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Mariana Trench's avatar

Oh my God. I just had this fight with an MD and NP. An old woman suddenly gets demented. Well, urinary tract infections can cause that. Oh, but we can't test old ladies for UTIs because turns out old ladies often have bacteria in their urine that isn't causing any harm. So then we overtreat old ladies, and overtreating is way worse, apparently, than treating the subset of old ladies who could be brought back out of dementia by getting their UTIs treated. My late mother tended to get demented with UTIs and get better after treatment, so I'm cranky about this trend. I'll probably get them too and no one will test and treat and I'll die demented because OTHER old ladies have asymptomatic bacteriuria.

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Michael Keenan's avatar

Thank you for writing about this! I've also been very frustrated to hear about it.

I suspect it's largely explained by medical liability. If you're a doctor and you estimate that a weird nodule is probably not worth the painful and risky biopsy, you gain nothing when it's actually nothing, but you'll be sued for ignoring it in the cases where it turns out to be a problem. Scott Alexander has a post about the stories doctors tell each other about this kind of thing (he flags at the top of the post that this particular story is fishy, but that doesn't affect that doctors believe that this kind of thing happens): https://slatestarcodex.com/2014/06/23/court-ing-disaster/

This article, Overtreatment in the United States, describes a survey of doctors from the AMA, and notes that "At 85% of respondents, “fear of malpractice” was the top cited reason for overtreatment."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587107/

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