Breast Cancer and Emotions

Breast cancer makes me quite emotional.
My mother and two of my sisters have had breast cancer; all were picked up with mammograms.  A good friend of ours was diagnosed in her forties with aggressive breast cancer through mammography.  She is currently doing well.

I don\’t like breast cancer and am definitely against women dying from it.

This is my backdrop when I consider the USPTF\’s latest recommendations:

  • The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient\’s values regarding specific benefits and harms.
    Grade: C recommendation.
  • The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
    Grade: B recommendation.
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
    Grade: I Statement.
  • The USPSTF recommends against teaching breast self-examination (BSE).
    Grade: D recommendation.
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
    Grade: I Statement.
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
    Grade: I Statement.

This has made the general public quite emotional.

There has been a huge public backlash.  People don\’t trust these findings and are willing to talk about it.  Why in the world would they recommend against teaching self-breast exam?  Is this the Obama administration\’s ploy to cut cost?  Are women\’s health concerns being pushed aside for the sake of saving money?

Now congress is getting involved. There are going to be congressional hearings about the issue of how breast cancer screening is best done.

Why has this sparked so much emotion?  Nobody got worked up with the recommendations about car seats.  As emotional an issue as immunizations is to many, recommendations in that area do not spark congressional hearings, front page articles, and public emotion like these breast cancer recommendations.

There are several things that charge this issue beyond that of rational debate:

  1. It is happening in the midst of reform discussions.  Anything that recommends less care is held suspect, as the timing implies that this is a politically motivated recommendation.
  2. It deals with a disease that brings fear in most of us, pulling out the reassurance that it can be prevented.  People want to believe that science can keep them from harm and this makes us feel more vulnerable again.
  3. It contradicts the previous recommendations that moved from simple science to public crusade.  Every woman who did not get mammograms or do self-breast exams were made to feel guilty about it.  Medical students and residents were scolded by attendings if they did not address this issue.
  4. It is a \”women\’s issue\” that makes some feel like women\’s needs are being set aside.

To everyone else, this is a political, social, and scientific discussion.  The debate can rage in the halls of congress, on TV talk shows, and over the blogosphere.  But at the end of the day, I am the one who has to face the patient and discuss the reality of cancer screening.  All of this talk and debate is about what I do for a living.  I am at the eye of this storm, despite what grandstanding congressmen make, what accusations Obama-haters fling, or what eye-rolling scientific purists say.

That makes me quite emotional.

My job is being taken over by congressmen.  They will decide what is appropriate for me to order, and not doing so will go against the standard of care.  Medical science is being torn away from what\’s best for people and is becoming fodder for stump speeches, talk shows, and attacks on political opponents.  Discussing mammograms in the exam room no longer centers around what is best or what has the best evidence, it centers on politics.

Please let me be a doctor.  Please let me get to know the patient, read the authorities I trust, and make the best decisions for that patient.  Stay away from this, politicians!  You are bad at making political decisions, so why should you be trusted in medical decisions?  Don\’t say you do this in the public interest when it clearly involves what\’s best for your political career.  I don\’t like being a pawn.

Unfortunately, there is little chance of that.  If a recommendation by the USPTF causes this kind of brouhaha, do you think good reform can really happen?  I doubt it.

And that makes me quite emotional.

This post isn\’t about the content of those recommendations.  I have read both sides of the issue and see rationale both ways.  I would rather not debate the issue itself (it caused an argument at home this morning already), as I understand how people\’s emotions are high as well.  I am just frightened of a world in which science needs to be ratified by congress.  I don\’t like it when Oprah has an influence on how I do my job.  I don\’t like the USPTF to be accused of being a covert wing of the Democratic party.

My job is hard enough.  My decisions are hard enough.  My days are hard enough.  Why can\’t I just be a doctor?

35 thoughts on “Breast Cancer and Emotions”

  1. This struck the loudest chord for me: “Why can’t I just be a doctor?” I’ve seen so many changes over the years in the medical field and it’s truly sad. Years ago I used to work for a physician-owned medical malpractice insurance company. My eyes were opened then when I saw how proactive physicians were to protect themselves. Now it’s gotten even worse. Physicians are being attacked on both sides. What happened to those doctors back in the days of the old Western movies? It seemed much simpler back then. Get shot, go see Doc, drink whiskey, get fixed, give him a goat, all better.

  2. This struck the loudest chord for me: “Why can’t I just be a doctor?” I’ve seen so many changes over the years in the medical field and it’s truly sad. Years ago I used to work for a physician-owned medical malpractice insurance company. My eyes were opened then when I saw how proactive physicians were to protect themselves. Now it’s gotten even worse. Physicians are being attacked on both sides. What happened to those doctors back in the days of the old Western movies? It seemed much simpler back then. Get shot, go see Doc, drink whiskey, get fixed, give him a goat, all better.

  3. This is an excellent post. It important to have dialogue about it. There are 4 issues, IMHO.1) the false positives ( 1 in 5) and 50% for those between age 40 – 50
    2) self-exam (who’ll stop me?!)
    3) rationale decisions BY THE PATIENT – with information: existing conditions(e.g., pregnancy) , comorbidities, history of breast cancer, options, treatments
    4) the politics of your US discussions of Universal Health Care

    The biopsychosocial issues of false positives behoove the patient to get a 2nd reading. Reading a mammography is an interpretive issues, as has been written. Many in Canada are getting their heads around screening vs. diagnosis.
    And self-exams: as a middle-aged woman I have lumps everywhere. I have lumps I’ve had since my pregnancy days, and lumps that have just developed that we monitor.
    It i important to check yourself, know your body, and do what makes sense for the individual. I feel for those who do pre-diagnosis, double masectomies in fear and misunderstanding.

  4. This is an excellent post. It important to have dialogue about it. There are 4 issues, IMHO.1) the false positives ( 1 in 5) and 50% for those between age 40 – 50
    2) self-exam (who’ll stop me?!)
    3) rationale decisions BY THE PATIENT – with information: existing conditions(e.g., pregnancy) , comorbidities, history of breast cancer, options, treatments
    4) the politics of your US discussions of Universal Health Care

    The biopsychosocial issues of false positives behoove the patient to get a 2nd reading. Reading a mammography is an interpretive issues, as has been written. Many in Canada are getting their heads around screening vs. diagnosis.
    And self-exams: as a middle-aged woman I have lumps everywhere. I have lumps I’ve had since my pregnancy days, and lumps that have just developed that we monitor.
    It i important to check yourself, know your body, and do what makes sense for the individual. I feel for those who do pre-diagnosis, double masectomies in fear and misunderstanding.

  5. You can imagine my thoughts when this came out. How utterly stupid to put that out there. Women must be proactive in looking after their own health. I know so many young women that have had this disease long before 40, that it boggles my mind they would make these recommendations. Young women, who are diagnosed, are found to have very invasive, aggressive tumors. I do feel they are trying to cut costs. It was my first gut reaction to it.
    We have too many things getting in the way of the doctor/patient relationship. Let our doctors do what they are trained to do! I’ll respectfully stop right here.

  6. You can imagine my thoughts when this came out. How utterly stupid to put that out there. Women must be proactive in looking after their own health. I know so many young women that have had this disease long before 40, that it boggles my mind they would make these recommendations. Young women, who are diagnosed, are found to have very invasive, aggressive tumors. I do feel they are trying to cut costs. It was my first gut reaction to it.
    We have too many things getting in the way of the doctor/patient relationship. Let our doctors do what they are trained to do! I’ll respectfully stop right here.

  7. Evidence is evidence.
    One can argue that evidence differs from “the truth” depending on the methods devised to seek it out and I can see how that argument works.

    Many people will turn to emotional anecdotes to overrule dry facts and this has, by and large, been a successful endeavor in appealing to politicians and the broader public unused to ideas like
    “# The USPSTF recommends against teaching breast self-examination (BSE).
    Grade: D recommendation.
    # The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.”

    However, anecdotes do not sway the evidence until they reach a statistically significant level of contribution. That’s a tough sell.

  8. Evidence is evidence.
    One can argue that evidence differs from “the truth” depending on the methods devised to seek it out and I can see how that argument works.

    Many people will turn to emotional anecdotes to overrule dry facts and this has, by and large, been a successful endeavor in appealing to politicians and the broader public unused to ideas like
    “# The USPSTF recommends against teaching breast self-examination (BSE).
    Grade: D recommendation.
    # The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.”

    However, anecdotes do not sway the evidence until they reach a statistically significant level of contribution. That’s a tough sell.

  9. you can’t just be a doctor because you might not tell patients what the suits du jour pulling the strings and controlling the money want you to tell them.
    As long as someone else is paying, someone else will be getting between you and the patient.

  10. you can’t just be a doctor because you might not tell patients what the suits du jour pulling the strings and controlling the money want you to tell them.
    As long as someone else is paying, someone else will be getting between you and the patient.

  11. As a working clinician I have tend to trust the USPSTF. They have little agenda and spend a lot of time carefully studying mountains of data. I am a bit irritated by all the public outcry and the fact that a whole lot of doctors seem eager to jump on an irrational bandwagon. Men can also get breast cancer as well as women in their 30’s. Some of them will die of this. The question is will screening men and 30 year old women kill more people by unnecessary treatments than it saves? Yes. Hence the reason for guidelines.
    The trouble is that the guidelines are based on mountains of studies that the public and politicians are unequipped to evaluate for themselves. So they go for next best thing: Anecdotal evidence. They hang their opinions on stories of women in their 40’s that died of Breast Cancer (or Prostate Cancer in a discussion of PSA). All the evidence in the world is no competition for a good sad story.

    What the USPSTF needs to do is come up with a convincing story. Stop referring to data that nobody understands and give your argument a face. Parade the widower of and orphan kids of a woman that died as the result of a workup for a false positive mammogram.

  12. As a working clinician I have tend to trust the USPSTF. They have little agenda and spend a lot of time carefully studying mountains of data. I am a bit irritated by all the public outcry and the fact that a whole lot of doctors seem eager to jump on an irrational bandwagon. Men can also get breast cancer as well as women in their 30’s. Some of them will die of this. The question is will screening men and 30 year old women kill more people by unnecessary treatments than it saves? Yes. Hence the reason for guidelines.
    The trouble is that the guidelines are based on mountains of studies that the public and politicians are unequipped to evaluate for themselves. So they go for next best thing: Anecdotal evidence. They hang their opinions on stories of women in their 40’s that died of Breast Cancer (or Prostate Cancer in a discussion of PSA). All the evidence in the world is no competition for a good sad story.

    What the USPSTF needs to do is come up with a convincing story. Stop referring to data that nobody understands and give your argument a face. Parade the widower of and orphan kids of a woman that died as the result of a workup for a false positive mammogram.

  13. Agree that mammogram mania has had a volcanic emotional reaction. There’s a lesson here, and it doesn’t bode well for the success of health care reform. To begin, the USPSTF has earned a reputation for objectivity and impartiality. It is nobody’s tool. They performed the very role that Obama has properly championed and funded – comparative effectiveness research (CER). Ironically, the government now rejects the CER findings of its own medical task force, allowing the politics of breast cancer to trump the science. This demonstrates that it may be impossible to successfully excise excessive medical care and treatments from our bloated system. The government had an opportunity to lead, and it fumbled. http://www.MDWhistleblower.blogspot.com

  14. Agree that mammogram mania has had a volcanic emotional reaction. There’s a lesson here, and it doesn’t bode well for the success of health care reform. To begin, the USPSTF has earned a reputation for objectivity and impartiality. It is nobody’s tool. They performed the very role that Obama has properly championed and funded – comparative effectiveness research (CER). Ironically, the government now rejects the CER findings of its own medical task force, allowing the politics of breast cancer to trump the science. This demonstrates that it may be impossible to successfully excise excessive medical care and treatments from our bloated system. The government had an opportunity to lead, and it fumbled. http://www.MDWhistleblower.blogspot.com

  15. May I ask a question from Canada?Currently, what is the process for getting a mammogram?

    In Canada, if we have a lump, we are sent for tests of one sort or another by our family physician, or we are sent to an oncologist. (Mammogram, or biopsy, could be the result – it depends.)
    If our physician thinks we should have an annual mammogram we are sent for one.
    We have this paid for through our health care system. Most send us, after age 50.

    If you want a mammogram in the US, can you just sign up for one?
    Do you have it paid for through your insurance carrier? If you do not have insurance, can you have one done? Can an insurance company refuse to pay for it? –is that why Americans are so upset with this USPSTF pronouncement?
    I am confused about the controversy here. But fascinated, nonetheless!
    Thanks!

  16. May I ask a question from Canada?Currently, what is the process for getting a mammogram?

    In Canada, if we have a lump, we are sent for tests of one sort or another by our family physician, or we are sent to an oncologist. (Mammogram, or biopsy, could be the result – it depends.)
    If our physician thinks we should have an annual mammogram we are sent for one.
    We have this paid for through our health care system. Most send us, after age 50.

    If you want a mammogram in the US, can you just sign up for one?
    Do you have it paid for through your insurance carrier? If you do not have insurance, can you have one done? Can an insurance company refuse to pay for it? –is that why Americans are so upset with this USPSTF pronouncement?
    I am confused about the controversy here. But fascinated, nonetheless!
    Thanks!

  17. chrys, what in the world do the new guidelines have to do with women under 40? You do realize that the change doesn’t effect them, as the current guidelines don’t recommend screening for them, and never has.
    The problem is that mammograms don’t work very well in young women, so routinely screening them doesn’t make sense.

    I’m a believer in evidence based medicine. The evidence says that all this screening isn’t really saving many lives. We should move past the screening hype, which is really a distraction, and focus more on better treatments, finding cures, and the reasons behind the cancers (prevention).

    And by the way, my aggressive cancer was found, by myself, by accident, at age 39. Yes, I wish I was screened in my thirties. But with no real risk factors, why would anyone have thought to do it?

  18. chrys, what in the world do the new guidelines have to do with women under 40? You do realize that the change doesn’t effect them, as the current guidelines don’t recommend screening for them, and never has.
    The problem is that mammograms don’t work very well in young women, so routinely screening them doesn’t make sense.

    I’m a believer in evidence based medicine. The evidence says that all this screening isn’t really saving many lives. We should move past the screening hype, which is really a distraction, and focus more on better treatments, finding cures, and the reasons behind the cancers (prevention).

    And by the way, my aggressive cancer was found, by myself, by accident, at age 39. Yes, I wish I was screened in my thirties. But with no real risk factors, why would anyone have thought to do it?

  19. Grisbe, I had to go back and look at what I wrote that had you thinking I felt mammograms in particular should be done sooner. I didn’t state anything of the kind.I was also referring to their feelings on BSE. Without BSE some women will never find their own cancers until it is too late.

    I was 36, and my cancer had spread. I had two tumors, and they were very aggressive and invasive. I went to my doctor and he felt I was “too young” and he said he didn’t feel anything (even when I put his hand right on it). A mammogram found the two tumors. When I went to the surgeon he couldn’t even feel the lump. I had to place his fingers on the site so he could do the biopsy. My point may not be refreshing – but it was that women must know their own bodies. Both of these highly trained, experienced doctors did not feel it, even when their fingers were right on it.

    I think about the women that don’t know their family’s medical history. Some don’t know they are carrying the BRCA1 and 2 genes (I was not). If we don’t do anything at all until 50, they will go undetected. We need better screening methods in younger women, as well as better treatments. If both of my doctors had poo pooed me and now I was to wait until 50, it wouldn’t have been an issue at all by then.

    Yes, I agree we need to find better treatments. We need to find a cure. We need to find better screening. I was part of the Young Survival Coalition and the stories are heart breaking. Cancers in younger women cause issues that the older population won’t have to deal with in the same way.

    To those of you who feel I have no common sense, please know me before you judge me, and remember – it is very hard to express exactly what you mean with words, when you’re trying to leave a quick comment. I address everyone I’ve ever come in contact with, with respect. I’ve lost many friends to this disease, and I suffered through my treatments and lost my last chance of ever having a family of my own, so I ask you all to please forgive me if I come across as being emotional on this topic. That’s why I didn’t elaborate in my first comment. Being emotional about something that brings with it such pain doesn’t seem like such a crime to me. I am, however, not stupid and don’t like being addressed in a tone that inflects or suggests I am.

    One of the reasons I’ve loved Rob’s site is for his kindness, and the fact that he allows both patients as well as medical personnel to exchange in peace here. How can people learn from each other if they aren’t respectful of the differences and various walks of life each comes from? Now, let’s move on, please. I’ll read silently when Rob comes back, and I, respectfully, will keep my opinions to myself.

  20. Grisbe, I had to go back and look at what I wrote that had you thinking I felt mammograms in particular should be done sooner. I didn’t state anything of the kind.I was also referring to their feelings on BSE. Without BSE some women will never find their own cancers until it is too late.

    I was 36, and my cancer had spread. I had two tumors, and they were very aggressive and invasive. I went to my doctor and he felt I was “too young” and he said he didn’t feel anything (even when I put his hand right on it). A mammogram found the two tumors. When I went to the surgeon he couldn’t even feel the lump. I had to place his fingers on the site so he could do the biopsy. My point may not be refreshing – but it was that women must know their own bodies. Both of these highly trained, experienced doctors did not feel it, even when their fingers were right on it.

    I think about the women that don’t know their family’s medical history. Some don’t know they are carrying the BRCA1 and 2 genes (I was not). If we don’t do anything at all until 50, they will go undetected. We need better screening methods in younger women, as well as better treatments. If both of my doctors had poo pooed me and now I was to wait until 50, it wouldn’t have been an issue at all by then.

    Yes, I agree we need to find better treatments. We need to find a cure. We need to find better screening. I was part of the Young Survival Coalition and the stories are heart breaking. Cancers in younger women cause issues that the older population won’t have to deal with in the same way.

    To those of you who feel I have no common sense, please know me before you judge me, and remember – it is very hard to express exactly what you mean with words, when you’re trying to leave a quick comment. I address everyone I’ve ever come in contact with, with respect. I’ve lost many friends to this disease, and I suffered through my treatments and lost my last chance of ever having a family of my own, so I ask you all to please forgive me if I come across as being emotional on this topic. That’s why I didn’t elaborate in my first comment. Being emotional about something that brings with it such pain doesn’t seem like such a crime to me. I am, however, not stupid and don’t like being addressed in a tone that inflects or suggests I am.

    One of the reasons I’ve loved Rob’s site is for his kindness, and the fact that he allows both patients as well as medical personnel to exchange in peace here. How can people learn from each other if they aren’t respectful of the differences and various walks of life each comes from? Now, let’s move on, please. I’ll read silently when Rob comes back, and I, respectfully, will keep my opinions to myself.

  21. Chrys, no one could read your comment and not appreciate how you view the mammogram issue from a painful personal perspective. This was not evident in your initial comment. Most importantly, I hope you are well. I agree with you wholeheartedly that patients (with their families) need to advocate for themselves, for the reasons that you expressed. The remaining issue, which I cannot solve, is how broad should we be in screening populations for certain diseases? I know that lives are at stakes, but there are other issues at play as well. Consider the screening colonoscopy, which I perform every day. Guidelines and expert opinion recommend that this test begin at age 50, unless certain risk factors are present. We all know that there will be a few people in their 40 ‘s, or even younger, who will contract this dreadful disease. How do we capture these folks in the system with the tools currently available? Should we do colon exams starting at age 35 so we can save these folks who are currently missed by the system? I think we could agree that there would be many downsides to this approach, even though the intent is to help people. It is quite clear that you have quite a bit of common sense and heart also. http://www.MDWhistleblower.blogspot.com

  22. Chrys, no one could read your comment and not appreciate how you view the mammogram issue from a painful personal perspective. This was not evident in your initial comment. Most importantly, I hope you are well. I agree with you wholeheartedly that patients (with their families) need to advocate for themselves, for the reasons that you expressed. The remaining issue, which I cannot solve, is how broad should we be in screening populations for certain diseases? I know that lives are at stakes, but there are other issues at play as well. Consider the screening colonoscopy, which I perform every day. Guidelines and expert opinion recommend that this test begin at age 50, unless certain risk factors are present. We all know that there will be a few people in their 40 ‘s, or even younger, who will contract this dreadful disease. How do we capture these folks in the system with the tools currently available? Should we do colon exams starting at age 35 so we can save these folks who are currently missed by the system? I think we could agree that there would be many downsides to this approach, even though the intent is to help people. It is quite clear that you have quite a bit of common sense and heart also. http://www.MDWhistleblower.blogspot.com

  23. Chrys ~ thank you for sharing. I agree 100% we need to be strong advocates for our own health. How many errors could be avoided (or missed diagnoses) if patients were educated enough and/or brave enough to speak up? It’s difficult to speak up when you’re at the end of your rope, not feeling well, and/or you’re made to feel like you should just accept whatever is being told to you.

  24. Chrys ~ thank you for sharing. I agree 100% we need to be strong advocates for our own health. How many errors could be avoided (or missed diagnoses) if patients were educated enough and/or brave enough to speak up? It’s difficult to speak up when you’re at the end of your rope, not feeling well, and/or you’re made to feel like you should just accept whatever is being told to you.

  25. Thank you for your respectful reply to me, Michael. It is hard to write a brief comment and be understood by all.
    I am quite well. I have survived.

    MT, I appreciated you coming out and understanding me. Thank you.

  26. Thank you for your respectful reply to me, Michael. It is hard to write a brief comment and be understood by all.
    I am quite well. I have survived.

    MT, I appreciated you coming out and understanding me. Thank you.

  27. Angel – I have been blogging with you for 3 years now and you are ALWAYS respectful, insightful and compassionate… and it’s been a pleasure getting to know you and share thoughts, life events and laughs and even tears (on my part). You have been a friend I can trust and count on… and as you know ..have sought your advice/guidance.
    Some years ago ..I had known a young woman ..30 years old..who had a husband and 2 very young little girls. She ..at that young age had bi-lateral breast cancer and subsequently died. Thankfully that is not the norm.

    A few years ago, I had a breast lump that was cleared by the surgeon after palpating it in the exam room. I didn’t think twice about pursuing it..but it was superficial. (Those lumps confuse me) He told me (back in Oct 06) that studies show self breast exams don’t make any difference in outcomes… or something like that.

    I was good with that because I hate doing it because just thinking about it is so unnerving. I know prevention is key. I would think self exams would be good.

    Anyway..one thing I do not understand is the docs who examine my breasts go so quickly. I suppose it would be weird if they lingered.. but don’t they run the risk of missing something when going so fast? maybe I am focused on the wrong things to feel. ?

  28. Angel – I have been blogging with you for 3 years now and you are ALWAYS respectful, insightful and compassionate… and it’s been a pleasure getting to know you and share thoughts, life events and laughs and even tears (on my part). You have been a friend I can trust and count on… and as you know ..have sought your advice/guidance.
    Some years ago ..I had known a young woman ..30 years old..who had a husband and 2 very young little girls. She ..at that young age had bi-lateral breast cancer and subsequently died. Thankfully that is not the norm.

    A few years ago, I had a breast lump that was cleared by the surgeon after palpating it in the exam room. I didn’t think twice about pursuing it..but it was superficial. (Those lumps confuse me) He told me (back in Oct 06) that studies show self breast exams don’t make any difference in outcomes… or something like that.

    I was good with that because I hate doing it because just thinking about it is so unnerving. I know prevention is key. I would think self exams would be good.

    Anyway..one thing I do not understand is the docs who examine my breasts go so quickly. I suppose it would be weird if they lingered.. but don’t they run the risk of missing something when going so fast? maybe I am focused on the wrong things to feel. ?

  29. I liken the guidelines for mammography to what the airlines do in regard to modification of their aircraft — the airlines determine how much the modification would cost if it were done to all their aircraft and how much a plane crash would cost them in lawsuits and then determine which is cheaper. In other words, what is an acceptable loss? In material cost (the loss of the plane and its cargo), in loss of life, in passenger injuries, in loss of money due to lawsuits. Many times the airlines gamble that their planes will not fail even if the modification is not done — and many times they’re right. When they’re wrong, they pay the price and usually are forced to perform the modification to the rest of their fleet.
    Physicians, on the other hand, usually cannot gamble that they’ll be lucky, hence they purchase malpractice insurance and order jillions of tests and procedures to cover themselves. In the case of annual mammograms most of the populace is surprised about the new guidelines because they are not used to being told that finding cancer in a few women is not worth the expense of screening everyone. So they’ve gotten emotional. Why are all y’all surprised that we’re surprised to be told we’re not worth the expense?

  30. I liken the guidelines for mammography to what the airlines do in regard to modification of their aircraft — the airlines determine how much the modification would cost if it were done to all their aircraft and how much a plane crash would cost them in lawsuits and then determine which is cheaper. In other words, what is an acceptable loss? In material cost (the loss of the plane and its cargo), in loss of life, in passenger injuries, in loss of money due to lawsuits. Many times the airlines gamble that their planes will not fail even if the modification is not done — and many times they’re right. When they’re wrong, they pay the price and usually are forced to perform the modification to the rest of their fleet.
    Physicians, on the other hand, usually cannot gamble that they’ll be lucky, hence they purchase malpractice insurance and order jillions of tests and procedures to cover themselves. In the case of annual mammograms most of the populace is surprised about the new guidelines because they are not used to being told that finding cancer in a few women is not worth the expense of screening everyone. So they’ve gotten emotional. Why are all y’all surprised that we’re surprised to be told we’re not worth the expense?

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