Heart surgeons refuse difficult operations to avoid poor mortality ratings • Hacker News Board

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#41

Post by MarkMc » Sat, Apr 21, 2018, 6:50 PM UTC

sebazzz wrote: post #6

Would it be possible to determine a "risk" factor and count that in the mortality ratings, or is this too simple?

There is probably already some adjustment for risk - anyone can see that a smoker in his 60s will have higher mortality than a non-smoker in his 30s.

The problem might be that the statistician doing the risk adjustment doesn't have 'skin in the game', so his/her assessment of risk is worse than the surgeon's. (Although if that were the case I would expect the statistician to be just as likely to overestimate the risk than underestimate it, yet I never hear about surgeons favouring the difficult cases because they think they can improve on the expected mortality rate in such cases).

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#42

Post by unpopular42 » Sat, Apr 21, 2018, 6:53 PM UTC

drewg123 wrote: post #17

It was not heart surgery, but after being diagnosed with lung cancer, my mother had one of her lungs removed by a surgeon who assured us he'd be able to get all the cancer. She had a miserable, painful recovery that I would not wish on anybody. Within a week or two of her recovering to the point where she could walk short distances, the cancer was found in her other lung and went on to kill her within a few more mont…

That surgeon may have made a mistake, but you're suggesting to inject (more) unrelated incentives into this kind of decisions and expect them to get better? I'm sorry, but this sounds completely idiotic.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#43

Post by Mononokay » Sat, Apr 21, 2018, 6:54 PM UTC

trumped wrote: post #40

Some doctors probably refuse patients that left bad reviews at competing offices...

"I don't appreciate the service they provide and they're terrible people !!!"

"Okay, we won't serve you if you're just going to trash us."

"EVIL HOW DARE YOU!"

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#44

Post by kazinator » Sat, Apr 21, 2018, 6:55 PM UTC

cs702 wrote: post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

Low mortality is a good damned measure.

I don't want to be operated on some yahoo surgeon who unconditionally operates regardless of risk and has a high mortality track record as a result.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#45

Post by Numberwang » Sat, Apr 21, 2018, 6:55 PM UTC

It's sad to hear this when it's totally unnecessary.

Hear disease has been a solved problem for decades. Just compare the rates of disease for vegans with the general population.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#46

Post by trumped » Sat, Apr 21, 2018, 6:57 PM UTC

Mononokay wrote: post #43

trumped wrote: post #40

Some doctors probably refuse patients that left bad reviews at competing offices...

"I don't appreciate the service they provide and they're terrible people !!!" "Okay, we won't serve you if you're just going to trash us." "EVIL HOW DARE YOU!"

I meant if you left a bad review somewhere else...

Of course someone should not go back where they don't like to go....

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#47

Post by NTDF9 » Sat, Apr 21, 2018, 6:58 PM UTC

Reminds me of why some devs will not touch critical pieces of code because the next time a bug comes in that module, git log shows they were last editors and will be asked to take a look (even if the bug is unrelated to them)

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#48

Post by TheRealPomax » Sat, Apr 21, 2018, 6:58 PM UTC

maxerickson wrote: post #15

tgraham wrote: post #10

66% of 115 specialists polled did not refuse a difficult operation. 33% thought about how it would impact their statistics, or put more generously, thought hard about the probability of the patient surviving presumably quite serious surgery. Yes mortality is a blunt statistic for a surgeon, but perhaps giving people pause for thought about the odds of success is no bad thing. Contra point: would you rather not know h…

A large portion of the people undergoing heart surgeries still face a high risk of death if they don't have the surgery (with the surgery bringing the chance of a longer, more comfortable life). Here's why your hot take isn't the best take: “About 30 percent of them said they had turned patients down for surgery even when they knew full well that surgery was in their best interest.”

Here's the converse of that, though: why do we think it's okay to expect a team of doctors and nurses to be okay with almost assuredly killing someone during surgery? They're not robots, "it's their job" is not an acceptable answer.

Even if the surgery is in a patient's best interest, if the odds of killing them are all but guaranteed then it's most definitely not a matter of looking at the patient and rationalising it with "they will die otherwise anyway". It's not just about the patient.

People who make this argument seem to forget that there's also an entire team of medical professionals that your rationalisation says should be okay with going into a surgery knowing they are almost guaranteed to kill this patient. They have the stats, the stats say "this person will die under the knife", many more lives are affected in this decision than just the patient.

So expecting them to just do the surgery instead of going "No. This will kill the patient, I don't want that on me and my team" is very far from an okay attitude towards fellow human beings, and leads to terrible medical practices.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#49

Post by killjoywashere » Sat, Apr 21, 2018, 6:59 PM UTC

make3 wrote: post #24

samfisher83 wrote: post #20

Sports athletes do this. For example players won't attempt end of the quarter half court shots since that will lower their percentages, or QBs taking sacks to not lower their QB ratings. What they do in sports is keep advanced stats. Instead of just giving a pure mortality rating have mortality rating, by surgery type.

Then they just dodge the hard cases of each specific type of surgery. It's probably still an improvement though on just avoiding a surgery type altogether.

Then you track the deferral rates.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#50

Post by fricat1ve » Sat, Apr 21, 2018, 7:00 PM UTC

carbocation wrote: post #8

The advent of public reporting of outcomes after intervention for myocardial infarction (heart attack) led to an increase in mortality in Massachusetts and New York.[1] 1 = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4368858/

A better way to make this claim would be to plot the mortality rates for the states over time and show that the rates in those places requiring reporting begin to diverge as the new policy is implemented.