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Bias in the ER

nautil.us

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Re: Bias in the ER

#61

Post by gech »

throwawaydbdksn wrote: post #56
ubernostrum wrote: post #49

Earlier quoted context omitted.

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 wa…

Consumers need protection from doctor's mistakes, plain and simple. I don't need to make an argument either. Call someone who has lost their child to a doctor's mistake.

Re: Bias in the ER

#62

Post by BostonEnginerd »

rcxdude wrote: post #48
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?

They are hugely complex pieces of kit, manufactured in relatively low volumes and requiring lots of specialized materials and development. Not an easy thing to cost-reduce. (That said, each scan has very low marginal cost).

I agree that they're highly complicated, but they're made in surprisingly large volumes. There are 5,564 hospitals in the US, and each one will likely have several. A manufacturer will probably ship 500 units/year. This is decent enough volume where you can drive good cost reductions.

Re: Bias in the ER

#63

Post by rscho »

This article seems mostly a glorified praise of a top-med-school-doc, who in fact is probably in no way exceptional.

Some points:

- the cardiac arrhythmia and pneumothorax anecdote absolutely screams "inexperienced staff on scene". Not performing basic imaging for car crash victims, and furthermore thinking of a medical (vs. surgical) cause first, would be absolutely laughable for any trauma/ER doc, and does not respect standard care guidelines. Big trauma centers also means lots of resident docs, more or less supervised. Additionally, the article does not give a lot of details about the case, so judgment of this particular case from an armchair is presumptuous.

- Many medical professionals not only do not think statistically, they also believe statistical studies to be less reliable than their own clinical experience-based judgment, and often rightly so. People outside of the field often miss how catastrophic the quality of medical statistics are. The end result is that professors will cite the literature when it supports their opinion, and will say something on the order of: "in my experience as a clinician, it would be better to do such and such..." when it does not.

- a serious and reliable approach to statistics is a priority concern of today's medical system. The main problems are 1) inability to collect reliable data, and 2) professionals with no statistical education analyzing said data. This is changing, albeit very slowly.

Re: Bias in the ER

#64

Post by tim333 »

masklinn wrote: post #36
nordify wrote: post #28

Earlier quoted context omitted.

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.

You can get the scans in India for ~ $50-$100 if you're out that way https://www.medifee.com/tests/mri-scan-cost/ https://blog.labsadvisor.com/2016/05/28/ct-scan-cost-in-delh...

Re: Bias in the ER

#65

Post by tim333 »

TheSpiceIsLife wrote: post #40
ccvannorman wrote: post #32

Earlier quoted context omitted.

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.

Yeah, brief googling has bacteria at 1-2% by weight, 1-10x by number.

Re: Bias in the ER

#66

Post by tim333 »

wallace_f wrote: post #30

I wasn't aware of this, from the article, which appears to me to be a very, very big deal > more people died every year as a result of preventable accidents in hospitals than died in car crashes—which was saying something

It's a new finding a quite striking if true

Estimates are ~250k/yr for medical error, ~30k road deaths for the US

https://news.ycombinator.com/item?id=11627213

You can hear the researcher talking about it here:

http://www.bmj.com/content/353/bmj.i2139

Re: Bias in the ER

#67

Post by JshWright »

rscho wrote: post #63

This article seems mostly a glorified praise of a top-med-school-doc, who in fact is probably in no way exceptional. Some points: - the cardiac arrhythmia and pneumothorax anecdote absolutely screams "inexperienced staff on scene". Not performing basic imaging for car crash victims, and furthermore thinking of a medical (vs. surgical) cause first, would be absolutely laughable for any trauma/ER doc, and does not resp…

> Big trauma centers also means lots of resident docs, more or less supervised.

Yep, that was my thought as well. That sounds a lot like a resident who started heading down the wrong path before the attending pointed them back in the right direction. A 'teachable moment' of the sort that occurs hundreds of times a day at teaching hospitals across the continent.

Re: Bias in the ER

#68

Post by JshWright »

tim333 wrote: post #66
wallace_f wrote: post #30

I wasn't aware of this, from the article, which appears to me to be a very, very big deal > more people died every year as a result of preventable accidents in hospitals than died in car crashes—which was saying something

It's a new finding a quite striking if true Estimates are ~250k/yr for medical error, ~30k road deaths for the US https://news.ycombinator.com/item?id=11627213 You can hear the researcher talking about it here: http://www.bmj.com/content/353/bmj.i2139

The number of people killed by medical errors thing is a little controversial. People who are about to die anyway get a lot of medical interventions (which is more opportunity for errors, big small). If a patient accidentally gets an extra dose of their antacid 48 hours before they die, is it really likely that error led to their death? Because it would be counted in that 250k/yr number...

Re: Bias in the ER

#69

Post by projektir »

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…

> I think there's more factors than that. Air traffic controllers are very overworked and they don't often cause collisions[1].

Seems like they're getting pretty close. Air traffic and medicine are not the same field, I wouldn't expect the probabilities and risks to be the same.

> The study found that nearly 2 in 10 controllers had committed significant errors in the previous year — such as bringing planes too close together — and over half attributed the errors to fatigue. A third of controllers said they perceived fatigue to be a "high" or "extreme" safety risk. Greater than 6 in 10 controllers indicated that in the previous year they had fallen asleep or experienced a lapse of attention while driving to or from midnight shifts, which typically begin about 10 p.m. and end around 6 a.m.

Re: Bias in the ER

#70

Post by tim333 »

JshWright wrote: post #68
tim333 wrote: post #66

Earlier quoted context omitted.

It's a new finding a quite striking if true Estimates are ~250k/yr for medical error, ~30k road deaths for the US https://news.ycombinator.com/item?id=11627213 You can hear the researcher talking about it here: http://www.bmj.com/content/353/bmj.i2139

The number of people killed by medical errors thing is a little controversial. People who are about to die anyway get a lot of medical interventions (which is more opportunity for errors, big small). If a patient accidentally gets an extra dose of their antacid 48 hours before they die, is it really likely that error led to their death? Because it would be counted in that 250k/yr number...

Yeah there are question marks about the methodology etc. though it still seems there are a lot of errors https://www.pamedsoc.org/tools-you-can-use/topics/quality-an...
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