help teaching about likelihood ratios, sensitivity, positive pred values!

Mark Gusack gusackm at COMCAST.NET
Sun Sep 9 04:22:56 UTC 2018


I can attest to that book.  I purchased a copy from Dr. Brush three DEM conferences ago and it is well worth the cost.  It is a well written, organized book with critical information that should be mandatory for our medical students, interns, and residents.

 

Mark Gusack, M.D.

President

MANX Enterprises, Ltd.

304 521-1980

 

From: Tom Benzoni <benzonit at GMAIL.COM> 
Sent: Saturday, September 8, 2018 5:12 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] help teaching about likelihood ratios, sensitivity, positive pred values!

 

John Brush, The Art of the Science of Medicine

ISBN-13: 978-0990961376 

Says it better than I can.

tom benzoni

 

On Sat, Sep 8, 2018 at 12:29 PM Tom Yuen <0000001243181998-dmarc-request at list.improvediagnosis.org <mailto:0000001243181998-dmarc-request at list.improvediagnosis.org> > wrote:

Hello, 

 

Young faculty here just tasked with teaching new family medicine residents diagnostic reasoning. During my inaugural lecture on LR (likelihood ratios)/PPV (positive predictive value)/NPV (negative predictive value) and sens/specificity, a newly minted 2nd year resident posed this comment: 

 

 "I understand that mathematically and statistically these are all subtly different. But in the real world, when I'm admitting someone for chest pain- all these things are pretty much the same.  A very sensitive test that is negative means that the likelihood of the disease is very low.  Most sensitive tests also are low likelihood rations and very good NPV. It's all pretty much the same in the real world. Why learn how these are different?”

 

As an example another resident quoted these numbers (I have yet to confirm them, but irregardless her point was):  A negative troponin has a sensitivity of 95% and a neg LR of 0.06 and a NPV of 98% for acute myocardial infarction.  What does it matter which statistic you use, they all "say the same thing”.

 

Intellectually I was able to dig myself out, at least with NPV since it depends on the prevelence of the disease. But I did not have a more eloquent answer for LR and sensitivity.  And it all rang hollow to me as I tried to put myself in their shoes.

 

Does anyone have any suggestions, or tips? Or reading? Or are they right that these numbers are tell pretty much the same tale when being used by a on-call resident at 2am in the "real world”?

 

Thanks. Tom Yuen, MD

 

Faculty Crozer Family Medicine Residency

 

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