18 Anticipating System Change

A patient arrives at the emergency department with chest pain. Is it a heart attack? A doctor can find out by conducting a test. A positive test will allow the doctor to treat the patient quickly, with clear benefits. But the tests are expensive and also invasive. Imaging tests use radiation, which can increase the long-term risk of cancer. A treadmill session poses a small but defined risk of cardiac arrest. Cardiac catheterization involves radiation as well as a risk of arterial damage.1 It isn’t an easy decision.

The physician needs to weigh these benefits and costs. How likely is it that the patient is really having a heart attack? This is a prediction. If the prediction is that the likelihood is high, that ...

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