Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Bias in the ER

nautil.us

Post reply on HN
Print view View original

51–60 of 84 posts

Re: Bias in the ER

#51

Post by rcxdude »

moxious wrote: 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…

There's both more risks but also there's a substantial time pressure on doctors which engineers generally do not face when designing something (ask an engineer to design a critical part of a bridge in an hour and they'll rightly tell you to fuck off, but a doctor often has less time to make critical decisions). The other problem, which is fixable, is the general overworking of medical professionals. The hours they work are often ridiculous, and this also worsens the time pressure and means there's less scope for serious review.

Re: Bias in the ER

#53

Post by coredog64 »

ubernostrum wrote: post #49
throwawaydbdksn wrote: post #37

Earlier quoted context omitted.

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…

pass laws to protect physicians from frivolous lawsuits or at least limit damages Several US states have harsh caps on medical malpractice damages. They still see massively-rising medical costs. And in uncapped states the rate of growth in malpractice damage awards hovers very close to the rate of inflation of the US dollar. Which sort of destroys the argument that "frivolous lawsuits" and massive damage awards drive…

It's less the actual damages as much as it the defensive medicine that occurs because of the constant risk. If you show up with the flu, but it could be some weird disease that shows up in an MRI, the incentive for the doctor is to get you an MRI.

I used to believe in caps, but I think we could do better than that. Create a no-fault insurance market that pays people without the hassle of civil trials. That has the potential to allow medical professionals to be more open and honest about mistakes they make (similar to the aviation industry). That, in turn, would allow for data-driven decisions about how to make the biggest improvements for the lowest dollar amount.

Oh, and while we're at it, how about a self-driving unicorn that runs on rainbows...

Re: Bias in the ER

#54

Post by mikenuman »

snowpanda wrote: post #20
projektir wrote: post #2

I wonder how much this is influenced by medical staff being overworked.

I think there's more factors than that. Air traffic controllers are very overworked and they don't often cause collisions[1]. I think this part of the article is what the big problem is: “Eighty percent of doctors don’t think probabilities apply to their patients,” I've recently gone through 4 years of medical treatment, and it's still ongoing. Only to find out this week that I have Lyme disease. Given that the chanc…

Lyme is the new fibromyalgia, which replaced ME, which replaced the "Victorian lady took to her bed for a number of years" trope. Be very careful of jumping down this rabbit hole. The tests you'll have had are not validated.

Re: Bias in the ER

#55

Post by throwawaydbdksn »

davak wrote: post #44
throwawaydbdksn wrote: post #37

Earlier quoted context omitted.

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…

One brief clarification. Doc salaries are higher, but cost and length of training is higher too. Four years of college and four years of med school dig the hole very deep. Then three to eight more years often working below minimum wage as the interest on the debt compounds.

Medical school definitely needs to be less expensive to lower salaries. It's also pushing doctors towards specialities that pay more and leaving us with a thortage of GP's

Re: Bias in the ER

#56

Post by throwawaydbdksn »

ubernostrum wrote: post #49
throwawaydbdksn wrote: post #37

Earlier quoted context omitted.

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…

pass laws to protect physicians from frivolous lawsuits or at least limit damages Several US states have harsh caps on medical malpractice damages. They still see massively-rising medical costs. And in uncapped states the rate of growth in malpractice damage awards hovers very close to the rate of inflation of the US dollar. Which sort of destroys the argument that "frivolous lawsuits" and massive damage awards drive…

I don't need to make an argument. Call your doctor and ask him how much he pays for his malpractice insurance.

I used to know some people in healthcare tangentially and the answer is $50,000 to $250,000 A YEAR depending on specialty etc.

Sometimes the practice will pay these costs for you, so the doctor might not be paying it directly but the money is coming from somewhere.

My friends told me malpractice insurance was generally about a third of your salary. And this includes people like pharmacists and physicians assistants too. So if much higher than world average doctor salaries in the US are any part of the reason for high medical costs, lawsuits are a third of that

Re: Bias in the ER

#57

Post by analog31 »

throwawaydbdksn wrote: post #37
wyager wrote: 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…

Doctors salaries don't tell the whole story. I've read that roughly half of doctors are self employed. They are also the owners, or major shareholders, in medical related businesses such as provider networks and malpractice insurance companies. Being a doctor means that you can make what I call "insider investments" that aren't available to the public, and the cost of training ensures that the only people who are doctors, have family money available to invest in those businesses.

The rat's nest of business entities makes it impossible to figure out where the money is going, or who is making how much. That way, everybody can point the finger at somebody else. I suspect a reason why medicine costs less in countries with nationalized systems is that it's possible to figure out where the costs are going.

I'd favor a system where medical school is free, and doctors work as employees of the government.

Re: Bias in the ER

#58

Post by rscho »

snowpanda wrote: post #20
projektir wrote: post #2

I wonder how much this is influenced by medical staff being overworked.

I think there's more factors than that. Air traffic controllers are very overworked and they don't often cause collisions[1]. I think this part of the article is what the big problem is: “Eighty percent of doctors don’t think probabilities apply to their patients,” I've recently gone through 4 years of medical treatment, and it's still ongoing. Only to find out this week that I have Lyme disease. Given that the chanc…

As a matter of fact, their training could indeed have motivated their refusal to test. The Lyme test not being perfect and the disease not being that frequent in your area makes testing dubious, depending on the particular numbers. In more scientific words: if the prevalence of the disease goes down, then the positive predictive value of the test decreases as well [1][2].

[1] https://en.wikipedia.org/wiki/Positive_and_negative_predicti...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540558/pdf/bmj...

Re: Bias in the ER

#59

Post by mistermann »

patrickg_zill wrote: post #42
nojvek wrote: 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?

I was quoted prices that varied by almost ten times when I was looking for a CT scan. An independent lab, owned by the head of radiology at a hospital in another County, was $268 USD if paid at time of service, cash or credit card. He used to have several locations, but the other hospital bought out all the locations near them. And closed them almost immediately.

And this is just one of the many problems with the US medical system, even if it went to a single payer system taking the individual off the hook, the cost of delivery is completely out of control due to (in my opinion) a lack of "proper" capitalism.

Perhaps any acquisitions in the field of medicine should be subject to antitrust laws?

Re: Bias in the ER

#60

Post by gech »

davak wrote: post #44
throwawaydbdksn wrote: post #37

Earlier quoted context omitted.

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…

One brief clarification. Doc salaries are higher, but cost and length of training is higher too. Four years of college and four years of med school dig the hole very deep. Then three to eight more years often working below minimum wage as the interest on the debt compounds.

Did they have a choice in their career path?
Post reply on HN