Use of Probability in Clinical Diagnosis

I am happy to see this note from the website of John Hopkins Breast Cancer.  In particular, I am happy to see the word “probability.”  It jibes with my usual practice of giving estimates of probability or certainty of clinical diagnosis (most of the time, using subjective probability based on objective clinical findings, prevalence and experience).  See sample of a medical record  below.

“At the Johns Hopkins Breast Center, our team of breast cancer specialists is incredibly sensitive to the anxiety a possible diagnosis of breast cancer creates for our patients. Therefore, we follow strict guidelines for evaluation, biopsies and pathology reports. On the day of your breast biopsy, you will be given the probability that the biopsy is a fibroadenoma. Firm confirmation will follow within 24 hours.

https://www.hopkinsmedicine.org/breast_center/breast_cancers_other_conditions/fibroadenoma.html


Sample of ROJoson’s Medical Record – Note the estimates of probability of clinical diagnosis. Depending on the clinical findings and my judgement, I usually give 60-40; 70-30; 80-20; 90-10; 95-5; 98-99-2-1.  I don’t give an estimate of 50-50.

informed_consent_thyroid_1_roj_17jul13a

Concerning this statement: “At the Johns Hopkins Breast Center, our team of breast cancer specialists is incredibly sensitive to the anxiety a possible diagnosis of breast cancer creates for our patients. ”  This is true.  If the clinical diagnosis has a high probability of a benign condition, by telling the patient so, rather than saying 50-50 or no estimate, it instantly will offer great relief to the anxiety of the patient.



ROJoson’s TPOR (Thoughts, Perceptions, Opinions, and Recommendations)

ROJoson’s RRR (Re-study, Refine, and Reaffirm)



rojoson_way


ROJ@18may23

This entry was posted in Clinical Diagnosis, Probabilistic Medical Reasoning and Clinical Decision-making. Bookmark the permalink.

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