Counterintuitive Predictions
1. True or False. What occurs in the world is not always reasonable, logical, or right. Even so, it might be true. You’ll decide whether the Premises below are True or False.
2. Reasonable or Unreasonable. People act for reasons other than logic; among them sympathy, loyalty, hope, fear, vested interest, greed, and ineptitude. You’ll decide whether the Premises below are Reasonable or Unreasonable.
3. Right or Wrong. Decisions based on logic or reason can be ethical and moral, unethical or immoral. You’ll decide whether the Premises below are Good or Bad, Ethical or Unethical, Moral or Immoral.
Your Predictions
Before hearing about the Mammogram team at Kaiser Permanente Hospital or reading the associated article, respond in three ways to the Premises below.
First: declare whether the statements made appear to be True or False (you could also answer Likely or Unlikely).
Second: declare whether the statements appear to be Reasonable or Unreasonable (or if you prefer: Batshit Crazy, or Not Insane).
Third: Declare the statements’ moral or ethical position to be Good or Bad. (If the statement doesn’t permit a moral judgment, you could still pronounce it a Good thing, or fundamentally Just Wrong.)
Respond in three ways for each Premise.
1. Likely / Batshit Crazy / Bad
2. False / Reasonable / Good
3. Unlikely / Unreasonable / Wrong
4. True / Not Crazy / Right
Of course, in paradise, the Reasonable would always be True and Good, and the Crazy would always be Untrue, and universally recognized as Bad. But we know better, don’t we? At the end of class, return to your predictions. How many of your expectations were met?
The Article
Mammogram Team Learns from its Errors
The Premises
1. Women who find out how many cancers their doctors miss in routine mammograms stop getting mammograms.
2. Radiologists who perform mammograms are held accountable for the accuracy of their readings.
3. A doctor who finds hundreds of tumors in a year and a half, but who misses 10, is almost always fired.
4. Doctors who read only a few mammograms a month are removed from film-reading teams so that they read none at all.
5. Publishing the failure rates of radiologists improves their accuracy to the best the discipline can achieve.
6. The best technique for improving diagnosis accuracy has been adopted by almost no radiology departments.
7. Congress demands that radiologists be held accountable for their accuracy at detecting tumors in mammogram films.
8. The 20,000 US doctors who read breast X-rays are trained to do so; their accuracy is known and tested.
9. The medical profession accepts that, to varying degrees, all doctors make the same mistakes.
10. Doctors who do mammographies follow up with those patients to discover whether their diagnoses were correct.
11. Doctors appreciate knowing whether they missed actual tumors or misread the “shadows and swirls” of a mammogram as a tumor.
12. The “shame” of confronting an incorrect diagnosis is a valuable teaching tool for doctors who diagnose cancers from mammograms.
13. An accuracy rate of 80% in detecting cancers from mammograms is something to brag about.
14. The best doctor to head a radiology department is a squeamish physician who trained as a lawyer and prefers not to deal with patients “and their blood.”
15. Radiology can be tracked well statistically because patients either have tumors or they don’t.
16. When the director of the radiology department discovers a way to improve the accuracy of cancer diagnoses, his method is immediately embraced by hospital administrators.
17. When New York hospitals began to publish their surgeons’ heart surgery successes and failures, the death rate fell by 40%.
18. The falling death rate meant that heart surgeons were doing more careful work.
19. Hospitals that reduce their false diagnoses proudly advertise that they “make 20% fewer errors” than their competitors.
20. Publishing the error rates of mammography radiologists results in an uncertain but significant number of cancer deaths in women who avoid testing.
21. A radiologist who is known to have missed a tumor is likely to have missed a dozen out of 3000 he declared to be tumor-free.
22. Out of those 3000, when 250 were scanned again, and 30 were biopsied, 10 were found to have cancers he had missed.
23. Finding those 10 cancers was reported as a front-page medical scandal instead of a triumph of an enlightened new technique for avoiding missed diagnoses.
24. Many of the 250 women who were told they needed followup were angry.
25. Of the ten whose cancers were missed by the first doctor but discovered in followup screenings, most sued the hospital for malpractice.
26. The doctor who missed the 10 tumors felt he had been treated unfairly, that only 3 of the cancers could be blamed on him, and that his error rate was acceptable.
27. After being fired, he was hired as a fill-in radiologist in five states bordering North Carolina.
28. The radiologists on the terminated doctor’s team supported him, not the hospital, and resent having their work scrutinized and their failure rates published.
29. While some doctors read 14,000 films a year, and others fewer than 500, failure rates are very similar.
30. Doctors who read just 500 films a year get re-assigned to other work since their sample size is too small to determine their accuracy.
31. Doctors who are “fired” from film reading based on low volume are relieved to have the diagnostic responsibility taken from them.
32. Doctors would rather bring a patient back for a second look or a biopsy than miss a tumor.
33. Doctors are much happier to find evidence on the film of a cancer that has “been around for awhile.”
34. Routinely experiencing the shame of missed diagnoses in tests every four months builds confidence in radiologists.
35. Most hospitals send out lists of actual missed tumors or “false negatives” to their radiologists every year so they can study the films they misinterpreted.
36. The Kaiser Permanente department has learned to detect various “presentations” of tumors on film by studying films of actual missed tumors after the fact.
37. In North Carolina, for every two cancers radiologists find, they miss one.
38. If the results at Kaiser Permanente were replicated nationwide, better than 80% of cancers would be found and 10,000 more cancers would be correctly detected each year.
39. False positives are easy to track, but almost nobody tracks false negatives (missed tumors that show up in later mammograms).
40. There is no routine followup for women who, on the basis of their mammograms, are determined to be tumor free.
41. Holding radiologists to a higher standard of competency results in reduced access to quality care.
42. Making failure rates public increases the likelihood of malpractice claims, which in turn drives up insurance rates, which in turn drives good doctors from the field.
43. Having two doctors instead of one review every film improves accuracy and drives down costs.
44. A nationwide 70% effectiveness rate is considered the best that can be achieved practically and politically.
45. Government oversight of physician performance to standardize techniques nationally has actually reduced accuracy.
46. Dr. Adcock, who improved effectiveness in his radiology department by 25%, took himself off the team when his volume dropped.
47. The most conscientious doctors, who agonize over the presence or absence of tumors on every film, are by far the most effective.
48. When they have a choice, women are best served by the doctors who send the largest percentage of women for biopsies because they miss the fewest cancers.
49. The best indicator of whether a doctor is competent to read mammograms is the number of times she’s been sued.
50. A good day for mammograms is Mother’s Day, when many clinics offer free or discounted exams.
The Blind Summary.
When you finish classifying the claims for Truth/Reasonableness/Goodness, in one paragraph, try to summarize the article you have not read. Use the heading “BLIND SUMMARY.”
Got through 41 of the claims in class
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Predictions made off the claims: (say whether its true/false ,reasonable/unreasonable, right or wrong
1. Women who find out how many cancers they docs miss in their mammograms stop getting mammograms ( true, unreasonable, wrong)
2.Radiologists who perform mammograms are held accountable for the accuracy of their readings.(false, unreasonable, wrong)
3. A doctor who finds hundreds of tumors in a year and a half, but who misses 10, is almost always fired.(False, unreasonable, wrong)
4. Doctors who read only a few mammograms a month are removed from film-reading teams so that they read none at all.(True , reasonable, right)
5. Publishing the failure rates of radiologists improves their accuracy to the best the discipline can achieve.(True, reasonable, right)
6. The best technique for improving diagnosis accuracy has been adopted by almost no radiology departments.(false, unreasonable, wrong)
7. Congress demands that radiologists be held accountable for their accuracy at detecting tumors in mammogram films.(False, unreasonable, right)
8. The 20,000 US doctors who read breast X-rays are trained to do so; their accuracy is known and tested.(False, reasonable, right)
9. The medical profession accepts that, to varying degrees, all doctors make the same mistakes. (True, reasonable, wrong)
10. Doctors who do mammographies follow up with those patients to discover whether their diagnoses were correct.(True, reasonable, right)
11. Doctors appreciate knowing whether they missed actual tumors or misread the “shadows and swirls” of a mammogram as a tumor.(True , reasonable, right)
12. The “shame” of confronting an incorrect diagnosis is a valuable teaching tool for doctors who diagnose cancers from mammograms.(true, reasonable, right)
13. An accuracy rate of 80% in detecting cancers from mammograms is something to brag about. (true, reasonable, wrong)
14. The best doctor to head a radiology department is a squeamish physician who trained as a lawyer and prefers not to deal with patients “and their blood.”(flase, unreasonable, wrong)
15. Radiology can be tracked well statistically because patients either have tumors or they don’t.(False, unreasonable, wrong)
16. When the director of the radiology department discovers a way to improve the accuracy of cancer diagnoses, his method is immediately embraced by hospital administrators.(false, reasonable, right)
17. When New York hospitals began to publish their surgeons’ heart surgery successes and failures, the death rate fell by 40%.(True, reasonable, wrong)
18. The falling death rate meant that heart surgeons were doing more careful work.(True, reasonable, right)
19. Hospitals that reduce their false diagnoses proudly advertise that they “make 20% fewer errors” than their competitors.(False, unreasonable ,wrong)
20. Publishing the error rates of mammography radiologists results in an uncertain but significant number of cancer deaths in women who avoid testing.(true, unreasonable , right)
21. A radiologist who is known to have missed a tumor is likely to have missed a dozen out of 3000 he declared to be tumor-free.(false, reasonable, right)
22. Out of those 3000, when 250 were scanned again, and 30 were biopsied, 10 were found to have cancers he had missed.(True, reasonable, right)
23. Finding those 10 cancers was reported as a front-page medical scandal instead of a triumph of an enlightened new technique for avoiding missed diagnoses.(True, unreasonable, wrong)
24. Many of the 250 women who were told they needed followup were angry.(True, reasonable, right)
25. Of the ten whose cancers were missed by the first doctor but discovered in followup screenings, most sued the hospital for malpractice.(True, reasonable, right)
26. The doctor who missed the 10 tumors felt he had been treated unfairly, that only 3 of the cancers could be blamed on him, and that his error rate was acceptable.(True, reasonable, wrong)
27. After being fired, he was hired as a fill-in radiologist in five states bordering North Carolina.(True, reasonable, right)
28. The radiologists on the terminated doctor’s team supported him, not the hospital, and resent having their work scrutinized and their failure rates published.(True, reasonable , right)
29. While some doctors read 14,000 films a year, and others fewer than 500, failure rates are very similar. (False, unreasonable, right)
30. Doctors who read just 500 films a year get re-assigned to other work since their sample size is too small to determine their accuracy.(false, reasonable, right)
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25.True/Reasonable/Right Of the ten whose cancers were missed by the first doctor but discovered in follow up screenings, most sued the hospital for malpractice.
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True, reasonable, right morally
True reasonable, right morally
False, not reasonable, wrong morally
False, not reasonable, wrong
true/ reasonable/ right
true/ reasonable/ right
true/ reasonable/ right
true/ reasonable/ right
Got to 32 claims.
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1.True/Unreasonable/Wrong
2.False/Reasonable/Right
3.Unlikely/Reasonable/Right
4.Likely/Reasonable/Right
5.True/Reasonable/Right
6.True/Reasonable/Wrong
7.False/Unreasonable/Wrong
8.True/Reasonable/Right
9.True/Unreasonable/Wrong
10.True/Reasonable/Right
11.True/Reasonable/Right
12.Likely/Reasonable/Right
13.False/Reasonable/Wrong
14. False/Unreasonable/Wrong
15. False/Unreasonable/Neutral
16. False/Reasonable/Right
17. True/Reasonable/Right
18.True/Reasonable/Right
19.True/Unreasonable/Wrong
20.False/Unreasonable/Wrong
21.Likely/Reasonable/Right
22.True/Reasonable/Right
23.True/Unreasonable/Wrong
24.Likely/Reasonable/Wrong
25.Likely/Reasonable/Right
26.True/Reasonable/Right
27.Likely/Unreasonable/Wrong
28.True/Reasonable/Right
29.Likely/Unreasonable/Right
30.False/Reasonable/Right
31.True/Unreasonable/Wrong
32.True/Reasonable/Right
33.False/Unreasonable/Wrong
34.Likely/Reasonable/Neutral
35.Likely/Reasonable/Right
36.Likely/Reasonable/Right
37.Likely/Reasonable/Wrong
38.True/Reasonable/Right
39.Likely/Unreasonable/Wrong
40.False/Unreasonable/Wrong
41.False/Unreasonable/Wrong
42.Likely/Unreasonable/Wrong
43.True/Reasonable/Right
44.Likely/Unreasonable/Wrong
45.Likely/Unreasonable/Wrong
46.True/Unreasonable/Wrong
47.True/Reasonable/Right
48.True/Reasonable/Right
49.Likely/Reasonable/Neutral
50.True/Reasonable/Right
Blind Summary:
This article is probably about the accuracy of mammograms, and the failure rates and reliability of doctors. Doctors are being criticized because they have been giving a lot of false-negatives or false-positives. Some people are saying that pressuring doctors to do better can improve their success rates.
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1 True, unreasonable, wrong
2 False, unreasonable, wrong
3 False, reasonable, right
4 False, unreasonable, wrong
5 True, reasonable, right
6 True, reasonable, right
7 true , reasonable, right
8 False, reasonable, right
9 True, reasonable, wrong
10 False, reasonable, right
11 False, reasonable,wrong
12 True, unreasonable,right
13 True, reasonable, wrong
14 False, unreasonable,wrong
15 False, unreasonable, wrong
16 True,, reasonable, right
17 True, reasonable, right
18 False, reasonable,right
19 True, unreasonable, wrong
20 True, unreasonable, right
21 True, unreasonable, wrong
22 True, unreasonable, wrong
23 True, reasonable, right
24 True, reasonable, wrong
25 True, reasonable,right
26 True, unreasonable, wrong
27 True, unreasonable,wrong
28 True, unreasonable, wrong
29 False, reasonable, right
30 True, reasonable, right
31 False, reasonable, wrong
32 True, reasonable, right
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Summary:
Many mammogram readings are highly inaccurate, however the doctors and readers feel they are trying their best. Many women are extremely upset with the amount of false readings, both negative and positive, and hospitals are trying to improve their accuracy rates as best they can. This leads to higher costs and longer reads, however it’s better to be more accurate now than miss something and have to have someone come in for multiple readings. Doctors are rarely held accountable or punished for false readings, but hospitals themselves are publishing the success rates publicly in an attempt to push their doctors to perform better.
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BLIND SUMMARY:
This article is most likely about the dropping accuracy of mammograms in our nations hospitals. A doctor who was just hired into a hospital with an astonishingly low accuracy rate instituted a shame tactic to try and raise accuracy rates and eliminate the weak links of his radiology departments. By doing this, he was successfully able to raise the accuracy rates in his hospital and achieve his goal. It is commonly believed by the general public that this tactic should be used in all hospitals, however that is not the case due to doctors not wanting to be publicly shamed by posting their negative results. By instituting this policy, the accuracy rates of mammograms will rise and the lawsuits of falsely diagnosed women will drop.
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1-likely/batshit crazy/bad
2-true/not crazy/right
3-unlikely/unreasonable/wrong
4-true/not crazy/right
5-true/not crazy/right
6-likely/batshit crazy/bad
7-true/not crazy/right
8-true/not crazy/right
9-true/not crazy/right
10-true/not crazy/right
11-true/not crazy/right
12-true/not crazy/right
13-likely/batshit crazy/bad
14-likely/batshit crazy/bad
15-true/not crazy/right
16-true/not crazy/right
17-likely/batshit crazy/bad
18-unlikely/unreasonable/wrong
19-likely/batshit crazy/bad
20-likely/batshit crazy/bad
21-likely/batshit crazy/bad
22-likely/batshit crazy/bad
23-likely/batshit crazy/bad
24-true/not crazy/right
25-true/not crazy/right
26-likely/batshit crazy/bad
27-likely/batshit crazy/bad
28-true/not crazy/right
29-likely/batshit crazy/bad
30-true/not crazy/right
31-true/not crazy/right
32-true/not crazy/right
33-unlikely/unreasonable/wrong
34-likely/batshit crazy/bad
35-true/not crazy/right
36-likely/batshit crazy/bad
37-likely/batshit crazy/bad
38-true/not crazy/right
39-likely/batshit crazy/bad
40-unlikely/unreasonable/wrong
41-likely/batshit crazy/bad
42-true/not crazy/right
43-true/not crazy/right
44-likely/batshit crazy/bad
45-likely/batshit crazy/bad
46-likely/batshit crazy/bad
47-true/not crazy/right
48-true/not crazy/right
49-true/not crazy/right
50-true/not crazy/right
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Blind summary: Radiologist are expected to correctly find a certain percentage of tumors out of the total amount they scan for(likely around 70%) A doctor discovered a new way to search for cancer tumors through mammograms, which resulted in hundreds of correct predictions of tumors. Rather than accept this new technique, the hospital publicly posted about his missed readings(about ten) a as a medical scandal. Which resulted in him being fired. His colleges and him feel as if they were unfairly treated in regards to their findings. Some of the 10 women who got tested again and turned out to have tumors sued the hospital for malpractice.
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This article is most likely about a group of doctors who have misread and misdiagnosed the mammograms. This article talks about how sometimes its not always the doctors fault for misreading the mammograms but sometimes their technology isn’t up to par. This hospital at where the doctors work at doesn’t seem to stable especially after they made their data public. The data caused a lot of pressure on the doctors to be that high example in New York which caused them to get careless.
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Blind review:
The article focuses on the effectiveness of mammograms. There have been ongoing challenges where there have been accidentally missed reading of women’s scans, where some were told that they were fin, when in reality that their canner was missed. This forced on the effectiveness that radiologists need to do a better job at reading scans, while also putting pressure on a doctor to be able to count on their radiologist to proved the correct diagnoses to their patients.
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Blind summary: Diagnoses accuracy of mammograms is a significant issue when detecting cancer. There is simply not enough being done to ensure the accuracy of these diagnosis. Whether there are missed tumors or unfollowed mammograms, there are people walking around having cancer without their knowledge. Further, there is little being done to enforce better performance on mammograms by radiologists. There is one technique, however, that proved to be successful. But instead of viewing it that way, being that he missed ten tumors, and with the requirement for follow ups, he was sued for malpractice.
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