talking about is obviously not wholly monetary. (Or even mostly.)
I suppose you're right that the expected value of information, not including the acquisition costs, is never negative.
That feels like cheating though--this information isn't free.
My argument is that the expected value of this information, including acquisition costs, can very easily be negative, since you can't just "ignore" being dead. These costs are extremely large in my snarky autopsy suggestion, but dominate for whole-body MRIs + followups too. The catch is that the scan doesn't have huge benefits and the costs of the followups, while non-trivial, aren't exactly open-heart surgery either, so both are in the neighborhood of zero, except for the monetary expense, which will be crazy high.
Yup, agreed! In fact I wouldn't have done the test mentioned above if I'd been better informed (an MRI with gadolinium contrast; I was only told the latter bit the day I showed up for it. There seems to be a bit of controversy about possible low-level health effects of this contrast agent, and considering I was very probably fine a priori, I think it was a mistake to do this. But it's kind of another thing to decide this on the spot after making an appointment.)
(To say nothing of the extra $1000 surprise bill...)
Anyway, what is raising my hackles doesn't seem rational in the same way. It seems to have the flavor of "when we look and see certain signs, our system too often takes stupid harmful costly actions on that information. Therefore, don't look!" It'd be reassuring to continue "This is a workaround to an admittedly irrational system while we have the following people researching better ways to improve." But that's not the sort of thing I've read.
My hunch from reading these comments is that the doctors tend to be experienced and pragmatic, and their experience teaches them what tests matter and when. The problem with this though is they start to believe those tests are useless when they might not be.
It becomes more complicated when you consider doctors have limited time and resources and cannot spend too much time with any single patient, at least the way the US healthcare system is designed. I believe this is a large contributing factor for why they behave the way they do - it's how the system is designed. And it's why I have all but given up on doctors even trying to help me with my bizarre symptoms, where I have been accused of lying multiple times.
Sympathies -- I've had some experience of that sort too. I'd have more sympathy with the doctors' side (it is a very difficult position) if they weren't set up as gatekeepers.
