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Podcast: Is It Possible To Have TMI During A Visit To The Doctor?

“You get more and more used to seeing these patterns and symptoms, sort of in the back of your head, while you are validating concerns, being empathetic, realizing this is a real person — this is not a set of symptoms and signs and data that you’re analyzing.”

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We’ve all been to a doctor and had to fill out pages and pages of forms to give our medical details. That is only the first point where data seeps into our relationship with our doctors. With new technology and increased public awareness, how diseases are treated and prevented is changing as we are able to gather more information about our health and connect it in new ways. But the influx of data can also create fear and lead to overtesting.

In this episode of our podcast What’s The Point, we talk to Dr. James Hamblin, a senior editor at The Atlantic and host of the video series “If Our Bodies Could Talk.” Hamblin discusses how data is changing each step of the health care system by diagnosing my fake illness during my fake visit to his fake (data-driven) family practice. Stream or download the full episode above, and find a video excerpt along with a partial transcript below.


Video: Big Data Can Create More Inefficiencies


Data will never replace a doctor’s intuition …

HAMBLIN: Increasingly, yes, you’re driven by data and algorithms, but we’re far, far from replacing human intuition. A lot of doctors, especially emergency room doctors, get really good at, within 20 to 30 seconds, just sizing up how sick someone is.

AVIRGAN: So, size me up.

HAMBLIN: You seem very well.

AVIRGAN: OK, thank you. Because I have been faking — my stomach is fine.

HAMBLIN: I’m going to think you’re fine. I’m not going to say your symptoms are fake, but I’m going to not need to put all my other patients on hold and drop everything. And there’s something in the intangibles of the data collection that we’re far from just replacing with an algorithm — not to mention the empathy and comforting and relating.

With more information, comes more …

AVIRGAN: You’ve done an initial diagnosis — maybe you’ve checked a database. But there’s a complication to our visit, which is that I am bringing loads of data already with me because I have a Fitbit. I Googled and I went on WebMD, and it basically said “you have cancer,” which is basically what WebMD says every time you look up anything. Clearly patients are coming in with lots more information of their own that they’ve self-generated. So how’s that data changing the equation?

HAMBLIN: I think you have people recognizing things earlier, which can be good.

AVIRGAN: In what sense?

HAMBLIN: Some people are able to put things together that might be a constellation of things and saying, “Hey, oh, maybe I should get checked out, and maybe I should see a gastroenterologist about this.” More likely, you have people who think that they have something that they don’t have. So then the role of the doctor switches to a reactive thing, to comforting and telling someone to relax. There’s more transparency; it’s a more collegial relationship where you’re talking about these possibilities because the patient knows the name of the diagnosis and knows what the symptoms are. WebMD is not inaccurate. It’s very easy to see yourself in a lot of diagnoses.

Creating more efficiencies in the system …

AVIRGAN: There’s sort of an extreme end of the spectrum too where people can, for a couple thousand dollars, get their full genomic sequence.

HAMBLIN: So a great example of [overtesting] is the mammography data that has come out recently. People are questioning whether screening mammograms are even a good use of patient-doctor time. [That] seemed like one of the most basic things: We’re able to take a quick, cheap X-ray that uses almost no radiation. And now: “Oh, well, it actually might be leading to more biopsies, more unnecessary surgeries.” So there’s conflicting data on that. People aren’t changing the practice. We’re able to look for breast cancer at an early stage with a simple X-ray. How could that not be a good thing? It’s actually not.

The same thing with screening for prostate cancer. We have a simple blood test that can track a tumor marker in your blood that should tell us if you’re at risk of having prostate cancer. And yet most of the data is saying that it’s not good because it leads to more unnecessary tests, surgeries that don’t necessarily prolong life or improve life, so people are not using this theoretically wonderful test. That’s the problem with having too many tests. You go down roads, you need more and more expensive imaging tests, diagnostic biopsies, exploratory surgeries in some cases — all sorts of things that just end up not being good. I think what we need is to just refine the data.


If you’re a fan of What’s The Point, subscribe on iTunes, and please leave a rating/review — that helps spread the word to other listeners. And be sure to check out our sports show Hot Takedown as well. Have something to say about this episode, or have an idea for a future show? Get in touch by email, on Twitter, or in the comments.

What’s The Point’s music was composed by Hrishikesh Hirway, host of the “Song Exploder” podcast.

Jody Avirgan hosts and produces podcasts for FiveThirtyEight.

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