The dual role of probability in application as chance and evidence' implications for diagnosis

Jain, Bimal P.,M.D. BJAIN at PARTNERS.ORG
Wed Mar 7 12:09:01 UTC 2018


I agree it is important to consider the probability of a disease during diagnosis as it tells us about the chance of a disease being present. And we should evaluate the disease with the highest probability first as it has the greatest chance of being present. What I am objecting to is considering probability of a disease as evidence for it in a given patient as is advocated in the Bayesian method. This is likely to lead to errors in diagnosis of diseases with atypical presentations as their low prior probabilities may be interpreted as prior evidence against them in a patient causing them to be ruled out without further evaluation.

Bimal

From: Nick Rainey [mailto:nickraineydpt at gmail.com]
Sent: Tuesday, March 06, 2018 10:57 PM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at list.improvediagnosis.org>; Jain, Bimal P.,M.D. <BJAIN at PARTNERS.ORG>
Subject: Re: [IMPROVEDX] The dual role of probability in application as chance and evidence' implications for diagnosis

I definitely agree that each patient needs to be looked at individually. Being right 98% of the time in many cases is not good enough. In my opinion, however, without considering the probability of a diagnosis the forest can be missed and all we see are trees.


--
Nick Rainey
520-955-1820

On Tue, Mar 6, 2018 at 8:04 AM, Jain, Bimal P.,M.D. <BJAIN at partners.org<mailto:BJAIN at partners.org>> wrote:
In this attached paper, I point out that probability plays a dual role in application as chance in referring to an outcome in an individual instance and as evidence in referring to outcomes in a population of instances. Thus it is not able to represent evidence in a given patient during diagnosis and is not suitable for it in practice.
Please review and comment on this paper.
Thanks

Bimal

Bimal P Jain MD
Northshore Medical Center
Lynn MA 01904

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