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Bias in the ER

nautil.us

31–40 of 84 posts

Re: Bias in the ER

#31
post #25

Earlier quoted context omitted.

I had a professor in undergrad who worked on order entry research. He talked about one of the problems facing Vanderbilt as far as scanning costs. CT scans and MRI are crazy expensive. Trauma patient comes in, doc orders a CT scan, it comes back and he says, "shit, this doesn't tell me what I need to. I knew I should have ordered an MRI instead." They used a decision tree learning algorithm and trained it using attri…

Just curious why are MRI and CT machines so expensive? They are the ultimate tool for debugging the human body. Shouldn't they be very affordable?

Your comment is basically Anselm's ontological argument. Very strange to see it applied to medical imaging!

Re: Bias in the ER

#32
post #16
post #12

Earlier quoted context omitted.

While this has nothing directly to do with the OP, but there's an assumption of cleanliness amongst everyone I know. If it looks clean, it must be clean, right? 100% completely wrong. Simple casual observation of people exiting restrooms is proof that if anything is touched, it cannot be clean. I have seen far too many people not washing after going #2 that I simply do not trust a single damn thing that I touch in pu…

Counterpoint: I go through none of this trouble and rarely get sick.

Same. You were not just born into a filthy world. You evolved with the rest of us in a world incredibly densely populated with microbes, and in fact by weight you are more microbes than human.

Re: Bias in the ER

#33
post #25

Earlier quoted context omitted.

I had a professor in undergrad who worked on order entry research. He talked about one of the problems facing Vanderbilt as far as scanning costs. CT scans and MRI are crazy expensive. Trauma patient comes in, doc orders a CT scan, it comes back and he says, "shit, this doesn't tell me what I need to. I knew I should have ordered an MRI instead." They used a decision tree learning algorithm and trained it using attri…

Just curious why are MRI and CT machines so expensive? They are the ultimate tool for debugging the human body. Shouldn't they be very affordable?

Cost inflation in the US is huge due to a combination of red tape, CYA, customers with good insurance subsidizing people with bad/no insurance, and many other factors. There's no simple answer, unfortunately. No one is entirely sure why medical costs are so high in the US. It doesn't appear to be any one factor that people commonly blame.

Fundamentally, they don't need to be expensive; via private medical tourism, you can get any sort of scan at a fraction of the US cost.

Re: Bias in the ER

#34

Earlier quoted context omitted.

I had a professor in undergrad who worked on order entry research. He talked about one of the problems facing Vanderbilt as far as scanning costs. CT scans and MRI are crazy expensive. Trauma patient comes in, doc orders a CT scan, it comes back and he says, "shit, this doesn't tell me what I need to. I knew I should have ordered an MRI instead." They used a decision tree learning algorithm and trained it using attri…

Bigger issue with CT scans is the radiation, they absolutely destroy the brain tissue.

Source? Because I'm pretty sure that's completely untrue. Nervous tissue like the brain is the most resistant to radiation of any cell types in the body. Radiation affects faster growing cells the most, and nerve cells grow the slowest of any in the body. The brain is also the best shielded part of the body against x-rays, and the x-rays in a CT machine are necessarily highly collated, so unless your brain is getting scanned your brain is receiving almost zero dose.

If CT scans damaged the body, it would be visible in the lymphatic and immune system first, and way before any other systems.

Re: Bias in the ER

#35
post #4

There's a book called "Thinking Fast and Slow" by Daniel Kahneman that talks about systematic bias in human heuristic thinking. > The more easily people can call a scenario to mind, the more probable they find it. This is practically a restatement of the "availability bias" from that book. It came to mind immediately when I saw the article's title "How can Medical Professionals Avoid Making Assumptions That Lead to M…

It's a bit different because a doctor's mistake can lead to an irreversible outcome. That's true of some engineers (those who design bridges or the software that goes in a pacemaker or car ECU), but not others (the engineer that designs alarm clocks .. or the ones that design half the shit Big Clive buys from China). Sure mistakes in other fields can lead to loss of work or infrastructure changes/mistakes that lead t…

You're thinking small. Imagine the impact a bug in a FEM software package could cause if everything was then designed to be half the strength it should. Or a low quality chainsaw chain pin that would randomly break and release a sharpened chain at high speed. A propane water heater that isn't vented correctly, suffocating everyone in the house when the wind changes direction. Or even furniture that has screws that are too long, so the kid who jumps on the couch gets stabbed.

These kinds of examples are everywhere. Doctors aren't special snowflakes who hold human life in the palm of their hand, everyone from bus drivers to lawyers to electricians can kill people if they screw up.

Re: Bias in the ER

#36
post #28
post #25

Earlier quoted context omitted.

Just curious why are MRI and CT machines so expensive? They are the ultimate tool for debugging the human body. Shouldn't they be very affordable?

Scans do not need to be crazy expensive. In Finland, unsubsidized, undiscounted and no questions asked, just pay prices for scans from a private health company are 258€. Expensive, yes. Crazy expensive, no.

During the ACA runup a few years back, japanese neck MRI were quoted below $100.

Re: Bias in the ER

#37
post #33
post #25

Earlier quoted context omitted.

Just curious why are MRI and CT machines so expensive? They are the ultimate tool for debugging the human body. Shouldn't they be very affordable?

Cost inflation in the US is huge due to a combination of red tape, CYA, customers with good insurance subsidizing people with bad/no insurance, and many other factors. There's no simple answer, unfortunately. No one is entirely sure why medical costs are so high in the US. It doesn't appear to be any one factor that people commonly blame. Fundamentally, they don't need to be expensive; via private medical tourism, yo…

The problem is everyone gets paid too much. Our doctors salaries are far out of line with most countries , we have the strictest drug pricing laws in the world, and people love to sue. We also have a significant portion of the population paying no medical bills while the rest is overcharged to compensate. On top of that our health insurance is full of middle men like "PBM's" that do nothing but raise costs.

The combo means docs, drugs, treatment, and insurance are all more costly.

A fix is hard to come by but would work something like this.

1)subsidize the cost of medical school increasing supply of MDS 2)pass laws to protect physicians from frivolous lawsuits or at least limit damages. 3)disallow drug companies from advertising, ban rampant kickbacks to doc's that prescribe their drugs 4)ban anti competitive practices that prevent insurance companies from negotiating prices directly with manufacturers. 5) provide healthcare centers of last resort(the ER) compensation for patients unable to pay.

My last point is state specific and really controversial but it's based on what I've personally seen.

States with a lot of illegal immigrants spend an enormous amount for healthcare at the ER for these people. Around 1/4 of the people that came into the ER I was familiar with were likely illegal and over 90% either gave a fake name or never paid. The majority of those costs are passed on to those with insurance. I lived in an area with probably 3% of the population were undocumented.

Since the ER is healthcare of last resort they are forced to treat you even if you give them completely false info with no intention of paying. Illegal immigrants know this and preferentially go to the ER because they get treated without probing questions or need to pay. They also already have fake ID's in most cases so giving one to the hospital isn't a big deal. This enomous cost gets buried because it's politically unpopular to say and because the hospital just raises prices in everyone else to compensate.

Re: Bias in the ER

#38
post #10

Earlier quoted context omitted.

Unfortunately, just being metal isn't enough. Most metal surfaces in hospitals are stainless steel, which can hold viable pathogens for a week or more. Silver plating would sterilize some pathogens in as little as 5 minutes.

> Silver plating would sterilize some pathogens in as little as 5 minutes That would be very expensive for very little benefit - five minutes is more than long enough for multiple people to use the same buttons at a busy hospital during the day. It's much better to promote behaviors like washing hands before touching food or mucous membranes (like rubbing your eyes) and using alcohol-based hand sanitizers when that i…

> That's why you see hand sanitizer dispensers every few feet at (good) hospitals, and why infection rates plummeted when hospitals introduced them.

Alcohol hand gels give a false sense of cleanliness though. Some hospitals have problems with Norovirus, and it's likely members of the public who've recently had vomiting think it's okay for them to visit a relative because of all the handgel.

Re: Bias in the ER

#39
post #33

Earlier quoted context omitted.

Cost inflation in the US is huge due to a combination of red tape, CYA, customers with good insurance subsidizing people with bad/no insurance, and many other factors. There's no simple answer, unfortunately. No one is entirely sure why medical costs are so high in the US. It doesn't appear to be any one factor that people commonly blame. Fundamentally, they don't need to be expensive; via private medical tourism, yo…

The problem is everyone gets paid too much. Our doctors salaries are far out of line with most countries , we have the strictest drug pricing laws in the world, and people love to sue. We also have a significant portion of the population paying no medical bills while the rest is overcharged to compensate. On top of that our health insurance is full of middle men like "PBM's" that do nothing but raise costs. The combo…

Alternatively, increased free clinics for basic healthcare (flu, checkups, non-emergency procedures) could eliminate a large percentage of wasted effort and time. Free regular checkups just a few times a year would catch so many issues before they became big expensive issues and it would eliminate the use of the ER as a general physician visit.

We're already paying out crazy amounts for doctors time and for expensive visits, might as well make the basic health checks free. No need to bring insurance in on matters like just having a doctor write "you have the flu. Rest 4 days and take this" when the entire operation is 15 minutes for a quick culture.

Re: Bias in the ER

#40
post #16

Earlier quoted context omitted.

Counterpoint: I go through none of this trouble and rarely get sick.

Same. You were not just born into a filthy world. You evolved with the rest of us in a world incredibly densely populated with microbes, and in fact by weight you are more microbes than human.

That doesn't sound right.

I think maybe by number of cells we are more gut bacteria than human.

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