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

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

#61

Post by fricat1ve » Sat, Apr 21, 2018, 7:05 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.”

One problem is that fee-for-service incentives strongly distort what people think they "know full well."

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

#62

Post by KMag » Sat, Apr 21, 2018, 7:07 PM UTC

JumpCrisscross wrote: post #34

If you’re a patient, wouldn’t this still mean starting with the lowest-mortality surgeon? If they take your case, you’re least likely to die. If not, you have a better appraisal of your odds.

That strategy may very well end up skipping (well, delaying selection) of a surgeon that routinely takes much harder cases than yours. I don't know enough about heart surgery to know if practice at more difficult procedures has any carryover to less difficult procedures, but it's conceivable . Your strategy might make sense, but it's not obviously optimal.

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

#63

Post by sh4z » Sat, Apr 21, 2018, 7:10 PM UTC

kazinator wrote: post #44

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.

A doctor might have a 5% mortality track record for a surgery that generally has a 20% mortality risk. I feel like you are pushing it to an extreme with this yahoo doctor example.

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

#64

Post by [deleted] » Sat, Apr 21, 2018, 7:11 PM UTC

walshemj wrote: post #33

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…

Do not Doctors Surgeons disclose the potential errors and things that might go wrong in the US? I have had several ops in the last 18 months in the UK and they always go though what can go wrong and tell you the odds.

[deleted]

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

#65

Post by SilasX » Sat, Apr 21, 2018, 7:13 PM UTC

We bundle up too many conflicting jobs into the role of the doctor. Rating the difficulty and status of an incoming patient should be completely separate from the job of treating them, and all judgments about doctor effectiveness should be judged relative to those assessments.

(Credit: alerted to this misincentive by Yudkowsky’s recent book Inadequate Equilibria.)

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

#66

Post by [deleted] » Sat, Apr 21, 2018, 7:14 PM UTC

prepend wrote: post #25

billfruit wrote: post #12

On a related vein, do surgical procedures involve any type of quality control, where the work is independently audited? If so I wasn't aware. Quality control is such an important cogwheel of processes in many other industries, yet I don't hear much talk of it in relation to medical profession.

There are process checklist reviews ( http://qualitysafety.bmj.com/content/23/4/299 ) and medical review panels ( https://mrp.ky.gov/Pages/index.aspx ).

[deleted]

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

#67

Post by maxerickson » Sat, Apr 21, 2018, 7:14 PM UTC

TheRealPomax wrote: post #48

maxerickson wrote: post #15

Earlier quoted context omitted.

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…

I don't see where the article says "the odds of killing them are all but guaranteed", so I don't really appreciate you stuffing that meaning into my comment. I highly doubt that surgeries at that level of risk are actually in the medical interests of the patient (the standard I used).

Are you speaking from further knowledge of the the statistics of the cases where surgery is refused? If so, why not drop that instead of the lecture?

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

#68

Post by Numberwang » Sat, Apr 21, 2018, 7:16 PM UTC

danans wrote: post #58

Numberwang wrote: post #45

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.

> Just compare the rates of disease for vegans with the general population. "Disease" is such a broad category that it's sort of meaningless here. Maybe veganism is healthier than an animal diet, but the degree of its impact can only be stated only after removing the many other environmental factors that might be contributing to lower disease rates among vegans, including income and location.

Yes, lot's of things are always involved. Including air quality etc as I think I saw on HN just the other day.

I find it interesting though that the right type of vegan diet will basically make you hypertension and heart attack proof and that it may also reverse heard disease (the only diet to do so). Especially when you look at mortality and costs of healthcare this really need to be more generally recognized.

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

#69

Post by [deleted] » Sat, Apr 21, 2018, 7:17 PM UTC

TheRealPomax wrote: post #48

maxerickson wrote: post #15

Earlier quoted context omitted.

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…

[deleted]

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

#70

Post by agumonkey » Sat, Apr 21, 2018, 7:17 PM UTC

kankroc wrote: post #59

agumonkey wrote: post #36

it's been said a few times on /r/medicine, surgeons have their lawyer in mind when operating, they're skilled, but they first avoid anything that could damage their own life irreversably. Of course to an extent this goal aligns with the patient, but not always, and a bit sad on the ideal side.

Can someone really sue their surgeon in the US?

I can't recall what countries these guys were.