Thread by @opinion

In yet another massive public health failure in the U.S., we still have no clear messaging about the relative risks and benefits of going to the doctor trib.al/gUmlqzX

Medical professionals have taken great care to keep patients safe — giving everyone a mask, for example, and using temperature checks at the door.

But for some patients, telemedicine is still a better option trib.al/gUmlqzX

That’s not because the office visit is particularly dangerous, but because telemedicine was a good option even before the pandemic started.

For many kinds of visits, it saves everyone time trib.al/gUmlqzX

Still, there are screenings and surgeries and other kinds of exams that have to be done in person. Is it worth the risk to go?

It depends. Some medical procedures are lifesaving or alleviate suffering, and others are unnecessary — or even harmful trib.al/gUmlqzX

In a way the pandemic has been a natural experiment, since almost all routine health care in New York City was put on hold for several months in the spring.

After the hiatus, cardiologist @sjauhar said patients looked far healthier than he expected trib.al/gUmlqzX

Not all medical care is unnecessary, and @sjauhar emphasized that fear of the pandemic may have indirectly caused deaths because people didn’t seek medical care.

But doctors need to get serious about overtreatment trib.al/gUmlqzX

Treatment varies by geography in a way that can’t possibly reflect differences in disease incidence.

In Minnesota, there’s a 7-10-fold difference in the number prostatectomies by region — with no reason to suspect prostate cancer rates vary that much trib.al/gUmlqzX

Many diagnostics are ambiguous.

Patients may prefer to be treated even if there’s only a small chance they have a dangerous condition. Even when compelling evidence shows a treatment isn’t saving people, it can be hard to give it up trib.al/gUmlqzX

According to Paul Offit, an infectious disease doctor, these treatments are overused to the point of causing harm:

♥️Heart stents
💊Antibiotics
🏥Some cancer screenings trib.al/gUmlqzX

Thousands of people have undergone unnecessary surgery, radiation or chemotherapy for suspected breast or thyroid cancers that never would have killed them.

Not all slow-growing tumors should be considered cancerous trib.al/gUmlqzX

The good news is that for things like a routine check-up, many people may be served just fine by getting blood work done and then having a teleconference with the doctor trib.al/gUmlqzX

The decision to get in-person care is complicated. It may depend on:

1. Your risk factors for getting severe Covid-19
2. The risk factors of people you live with
3. The risks of skipping a test or treatment
4. The infection rate in your region trib.al/gUmlqzX

The risk of getting Covid-19 from your doctor looks to be low.

Nobody with a serious medical condition should suffer or die from staying home too long trib.al/gUmlqzX