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[deleted] t1_itvl8o6 wrote

Reply to comment by SenTedStevens in Neema Roshania Patel, Post editor who cultivated younger audiences, dies at 35 by aresef

Yes, because nine times out of 10, the vague symptoms correspond to a benign condition, and you would on average do more harm than good to patients if you aggressively workup every stomach ache that walks into your office. It sucks, but some conditions are just really hard to detect until they are advanced enough to cause severe problems and are hard to treat at that point.

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lc1138 t1_itvlevm wrote

That’s not an excuse for doctors to blow off patients who complain about chronic gastro problems that are similar to IBS/GERD/Crohn’s

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[deleted] t1_itvnjxz wrote

They're not "blowing off patients." Medicine has guidelines for who needs additional work-up based on research; it's not appropriate to do endoscopic biopsy on everyone who is theoretically at risk for early stage stomach cancer based on the non-specific symptoms. Out of 100 people, you might catch 1 case early but you've just subjected 100 people to an invasive procedure, stressed each of them out for 4 weeks waiting for biopsy results to come back, and like 5 of them will have a surgical complication, bad reaction to anesthesia, or pick up an infection in the hospital solely because you put them through a procedure that had a 99% chance of not helping them in any way.

Science illiterate people just can't comprehend the idea that sometimes a doctor can make the right decision but some patients will be unlucky and still have a bad outcome. Medicine is based on statistics, not a magic ball that can predict the future for individual patients.

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EurekasCashel t1_itvo96r wrote

I agree with your point completely, but I'd just like to add that the guidelines will work for more than 99% of people. Gastric cancer is not common. IBS is incredibly common.

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[deleted] t1_itvutaq wrote

The problem is the guidelines "work" in the sense you correctly figure out they don't have anything more serious and avoid any iatrogenic complications from aggressively trying to diagnose something that isn't there. The patients understandably continue to feel anxious and are constantly in pain because there aren't really great IBS treatments. So it basically seems from their perspective like the guidelines don't work, which is frustrating for everyone when they come back every month asking for further work-up when no further tests would really be appropriate to offer them.

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lc1138 t1_itvoqmf wrote

Sheesh I wasn’t saying to put everyone through a endoscopic biopsy, obviously that’s ridiculous. Get off your high horse

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[deleted] t1_itvrzm4 wrote

That's literally the only thing that could have possibly caught this early. If you are lucky, you can see a small lesion, biopsy it, and figure out it is cancer before it would cause any symptoms that really scream "cancer". Even then, catching it early wouldn't have 100% guaranteed you could treat it and prevent her death. Some types of cancer are just really resistant to chemo and/or metastasize quickly.

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lc1138 t1_itw06sa wrote

So are you saying the majority of people with stomach cancer will most likely not get diagnosed until it’s too late because it’s not appropriate to biopsy everyone? Therefore too bad so sad, deal with it?

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[deleted] t1_itw45be wrote

Yep, it's unfortunately just a limitation of medicine currently; there is not an easy way to tell "good" cells from cancerous ones without performing a biopsy. It is unacceptably dangerous to biopsy someone's stomach when they have mild GI symptoms because >99% of them won't have cancer. It's just how it is; you or I could also be walking around with advanced pancreatic cancer or an early brain cancer right now, but there isn't anything we can do about it with the current state of medical knowledge.

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lc1138 t1_itw8yug wrote

This is taking it in another direction, but do you think there’s any truth to the claim that we’ll never have a cure for cancer because the pharmaceutical industry makes too much money off it? Like just baffles me that this is the way it is sigh

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[deleted] t1_itwpw37 wrote

There has been an explosion in neat novel anti-cancer agents that are basically synthetic antibodies that target specific cell receptors on cancer cells, exorbitantly expensive for the most part of course. Patients generally aren't on the same cancer drug for years at a time. It's more profitable to try to discover some new drug that actually cures them so you are selling the $400,000 first choice drug whenever a patient has melanoma with a certain gene mutation for example. You need to "win" outright and kill essentially all of the cancer cells so the patient goes into remission; if the tumor starts to resist the drug or develops a bunch of new mutations, the oncologist will need to switch to something else if your drug is clearly not working.

The real pharmaceutical scam is meds for things like GERD and hypertension where you find a new drug that is debatably 2% better, market it directly to patients on TV, then charge Medicare 10 times as much as the old drug while 20% of the US population takes it.

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legitsh1t t1_itwki57 wrote

I mean, yes, that's statistically true. Gastric cancer is often caught too late in the course to do much about it, specifically because it's so rare and so similar to many benign conditions that can be treated non-invasively.

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SenTedStevens t1_itvn6dz wrote

Yeah, but that's a garbage explanation if you're a doctor and have the same patient coming to your office with the same issues repeatedly and simply dismiss them. 9/10 times it may be something benign, but if someone keeps coming in they should at least try more advanced diagnostics. And doctors love giving non-specific diagnosis like IBS or some kind of -itis. Oh, you're having stomach aches/shitting weirdly or have some kind of inflammation, just deal with it and/or take extra Aleve.

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[deleted] t1_itvqz9v wrote

If someone comes in every month for a stomach ache and there is nothing else wrong with them (no hematemesis, no weight loss, no blood work abnormalities, nothing on imaging), it would absolutely be malpractice to send them for an unnecessary (surgical) work-up just because they are repeatedly requesting it.

In a lot of cases, the gastroenterologist will actually make more money if they just perform the endoscopy even when it is not indicated, but any good doctor will refuse to perform a procedure unless they think the likely benefit to that patient outweighs the potential harm. There is nothing wrong with getting a 2nd opinion, but if two doctors are both saying "based on your current symptoms, I don't think there is anything serious/treatable, let's hold off on anything drastic," then the absolute worst thing you can do is go to a 3rd, 4th, 5th doctor until you find one who will do surgery when it is way more likely to harm you than find some sort of treatable root cause.

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RadsCatMD t1_itwfi5u wrote

I'm not sure if that's necessarily true. As part of a workup for chronic GI symptoms that are nonresponsive to standard therapy, I can see some causes that might only be clearly evident with direct visualization. Strictures, HPylori sampling / ulcers, gastroesophagitis, malignancies, inflammatory bowel typically require endoscopy. Point remains though, this is for patients who have undergone reasonable workup in a step wise fashion, usually with lifestyle changes and medications beforehand.

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[deleted] t1_itwkx1x wrote

That's fair. Let's be honest though. The average patient who sees their doctor every month for IBS has probably already had at least one unremarkable EGD. My point was, if your GI doc is telling you he doesn't want to scope you (again), there is almost definitely some medical reason, rather than him just wanting patients to suffer and not receive medical care.

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