Econtalk had a good interview this month on this general phenomenon discussing the book "The Tyranny of Metrics"
http://www.econtalk.org/archives/2018/04/jerry_muller_on.htm...
Heart surgeons refuse difficult operations to avoid poor mortality ratings
201–210 of 274 posts
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#202[deleted]
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#203It'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
Apologies for the silly comment in advance - but how ironical that "Goodhart" is applied in this case to heart surgeons.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#204Earlier quoted context omitted.
I worked in a call center, as well, but they didn’t prioritize call length as a metric/KPI. Their number one KPI was “first call resolution”, meaning even if it took an hour as long as the problem was resolved the call was considered a success. I feel like it was a much healthier way to measure call center performance.
One support team I used to work with prioritized "first touch resolution" for email cases as well, so the agents would answer every case with a 16-page DYI flowchart listing every single possible problem and its resolution. KPIs are hard...
Maybe I’m weird but that’s exactly the kind of response I would want.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#205This is the classic problem where people use averages as a metric, but ignore the fact that variations are not distributed evenly.
I remember looking at the economics of a clinic for our product. Someone said "let's just give them a 5% discount as on average they will break-even.
That works if you look at on average how much they make, but ignore the fact that every clinic has a different mix of insurance companies and *their own economics are all different."
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#206Earlier quoted context omitted.
I'd also expect a bunch of "I'm going to transfer you... oops, pressed a wrong button and it hang up!" As a customer, I've had a fair measure of mysteriously hang up calls to support, I wonder how many of those are metrics-driven...
There was recently a story about a 911 operator being jailed for hanging up on thousands of calls.[1] If someone could get away with it at a 911 call center, it could happen anywhere... and might happen oftener than we think. [1] - https://www.sfgate.com/news/article/911-dispatcher-sentenced...
That Houston lady that did that didn’t care about metrics, she literally just couldn’t be bothered. “Ain’t nobody got time for that.”
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#207Check out the comments over on /r/medicine and you will likely be horrified. It is career over everything. There was even a thread this week about how you should NEVER correct someone above you (med students should never correct a resident and a resident should never correct an attending). That mentality is terrible for everyone and every thing, except the physicians' careers. I don't know if we need to select for be…
Yes, the system is horrendous and broken. There should be complete oversight and full transparency for self-regulation purposes, which includes ongoing learning and education, and get lawyers involved once the self-regulating is found to be inadequate - such as a surgeon who repeatedly makes the same mistakes and hasn't bothered to learn or care to improve their skills, or prevented from continuing. From my own strug…
Or maybe this attitude you have, that doctors should be sued for vague ideas like lack of "critical thinking skills" is exactly the reason why doctors are incredibly risk averse and the system is messed up to begin with.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#208Earlier quoted context omitted.
I guess I'm just shocked that the surgeon could offer that level of assurance about something like that.
Unbelievable! The five year survival rate for lung cancer is only 18%! Even when the cancer is localized the five year survival rate is only 55%![1] It's irresponsible for the doctor to not give a reasonable prognosis! [1] http://www.lung.org/lung-health-and-diseases/lung-disease-lo...
we should find this person and sue them for what I'm sure is a 100% accurate retelling of a 20-year old story on hacker news.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#209Earlier quoted context omitted.
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".
Not really. A treatment can decrease quality of life to the point where you don't want to live, or perhaps bankrupt your family for a small chance of success. This logic only holds if you assign infinite value to "live at any cost"
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#210It'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
Ironically applied to not-good hearts
"These doctors are vile dogs. If I was a physician I would take all the hard patients, heal them all, and be a hero of the people."
Yeah, if you were given one operation where the patient has a 100% chance of dying without it, but 80% of you killing them if you operate + 20% chance of them living after, maybe you'd do this once and get lucky. But try doing this twice, you have a a 96% chance of killing a patient, three times makes a 99.2% chance of killing at least a single patient. This probability quickly approaches 100%. If you kill a patient you get dragged into court, branded as a murderer by the opposing lawyer, and your career which you have spent your youth, your 20s and a half a million dollars training for is down the drain. Taking risky cases, if that's not your niche, is is guaranteed to have you out of a job and in debt from legal fees.
To suggest that "bad hearts" are involved in this necessary calculation, is incredibly naive.