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

Heart surgeons refuse difficult operations to avoid poor mortality ratings

telegraph.co.uk

Post reply on HN
Print view View original

131–140 of 274 posts

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

#131

Post by ouid »

emodendroket wrote: post #103
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

When I was fresh out of a school I worked in a call center for a while. One of the most important metrics (and everything you did was measured) was the average length of each call. So it was common practice, when you got cases that basically were going to be long calls or ones you probably couldn't actually resolve (e.g., "I want the service back on but cannot pay"), to deliberately upset the customers so that they w…

Does this mean that I can threaten to not talk to their supervisor?

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

#132

Post by danzig13 »

sowbug wrote: post #121
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

The version I've heard might be a corollary: if you measure it, it will improve. The subtext is that the system won't improve; rather, something in the system will be sacrificed to improve the metric. The end result (usually quality) won't improve.

At best it probably only identifies the people to replace.

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

#133

Post by paulcole »

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.

>For example players won't attempt end of the quarter half court shots since that will lower their percentages

Durant is particularly bad at this. In an AMA on Reddit, Daryl Morey said he tells his players they keep their own internal stats (most teams do) and ignore heaves. The idea is they’ll be more likely to take them knowing the team won’t hold it against them when negotiating a contract.

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

#135

Post by paulcole »

skookumchuck wrote: post #85
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.

One could break out the quarter half court shots as a separate statistic.

At this point it’s very likely all teams do. The stats they’re using are nothing like what was printed on the back of basketball cards when we were kids.

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

#136

Post by rtkwe »

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.

It becomes a bad measure because once it's a target people start to manipulate it in order to hit the target. In this case if a surgeon refuses to take anything but easy surgeries their stats will look amazing but it says very little about their actual abilities.

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

#137

Post by fricat1ve »

billfruit wrote: post #100
fricat1ve wrote: post #79

Earlier quoted context omitted.

In the US, if the surgery is in hospital: - Well-regarded hospitals will vet surgeons before granting privileges. - Average hospitals give out privileges fairly easily if there are no actions against a person's license. - There is a "collegial" review of big screw-ups that carry major reputational risk. - As with any fee-for-service firm, "rainmakers" are highly sought after and get away with more. - Privileges are d…

I was thinking something more akin to routine inspection program carried out by independent personnnel applicable to all procedures, not just the reviews that are necessitated due to screw ups.

As far as a performance evaluation that directly scores a surgeon's judgment and whether the procedures s/he is performing are actually beneficial...in the absence of a big screw-up or complaint, I don't believe there is any forum to do that after training is complete.

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

#138

Post by calcifer »

emodendroket wrote: post #101
Johnny555 wrote: post #71

Earlier quoted context omitted.

Sadly, it seems that your mother would not have had a better outcome with or without the surgery - if the doctor had said "I'm 75% sure that the cancer is contained in the one lung, so removing the lung will remove the cancer", would that have changed the decision to have the surgery? What it was was 50%? What is the threshold where someone with a fatal illness will accept the risk for a possible cure?

Perhaps the patient should have the right to decide what that threshold is for themselves rather than having the information hidden from them.

What information? Apparently the doctor told them he could do it. If he really believed in himself, then he told the patient everything she needed to know. Remember, the other option is "go die". So assigning a percentage chance on the successful outcome of a surgery is utterly meaningless when the alternative is a 100% "go die".

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

#139

Post by lambdasquirrel »

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

On a less dire area of work, I’m starting to turn away from risky jobs/startups. It seems like there’s more and more newcomers in tech these days, and they’ll reject you for not being at gigs for longer. If I get the impression a future manager will be inexperienced, or that they’d failed to build a team before, I hesitate now. It’s a little frustrating, but that’s just how it is.

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

#140

Post by calcifer »

crusso wrote: post #108

Ultimately, we need to compare apples to apples by building rating systems that account for the difficulty of treating patients with various, ailments at various ages, with various complications. Think of it in terms of competitive diving, gymnastics, or snowboarding: Your scores depend upon the difficulty of the moves you attempted combined with your performance of those specific moves. The more difficult the move,…

> some system of having different physicians assess ratings than the ones performing the procedures - maybe in some kind of double-blind fashion to prevent any kind of coordination strategy.

That would simply result in an unwritten rule where everyone gives everyone else good ratings.

Post reply on HN