Snowball in a Blizzard
A Physician's Notes on Uncertainty in Medicine
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- $17.99
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- $17.99
Publisher Description
There's a running joke among radiologists: finding a tumor in a mammogram is akin to finding a snowball in a blizzard. A bit of medical gallows humor, this simile illustrates the difficulties of finding signals (the snowball) against a background of noise (the blizzard). Doctors are faced with similar difficulties every day when sifting through piles of data from blood tests to X-rays to endless lists of patient symptoms.
Diagnoses are often just educated guesses, and prognoses less certain still. There is a significant amount of uncertainty in the daily practice of medicine, resulting in confusion and potentially deadly complications. Dr. Steven Hatch argues that instead of ignoring this uncertainty, we should embrace it. By digging deeply into a number of rancorous controversies, from breast cancer screening to blood pressure management, Hatch shows us how medicine can fail-sometimes spectacularly-when patients and doctors alike place too much faith in modern medical technology. The key to good health might lie in the ability to recognize the hype created by so many medical reports, sense when to push a physician for more testing, or resist a physician's enthusiasm when unnecessary tests or treatments are being offered.
Both humbling and empowering, Snowball in a Blizzard lays bare the inescapable murkiness that permeates the theory and practice of modern medicine. Essential reading for physicians and patients alike, this book shows how, by recognizing rather than denying that uncertainty, we can all make better health decisions.
PUBLISHERS WEEKLY
In this carefully argued, unsettling, and important work, Hatch, assistant professor of medicine at the University of Massachusetts Medical School, analyzes how doctors deal with diagnostic ambiguity. Early detection should save lives, yet, unnervingly, as diagnostic tests detect more early disease, death rates haven't declined. Hatch explains sophisticated technology (ultrasound, the PSA blood test, CT scans) that turn up subtle abnormalities, and why interpreting a mammogram, for instance, is difficult. He discusses the aftermath of a 2009 decision by the U.S. Preventative Services Task Force, which concluded that yearly mammograms are often not lifesaving and are sometimes harmful. They recommended that women between the ages of 50 and 74 have one biennially, though older and younger women could skip it. Their recommendation was unanimous, but so was the outrage from both doctors and women who have ignored it, despite subsequent studies that confirm its validity. Using simple math, illustrations, and vivid anecdotes, Hatch explains that "positive" tests may be vague, and that people yearn for treatments to succeed so much that they tend to ignore evidence that casts doubt. Hatch's book may prove to be a tough sell because its conclusions contradict human impulses, but it is worthwhile reading for both doctors and patients.