Snowball in a Blizzard: A Physician's Notes on Uncertainty in Medicine

Snowball in a Blizzard: A Physician's Notes on Uncertainty in Medicine

by Steven Hatch


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Snowball in a Blizzard: A Physician's Notes on Uncertainty in Medicine by Steven Hatch

There's a running joke among radiologists: finding a tumor in a mammogram is akin to finding a snowball in a blizzard. A bit of medical gallows humor, this simile illustrates the difficulties of finding signals (the snowball) against a background of noise (the blizzard). Doctors are faced with similar difficulties every day when sifting through piles of data from blood tests to X-rays to endless lists of patient symptoms.

Diagnoses are often just educated guesses, and prognoses less certain still. There is a significant amount of uncertainty in the daily practice of medicine, resulting in confusion and potentially deadly complications. Dr. Steven Hatch argues that instead of ignoring this uncertainty, we should embrace it. By digging deeply into a number of rancorous controversies, from breast cancer screening to blood pressure management, Hatch shows us how medicine can fail-sometimes spectacularly-when patients and doctors alike place too much faith in modern medical technology. The key to good health might lie in the ability to recognize the hype created by so many medical reports, sense when to push a physician for more testing, or resist a physician's enthusiasm when unnecessary tests or treatments are being offered.

Both humbling and empowering, Snowball in a Blizzard lays bare the inescapable murkiness that permeates the theory and practice of modern medicine. Essential reading for physicians and patients alike, this book shows how, by recognizing rather than denying that uncertainty, we can all make better health decisions.

Product Details

ISBN-13: 9780465050642
Publisher: Basic Books
Publication date: 02/23/2016
Pages: 312
Sales rank: 948,284
Product dimensions: 6.20(w) x 9.30(h) x 1.20(d)

About the Author

Steven Hatch is an assistant professor of medicine at the University of Massachusetts Medical School, working in the Division of Infectious Disease and Immunology. He lives in Newton, Massachusetts.

Table of Contents

Author's Note ix

Foreword xiii

Introduction 1

1 Primum Non Nocere: The Motivations and Hazards of Overdiagnosis 23

2 Vignette: The Perils of Predictive Value 53

3 Snowball in a Blizzard 57

4 The Pressures of Managing Pressure 87

5 Lyme's False Prophets: Chronic Fatigue, Tick-Borne Illness, and the Overselling of Certainty 99

6 The Origins of Knowledge and the Seeds of Uncertainty 127

7 The Correlation/Causation Problem, or Why Dark Chocolate May Not Lower Your Risk of Heart Failure 153

8 "Health Watch": Hype, Hysteria, and the Media's Overconfident March of Progress 181

9 Conclusion: The Conversation 211

Acknowledgments 237

Appendix: A Very Nonmathematical Description of Statistical Significance 241

Bibliography 261

Index 275

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