I’ve been thinking about this analogy for a while (I may be stealing this from someone, but I don’t recall, so my apologies in advance) and was reminded of it again with the latest brouhaha about the “new” USPSTF mammography guidelines.
A fireman who is also an arsonist, who comes to your house and sets it on fire. You desperately work to try to contain it and you’re not sure you’re going to be able to save the house. Thankfully, the fireman/arsonist comes back w/the rest of the fire department and they put out the fire. How do you feel? Are you grateful? Are you relieved? Are you angry?
A doctor recommends a mammogram. It is abnormal, making you worried that you have cancer. You can’t sleep for 2 wks, and ultimately get an invasive biopsy, which turns out to be normal. How do you feel? Are you grateful? Are you relieved? Are you angry?
The times I’ve been the doctor in scenario 2, patients are invariably so relieved when they find out that they don’t have cancer, they forget to be angry that I was the one who caused this unnecessary worry and invasive procedure. They thank me for taking such good care of them. And I’m certain that they tell their friends how wonderful the mammography test is, and how they should get it as well. I’m sure some of the backlash against the new USPSTF guideline are from women who have had this experience which ended with relief, leading them to remember the whole experience in a positive light.
I’d love to better understand the psychology of what’s going on here. I don’t know if there’s a solution, but I wonder if there are important lessons in decreasing the overuse of medical interventions in this example.