A radiologist friend posted this illuminating article, Who is the Better Radiologist. It considers the challenges of selecting for quality, given the reality of trade-offs between sensitivity and specificity.
The article compares two fictional radiologists, one who is very detailed, never misses a thing, asks for lots of follow up testing, and is likely to over-diagnose. The other is faster, more direct, but may miss some subtle things.
If you were a patient who would you prefer read your scan, the under calling, decisive Dr. Singh or the over calling, painfully cautious Dr. Jha?
If you were a referring physician which report would you value more, the brief report with decisive language and a paucity of differential diagnoses or the lengthy verbose report with long lists on the differential?
Which would you rather have reading your images? We'd rather the careful one if the subtle thing they see is going to be a problem for us. We'd rather the more efficient one if the subtle thing they'll miss would not cause us harm.
But we can't actually choose. And the author of the article understands that.
Trade-off is a fact of life. Yes, I know it’s very un-American to acknowledge trade-offs. And I respect the sentiment. The country did, after all, send many men to the moon.
Nevertheless, whether we like it or not trade-offs exist. And no more so than in the components that make up the amorphous terms “quality” and “value.”
This is a very common problem in medicine! Balancing risk and uncertainty against avoidance of harm and cost is not something we can solve overnight, but even being aware of the struggle makes discussions with patients better-informed; that is a step forward to providing the right care.